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1. The Individual Differences Approach 2. What is Abnormal Behaviour? 3. Some definitions of abnormality <ul><li>Stratton & Hayes (1993) .. Abnormality IS…
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  • 1. The Individual Differences Approach
  • 2. What is Abnormal Behaviour?
  • 3. Some definitions of abnormality <ul><li>Stratton & Hayes (1993) .. Abnormality IS </li></ul><ul><ul><li>Behaviour which deviates from the norm </li></ul></ul><ul><ul><ul><li>most people don’t behave that way </li></ul></ul></ul><ul><ul><li>Behaviour which does not conform to social demands </li></ul></ul><ul><ul><ul><li>most people don’t like that behaviour </li></ul></ul></ul><ul><ul><li>Behaviour which is maladaptive or painful to the individual </li></ul></ul><ul><ul><ul><li>its not normal to harm yourself </li></ul></ul></ul>
  • 4. One Flew Over The Cuckoo’s Nest Clip
  • 5. Categorising Mental Illness <ul><li>Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) </li></ul><ul><li>International Statistical Classification of Diseases and Related Health Problems (ICD) </li></ul>
  • 6. Diagnoses or Labelling?
  • 7. Social Stigma? <ul><li>Many people misunderstand and may even fear those with a mental illness. </li></ul><ul><li>Frank Bruno, one of the nations favourite Boxers who won the ABA Heavyweight Championship at just 18 had to be sectioned in 2003 for Depression. This shows how anyone can be affected by mental illness, whether famous, successful or otherwise. </li></ul>
  • 8. What is Schizophrenia? <ul><li>A serious mental disorder </li></ul><ul><li>Positive Symptoms (additional to normal behaviour) include: hallucinations, delusions and thought disorder </li></ul><ul><li>Negative Symptoms (reduction in normal experiences or behaviour) include unusual emotional responses and lack of motivation. </li></ul>
  • 9. What do you think it would be like to have Schizophrenia?
  • 10. How did it feel? <ul><li>If you had a mental illness how would you like to be treated? </li></ul>
  • 11. The Question <ul><li>If sanity and insanity exist </li></ul><ul><li>How shall we recognise them? </li></ul>
  • 12. D.L. Rosenhan (1973) <ul><li>The ground breaking study : </li></ul><ul><li>“ On being sane in insane places” </li></ul><ul><li>Read Pages 126-128 </li></ul>
  • 13. The volunteers <ul><li>EIGHT sane people </li></ul><ul><ul><li>one graduate student </li></ul></ul><ul><ul><li>three psychologists </li></ul></ul><ul><ul><li>a paediatrician </li></ul></ul><ul><ul><li>a painter </li></ul></ul><ul><ul><li>housewives </li></ul></ul>
  • 14. What did they do? The procedure: <ul><li>telephoned 12 psychiatric hospitals for urgent appointments </li></ul><ul><li>gave false name and address </li></ul><ul><li>complained of hearing unclear voices … saying “empty, hollow, thud” </li></ul><ul><ul><li>Simulated ‘existential crisis’ </li></ul></ul><ul><ul><li>“ Who am I, what’s it all for?” </li></ul></ul>
  • 15. What happened? <ul><li>All were admitted to hospital </li></ul><ul><li>All but one were diagnosed as suffering from schizophrenia </li></ul><ul><li>Once admitted the ‘pseudo-patients’ stopped simulating ANY symptoms </li></ul><ul><li>Took part in ward activities </li></ul>
  • 16. How did the ward staff ‘see’ them? <ul><li>Normal behaviour was misinterpreted </li></ul><ul><li>Writing notes was described as - </li></ul><ul><ul><li>“ The patient engaged in writing behaviour” </li></ul></ul><ul><li>Arriving early for lunch described as </li></ul><ul><ul><li>“ oral acquisitive syndrome” </li></ul></ul><ul><ul><li>Behaviour distorted to ‘fit in’ with label </li></ul></ul>
  • 17. How long did they stay in hospital? <ul><li>The shortest stay was 7 days </li></ul><ul><li>The longest stay was 52 days </li></ul><ul><li>The average stay was 19 days </li></ul><ul><ul><li>They had agreed to stay until they convinced the staff they were sane. </li></ul></ul><ul><ul><li>Discuss: How would YOU convince someone you are sane? </li></ul></ul>
  • 18. Were they treated in the same way as normal patients? <ul><li>Given total of 2100 medication tablets </li></ul><ul><ul><li>they flushed them down the loos </li></ul></ul><ul><ul><li>Noted that other patients did the same and that this was ignored as long as patients behaved themselves! </li></ul></ul>
  • 19. What sorts of records did they keep? <ul><li>Nurses stayed in ward offices 90% of time </li></ul><ul><li>Each ‘real patient’ spent less than 7 minutes per day with psychiatric staff </li></ul>
  • 20. Perhaps they behaved ‘abnormally’ <ul><li>Pseudo-patient’s visitors detected “No serious behavioural consequences” </li></ul><ul><li>DID ANYONE SUSPECT? </li></ul>
  • 21. What about the REAL patients? <ul><li>35 out of 118 patients voiced their suspicions </li></ul>
  • 22. On release - <ul><li>The pseudo-patients were diagnosed as </li></ul><ul><li>Schizophrenia “IN REMISSION” </li></ul>
  • 23. Rosenhan: The follow up study <ul><li>A teaching & research hospital was told of the first study </li></ul><ul><li>and warned that … </li></ul><ul><li>Over the next three months ONE OR MORE pseudo-patient will attempt to be admitted </li></ul>
  • 24. What happened? <ul><li>Staff members rated ‘new patients’ on scale 1 - 10 as ‘how likely to be a fraud’ </li></ul><ul><li>193 patients ‘assessed’ </li></ul><ul><li>41 rated as a pseudo-patient (by staff) </li></ul><ul><li>23 rated as pseudo-patient (by psychiatrist) </li></ul><ul><li>19 rated as pseudo-patient (by both) </li></ul>
  • 25. How many of these SUSPECTS were pseudo-patients? <ul><li>NONE </li></ul><ul><li>No pseudo-patients were sent – the staff were rating their regular intake </li></ul>
  • 26. Rosenhan’s conclusion <ul><li>“ It is clear that we are unable to distinguish the sane from the insane in psychiatric hospitals” </li></ul><ul><ul><li>In the first study : </li></ul></ul><ul><ul><li>We are unable to detect ‘sanity’ </li></ul></ul><ul><ul><li>In the follow up study : </li></ul></ul><ul><ul><li>We are unable to detect ‘insanity’ </li></ul></ul>
  • 27. Rosenhan’s study highlighted <ul><li>The depersonalisation and powerlessness of patients in psychiatric hospitals </li></ul><ul><li>That behaviour is interpreted according to expectations of staff and that these expectations are created by the labels SANITY & INSANITY </li></ul>
  • 28. Questions YOU should be able to answer <ul><li>Methodology: This was a field experiment </li></ul><ul><li>Who were the participants? </li></ul><ul><li>Was this study ethical? If not why not? </li></ul>
  • 29. Questions YOU should be able to answer <ul><li>Why might the reports of the pseudo-patients have been unreliable? </li></ul>
  • 30. Rosenhan ….. YOU must read this study <ul><li>It is one of the most influential studies in Abnormal Psychology </li></ul><ul><li>If there are such things as SANITY and INSANITY HOW SHALL WE KNOW THEM? </li></ul>
  • 31. On being sane in insane places... <ul><li>D L Rosenhan (1973) </li></ul>
  • 32. Study 3! (last but certainly not least!) <ul><li>Aim: to investigate patient-staff contact. </li></ul><ul><li>Method: In 4 of the hospitals pseudo-patients approached a member of staff and asked~ </li></ul><ul><li>“ Pardon me, Mr/Mrs/Dr X, could you tell me when I will be eligible for ground privileges?” </li></ul>
  • 33. <ul><li>Method continued: </li></ul><ul><li>The pseudopatient did this as normally as possible and avoided asking the same person more than once a day. </li></ul>
  • 34. Results <ul><li>A brief reply as the member of staff continued walking and did not make eye contact. </li></ul><ul><li>4% psychiatrists stop to talk </li></ul><ul><li>0.5% nurses stopped </li></ul><ul><li>Overall 2% in each group paused and chatted. </li></ul>
  • 35. Results continued: The Control <ul><li>Young female participant </li></ul><ul><li>Stanford University Campus </li></ul><ul><li>Asked 6 questions </li></ul><ul><li>All staff stopped and answered all questions and made eye contact. </li></ul>
  • 36. Conclusion: <ul><li>The lack of eye contact between staff and patients depersonalises the patients. </li></ul>
  • 37. Summary and conclusion <ul><li>We cannot distinguish the sane from the insane all of the time. </li></ul><ul><li>Hospitalisation for the mentally ill isn’t the solution as it results in powerlessness, depersonalisation, segregation, mortification and self-labelling- all counter-therapeutic. </li></ul>
  • 38. Powerlessness and Depersonalisation <ul><li>Staff treated patients will little respect: Beating them and swearing at them for minor incidents- this is depersonalising and leads to patients feeling powerless. </li></ul><ul><li>This is added to by; patients being unable to initiate contact with staff, lack of privacy (physical examinations are conducted in semi-private rooms) </li></ul><ul><li>The general activity around the patient is conducted as if they are invisible. </li></ul>
  • 39. And don’t forget…. <ul><li>ETHICS!!! </li></ul>
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