Key assumptions of the area Main methods of research (C.O.S.E.) Exit Question: The 5 areas and 2 perspectives in Psychology Key assumptions of the area Main methods of research (C.O.S.E.) How it stands on each debate 2 pieces of research Behaviourist, Biological, Cognitive, Developmental, Individual Differences, Psychodynamic, Social

"If sanity and insanity exist, how shall we know them?" Prep (and cover work) for Friday 8/6/18 Match the questions to the answers Watch 1st https://www.youtube.com/watch?v=D8OxdGV_7lo Watch 2nd https://www.youtube.com/watch?v=Vo8KgPduHXM Overview of the Key Study: turn sound off https://www.youtube.com/watch?v=31lFQPSt-ro

"If sanity and insanity exist, how shall we know them?" If I labelled you as ‘needing support’, would this change you in any way?

"If sanity and insanity exist, how shall we know them?" Can you diagnose people with an illness (mental or physical) by using a checklist?

"If sanity and insanity exist, how shall we know them?" Who prefers to be labelled with a mental health disorder: the patient or the psychiatrist? https://www.youtube.com/watch?v=KhwyYCg0BZA

"If sanity and insanity exist, how shall we know them?" Are asylums the best place to be for people with mental illness? https://www.youtube.com/watch?v=KhwyYCg0BZA

"If sanity and insanity exist, how shall we know them?" Aim To summarise the aim, procedure, findings and evaluation of Rosenhan’s (1973) study. Learning Objectives Understand the context of mental illness and the history of defining abnormality and the way in which mental illness is classified and diagnosed. Describe the Rosenhan (1973) study and appreciate how it relates to the topic area in terms of the reliability and validity of the diagnosis of mental illness. Apply issues and debates such as generalisability, reliability and validity, ethical issues and usefulness of research. https://www.youtube.com/watch?v=57-c0y_T18E https://www.youtube.com/watch?v=D8OxdGV_7lo

Does madness lie in the eye of the observer? Do the characteristics of abnormality reside in the patients? or In the environments in which they are observed? Does madness lie in the eye of the observer?

Exit Question: the Statistical Tests Test of association (Correlation) Spearman’s Rho Test of difference, nominal data and independent measures Chi2 Test of difference, nominal data and repeated measures design Binomial S test Test of difference, ordinal / interval data and independent measures Mann Whitney U Test of difference, ordinal / interval data and repeated measures Wilcoxon T

Background A long history of attempting to classify abnormal behaviour. Most commonly accepted approach to understanding & classifying abnormal behaviour is the medical model. Psychiatry Psychiatrists are medical doctors and regard mental illness as another kind of illness (in addition to physical) Beginning in the 1950s the medical model has used the Diagnostic and Statistical Manual of Mental Disorders (DSM) to classify abnormal behaviour The medical model suggests that the cause of abnormality is biochemical, genetics, and/or brain abnormality

The Medical Model Assumes that psychological disorders are mental illnesses that need to be diagnosed & treated through medication or surgery or ECT

DSM-V Labels The Diagnostic and Statistical Manual of Mental Disorders provides an authoritative classification scheme. Describes disorders and their prevalence without presuming to explain their causes Although diagnostic labels may help communication and research, they can also bias our perception of people’s past and present behaviour and unfairly stigmatize these individuals. CRAZY!

Background 1960s - The anti-psychiatry movement (psychiatrists & psychotherapists) began to criticize the medical model Rosenhan was also a critic of the medical model – “Its a worrying thought that there could be thousands of people stuck in institutes that are just as ‘sane’ as we are.” His study can be seen as an attempt to demonstrate that psychiatric classification is unreliable

Background Difficulty of judging what is 'normal' Varies over time / between societies Rosenhan asked "If sanity and insanity exist, how shall we know them?" Research Q: if 'normal' people attempt admission to psychiatric hospitals, will they be detected? / how?

Background https://www.youtube.com/watch?v=D8OxdGV_7lo

https://www.youtube.com/watch?v=3WXBdiJWE3c https://www.youtube.com/watch?v=KmuHBFmolpk

Aim Test the hypothesis that psychiatrists cannot reliably tell the difference between people who are sane and those who are insane.

The Researchers Confederates (not the subjects) EIGHT sane people! Three women and five men One graduate student Three psychologists One pediatrician A painter A housewife A psychiatrist Pseudo-Patients!

Procedures Telephoned 12 psychiatric hospitals for urgent appointment (5 US states) Arrived at admissions Gave false names and occupations Gave other ‘life’ details correctly

So here’s my cunning plan So here’s my cunning plan. I’m going to send these people to a hospital and see what happens if they say they’ve got symptoms of madness.

What symptom could they use? And why?

They said their only symptom was hearing a voice, the same sex as they are, saying the following: Thud Hollow Empty

Procedure Complained that they had been hearing voices Unfamiliar and the same sex as themselves Said 'empty', 'hollow', 'thud'. Symptoms were partly chosen because they were similar to existential crisis symptoms (Who am I? What is it all for? – meaninglessness of one’s life) Also chosen because there is no mention of existential psychosis in the literature.

Did they get let in? 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

Procedure Kept notes on their experiences Did this secretly to begin with Then openly when they realised no one cared or paid any attention to them doing this

Procedure The pseudo-patients were never detected All pseudo-patients wished to be discharged immediately BUT - they waited until they were diagnosed as “fit to be discharged”

How did the staff perceive them? Normal behaviour was misinterpreted: Writing notes described as -“The patient engaged in compulsive writing behaviour” Arriving early for lunch described as - “oral acquisitive syndrome” Outburst from patient – never enquire what caused response Behaviour distorted to ‘fit in’ with diagnosis/label

4 of the pseudo-patients carried out an observation on how patients were treated by staff…..

The pseudo-patient’s observations Who has said ‘hello’ to you this morning? Who has looked you in the eye to talk to you? Which member of staff has stopped to talk with you this week?

The pseudo-patient’s observations If patients approached staff with simple requests (NURSES & ATTENDANTS) 88% ignored them (walked away with head averted) 10% made eye contact 2% stopped for a chat (1283 attempts)

The pseudo-patient’s observations If they approached staff with simple requests PSYCHIATRISTS 71% ignored them (walked away with head averted) 23% made eye contact 2% stopped for a chat (185 attempts) Nurses stayed in ward offices 90% of time Each ‘real patient’ spent less than 7 minutes per day with psychiatric staff

Powerlessness and Depersonalization Medical records were open to all staff regardless of status or therapeutic relationship with the patient Personal hygiene monitored Many of the toilets did not have doors Some of the ward orderlies were brutal to patients in front of other patients ~ would stop when another staff member approached This indicated that staff were credible witnesses but patients were not

How many words can you make from this phrase? Rosenhan’s On being sane in insane place 20 words = good 30 words = great 40 words = fabulous

Starter Task: Rosenhan’s Facebook Page https://www.youtube.com/watch?v=KmuHBFmolpk

How long did they stay in hospital? * 07/16/96 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!! * ##

Were they treated in the same way as normal patients... * 07/16/96 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 !! * ##

35 out of 118 patients voiced suspicions about the pseudo-patients Did anyone suspect? 35 out of 118 patients voiced suspicions about the pseudo-patients “You’re not crazy” “You’re a journalist” “You’re a professor, checking up on the hospital”

Schizophrenia “IN REMISSION” On Release The pseudo-patients were diagnosed with Schizophrenia “IN REMISSION”

So… Lack of monitoring Distortion of behaviour Lack of normal interaction Powerlessness & depersonalization

Quick Questions What was the IV for this experiment? What was the DV for this experiment? What was the experimental method used?

Rosenhan: The follow up study… * 07/16/96 A teaching & research hospital heard of the first study – didn’t think they would make the same mistake They were warned that … Over the next 3 months ONE OR MORE pseudo-patient would attempt to be admitted * ##

What happened……….? * 07/16/96 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) * ##

Rosenhan (1973) Sane in Insane places

Just guess how many I’d really sent....... AH HA HA HA! Just guess how many I’d really sent.......

How many of these SUSPECTS were pseudo-patients?……... * 07/16/96 NONE No pseudo-patients were sent Staff were rating their regular intake * ##

Quick Questions What was the IV for this 2nd experiment? What was the DV for this 2nd experiment? What was the experimental method used?

What did Rosenhan conclude? * 07/16/96 Remember, his question was … Do the characteristics of abnormality reside in the patients? OR In the environments in which they are observed? Does madness lie in the eye of the observer? * ##

What did Rosenhan conclude? * 07/16/96 “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’ This is what’s known as a Type I error – false positive - diagnosing healthy people as sick In the follow up study - We are unable to detect ‘insanity’ This is what’s known as a Type 2 error – diagnosing sick people as healthy – false negative * ##

Rosenhan’s study highlighted: * 07/16/96 The depersonalisation and powerlessness of patients in psychiatric hospitals That behaviour is interpreted according to expectations of staff and that these expectations are created by the labels SANITY & INSANITY * ##

Another thing Rosenhan noted ... * 07/16/96 The pseudo-patients described their stay in the hospitals as a negative experience This is not to say that REAL patients have similar experiences Real patients do not know the diagnosis is false & are NOT pretending * ##

Rosenhan: Possible conclusions Psychiatric diagnosis is extremely inaccurate and the sane cannot be distinguished from the insane in psychiatric hospitals.

Rosenhan: Possible conclusions Hospitals seem to be special environments where behaviour gets easily distorted and patients are treated in a way which continues any problems they may have rather than providing the kind of environment which would help and support them.

Rosenhan: Possible conclusions Patients in psychiatric hospitals experience powerlessness and depersonalisation.

Rosenhan: Possible conclusions Significant labelling in producing expectations and influencing behaviour; once a patient has been labelled ‘insane’, all subsequent behaviour is seen in the light of the label given. This was shown by the fact that patients were discharged with the label ‘Schizophrenia in Remission’.

Rosenhan: Possible conclusions Institutionalisation in psychiatric hospitals has negative effects on the in-patients. Mental health workers are insensitive to the feelings and emotions of psychiatric patients.

Rosenhan: Possible conclusions The DSM had poor reliability. The diagnosis of mental illness can be influenced by the situation an individual finds themselves in

Understanding Rosenhan https://quizlet.com/211133791/ocr-psychology-issues-of-mental-health-rosenhan-flash-cards/ 3 minutes to prepare Concision is important 30 seconds to feedback https://www.classtools.net/random-name-picker/99_B2ZkWZ

Understanding Rosenhan Highlight 1 -2 words phrases per box to summarise it

Starter Task: Rosenhan * 07/16/96 State 3 quantitative findings from Rosenhan’s study * ##

Starter Task: Rosenhan * 07/16/96 State 3 qualitative findings from Rosenhan’s study * ##

Evaluating Rosenhan https://www.classtools.net/random-name-picker/4_PgjRNA

Evaluation: Research Method: Field Experiment * 07/16/96 Although high in ecological validity, there is a lack of control which could make the results less valid. For example, differences in staff could affect the results. * ##

Evaluation: Generalisable? * 07/16/96 12 hospitals were used across 5 states so could be said to be fairly representative, but not to the rest of the world. This is a problem as it lacks population validity. * ##

Evaluation: Reliable? Valid? * 07/16/96 Reliability and validity are methodological issues. This means that the WAY in which research is done (methodology) might have issues with it being consistent and/or true. * ##

Internal validity Internal reliability Test re-test reliability * 07/16/96 External Validity Concurrent validity Test re-test reliability Split half reliability Construct validity Criterion validity Internal validity Population validity External reliability Ecological validity Inter- rater reliability Face validity * ##

Evaluation: Reliable? * 07/16/96 The process of being admitted to, and then released from the hospitals was consistent across all of the pseudo-patients, so it has high internal reliability. * ##

Evaluation: Reliable? * 07/16/96  Participant observations are not very reliable, as they may miss observing behaviours. But they do allow the collection of highly detailed data without the problem of demand characteristics (good construct validity). * ##

Evaluation: Valid? * 07/16/96  The process of being admitted to, and then released from the hospitals was very true to real life, so it has high ecological validity. * ##

Evaluation: Ethics * 07/16/96 The hospital staff was unaware of the pseudo patients so were deceived. It is debateable whether or not this was acceptable deceit. * ##

Evaluation: Ethics * 07/16/96 The pseudo patients were told to stay in hospital until they were released, so could be said to have been unable to withdraw from the study. They could also have suffered harm. * ##

Relating the Debates to Rosenhan * 07/16/96 The 8 debates are: 1. Nature/nurture 2. Freewill/Determinism 3. Reductionism/Holism 4. Individual/Situational Explanation 5. Usefulness of Research 6. Ethical Considerations 7. Conducting Socially Sensitive Research 8. Psychology as a Science * ##

Relating the Debates to Rosenhan * 07/16/96 Nature / nurture 3 key terms of the debate * ##

Relating the Debates to Rosenhan * 07/16/96 Nature / nurture What perspective does Rosenhan have? * ##

Relating the Debates to Rosenhan * 07/16/96 Free will v determinism 3 key terms of the debate * ##

Relating the Debates to Rosenhan * 07/16/96 Free will v determinism What perspective does Rosenhan have? * ##

Relating the Debates to Rosenhan * 07/16/96 Reductionism v Holism 3 key terms of the debate * ##

Relating the Debates to Rosenhan * 07/16/96 Reductionism v Holism What perspective does Rosenhan have? * ##

Relating the Debates to Rosenhan * 07/16/96 Individual v Situational 3 key terms of the debate * ##

Relating the Debates to Rosenhan * 07/16/96 Individual v Situational Why does this study how a situational explanation? * ##

Relating the Debates to Rosenhan * 07/16/96 Usefulness of the research research is useful if it (D.R.U.G.V.) develops therapies, interventions, preventative action or treatments provokes further research in the field progresses understanding beyond previous findings is generalisable to a wide population is valid so that results are accurate * ##

Relating the Debates to Rosenhan * 07/16/96 Usefulness of the research research is useful if it (D.R.U.G.V.) develops action, provokes further research, progresses understanding, is generalisable, is valid Which core study is the most useful / least useful? * ##

Evaluation: usefulness * 07/16/96 Rosenhan came up with a new definition of abnormality (F2FA) Useful for hospital staff - treat patients with better, spend more time with them & don't interpret all behaviour in terms of the illness. DSM was updated. Diagnoses nowadays are more rigorous & more symptoms over a longer period have to be shown to be diagnosed. * ##

Relating the Debates to Rosenhan * 07/16/96 Usefulness How has Rosenhan’s study been useful? * ##

Relating the Debates to Rosenhan * 07/16/96 Socially sensitive research can S.C.A.R. Subject to social norms Controversial Able to shape the law / policy Risking stereotyping and prejudice * ##

Relating the Debates to Rosenhan * 07/16/96 Socially sensitive research can S.C.A.R. Subject to social norms Controversial Able to shape the law / policy Risking stereotyping and prejudice Identify 3 topics which are socially sensitive * ##

Relating the Debates to Rosenhan * 07/16/96 Socially sensitive research Why is Rosenhan’s study socially sensitive? * ##

Relating the Debates to Rosenhan * 07/16/96 Psychology as a science Falsifiable Objective Replicable Quantitative data Experiments * ##

Relating the Debates to Rosenhan * 07/16/96 Psychology as a science Falsifiable – yes – R tried to prove himself wrong with the 2nd study Objective – no – covert participant observation Replicable – yes Quantitative data – some Experiment – yes – field * ##

Individual (Dispositional) v Situational Explanations of Behaviour Discuss the individual / situational explanations debate. Use Core Studies to support your answer. [15]

Writing strong 15 mark answers Point Explanation Example Conclusion Challenge 1 paragraph

Writing strong 15 mark answers Point Explanation Example Conclusion Challenge 3 15 mark answer

Discuss the individual / situational explanations debate Discuss the individual / situational explanations debate. Use Core Studies to support your answer. [15] https://www.youtube.com/watch?v=8yATZ70of_I

Paper 3 – 10 mark essay style questions Explain how the research by … can be applied to … [10] 5 marks for AO1 KNOWLEDGE of the study 5 marks for AO2 APPLICATION to the question This means you can pre-prepare answers for these.

Paper 3 – 10 mark essay style questions 5 marks for KNOWLEDGE of the study Know the summary of the study: Aim Sample Procedure Results Conclusions WHERE POSSIBLE Write your summary of Rosenhan’s study

Assessment Objectives: How the Marks are Awarded AO1 Knowledge & Understanding the amount of relevant material presented, where low marks are awarded for brief or inappropriate material and high marks for accurate and detailed material

Assessment Objectives: How the Marks are Awarded AO2 Application of Knowledge the level and effectiveness of critical commentary where low marks are awarded for superficial consideration of a restricted range of issues and high marks for a good range of ideas and specialist terms, and effective use of material addressing a broad range of issues

Assessment Objective 2: Identify why this achieved 15 marks Practice assigning marks

Validity and Reliability of Diagnosis * 07/16/96 With reference to Rosenhan (1973), discuss the reliability of categorising and diagnosing mental disorders. [10] With reference to Rosenhan (1973), discuss the validity of categorising and diagnosing mental disorders. [10] * ##

Validity and Reliability of Diagnosis * 07/16/96 With reference to Rosenhan (1973), discuss the validity of categorising and diagnosing mental disorders. [10] Validity = truth / true Concurrent validity Predictive (Criterion) validity Comorbidity * ##

Validity and Reliability of Diagnosis * 07/16/96 With reference to Rosenhan (1973), discuss the reliability of categorising and diagnosing mental disorders. [10] Reliability = consistency Inter-rater reliability Test retest reliability * ##