1. Abnormal Psychology: Past and Present
chapter one
Abnormal Psychology: Past and Present

2. Abnormal Psychology: Past and Present
What is ABNORMAL PSYCHOLOGY?
Scientific study of abnormal behavior in an effort to describe, predict, explain, and change abnormal patterns of functioning
Workers in the field may be:
Clinical scientists
Clinical practitioners

3. VERBAL DEBUTS
There was a time not that long ago when terms used today did not exist.
When did these and similar words (including slang terms) make their debut in print as expressions of psychological dysfunction?
The Oxford English Dictionary offers the above terms and dates.

4. What Is Psychological Abnormality?
Many definitions have been proposed, yet none has won total acceptance
Most definitions, however, have four features in common: “The Four Ds”
DEVIANCE
DISTRESS
DYSFUNCTION
DANGER
While this definition is a useful starting point, it has key limitations
DEVIANCE – Different, extreme, unusual, perhaps even bizarre
DISTRESS – Unpleasant and upsetting to the person
DYSFUNCTION – Interfering with the person’s ability to conduct daily activities in a constructive way
DANGER – Posing risk of harm

5. Common Features of Psychological Abnormality
Deviance
From what?
SOCIAL NORMS and societal values
Specific circumstances or context
Distress
Behavior, ideas, or emotions
Usually have to cause distress before being labeled abnormal
Dysfunction
Abnormal behavior tends to interfere with daily functioning
Culture plays a role
Danger
Dangerous to oneself or others
May be exception rather than the rule
From what?
From behaviors, thoughts, and emotions that differ markedly from a society’s ideas about proper functioning
From SOCIAL NORMS
Stated and unstated rules for proper conduct
Abnormal behavior tends to be dysfunctional – it interferes with daily functioning
Here again culture plays a role in the definition of abnormality
Abnormal behavior may become dangerous to oneself or others
Behavior may be consistently careless, hostile, or confused
Although often cited as a feature of psychological abnormality, research suggests that dangerousness is the exception rather than the rule
Examples?
Judgments of abnormality vary from society to society as norms grow from a particular culture
They also depend on specific circumstances
According to many clinical theorists, behavior, ideas, or emotions usually have to cause distress before they can be labeled abnormal
Not always the case

6. Eccentrics MARCHING TO A DIFFERENT DRUMMER: ECCENTRICS
Deviate from common behavior patterns or display odd or whimsical behavior (Dictionary)
Possess many common characteristics: Nonconformity, creativity, strong curiosity, idealism, extreme interests and hobbies, lifelong awareness of being different, high intelligence, outspokenness, disinterests in others, noncompetitiveness, unusual eating and living habits, eldest or only child, poor spelling skills (Weeks and others)
Do not typically suffer from mental disorders or severely disrupted thought processes (Weeks)

7. The Elusive Nature of Abnormality
A society selects general criteria for defining abnormality and then uses those criteria to judge particular cases
Szasz finds the concept of mental illness to be invalid, a myth of sorts
Do you know why?
Szasz finds the concept of mental illness to be invalid, a myth of sorts.
Deviations called “abnormal” are only “problems of living.”
Societies invent the concept of mental illness to better control or change people who threaten social order.

8. The Elusive Nature of Abnormality
Even if we assume that psychological abnormality is a valid concept
Our definition may not be applied consistently
Criteria often are vague and subjective
Few categories of abnormality are clear-cut; most continue to be debated by clinicians
Although abnormality generally is defined as behavior that is deviant, distressful, dysfunctional, and sometimes dangerous, these criteria often are vague and subjective.
Examples:
Diagnosis of alcohol problems in colleges
Issue of abnormality versus eccentricity

9. What Is Treatment? TREATMENT, OR THERAPY
Procedure designed to change abnormal behavior into more normal behavior
Clinical treatment requires a careful definition
Carl Rogers
Jerome Frank
Others
Once clinicians decide that a person is suffering from abnormality, they seek to treat it.
Treatment requires careful definition.
Carl Rogers
“Therapists are not in agreement as to their goals or aims They are not in agreement as to what constitutes a successful outcome of their work. They cannot agree as to what constitutes a failure. It seems as though the field is completely chaotic and divided.”
According to Jerome Frank, all forms of therapy have three essential features:
A sufferer who seeks relief from the healer
A trained, socially accepted healer, whose expertise is accepted by the sufferer and his or her social group
A series of contacts between the healer and the sufferer, through which the healer tries to produce certain changes in the sufferer’s emotional state, attitudes, and behavior
Others
Abnormality as illness: therapy cures
Abnormality as problem in living: therapy teaches
Clinical treatment is surrounded by conflict and confusion:
Lack of agreement about goals or aims
Lack of agreement about successful outcome
Lack of agreement about failure
Are clinicians seeking to cure? To teach?
Are sufferers patients (ill) or clients (having difficulty)?

10. What Is Treatment?
But…despite their differences, most clinicians agree that large numbers of people need therapy of one kind or another
Evidence also indicates that therapy is indeed often helpful

11. How Was Abnormality Viewed and Treated in the Past?
In any given year as many as 30 percent of adults and 19 percent of children and adolescents in the United States display serious psychological disturbances and are in need of clinical treatment
In addition, most people have difficulty coping at various times
Is this the fault of modern society?
Although modern pressures may contribute, they are hardly the primary cause; every society, past and present, has witnessed psychological abnormality.

12. How Was Abnormality Viewed and Treated in the Past?
Many present-day ideas and treatments have roots in the past
Let’s take a look on the next slides

13. Ancient Views and Treatments
Ancient societies probably regarded abnormal behavior as the work of evil spirits
Treatment for severe abnormality was to force the demons from the body through trephination and exorcism
Ancient societies probably regarded abnormal behavior as the work of evil spirits.
This view may have begun as far back as the Stone Age.
The two holes in this skull recovered from ancient times indicate that the person underwent trephination

14. Greek and Roman Views and Treatments
500 B.C. to 500 A.D.
Philosophers and physicians offered different explanations and treatments for abnormal behaviors
Hippocrates believed and taught that illnesses had natural causes
Looked to an imbalance of the four fluids, or humors
Sought to correct the underlying physical pathology
To treat psychological dysfunction, Hippocrates sought to correct the underlying physical pathology.
Four fluids, or humors, that flowed through the body: yellow bile, black bile, blood, and phlegm

15. Europe in the Middle Ages: Demonology Returns
500 – 1350 A.D.
The church rejected scientific forms of investigation and religious beliefs dominated all aspects of life
Abnormality greatly increased, was seen as a conflict between good and evil, and often subject to demonological treatment
At the end of the Middle Ages
Demonology and its methods began to lose favor again
500 – 1350 A.D.
The church rejected scientific forms of investigation and controlled all education.
Religious beliefs dominated all aspects of life.
Once again, abnormality was seen as a conflict between good and evil.
Abnormal behavior apparently increased greatly during this period.
Some of the earlier demonological treatments reemerged.

16. The Renaissance and the Rise of Asylums
1400 – 1700 A.D.
Demonological views of abnormality continued to decline
German physician Johann Weyer believed that the mind was as susceptible to sickness as the body
The care of people with mental disorders continued to improve in this atmosphere

17. The Renaissance and the Rise of Asylums
Shrines
Across Europe, religious shrines were devoted to the humane and loving treatment of people with mental disorders
Asylums
There was a rise of asylums where the mentally ill became virtual prisoners due to overcrowding
Across Europe, religious shrines were devoted to the humane and loving treatment of people with mental disorders.
One, at Gheel, became a community mental health program of sorts.
Unfortunately, this time also saw a rise of asylums – institutions whose primary purpose was care of the mentally ill.
The intention was good care, but because of overcrowding they became virtual prisons.
The “crib”
Outrageous devices and techniques, such as the “crib,” were used in asylums, and some continued to be used even during the reforms of the nineteenth
century.

18. The Nineteenth Century: Reform and Moral Treatment
As 1800 approached
Treatment of people with mental disorders began to improve once again
Advocacy for more moral treatment emerged
Pinel (France) and Tuke (England)
Benjamin Rush and Dorothea Dix (U.S.)
By the end of the nineteenth century, reversal of the moral treatment movement began
Pinel (France) and Tuke (England) advocated moral treatment – care that emphasized moral guidance and humane and respectful techniques.
In the United States, Benjamin Rush (father of American psychiatry) and Dorothea Dix (Boston schoolteacher) were the primary proponents of moral treatment.
Dix’s work led to the creation of state hospitals.
By the end of the nineteenth century, several factors led to a reversal of the moral treatment movement:
Money and staff shortages
Declining recovery rates
Overcrowding
Emergence of prejudice

19. The Early Twentieth Century: Dual Perspectives
The Somatogenic Perspective
Abnormal functioning has physical causes
The Psychogenic Perspective
Abnormal functioning has psychological causes
By the early years of the twentieth century
The moral treatment movement had ground to a halt; long-term hospitalization became the rule once again
As the moral movement was declining in the late 1800s, two opposing perspectives emerged
As the moral movement was declining in the late 1800s, two opposing perspectives emerged

20. The Early Twentieth Century: The Somatogenic Perspective
Two factors were responsible for the rebirth of this perspective
Argument that physical factors (such as fatigue) are responsible for mental dysfunction
New biological discoveries
Biological approaches yielded mostly disappointing and sometimes immoral solutions
Eugenics
A number of effective medications were finally discovered
The somatogenic perspective has at least a 2,400-year history.
Two factors were responsible for the rebirth of this perspective:
Emil Kraepelin’s textbook argued that physical factors (such as fatigue) are responsible for mental dysfunction
New biological discoveries were made, such as the link between untreated syphilis and general paresis
Biological approaches yielded mostly disappointing results throughout the first half of the twentieth century.
A number of effective medications were finally discovered.
See Table 1.1 for additional information about eugenics and mental disorders.

21. The Early Twentieth Century: The Psychogenic Perspective
Hypnotism
Perspective based on work of
Mesmer and hysterical disorders
Breuer
Recent research
Hypnotic procedures are as capable of creating false memories as they are of uncovering real memories
Psychoanalysis
Perspective holds that many forms of abnormal and normal psychological function are psychogenic
Freud
Unconscious psychological processes
Techniques of psychoanalysis developed
Perspective was based on work of
Friedrich Mesmer and hysterical disorders
Recent research has clarified, however, that hypnotic procedures are as capable of creating false memories as they are of uncovering real memories.

22. Current Trends
This not yet a period of great enlightenment about or dependable treatment of mental disorders
43 percent of people surveyed believe that people bring mental health disorders upon themselves
35 percent consider mental health disorders to be caused by sinful behavior
Past half century has brought major changes in the ways clinicians understand and treat abnormal functioning—and more disagreements

23. How Are People with Severe Disturbances Cared For?
In the 1950s, researchers discovered a number of new psychotropic medications
Antipsychotic drugs
Antidepressant drugs
Antianxiety drugs
These discoveries led to deinstitutionalization and a rise in outpatient care
This change in care was not without problems
Can you identify any of these problems?
As a result, hundreds of thousands of persons with severe disturbances fail to make lasting recoveries, and they shuttle back and forth between the mental hospital and the community. After release from the hospital, they at best receive minimal care and often wind up living in decrepit rooming houses or on the streets.
At least 100,000 people with such disturbances are homeless on any given day; another 135,000 or more are inmates of jails and prisons. Their abandonment is truly a national disgrace.
The approach has been helpful for many patients, but too few community programs are available in the United States; only 40 to 60% of those with severe disturbances receive treatment of any kind
Figure 1-1
The impact of deinstitutionalization
The number of patients (fewer than 40,000) now hospitalized in public mental hospitals in the United States is a small fraction of the number hospitalized in (Information from: Althouse, 2010; Torrey, 2001; Lang, 1999.)
The impact of deinstitutionalization in the United States

24. How Are People with Less Severe Disturbances Treated?
Since the 1950s
Outpatient care has continued to be the preferred mode of treatment for those with moderate disturbances
Once exclusive to private psychotherapy
Now covered by most health insurance plans
Includes various settings and specialty care

25. How Are People with Less Severe Disturbances Treated?
Surveys suggest
Nearly 1 in 6 adults in the United States receives treatment for psychological disorders in the course of a year
Majority receive fewer than 5 sessions
Outpatient treatments are becoming available for more kinds of problems
Some outpatient care is devoted exclusively to one kind of psychological problem

26. A Growing Emphasis on Preventing Disorders and Promoting Mental Health
The community mental health approach has given rise to the prevention movement
Correct the social conditions that underlie psychological problems
Help individuals at risk for developing disorders
Prevention programs have been further energized by the growing interest in POSITIVE PSYCHOLOGY

27. A Growing Emphasis on Preventing Disorders and Promoting Mental Health
POSITIVE PSYCHOLOGY
Clinical practitioners teach people coping skills that may
Help protect them from stress
Encourage them to pursue psychological wellness, meaningful activities, and enriching relationships
Prevent mental disorders
POSITIVE PSYCHOLOGY is the study and promotion of positive feelings such as optimism and happiness, positive traits like hard work and wisdom, positive abilities, and group-directed virtues, including altruism and tolerance.
Positive psychology in action

28. Multicultural Psychology
In response to growing diversity in the United States, MULTICULTURAL PSYCHOLOGY has emerged
MULTICULTURAL PSYCHOLOGISTS seek to understand how culture, race, ethnicity, gender, and similar factors affect behavior and thought and how people of different cultures, races, and genders may differ psychologically

29. The Increasing Influence of Insurance Coverage
Today the dominant form of insurance coverage is the MANAGED CARE PROGRAM
At least 75 percent of all privately insured persons in the United States are enrolled in managed care programs
Reimbursements for mental disorders tend to be lower than those for medical disorders
Legislation
U.S. Congress federal parity law (2008)
Affordable Care Act (ACA/2014)
MANAGED CARE PROGRAM – A program in which the insurance company determines key care issues
Reimbursements for mental disorders tend to be lower than those for medical disorders; this places persons with psychological difficulties at a distinct disadvantage.
It is not yet clear whether such provisions in the legislation mentioned above will in fact result in better treatment for people with psychological problems.

30. What Are Today’s Leading Theories
One of the most important developments in the field of abnormal psychology is growth of numerous THEORETICAL PERSPECTIVES
Psychoanalytic
Biological
Behavioral
Cognitive
Humanistic-existential
Sociocultural
At present, no single perspective dominates the clinical field

31. What Are Today’s Leading Professions?
In addition to multiple perspectives, a variety of professionals now offer help to people with psychological problems
How many can you identify?
Psychiatrists
Clinical psychologists
Counseling psychologists
Educational and school psychological psychologists
Psychiatric nurses
Marriage therapists
Family therapists
Psychiatric social workers

32. Profiles of Mental Health Professionals in the United States
Degree
Began to Practice
Current Number
Average Annual Salary
Percent Female
Psychiatrists
MD, DO
1840s
50,000
$144,020 25
Psychologists
PhD, PsyD, EdD
Late 1940s
174,000
$63,000 52
Social workers
MSW, DSW
Early 1950s
607,000
$43,040 77
Counselors
Various
475,000
$47,530 90
Table 1-2

33. Technology and Mental Health
Effects of technological change on mental health and psychological dysfunction
Provision of new triggers and tools for abnormal behaviors
Negative consequences of violent media
Contributions to cognitive difficulties
Development and growth of CYBERTHERAPY (offered by professionals and non-professionals)
How can consumers optimize the chance of good outcomes when using a mental health app today?
New tools for stalking or bullying others, sexual exhibitionism, and pedophilic desires
CYBERTHERAPY The use of computer technology, such as Skype or avatars, to provide therapy. In the absence of regulation and proper research, consumers and therapists alike would be wise to investigate the reputation, manufacturer, content, and therapeutic principles of apps that they are considering.

34. What Do Clinical Researchers Do?
Clinical researchers face certain challenges that make their work very difficult
They work to discover universal laws, or principles, of abnormal psychological functioning
Search for NOMOTHETIC UNDERSTANDING
Typically do not assess, diagnose, or treat individual clients
Rely on the scientific method to pinpoint relationships between variables
Search for NOMOTHETIC UNDERSTANDING
General or universal laws or truths
Clinical researchers face certain challenges that make their work very difficult:
Measuring unconscious motives
Assessing private thoughts
Monitoring mood changes
Calculating human potential
Clinical researchers must consider different cultural backgrounds, races, and genders of the people they study.
They must always ensure that the rights of their research participants, both human and animal, are not violated.

35. What Do Clinical Researchers Do?
Three methods of investigation are used to form and test hypotheses and to draw broad conclusions
Case study
Correlational method
Experimental method

36. The Case Study Freud’s theories based mainly on case studies
Definition: Case study
Provides a detailed, interpretative description of a person’s life and psychological problems
Advantages
Can be a source of new ideas about behavior
May offer tentative support for a theory
May challenge a theory’s assumptions
May inspire new therapeutic techniques
May offer opportunities to study unusual problems
Limitations
May include reports by biased observers
Relies on subjective evidence
Provides little basis for generalization
Freud’s theories based mainly on case studies
Limitations addressed by the two other methods of investigation

37. The Correlational Method
Definitions
CORRELATION is the degree to which events or characteristics vary with each other
CORRELATIONAL METHOD is a research procedure used to determine the “co-relationship” between variables
Advantages
Can be trusted based on STATISTICAL ANALYSIS OF PROBABILITY
Can determine co-relationships between variables
Measures variables, observes participants, and applies statistical analyses
Can repeat studies with new samples to check earlier study results and generalize findings
Limitations
Does not explain the relationship
Does not explain causation
Freud’s theories are based mainly on case studies.
Limitations are addressed by the two other methods of investigation.
Preferred method of clinical investigation
Typically involve observing many individuals
Researchers apply procedures uniformly
Studies can be replicated
Researchers use statistical tests to analyze results.
Correlations can be trusted based on a STATISTICAL ANALYSIS OF PROBABILITY.
They ask how likely it is that the study's particular findings have occurred by chance.

38. Correlations
Correlational relationships
POSITIVE correlation
NEGATIVE correlation
UNRELATED correlation
Correlational strength or magnitude
HIGH MAGNITUDE
LOW MAGNITUDE
Correlational numerical calculation
CORRELATION COEFFICIENT
Perfect positive correlation to perfect negative correlation
SIGN
NUMBER
Relationships
When variables change the same way, their correlation is said to have a POSITIVE direction.
In a NEGATIVE correlation, the value of one variable increases as the value of the other variable decreases.
Variables also may be UNRELATED, meaning there is no consistent relationship between them.
The magnitude (strength) of a correlation is also important.
HIGH MAGNITUDE = variables that vary closely together
LOW MAGNITUDE = variables that do not vary as closely together
Direction and magnitude of a correlation are often calculated numerically.
This statistic is the “CORRELATION COEFFICIENT.”
The correlation coefficient can vary from (perfect positive correlation) to (perfect negative correlation).
SIGN (+ or -) indicates direction.
NUMBER indicates magnitude.
0.00 = no consistent relationship
Most correlations found in psychological research fall far short of “perfect.”

39. Special Forms of Correlational Research
EPIDEMIOLOGICAL STUDIES
Reveal the incidence and prevalence of a disorder in a particular population
INCIDENCE
PREVALENCE
Epidemiologic Catchment Area Study
LONGITUDINAL STUDIES
Involve observation of same individuals on many occasions over a long period
Incidence = Number of new cases that emerge in a given period
Prevalence = Total number of cases in a given period
Over the past 40 years, clinical researchers throughout the United States have worked on one of the largest epidemiological studies of mental disorders ever conducted, called the Epidemiologic Catchment Area Study.

40. Most Investigated Correlational Questions in Clinical Research
Most Common Correlational Questions
Are stress and onset of mental disorders related?
Is culture (or gender or race) generally linked to mental disorders?
Are income and mental disorders related?
Are social skills tied to mental disorders?
Is social support tied to mental disorders?
Are family conflict and mental disorders related?
Is treatment responsiveness tied to culture?
Which symptoms of a disorder appear together?
How common is a disorder in a particular population?

41. Twins, Correlation, and Inheritance
These healthy twin sisters are participating in a twin cultural festival at Honglingjin Park in Beijing, China.
Correlational studies of many pairs of twins have suggested a link between genetic factors and certain psychological disorders. Identical twins (who have identical genes) display a higher correlation for some disorders than do fraternal twins (whose genetic makeup is not identical).

42. The Experimental Method
EXPERIMENT is a research procedure in which a variable is manipulated and the manipulation’s effect on another variable is observed
INDEPENDENT variable
DEPENDENT variable
Questions about causal relationships can only be answered by an experiment
Manipulated variable = INDEPENDENT variable
Variable being observed = DEPENDENT variable
Experimental method allows researchers to ask questions such as: Does a particular therapy relieve the symptoms of a particular disorder?”

43. The Experimental Method
Statistics and research design are very important
Researchers must try to eliminate all CONFOUNDS
Three features are included in experiments to guard against confounds:
Control group
Random assignment
Bias, blind, and double-blind design
Researchers must try to eliminate all CONFOUNDS – variables other than the independent variable that may also be affecting the dependent variable.
A CONTROL GROUP is a group of research participants who are not exposed to the independent variable, but whose experience is similar to that of the experimental group.
By comparing the two groups, researchers can better determine the effect of the independent variable.
Researchers must also watch out for differences in the makeup of the experimental and control groups.
To do so, researchers use RANDOM ASSIGNMENT – any selection procedure that ensures that every participant in the experiment is as likely to be placed in one group as in another.
A final confound problem is bias.
To avoid bias by the participant, experimenters employ a “BLIND DESIGN,” in which participants are kept from knowing which assigned group (experimental or control) they are in.
One strategy for this is providing a PLACEBO – something that simulates real therapy but has none of its key ingredients.
To avoid bias by the experimenter, experimenters employ a “DOUBLE-BLIND DESIGN,” in which the experimenters and the participants are kept from knowing which condition of the study participants are in.
Often used in medication trials

44. Alternative Experimental Designs
It is not easy to devise an experiment that is both well controlled and enlightening
Clinical researchers often must settle for designs that are less than ideal
QUASI-EXPERIMENTAL, or MIXED, DESIGNS
NATURAL EXPERIMENTS
ANALOGUE EXPERIMENTS
SINGLE-SUBJECT EXPERIMENTS
REVERSAL DESIGN
Can you give an example for each of these?
In QUASI-EXPERIMENTAL, or MIXED, DESIGNS, investigators do not randomly assign participants to groups, but make use of groups that already exist.
Example: Children with a history of child abuse
To address the problem of confounds, researchers use MATCHED CONTROL GROUPS.
These groups are “matched” to the experimental group based on demographic and other variables.
In NATURAL EXPERIMENTS, nature manipulates the independent variable and the experimenter observes the effects.
Example: Psychological impact of flooding
ANALOGUE EXPERIMENTS allow investigators to freely manipulate independent variables while avoiding ethical and practical limitations.
They induce laboratory subjects to behave in ways that seem to resemble real life.
Example: Animal subjects
In a SINGLE-SUBJECT EXPERIMENT, a single participant is observed both before and after manipulation of an independent variable.
An example is the ABAB, or reversal, design.
In an ABAB (REVERSAL) DESIGN
Participant’s reactions are measured during a baseline period (A), after the introduction of the independent variable (B), after the removal of the independent variable (A), and after reintroduction of the independent variable (B).

45. Most Investigated Causal Questions in Clinical Research
Most Common Causal Questions
Does factor X cause a disorder?
Is cause A more influential than cause B?
How does family communication and structure affect family members?
How does a disorder affect the quality of a person’s life?
Does treatment X alleviate a disorder?
Is treatment X more helpful than no treatment at all?
Is treatment A more helpful than treatment B?
Why does treatment X work?
Can an intervention prevent abnormal functioning?
Table 1-4

46. Flawed Study, Gigantic Impact
The study: Spitzer’s (2001) research on “reparative” therapy
The findings: By undergoing reparative therapy, the paper claimed, gay men and women could change their sexual orientation
The recantation: Spitzer (2012) revealed two serious flaws in his study: Unreliable self-reports and lack of control group
The consequences: Then… and now?
Protesting reparative therapy Protestors from a gay rights group in Hong Kong hold up a banner outside a social welfare department in 2011 to protest the department’s endorsement of reparative therapy.
Protesting reparative therapy

47. What Are the Limits of Clinical Investigations?
The field has yet to agree on one definition of abnormality
Currently made up of conflicting schools of thought and treatment
Members are often unimpressed by the claims and accomplishments of the others
Clinical practice is carried out by a variety of professionals trained in different ways
Current research methods each have flaws that limit our knowledge and use of clinical information

48. Protecting Human Participants
Human research participants have needs and rights that must be respected
Researchers’ primary obligation is to avoid physically or psychologically harming the human participants in their studies
INSTITUTIONAL REVIEW BOARD (IRB)
An ethics committee in a research facility that is empowered to protect the rights and safety of human research participants

49. Institutional Review Board
IRB Participant Rights
Voluntary participation
Informed consent
Right to end participation at any time
Study benefits outweigh costs/risks
Protection from physical and psychological harm
Access to study information
Protection of privacy (confidentiality or anonymity)
IRB Limitations
Unclear informed consent forms
Subtle and elusive notions not easily translated into regulations
Ethical decisions influenced by differences in perspective, interpretation, and decision-making style
Government doctors and researchers conducted the Tuskegee Syphilis Study, a research undertaking conducted from 1932 to 1972, prior to the emergence of Institutional Review Boards. In this infamous study, 399 participants were not informed that they had the disease, and they continued to go untreated even after it was discovered that penicillin is an effective intervention for syphilis.