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Examine the concepts of normality and abnormality Normality and abnormality are two rather vague concepts used

in psychiatry, particularly for diagnosis. Normal behaviour can be defined as that which adheres to standard behaviour, or does not deviate from the norm. Abnormal behaviour can be defined as the subjective experience of feeling not normal (including feelings of anxiety, distress, etc.), or that which deviates fr om the statistical norm (an aberration). The definitions of normal or abnormal behaviour can be quite ambiguous and difficult to determine due to the differences in what normal is based on gender, age, culture. Thus, diagnoses in psychiatry can be difficult to determine. However, Jahoda (1958) claims that a diagnosis of abnormal behaviour should be based on the lack of certain characteristics present in mentally healthy people. Rosenhan and Seligman (1984), on the other hand, state that in order for a diagnosis of an abnormal patient to be made, the characteristics of mentally unhealthy people should be looked at. This essay will examine the concepts of abnormality and normality by analysing the Rosenhan et al.s (1973) study on schizophrenia and Caetanos (1973) study on labeling theory. Although diagnoses can be difficult to make due to the ambiguity present in the definitions of abnormal and normal behaviour, Jahoda (1958) and Rosenhan and Seligman (1984) posit certain criteria for diagnoses of abnormal behaviour. Jahoda (1958) said that when looking at patients displaying abnormal behaviour, the diagnosis should be made using the lack of characteristics present in mentally healthy people (i.e. based on what is considered healthy). According to Jahoda, if the patient lacks the following characteristics (which are present in mentally healthy people), the patient is abnormal: efficient self-perception, realistic self-esteem, voluntary control of behaviour, true perception of the world, sustaining relationships, selfdirection, and productivity. By contrast, Rosenhan and Seligman (1984) claimed that when looking at patients displaying abnormal behaviour, the diagnosis should instead be based on the presence of characteristics in mentally unhealthy people. If the patient displays criteria present in mentally ill people, the patient is abnormal: suffering, maladaptiveness, irrationality, unpredictability, unconventionality, and violation of morals or ideal standards. These contrasting views on what abnormal behaviour is would indicate that it is very difficult to define such abstract terms. Distinguishing between the sane and insane can be a difficult feat, especially for psychiatrists. Rosenhan et al. (1973) did a field study in which they aimed to test the hypothesis that psychiatrists cannot reliably tell the difference between people who are sane and those who are insane. In their study, 8 sane participants, named pseudo-patients (3 women and 8 men) were asked to gain admission to 12 different hospitals in 5 different states in the USA. The pseudo-patients booked an appointment with the hospitals and arrived at the admissions office complaining that theyd been hearing unfamiliar voices of the same-sex. These voices, often unclear, said empty, hollow or thud, and were chosen to resemble existential symptoms concerning the meaning of life. Rosenhan chose these because these symptoms werent actually in any psychiatric literature. The pseudo-patients gave a false name and job (so they wouldnt be affected after the study), but gave all other details of their life, such as life history, feelings, relationships, etc. After being admitted, the pseudo-patients stopped simulating any symptoms of abnormality (the voices). They took part in ward activities like ordinary patients, and when asked how they were feeling by the staff, replied by saying they were fine and werent hearing the voices anymore. All pseudo-patients were told by the researchers that they would have to find a way to get out and convince the staff that they werent insane. During the experience, the pseudo-patients wrote notes from their observations (which were initially done secretly, but later openly since it didnt bother anyone). Pseudo-patients were careful to act normal instead of abnormal at this point.

Findings of this field study showed that the pseudo-patients werent detected, and all but one were admitted with a diagnosis of schizophrenia and were eventually discharged as having schizophrenia in remission. The diagnosis made by hospital psychiatrists was made without one clear symptom of the disorder. Pseudo-patients remained in the hospital for 7-52 days (19 on average). Although staff didnt suspect anything, the actual insane patients suspected the sanity of the pseudo-patients. 35 out of 118 of the patients voiced their suspicions, and one even said youre not crazy, youre just checking up on the hospital. The hospital staff interpreted the pseudo-patients normal behaviour as part of their illness, such as the note-taking, which was seen as part of their pathological behaviour. Rosenhan notes that there was an enormous overlap between the insane and sane behaviour. Rosenhan et al. concluded from the study that there existed limitations in psychiatric classification and the conditions of the psychiatric hospitals were appalling. Pseudo-patients expressed that during their experience of hospitalization, they felt depersonalized and powerless. The study also showed how professional diagnosis regarding abnormality and normality is not always reliable or valid. Since this was a field study, evaluation of the studys results and methods is important to consider. One of the strengths of this study is that because it was a participant and covert observation, the pseudo-patients were able to experience the ward from a patients perspective while maintaining some degree of objectivity and gaining rich data. Since this was a field study, it was also ecologically valid because it was done in the natural clinical psychiatric environment. The study also controlled many variables, such as the pseudo-patients behaviour. Because Rosenhan used many types of hospitals (new, old, government-funded, different locations, etc.), the results of the study can be generalized to other American hospitals. Finally, the study provided insight into reliability of diagnosis, and stimulated further research into psychiatric diagnoses. On the other hand, there were also many limitations, one of them being that the study was unethical. Because the study was covert, the hospital was deceived and the staff may have felt betrayed and unsure of themselves afterwards. Also, the experiences of the pseudo-patients may not have been the same as real patients since real patients dont have the comfort of knowing that their diagnosis is false. Finally, this study used the DSM-II during 1973, and therefore used out-dated classifications of some disorders. Now that the DSM has reached its 5th edition, the results of the study may be different today. Overall, Rosenhan et al. (1973) provided insight and evidence for the general inability to tell the difference between abnormal and normal behaviour, and gave hospitals the incentive to improve hospital conditions and diagnosis reliability. This study showed how the concepts of abnormality and normality can be difficult to understand and apply in psychiatric diagnosis. The labels given to mentally ill patients can also influence psychiatric diagnoses, and therefore blur the line between abnormality and normality. Caetano (1973) carried out a standardized interview and survey with the aim to investigate the influence of labeling in psychiatric diagnoses. In this study, Caetano videotaped a male psychiatrist carrying out separate standardized interviews with a paid university student and a hospitalized mental patient. Two groups of people were shown these interviews: a group of 77 psychology students and a group of 36 psychiatrists attending a meeting. Both groups were asked to diagnose the interviewees and rate their degree of mental illness. Within each sample of viewers, they were randomly assigned to two different groups given difference information about the interviewees: one group was told that both interviewees were volunteers paid to participate, and another group was told both interviewees were patients in a state mental hospital. Caetano acknowledged that the paid students may have had a latent psychiatric disorder, or the real mentally ill patients may have been normal. Findings of the study indicated that the psychiatrists with clinical experience were more likely persuaded by the information given about the two interviewees and labeled them both as mentally ill (if both were described as patients) or both not mentally ill (if described as

paid volunteers). The study ultimately concluded that psychiatrists were easily swayed by labels to patients, and therefore may not always know who is abnormal or normal. As with all studies, it is important to look at the strengths and limitations of the study by evaluating the study. One of the strengths of the study was that it gave detailed information about the diagnosis since the method was a standardized interview. The study is also standardized, and therefore highly replicable and reliable. To an extent, the study also has some ecological validity since the psychiatrists were under the assumption they were at a meeting. Another strength of the study is that it gave insight into the reliability and validity of diagnose, especially the effect of labels. The study also had various limitations, one being that the paid university student could have had a latent or undiagnosed mental illness, and could therefore be a confounding variable. The study also utilized a survey to measure the degree of mental illness, which may be too subjective and reductionist. Since the study was done in 1973, the diagnoses were based on the DSM-II, and therefore yield different results today since the DSM is much more detailed now. The study is not very cross-culturally valid since the study was done in the US, and labeling may have more of an influence in American psychiatry. Finally the study may not be entirely ethical since the psychology students and psychiatrists were deceived. Psychiatrists may be unsure of their diagnoses in the future, if they were debriefed. Overall, Caetano (1973) gave insight into the biases involved in psychiatric diagnoses and how abnormality and normality can be easily mixed due to labels. In conclusion, the concepts of abnormality and normality are rather ambiguous and abstract, and pose problems in psychiatric diagnoses. This was demonstrated through the conflicting methods of diagnosis from the criteria of Jahoda (1958), who based diagnosis on mentally healthy characteristics, and Rosenhan and Seligman (1984), who based diagnosis on mentally unhealthy characteristics. This essay also explored the concepts of abnormality and normality by analysing Rosenhan et al. (1973) on Schizophrenia and lack of reliability in psychiatric diagnoses, and Caetano (1973) on the influence of labeling theory on interpretations of abnormality and normality. Ultimately, its not always easy to distinguish between abnormal and normal behaviour, but these terms are essential to understand in order to have a consistent and reliable form of psychiatric diagnosis.

Discuss the validity and reliability of diagnosis The reliability and validity of diagnosis is an essential aspect to consider in psychiatry, as patients must receive the accurate diagnosis to have access to the correct treatment. Diagnosis can be defined as identifying and classifying abnormal behaviour on the basis of symptoms, patient self-reports, clinical tests, observations, and other factors such as information from relatives. To make a diagnosis, psychiatrists use diagnostic manuals that have been standardized and reviewed by professional psychiatrists. One such diagnostic manual is the DSM-IV, which allows for the classification and standardization of diagnosis such that psychiatrists will use the same information to make consistent judgments. The DSM-IV, made by the American Psychiatric Association, is a list of mental disorders and their symptoms. Like the DSM-IV, the ICD-10 is another diagnostic manual used by WHO (World Health Organization). Diagnostic methods and manuals can differ from country to country, and that is one reason why reliability and validity of diagnosis is important to consider. Reliability refers to the extent to which different psychiatrists will reach the same diagnosis using the same classification system. Validity refers to the extent to which a diagnostic system accurately diagnoses those who are mentally ill. This essay will discuss the validity and reliability of diagnosis by firstly

examining reliability and validity (through Szaszs criticisms of the diagnost ic biomedical approach), and analyzing Rosenhans (1973) study on Schizophrenia, and Caetanos (1973) study on Labeling theory. To understand reliability and validity in diagnosis, one must first understand the types of reliability and criticisms of validity. There are two types of reliability. The first is inter-rater reliability which can be assessed by asking more than one psychiatrist to observe the same patient, using the same diagnostic system, to make a diagnosis. If the psychiatrists make the same decision about the diagnosis, the diagnostic system is reliable. Another type of reliability is test-retest reliability, which concerns itself with whether the same person will receive the same diagnosis if they are assessed more than once (ex. on two different days). Another concern with diagnosis is validity: can diagnostic systems correctly diagnose people those who actually have a mental disorder, and not misdiagnose those who are mentally healthy? According to Szaszs criticisms of the diagnostic biomedical approach, it is reductionist to assume that mental disorders are biological, and thus diseases. Szasz claimed that our diagnostic system is not valid because it is wrong to use the mental illness metaphor to describe behaviour that does not conform to our expectations. Mental illnesses are essentially labels given to a set of behaviours, emotions, and thoughts. For example, depression is unhappiness; unhappiness is not a symptom of depression. Thus, the validity and reliability of diagnosis depends on various factors, such as inter-rater and test-retest reliability, and the labels that are given to a disorder in a diagnostic system. Diagnosis can be particularly difficult and even unreliable when the lines between insanity and sanity blur. Rosenhan et al. (1973) did a field study in which they aimed to test the hypothesis that psychiatrists cannot reliably tell the difference between people who are sane and those who are insane. In their study, 8 sane participants, named pseudo-patients (3 women and 8 men) were asked to gain admission to 12 different hospitals in 5 different states in the USA. The pseudo-patients booked an appointment with the hospitals and arrived at the admissions office complaining that theyd been hearing unfamiliar voices of the same-sex. These voices, often unclear, said empty, hollow or thud, and were chosen to resemble existential symptoms concerning the meaning of life. Rosenhan chose these because these symptoms werent actually in any psychiatric literature. The pseudo-patients gave a false name and job (so they wouldnt be affected after the study), but gave all other details of their life, such as life history, feelings, relationships, etc. After being admitted, the pseudo-patients stopped simulating any symptoms of abnormality (the voices). They took part in ward activities like ordinary patients, and when asked how they were feeling by the staff, replied by saying they were fine and werent hearing the voices anymore. All pseudo-patients were told by the researchers that they would have to find a way to get out and convince the staff that they werent insane. During the experience, the pseudo-patients wrote notes from their observations (which were initially done secretly, but later openly since it didnt bother anyone). Findings of this field study showed that the pseudo-patients werent detected, and all but one were admitted with a diagnosis of schizophrenia and were eventually discharged as having schizophrenia in remission. The diagnosis made by hospital psychiatrists was made without one clear symptom of the disorder. Pseudo-patients remained in the hospital for 7-52 days (19 on average). Although staff didnt suspect anything, the actual insane patients suspected the sanity of the pseudo-patients. 35 out of 118 of the patients voiced their suspicions, and one even said youre not crazy, youre just checking up on the hospital. The hospital staff interpreted the pseudo-patients normal behaviour as part of their illness, such as the note-taking, which was seen as part of their pathological behaviour. Rosenhan notes that there was an enormous overlap between the insane and sane behaviour. Rosenhan et al. concluded from the study that there existed limitations in psychiatric classification and the conditions of the psychiatric hospitals were appalling. Pseudo-patients expressed that during their experience of hospitalization, they

felt depersonalized and powerless. The study also showed how professional diagnosis regarding abnormality and normality is not always reliable or valid. Reliability and validity of diagnoses may therefore not always be present. Since this was a field study, evaluation of the studys results and methods is important to consider. One of the strengths of this study is that because it was a participant and covert observation, the pseudo-patients were able to experience the ward from a patients perspective while maintaining some degree of objectivity and gaining rich data. Since this was a field study, it was also ecologically valid because it was done in the natural clinical psychiatric environment. The study also controlled many variables, such as the pseudo-patients behaviour. Because Rosenhan used many types of hospitals (new, old, government-funded, different locations, etc.), the results of the study can be generalized to other American hospitals. Finally, the study provided insight into reliability of diagnosis, and stimulated further research into psychiatric diagnoses. On the other hand, there were also many limitations, one of them being that the study was unethical. Because the study was covert, the hospital was deceived and the staff may have felt betrayed and unsure of themselves afterwards. Also, the experiences of the pseudo-patients may not have been the same as real patients since real patients dont have the comfort of knowing that their diagnosis is false. Finally, this study used the DSM-II during 1973, and therefore used out-dated classifications of some disorders. Now that the DSM has reached its 5th edition, the results of the study may be different today. Overall, Rosenhan et al. (1973) provided insight and evidence for the general inability to tell the difference between abnormal and normal behaviour, and gave hospitals the incentive to improve hospital conditions and diagnosis reliability. This study showed how psychiatric diagnoses are not always reliable, and diagnostic systems are not necessarily always valid. The labels given to mentally ill patients can also influence psychiatric diagnoses, and therefore influence the reliability and validity of diagnosis by psychiatrists. Caetano (1973) carried out a standardized interview and survey with the aim to investigate the influence of labeling in psychiatric diagnoses. In this study, Caetano videotaped a male psychiatrist carrying out separate standardized interviews with a paid university student and a hospitalized mental patient. Two groups of people were shown these interviews: a group of 77 psychology students and a group of 36 psychiatrists attending a meeting. Both groups were asked to diagnose the interviewees and rate their degree of mental illness. Within each sample of viewers, they were randomly assigned to two different groups given difference information about the interviewees: one group was told that both interviewees were volunteers paid to participate, and another group was told both interviewees were patients in a state mental hospital. Caetano acknowledged that the paid students may have had a latent psychiatric disorder, or the real mentally ill patients may have been normal. Findings of the study indicated that the psychiatrists with clinical experience were more likely persuaded by the information given about the two interviewees and labeled them both as mentally ill (if both were described as patients) or both not mentally ill (if described as paid volunteers). The study ultimately concluded that psychiatrists were easily swayed by labels to patients, and were therefore not always reliable despite their clinical training. As with all studies, it is important to look at the strengths and limitations of the study by evaluating the study. One of the strengths of the study was that it gave detailed information about the diagnosis since the method was a standardized interview. The study is also standardized, and therefore highly replicable and reliable. To an extent, the study also has some ecological validity since the psychiatrists were under the assumption they were at a meeting. Another strength of the study is that it gave insight into the reliability and validity of diagnose, especially the effect of labels. The study also had various limitations, one being that the paid university student could have had a latent or undiagnosed mental illness, and could therefore be a confounding variable. The study also utilized a survey to measure the degree of mental illness, which may be too subjective and reductionist. Since the study was done in 1973, the diagnoses were based on the

DSM-II, and therefore yield different results today since the DSM is much more detailed now. The study is not very cross-culturally valid since the study was done in the US, and labeling may have more of an influence in American psychiatry. Finally the study may not be entirely ethical since the psychology students and psychiatrists were deceived. Psychiatrists may be unsure of their diagnoses in the future, if they were debriefed. Overall, Caetano (1973) gave insight into the biases involved in psychiatric diagnoses and how labeling can negatively influence the validity and reliability of diagnosis. In conclusion, a diagnosis is not always reliable or valid, even if it was made by a professional psychiatrist. In order to test reliability, psychiatrists must agree with the diagnosis made about a patient, and consistent testing must have the same diagnostic results. Validity also depends on how accurate a diagnosis is, which, according to Szaszs criticisms of the diagnostic biomedical approach, depends on how psychiatrists view mental illness and labels. A diagnosis can differ from psychiatrist to psychiatrist, and even from country to country depending on the diagnostic manual, therefore questioning the reliability and validity of diagnosis. This was explored by analyzing Rosenhans (1973) study on schizophrenia and Caetanos (1973) study on labeling theory. Ultimately, reliability and validity of diagnosis is essential to consider in psychiatry as a patient must be diagnosed correctly in order to be treated properly. Although classified and standardized methods of diagnosis are used, such as the DSM-IV, a diagnosis may not always be reliable or valid.