Clinical Issues and Debates

Question 1

Ethical

Answer 1

Guardia et al (2012) chose not to have the P’s judge the body size of another anorexic individual. Even though this would have been good methodologically, it may have caused psychological harm to the woman being judged. Tenn et al (2003) was an ethical way to study the dopamine hypothesis (injecting rats with amphetamines); causing temporary psychosis in humans would be way too risky.

Question 2

Unethical

Answer 2

Clinical trials are essential for testing the effectiveness of drugs / therapies but they have ethical issues. The P’s are vulnerable people and may not be able to give informed consent. In single or double-blind drug trials, some patients are being given a placebo, which means that they are not receiving any treatment at all.

Question 3

Ethics classic study

Answer 3

Rosenhan (1973): Psychiatric institutions were deceived, which then has downstream consequences for informed consent, right to withdraw, etc. Rosenhan sought permission for himself, but not the other pseudopatients. May have harmed real patients by wasting the time of the doctors and nurses. Doctors and nurses were kept anonymous, but may have lost faith in their abilities.

Question 4

Reductionistic (bad)

Answer 4

The dopamine hypothesis is a reductionistic explanation of schizophrenia. It explains a disorder that has many complex features by using the smallest possible “unit” of explanation. It ignores the complex interrelationship between various neurotransmitter levels and also ignores social or environmental factors.

Question 5

Holistic (good)

Answer 5

Family therapy is holistic as it recognises the importance of communication and relationships with family as a mediating factor in triggering a relapse of mental illness. It doesn’t just focus on one component of mental illness but instead looks at wider factors such as social / emotional / family support and communication.

Question 6

Reductionism and holism classic study

Answer 6

Rosenhan (1973): The medical model employed by the DSM II was reductionistic in its approach to MHDs. Having a checklist approach to diagnosing people (i.e. a list of symptoms) was arguably what allowed the pseudopatients to get into the mental hospitals with just a single symptom (hearing the words “empty / hollow / thud”). Study gathered a wide range of data though (qual. + quant.) so holistic.

Question 7

Nature

Answer 7

There is a strong biological basis for schizophrenia. Gottesman (1991) found that concordance for MZ twins was 48% whilst for DZ it was only 17%. This indicates a strong genetic component (although not 100% concordance for MZ so obviously environment plays a role; diathesis-stress model). The dopamine hypothesis ignores the influence of outside factors entirely.

Question 8

Nurture

Answer 8

The sociocultural explanation of anorexia is very much on the side of nurture. Anorexia is more likely to occur in social and /or cultural groups that place a greater emphasis on the ideal that “slim is beautiful”. For example, Hoek et al (2005) found that the incidence of anorexia was much lower on the island of Curacao where it is seen as culturally acceptable to be overweight.

Question 9

Nature vs nurture classic study

Answer 9

Rosenhan (1973): Abnormality was defined by the DSM at the time in terms of violating certain societal norms, as opposed to being based on any kind of physical testing (e.g. brain function). If societal norms vary from place-to-place, then whether you are considered abnormal will also vary from place-to-place. Thus, culture has an effect on the diagnosis of mental disorders (nurture).

Question 10

Use of psychology in social control - electronvulsive therapy

Answer 10

Electroconvulsive therapy is sometimes given to people with severe unipolar depression; they often can’t give their consent because they are so depressed. Passing a current through their temples causes a violent seizure (so much so that patients have to be restrained and given muscle relaxants or they injure themselves). It can stabilise mood disorders but many consider it barbaric.

Question 11

Use of psychology in social control - giving drugs

Answer 11

In the 1970’s in-patients with schizophrenia were often given typical antipsychotic drugs for their condition. This was not because those drugs were so successful at treating the condition, but because a side effect was that it sedated patients and made them easier to manage. These drugs are consequently known as pharmacological straightjackets.

Question 12

Use of psychology for social control - classic study

Answer 12

Rosenhan (1973): Being labelled with a MHD has long been a form of social control (e.g. drapetomania, homosexuality, etc). This is evident in Rosenhan’s study; the pseudopatients had to accept the psychiatrists’ view of them before they were let out (e.g. “I was crazy but I’m better now”).

Question 13

The Use of Psychological Knowledge in Society - dopamine hypothesis

Answer 13

The dopamine hypothesis inspired dopamine antagonists as a treatment for schizophrenia. Likewise, research such as Carlsson et al (2000) may lead the way to better drugs in the future. These drugs will attempt to modulate glutamate to more effectively treat the disorder.

Question 14

The Use of Psychological Knowledge in Society - biological explanation of an

Answer 14

Biological explanations of anorexia have changed society’s view of the disorder to one that is more compassionate and less a case of “why don’t you just eat?”. In a landmark legal ruling, US health insurance companies now have to pay out to anorexia sufferers because it is a legitimate medical condition and not self-inflicted as they had previously claimed.

Question 15

The Use of Psychological Knowledge in Society - classic study

Answer 15

Rosenhan (1973): His research helped the psychiatric community recognise that their diagnostic system was flawed and in need of revision. It also improved how patients were treated within mental hospitals.

Question 16

scientific

Answer 16

Before a drug can be prescribed for a MHD such as schizophrenia, it needs to be passed for use. Research into the effectiveness of drugs involves large scale, double-blind, randomised control trials. The drug has to be proven to be better at reducing symptoms than a placebo and all possible side effects must be well recognised. As a result of their methodology, drug trials are highly scientific.

Question 17

unscientific

Answer 17

Research into the effectiveness of treatments / therapies can be rendered unscientific by “treatment bias”. This is where participation in a treatment programme is decided upon by clinicians, with only those people best suited to the intervention being put forward for it (e.g. family therapy for schizophrenia). As such, participants are not randomly allocated to conditions, which reduces internal validity.

Question 18

Psychology as a science classic study

Answer 18

Rosenhan (1973): Not all pseudopatients followed the standardised procedure so therefore it lacks control. Some of the measures were objective (e.g. admitted or not? Length of stay, number of minutes that doctors spoke to them per day). Other measures were subjective and were likely to be biased due to the pseudopatients being trapped. Hypothesis was specific, testable and falsifiable though.

Question 19

Practical issues research method interviews

Answer 19

Interviews are a popular research method in clinical psychology (esp. when diagnosing MHDs). Clinical interviews are usually semi-structured so the patient can tell their story but at the same time the clinician is forced to ask the right questions (e.g. to help them discover whether the patient’s social withdrawal is because of depression or schizophrenia). Normal problems with self-report though (e.g. SDB).

Question 20

Practical issues piece of research

Answer 20

Vallentine at al (2010) used semi-structured interviews with 42 males detained in Broadmoor high security hospital to understand their experiences as part of a psycho-educational group treatment programme. Study was more valid because the patients could fully explain their point of view, but was less reliable because the questions were not fully standardised.

Question 21

Practical issues classic study

Answer 21

Rosenhan (1973): High population validity thanks to the good sample (range of hospital types, ages and funding methods, across 5 different states). Observers may have been biased because they were trapped though. Rosenhan claimed that the pseudopatients only showed one symptom but this was not true (also nervous and asked to be admitted).

Question 22

Culture issues guardia

Answer 22

Guardia et al (2012) looked at 25 female patients with eating disorders, all from a clinic in Lille, France, yet the research draws conclusions about anorexia sufferers in general. As such, this research is culturally biased (towards France).

Question 23

Culture issues race and culture in diganosing

Answer 23

Race and culture can be issues in terms of the diagnosis of MHDs. Littlewood and Lipsedge (1997) have suggested that the reason why black and Irish people in Britain are more likely than others to receive a diagnosis of serious mental disorder has more to do with bias in the system than a genuine greater vulnerability in those groups (e.g. the case of Calvin).

Question 24

Culture issues classic study

Answer 24

Rosenhan (1973): Wide range of American psychiatric institutions sampled (different funding methods, old and new hospitals, across 5 states), so it generalises well to this particular culture. However, the findings are unlikely to apply outside of the USA, so it is culturally biased. Then again the study was supposed to address flaws in the DSM, which was mainly used in America at the time.

Question 25

Gender issues validity of diagnosis

Answer 25

The validity of diagnosis can be affected by a clinician’s implicit biases (see big textbook p.288). Depression is more prevalent in the female population. As such, if a woman and a man both present with the same symptoms, a clinician may be more likely to diagnose the woman as depressed than the man, because her symptoms fit the stereotype.

Question 26

gender issues goldstein

Answer 26

Goldstein (1988) found that gender differences in the course of schizophrenia are present in the early stages of the disorder, with poorer premorbid functioning in men being responsible for poorer outcome (namely longer stays in hospital and more relapses, especially over the first 5 years). This is not alpha-biased (it doesn’t exaggerate a difference, it just finds it).

Question 27

gender issues classic study

Answer 27

Rosenhan (1973): The participants in the study were the psychiatric institutions themselves, and those are not gendered. You might assume that the Dr/Nurse distinction in the study represents a M/F distinction, but that is not a totally safe assumption (even in 1973).

Question 28

How Psychological Understanding has Developed over Time carlsson et al 2000

Answer 28

Our understanding of the biological basis of schizophrenia is steadily improving (from the dopamine hypothesis which is perhaps an over-simplification, to the work of Carlsson et al, 2000, which is more nuanced). This is leading to the development of more effective anti-psychotic drugs (e.g. clozapine).

Question 29

How Psychological Understanding has Developed over Time psychiatric disorders

Answer 29

In the late 19th century Emil Kraeplin argued that psychiatric disorders were fundamentally physical in nature and should be treated as a branch of medical science. This ultimately led to the development of classification systems such as the ICD and DSM. These systems are under constant review and have undergone many revisions (we are currently on the DSM V and ICD-10).

Question 30

How Psychological Understanding has Developed over Time classic study

Answer 30

Rosenhan (1973): The study led to serious revisions and improvements of the DSM, leading to more valid diagnoses.

Question 31

socially sensitive research - defining behaviour as abnormal

Answer 31

The act of defining a behaviour as “abnormal” is socially sensitive because it can disadvantage entire groups of people. There is a long and sad history of diagnostic labels being applied to groups of people that society simply disapproved of (as opposed to those people actually having mental illnesses). This includes slaves who ran away, teenage mothers, and homosexuals.

Question 32

socially sensitive research - negative implications

Answer 32

Socially sensitive research is research that has negative implications for the individual or group they represent beyond the confines of a study. Guardia et al (2012) asked participants (who were anorexic) to compare their body size to that of another individual. A common symptom of anorexia is low self-esteem. Asking anorexics to actively compare their body size to others could have made their self-esteem worse.

Question 33

socially sensitive research - classic study

Answer 33

Rosenhan (1973): The study led to a lack of confidence in psychiatry. This may have led people to not seek help with MHD’s when they very much needed it, for fear of being “locked away”. As well as undermining public trust in the profession, psychiatrists may have lost confidence in themselves, making them worse at their job as a consequence and undermining patient care.

Question 34

Comparisons of Ways of Explaining Behaviour using Different Themes - biological vs non-biological explanation of schizo

Answer 34

Neurotransmitter explanation of schizophrenia vs. social causation hypothesis. The social causation hypothesis cannot explain schizophrenia on its own. It simply claims that the social world is a major source of stress, which can trigger schizophrenia. However, stress ultimately only causes schizophrenia via disruption to neurotransmitters.

Question 35

Comparisons of Ways of Explaining Behaviour using Different Themes - nonbiological vs biological explanation of anorexia

Answer 35

Genetic explanation of anorexia vs. sociocultural explanation of anorexia. The genetic explanation cannot account for why anorexia is more prevalent in certain cultures (e.g. UK, USA, Japan). The sociocultural explanation can account for this; these are cultures which hold the ideal of “slim is beautiful”.

Question 36

Comparisons of Ways of Explaining Behaviour using Different Themes - classic study

Answer 36

Rosenhan (1973): The study is based on the medical model of diagnosing and then treating mental illness. This contrasts with the psychodynamic approach where diagnosis and treatment are the same thing (i.e. gaining insight). Diagnosis is much more thorough with a Freudian therapist (e.g. free association, dream analysis, etc) so arguably they would have been less easily tricked than the clinicians in Rosenhan’s study.