1. Abnormal Psychology Lesson objective: Discuss the validity and reliability of diagnosis

2. Abnormal Behaviors How many can you correctly identify?

3. Diagnosing psychological disorders Interview + a detailed, flexible and sensitive method - lacks objectivity, self-reported responses are interpreted by psychiatrist Observation of behaviour + provides direct and detailed information - some symptoms cannot be observed

4. Diagnosing psychological disorders Brain scan (e.g. PET, CAT) + gives precise data on brain structure or activity - expensive and cannot be used to diagnose disorders alone Psychological testing and IQ tests + objectively rated, quick, and standardised - personality tests rely on self report and literacy

5. The ABCS Psychologists refer to the ABCS when describing symptoms of a disorder – Affective symptoms: emotional elements (fear, sadness, anger) – Behavioural symptoms: observational behaviours (crying, physical withdrawal from others, pacing) – Cognitive symptoms: ways of thinking (pessimism, personalization, self-image) – Somatic symptoms: physical symptoms (facial twitching, stomach cramping, amenorrhoea – the absence of menstruation)

6. Validity and Reliability of Diagnosis What makes a classification system, and therefore the diagnosis, valid and reliable? Reliability: it should be possible for different clinicians, using the same system, to arrive at the same diagnosis for the same individual Validity: one should be able to classify a real pattern of symptoms which can lead to an effective treatment

7. Diagnoses or Labelling? Click for video

8. Rosenhan Study Year 1973 Authors D. L. Rosenhan Title Rosenhan Experiment – ‘On being sane in insane places’

9. Aim to test the hypothesis that psychiatrists cannot reliably tell the difference between people who are sane and those who are insane. Rosenhan Study

10. Methodology Volunteers - 12 sane people – a graduate student – psychologists – a paediatrician – a painter – housewives

11. Methodology Procedure Telephoned 12 psychiatric hospitals for urgent appointments Gave false name and address Complained of hearing unclear voices … saying “empty, hollow, thud”

12. Methodology What happened All were admitted to hospital All but one were diagnosed as suffering from schizophrenia Once admitted the ‘pseudo-patients’ stopped simulating ANY symptoms Took part in ward activities

13. Results How did the ward staff ‘see’ them? Normal behaviour was misinterpreted Writing notes was described as - – “The patient engaged in writing behaviour” Arriving early for lunch described as – “oral acquisitive syndrome” – Behaviour distorted to ‘fit in’ with label How long did they stay in hospital? The shortest stay was 7 days The longest stay was 52 days The average stay was 19 days – They had agreed to stay until they convinced the staff they were sane.

14. Results Were they treated in the same way as normal patients? Given total of 2100 medication tablets – they flushed them down the loos – Noted that other patients did the same and that this was ignored as long as patients behaved themselves! What sorts of records did they keep? Nurses stayed in ward offices 90% of time Each ‘real patient’ spent less than 7 minutes per day with psychiatric staff On release The pseudo-patients were diagnosed as Schizophrenia “IN REMISSION”

15. Rosenhan: The follow up study A teaching & research hospital was told of the first study and warned that … – Over the next three months ONE OR MORE pseudo-patient will attempt to be admitted

16. What happened? Staff members rated ‘new patients’ on scale 1 - 10 as ‘how likely to be a fraud’ – 193 patients ‘assessed’ – 41 rated as a pseudo-patient (by staff) – 23 rated as pseudo-patient (by psychiatrist) – 19 rated as pseudo-patient (by both) How many of these SUSPECTS were pseudo-patients? NONE No pseudo-patients were sent – the staff were rating their regular intake Rosenhan: The follow up study

17. Conclusion “It is clear that we are unable to distinguish the sane from the insane in psychiatric hospitals” – In the first study : We are unable to detect ‘sanity’ – In the follow up study : We are unable to detect ‘insanity’

18. Summary What part of my ‘abnormal behaviour’ did you notice during the lesson? In reality… Just like Rosenhan stipulates, if you are seeking and expecting insanity or abnormality, it is easy to transform most of what you see to fit that description.