Issues & Debates

Question 1

Practical issues- General

Answer 1

Williams
Carlsson
Bradshaw
Brown
Meta-analysis
Content analysis
Thematic analysis
Grounded theory
Observations
Interviews
Cross-Sectional studies

Question 2

Practical issues- Rosenhan

Answer 2

• All USA sample
• Small sample
• Variety of backgrounds
• High ecological validity because of hospital setting
• Standardised- words given
• Low DCs from staff
• The fact real patients identified them as faking showed they weren’t ‘putting on an act’
• Possible extraneous variables
• Bias in their notes may be possible
• Qualitative data and Quantitative data
• No Inter-rater reliability

Question 3

Developedment over time- General

Answer 3

• 4Ds  Szasz
• 4Ds 5th D
• DSM/ICD updates
• ICD  DSM
• Spiritual model of illness  medical model
• Changes in diagnosis (removal of homosexuality)
• Biological explanation of Depression  drug treatment
• Drugs  more types/better types
• Upregulation can now explain delay in treatment
• Cognitive explanation  CBT
• Psychodynamic talking therapies  CBT and others
• Monoamine hypothesis  MAO  MAOIs
• Genetics  twin studies  genetic explanations  (5HTT gene)
• We now can look at specific genes
• CBT  ICBT  Williams
• Dopamine hypothesis of Sz  refined/developed over time

Question 4

Developedment over time- Rosenhan

Answer 4

• Institutions  hospitals/treatment
• DSM updates
• DSM still in use
• ICD  DSM
• Rosenhan  Szasz
• Medical model still in use
• Drug treatment still use
• Still a stigma on mental health
• Still V& R issues in diagnosis
• Similar studies have been repeated since

Question 5

Nature/Nurture- General

Answer 5

• Cultural differences in illness are due to nurture
• Social norms are nurture
• Neurotransmitters influencing Depression and Schizophrenia are nature
• Genetics influencing Depression and Schizophrenia are nature
• Drugs work by altering biology
• Life events are seen to be influential in causing both illnesses (diathesis stress model)
• Seligman and learned helplessness in Depression
• Cognitive explanation takes into account negative life experiences causing the maladaptive thoughts
• CBT shows people can be trained to re-evaluate thoughts (nurture)

Question 6

Nature/Nurture- Rosenhan

Answer 6

• Cultural differences in illness are due to nurture i.e. some people in other cultures might not have seen the symptoms reported as being SZ
• Social norms are nurture
• The environment and the diagnosis (and how the pseudo-patients were treated) were influenced by the environment (nurture)
• Drugs work by altering biology

Question 7

Reductionism- General

Answer 7

• Each of the 4Ds are reductionist in their own way
• Each of the 4Ds ignore duration
• Deviance has a number of factors which effect it i.e. age, sex etc therefore might be considered more holistic
• DSM & ICD both ignore spiritual factors and focus on medical explanations
• DSM and ICD both try to break down complex mental illnesses into a list of symptoms
• Many mental illnesses come with various ‘subtypes’ which attempt to categorise the illness
• One explanation of each illness only focused on Neurotransmitters so is reductionist
• However they have often been added to over time to make them more complete i.e. MAOI within depression
• Genetic explanation of Schizophrenia ignores other factors which could be relevant i.e. the environment
• However it does acknowledge the importance through diathesis-stress model
• Cognitive explanations of depression take into account environment/life experience in forming schemas
• Cognitive explanation of Schizophrenia does acknowledge the biological link to increased dopamine
• Drugs- focus only on changing NT
• CBT focuses only on changing faulty thought patterns and may ignore other explanations/factors
• Williams filtered ppts to remove EVs to be more reductionist and get better cause and effect

Question 8

Reductionism- Rosenhan

Answer 8

• DSM & ICD both ignore spiritual factors and focus on medical explanations
• DSM and ICD both try to break down complex mental illnesses into a list of symptoms
• Rosenhan reduced the symptoms of Sz down to just one illness
• Contained qualitative data so may be seen as less reductionist

Question 9

Psychology as a science- General

Answer 9

• Often uses Lab studies
• Drug studies use double blinds etc- which helps with controls and Internal validity
• Empirical- NT and genetics are…Cognitive and CBT are not
• Objective- NT and genetics are…Cognitive and CBT are not, neither are the definitions (and therefore measurements) of abnormality/mental health issues
• Falsifiable- NT and genetics are…Cognitive and CBT are not, neither are the definitions (and therefore measurements) of abnormality/mental health issues
• Reductionist- each theory ignores a number of factors i.e. biological ignores environment, how the studies measure things i.e. Williams using the particular question scales it does
• Hypothesis testing- Williams, Brown etc test hypotheses whilst Carlsson, Bradshaw and Rosenhan don’t (it does kind of but isn’t really an experiment so doesn’t really have an IV/DV therefore isn’t)
• Controls- Rosenhan, Williams, Brown and Bradshaw are in the real world therefore there will be EVS…Some studies like Williams did filtering for ppts to remove EVs/provide controls. However, Rosenhan did make sure people acted normally in the hospital so avoided DCs
• Reliable/replicable- Yes, you can repeat pretty much every study that we’ve looked at because they are standardised
• Internal Validity- Lots of controls in the biological methods like eliminating EVs, controls are present in most studies, not subjective etc
• Use of meta-analyses- helps with internal validity, controls, checking for replication etc

Question 10

Psychology as a science- Rosenhan

Answer 10

• Naturalistic observation- so will have issues with control/EVs…but high in ecological validity and empirical
• Empirical- measuring behaviour and treatment by the doctors etc therefore measuring an actual behaviour i.e. number of days, number of pills etc
• Objective- Some like those above will be objective but observations by the pseudopatients might be subjective
• Hypothesis testing- this doesn’t really have IVs and DVs therefore isn’t really testing a hypothesis
• Falsifiable- Since it doesn’t have a hypothesis it can’t be proven wrong…however you could say if they weren’t diagnosed it would’ve proven Rosenhan’s ideas wrong
• Reductionist- simplified Sz and diagnosis down to simple hallucinations/one word phrases, reduces diagnostic procedure of doctors (but might be a
• Controls- Everyone was trained the same, everyone began to behave normally, in real world environment so may be EVs
• Reliable/replicable- You could- various things were standardised like the words used for diagnosis
• Internal Validity- Some subjectivity in results, the pseudopatients acted normally and therefore reduced DCs, doctors didn’t know they were taking part so reduced DCs, EVs were possible

Question 11

Ethics- General

Answer 11

• Consent (informed)- People with mental health problems may have difficulty consenting, Carlsson used secondary data so people didn’t consent to his research persay (but we’re ok with that), Williams got informed consent (but may not have known they were on a waiting list control group etc), Brown and Bradshaw also had consent
• Deception- No deception in studies other than Rosenhan (below), often a problem in cases where patients are given a placebo drug
• Confidentiality- Pseudonyms in case studies like Carols and all other studies protected identities
• Debrief- Unknown
• Withdrawal- Right to withdraw clearly evident in both Williams and Brown….again we have to ask is someone with mental health difficulties is fully aware of this
• Protection from harm- harmful side-effects from medication being tested, some of the studies in Carlsson involved illegal drugs (which yes we didn’t get them addicted but is still an issue), injections for brain scans, revisiting past traumas in Brown- difficulty and stress in studies of CBT
• Animal studies could be harmful and they’d have to make sure they obeyed the rules about caring for animals and having them destroyed….but we do this research on animals because it would be unethical on humans

Question 12

Ethics- Rosenhan

Answer 12

• Consent (informed)- Doctors, nurses and patients had no informed consent (though the head of the hospital knew in study 2)
• Deception- Lied about the symptoms being experienced
• Confidentiality- Identities of the hospitals and staff were protected (and Pseudopatients given pseudonyms)
• Debrief- Not really, generally told after study 1 took place but not real debrief for the specific hospitals
• Withdrawal- Hospitals, doctors, nurses and patients couldn’t withdraw (and neither could the pseudopatients really)
• Protection from harm- Real patients may have lost time, attention and could’ve been distressed, staff could have been upset by the results, pseudopatients took psychoactive medication

Question 13

Social control- General

Answer 13

• Social norms in abnormality are socially controlling (Thomas Szasz ‘myth of mental illness’
• So might the other Ds (who decides what level of dysfunction, distress etc is important)
• DSM & ICD- what is and is not a mental health disorder (homosexuality, transgenderism, types of Sz, Aspergers, the bereavement clause for depression) is socially controlling
• Sectioning is a massive concern for social control because you lose the right to choose your own treatment
• However, we might argue this isn’t a issue as it is helping people
• Williams- might influence people being given CBT
• However, was only used for certain people/groups and therefore wouldn’t work for others and may not be see as social control
• Carlsson- could be socially controlling in what medication people are prescribed (but that would be a good thing)
• In clinical psychology drug therapy features often as a main therapy, such as for schizophrenia or for depression, anorexia or OCD.
• Anti-schizophrenic drugs for schizophrenia (including new ones), anti-depressant drugs for unipolar depression, SSRIs for anorexia (to treat depression or OCD which often go with anorexia) and anti-depressants can also be used for OCD.
• Drugs are prescribed by doctors and psychiatrists.
• Other therapies and treatments in clinical psychology include cognitive behavioural therapy, which links to cognitive psychology and learning theories, and relates to the links between thoughts, feelings and behaviour and their consequences…altering thoughts could be socially controlling
• CBT is more of a choice people make (you can’t be forced into it really) and therefore might be less socially controlling
• Rosenhan (1973) showed patients admitted wrongly (saying they had symptoms they did not and then acting normally) were not recognised as not having schizophrenia or a mental health disorder.
• CBT asks the client to do homework but leaves choices to the client.
• Rosenhan’s study showed the participants/patient as losing control in not being ‘allowed out’.
• Drugs have to be prescribed and the patient/client does not have control over the situation.
• There is an element of control in that there is the power to section someone over mental health issues, so that person then does not have the control and knowing this might lead to them accepting therapy they might otherwise not accept.

Question 14

Social control- Rosenhan

Answer 14

• Social norms in abnormality are socially controlling (Thomas Szasz ‘myth of mental illness’
• Normal behaviour was seen as abnormal in this study demonstrating the social control of ‘norms’, expectations and interpretation
• DSM & ICD- what is and is not a mental health disorder (homosexuality, transgenderism, types of Sz, Aspergers, the bereavement clause for depression) is socially controlling
• Sectioning is a massive concern for social control because you lose the right to choose your own treatment (which didn’t happen in this study but is a linked concept)
• Drugs are prescribed by doctors and psychiatrists.
• Rosenhan (1973) showed patients admitted wrongly (saying they had symptoms they did not and then acting normally) were not recognised as not having schizophrenia or a mental health disorder.
• Rosenhan’s study showed the participants/patient as losing control in not being ‘allowed out’.
• Stigma of mental illness could cause social control issues
• Times have changed since this study though so perhaps we’d see less social control
• May only be applicable to US culture so perhaps not socially controlling

Question 15

Usefullness- General

Answer 15

• Useful to know what the symptoms of a mental illness are so we can help people/entitle them to help
• However, poor IRR possible
• However, updates may make them not reliable…but updates arguably make it more valid and more useful
• Useful to know what the definitions of abnormality are so we can help people
• However, subjectivity
• However, each one might not be useful you would need all 4…possibly even 5 with duration
• It could be argued that it is useful to society that the diagnosis of abnormality itself not being easy is valuable and useful
• Knowing about cultural differences in illness/diagnosis can be useful in making sure people get the correct help
• Knowing about the biological causes of Sz and Depression are useful because we can treat it through altering their biology
• However sometimes use animal studies
• Evidence is often empirical and studied in scientific methods
• Useful to know what the symptoms of a mental illness are so we can help people/entitle them to help/knd nowing about genetic causes of Schizophrenia
• Knowing about cognitive causes of an illness can be useful when it comes to other therapies like CBT
• Not empirical and therefore might not be that useful
• Bradshaw is beneficial as it shows CBT works with Sz…however case study
• Williams shows that iCBT and CBM are useful
• Other eval points of Williams might argue for/against usefulness of the findings
• Brown shows what factors are risk factors for depression so we can put things in place such as support groups
• Carlsson shows the draw backs of illegal drugs (increased risk of Schizophrenia)
• Carlsson is useful because it shows that there are multiple drugs which might be beneficial for Sz which work in different ways

Question 16

Usefullness- Rosenhan

Answer 16

• Useful to know what the symptoms of a mental illness are so we can help people/entitle them to help
• However, poor IRR possible
• However, updates may make them not reliable…but updates arguably make it more valid and more useful
• It could be argued that it is useful to society that the diagnosis of abnormality itself not being easy is valuable and useful
• Tells us about the validity and reliability of the diagnosis which is important
• Knowing about cultural differences in illness/diagnosis can be useful in making sure people get the correct help (linked to hearing voices in Rosenhan)
• Useful to know how patients were treated in hospital at the time
• Useful to know about the stigmatisation of those with mental health problems

Question 17

Socially Sensitive- General

Answer 17

• Social norms in abnormality are socially sensitive (Thomas Szasz ‘myth of mental illness’ as are the other Ds (who decides what level of dysfunction, distress etc is important)- subjective socially sensitie
• DSM & ICD- what is and is not a mental health disorder (homosexuality, transgenderism, types of Sz, Aspergers, the bereavement clause for depression) is socially sensitive
• Cultural differences in illness are socially sensitive because it influences whether someone is ‘really seen as ill’
• Validity and Reliability of diagnosis are massive issues of social sensitivity because people are being labelled, stigmatized and treated differently based on what doctors say…and if this isn’t ‘true’ it is socially sensitive
• Williams- might influence people being given CBT- socially sensitive for people (though as they found it worked it is less socially sensitive)
• However, was only used for certain people/groups and therefore may not work for others- this could be socially sensitive
• In clinical psychology drug therapy features often as a main therapy, such as for schizophrenia or for depression, anorexia or OCD.
• Drugs are prescribed by doctors and psychiatrists- socially sensitive
• Cognitive explanations of Depression and Sz could be socially sensitive because it ‘blames’ their own negative thinking
• Other therapies and treatments in clinical psychology include cognitive behavioural therapy, which links to cognitive psychology and learning theories, and relates to the links between thoughts, feelings and behaviour and their consequences…altering thoughts could be socially sensitive
• CBT is more of a choice people make (you can’t be forced into it really) and therefore might be less socially sensitive

Question 18

Socially Sensitive- Rosenhan

Answer 18

• Social norms in abnormality are socially sensitive (Thomas Szasz ‘myth of mental illness’ as are the other Ds (who decides what level of dysfunction, distress etc is important)- subjective socially sensitie
• DSM & ICD- what is and is not a mental health disorder (homosexuality, transgenderism, types of Sz, Aspergers, the bereavement clause for depression) is socially sensitive
• Cultural differences in illness are socially sensitive because it influences whether someone is ‘really seen as ill’
• Validity and Reliability of diagnosis are massive issues of social sensitivity because people are being labelled, stigmatized and treated differently based on what doctors say…and if this isn’t ‘true’ it is socially sensitive
• Sectioning is a massive concern because you lose the right to choose your own treatment (which didn’t happen in this study but is a linked concept)- this is therefore socially sensitive
• Drugs are prescribed by doctors and psychiatrists.
• Rosenhan (1973) showed patients admitted wrongly (saying they had symptoms they did not and then acting normally) were not recognised as not having schizophrenia or a mental health disorder.
• Rosenhan’s study showed the participants/patient as losing control in not being ‘allowed out’.
• Stigma of mental illness could cause social sensitive issues
• Normal behaviours interpreted as mental illness ones shows the issues of social sensitivity which comes with diagnosis
• Times have changed since this study though so perhaps we’d see less social sensitive
• May only be applicable to US culture so perhaps not socially sensitive

Question 19

Culture and gender- General

Answer 19

• Social norms vary (both by culture and gender)- its good we acknowledge this (avoiding beta bias) but this could impact/effect results
• The 4 ds are subjective and could therefore be influenced by culture and gender i.e. differences in how they show distress/amount of distress
• Culturally bound syndromes are an issue for validity of diagnosis
• Ford & Widiger showed that gender bias is an issue in clinical psychology (alpha bias?)
• Gender differences in how people report symptoms need to be acknowledged to be valid, as do cultural differences
• DSM & ICD criteria might vary and thus impact on diagnosis with culture
• Mental illnesses effects males and females in different ratios and this being acknowledged is good (avoiding Beta-bias) i.e. Depression effects women more, Sz effects men more
• Goldstein- men have Sz twice as much/twice as many hospitalisations as women
• Culture impacts on symptoms of Sz i.e. __________ catatonia is more pronounced in Sri-Lanka
• % with Sz is generally the same worldwide though
• NT function shouldn’t really be effected too much by culture or gender
• Neither should the effectiveness of medication
• Cognitive explanations are influenced by past experience so we could see culture and gender as an influential factor here
• William’s study was done on both males and females therefore not beta-biased…however it might be beta-biased as they didn’t look for gender differences
• Brown and Bradshaw are both gynocentric focusing solely on women and therefore might not apply in the same way to males

Question 20

Culture and gender- Rosenhan

Answer 20

• Rosenhan (1973) had a mix of males and female participants so may be more representative of both genders
• Rosenhan’s (1973) participants infiltrated 12 hospitals in five American states with a variety of funding and conditions so is representative of American hospitals
• However, American mental hospitals in the 1970s may have been very different to those in collectivist cultures
• Behaviours might have been interpreted different by the doctors in another culture
• Pseudopatients in Rosenhan’s (1973) study complained of hearing voices which may not be a symptom of mental illness in some cultures
• Reliability/validity of mental disorders affect both genders so the implications of Rosenhan (1973) may be accurate and useful
• They didn’t however look at differences between the genders in their experiences so might have shown beta-bias
• Implications about the reliability/validity of diagnosis from Rosenhan (1973) are relevant to the DSM which is not a universal diagnostic tool

Question 21

Comparison of Themes- General

Answer 21

• Looks at both nature and nurture in its explanations of illness
• Genetics being a shared theme between Schizophrenia and aggression
• Neurotransmitters being a shared theme between Depression, Schizophrenia and drug addiction
• Cognitive processes being a shared concept between Depression, Schizophrenia and Memory
• Using medication to correct/change behaviour is shared between Depression, Schizophrenia and drug addiction
• CBT could be a theme shared between Depression, Schizophrenia and Autism
• The role of Dopamine and Glutamate in drug addiction is shared with Schizophrenia explanations
• Biological explanations however ignore the environment
• Culture influencing behaviour can be seen both in diagnosis and in social psychology
• Diagnostic criteria is a shared theme with DSM & ICD
• DSM, ICD & Rosenhan all demonstrate the medicalisation of behaviour

Question 22

Comparison of Themes- Rosenhan

Answer 22

• Culture influencing behaviour can be seen both in diagnosis and in social psychology
• Diagnostic criteria is a shared theme with DSM & ICD
• DSM, ICD & Rosenhan all demonstrate the medicalisation of behaviour
• Context/pre-established beliefs important for interpretation of behaviour is a theme for Abnormality and Rosenhan
• Labelling and stigma is an important issue in both Rosenhan and other studies like Sato
• Treated biologically through medication in Rosenhan which is a shared theme