Concept of mental illness not used correctly by psychiatrists.
Medical Model
Theory of abnormal behavior, which assumes that all such disorders have physiological causes
E.g. abnormal behaviour is the result of disordered neurotransmission
This leads to treatments that address the physiological problems, primarily with drug treatment.
Abnormal behaviour → psychopathology → psychological/ mental illness that is based on observation of a patient (observed symptoms)
A handbook was used by psychiatrists in the US to identify and classify symptoms of psychiatric disorders (Diagnostic and Statistical Manual of Mental Disorders: DSM- IV). Diagnosis based on factors like the person’s clinical and medical conditions and to what extent their mental state interferes with his or her daily life.
LIMITATIONS
Ethical concerns
Misuse of the model, since the criteria used for diagnosis are not objective and can be influenced by culture and politics (Gross 2002)
Used as an excuse to not hold responsibility
Reductionist
E.g.
Soviet Union political dissidents were diagnosed as schizophrenic, implying they were not responsible for their political beliefs
Classification system (PAGE 142)
A new system that psychiatrists use to diagnose patients with (supposed to be objective)
Bio psychosocial approach to diagnose and treat patients
Thomasz Szasz (US psychiatrist) [1962]
Argued against the concept of “mental illness”.
Although some neurophysiological disorders were diseases of the brain, most “mental disorders” could be considered as problems with/ in living
Against the idea of organic pathology in psychological disorders
Strange behaviour, normally classified as a mental illness by psychiatrists, Szasz believed that such behaviours were not symptoms of an underlying brain disease.
Frude (1998): few psychological disorders that can be associated to physiological reasons
Pilowsky (2006)
Neuropsychologists today have revealed possible chemical abnormality in the brain (temporal cortex) of people with Schizophrenia.
However, brain scans haven’t yet provided an ultimate answer to the questions raised by Szasz
What must happen for the classification system to be considered valid?
Which symptoms would you look for when diagnosing someone with MHD?
ROSENHAN (1973)
Aim:
To investigate whether psychiatrists were able to distinguish the difference between people who were genuinely mentally ill (insane) and those who weren’t (sane).
To investigate the reliability of psychiatric diagnosis and the impact of labeling.
Method
Field experiment
8 healthy researchers (5 males, 3 females) including Rosenhan
Attempted to gain admission to 12 different psychiatric hospitals
All but one got in by saying they could hear voices
Seven were diagnosed as having schizophrenia
The only way to get out of the hospital was to convince the staff that they were sane (said they were fine, no longer experiencing the symptoms)
Pseudo patients spent their time talking to other patients, making observations and notes of patients and staff
Finding
Each participant was discharged with a diagnosis of schizophrenia in remission
Participants were hospitalized from a range of 7-52 days, with an average 19 days
At the hospital ‘real’ patients suspected that the pseudo patients were not crazy (35 out of 188 patients)
Pseudo patients were given a total of 2,100 tablets. Even though most had the same disorder they were given a wide variety of tablets
Nursing records for 3 pseudo patients indicate that their writing was seen as an aspect of their pathological behaviour
Conclusions
Rosenhan concluded that it is not possible to distinguish the sane from the insane. The hospital itself imposes a special environment in which the meaning of behaviour can easily be misunderstood. The environment seems to counter-therapeutic (powerlessness, depersonalization, segregation, mortification and self-labeling)
Failure to detect sanity during the course of hospitalization may be due to the fact that the doctors were showing a strong type 2 error (physicians were more inclined to call a healthy person sick than a person healthy)
After having been labeled schizophrenic, there is nothing the pseudo patients could do to overcome the label. Once a person is labeled abnormal all of their other behaviours are coloured by this label. It is so powerful that many of the normal behaviours are overlooked completely or profoundly misinterpreted
Evaluation
Strengths
Valid- done by participant observation you would expect findings to be first hand and valid
Representative sample- both males and females were used in the study
Throws light on the nurture side of the debate; behaviour seems to be highly influenced by the abnormal environment around the patients
Limitations
Experimenter bias- likely that pseudo patients would have gone into the study with a biased view about how the insane are treated and this could affect their views of how the real patients were treated. Subjective
Ethical considerations- this experience of being treated with a label may have mentally hurt them
Reductionist- reduces schizophrenia to an explanation of how labeling affects the patients negatively and how they conform to the label
Cultural bias- this was done in the US, can’t generalize to other countries and also ethnocentric
Small number of pseudo patients went into the hospitals, participated in the study
Hawthorne affect- real patients could have changed their behaviour, as they may have known researchers of some kind were observing them
Other studies
He was not content with the findings of this study so he decided to investigate if abnormal individuals could be classified as normal. He told the staff at a psychiatric hospital that pseudo-patients would try to gain admittance. However no pseudo-patients appeared, but 41 real patients were judged with great confidence to be pseudo patients by at least one member of staff. Some of these genuine patients were suspected of being frauds.