Something important in psychology is to differentiate between what is considered normal and abnormal. Psychologists need to do this to decide what to diagnose as a mental illness, and the treatment for this mental illness. Unfortunately, for everyone involved, it is not always easy to discern between what is normal behavior, sometimes called effective psychological functioning, and abnormal behavior, which could possibly be the result of a psychological disorder. To help determine between, psychologists use a few decisive factors. This includes the context in which someone observes the behavior.
In relation to context, it means that the situation matters because in one situation a behavior may be normal, but not necessarily in all situations. Another factor is the persistence of the behavior or how often, over time, the behavior continues or occurs. How far, from the accepted social norm, the behavior deviates is also an important factor. Whether or not someone is aware of his or her own psychological difficulties is subjective distress. This subjective distress is often a great help to mental health professionals in making a psychological diagnosis.
When a person finds it impossible to be satisfied with life due to psychological problems, this is considered a psychological handicap. Effect on functioning could be considered the bottom line in psychological diagnosis: the extent to which the behaviors in question interfere with a person’s ability to live the life that he or she desires and that society will accept. These “symptoms” and characteristics of mental illness all involve judgments on the part of psychologists, psychiatrists, and others. So these mental health professionals still need to answer to important questions.
Are mental health professionals truly able to distinguish between the mentally ill and the mentally healthy? In addition, what are the consequences of mistakes? These are the questions addressed by David Rosenhan in his study. Rosenhan questioned whether the characteristics that lead to psychological diagnoses reside in the patients themselves or in the in which the people diagnosing find the patients. He reasoned that if the training mental health professionals have received for diagnosing mental illness are adequate, then those professionals should be able to distinguish correctly.
Rosenhan proposed that one way to test mental health professionals’ ability to correctly categorize would be to admit normal people to psychiatric facilities to see if they would be categorized as healthy. If these “pseudo patients” behaved in the hospital as they would on the outside, and if they were not discovered to be healthy/normal, this would be evidence that diagnoses of the mentally ill are tied more to the situation than to the patient. Rosenhan recruited eight subjects to serve as pseudo patients.
The subjects’ mission was to try to be admitted to twelve different psychological hospitals. All of the pseudo patients followed the same instructions. They called the hospital and made an appointment. Upon arrival at the hospital, they complained of hearing voices that said specific things. Other than this one thing, all subjects acted completely normal and gave very truthful information to the interviewer other than personal information. All the subjects were admitted to the various hospitals, and all but one was admitted with a diagnosis of “schizophrenia.
Once inside the hospital, the pseudo patients simply behaved normally. The subjects had no idea of when they would be allowed to leave the hospital. It was up to them to gain their release by convincing the hospital staff that they were healthy enough to be discharged. All of the subjects took notes of their experiences. At first, they tried to conceal this activity, but soon it was clear to all that this secrecy was unnecessary, since this was seen as just another symptom of their illness.
They all wanted to be released as soon as possible, so they behaved as model patients, cooperating with the staff and accepting all medications (which were not swallowed, but flushed down the toilet). The key finding in this study was that not one of the pseudo patients was detected by anyone on the hospital staff. When they were released, their mental health status was recorded in their files as “schizophrenia in remission. ” There were other interesting findings and observations.
While the hospital’s staff of doctors, nurses, and attendants failed to detect the subjects, the other patients could not be so easily fooled. Contacts between the patients and the staff were minimal and often bizarre. One of the tests made by the pseudo patients in the study was to approach various staff members and attempt to make verbal contact by asking common, normal questions. Rosenhan’s study demonstrated that normal people cannot be distinguished from the mentally ill in a hospital setting.
According to Rosenhan, this is because of the overwhelming influence of the psychiatric hospital setting on the staff’s judgment of the individual’s behavior. Once patients are admitted to such a facility, there is a strong tendency for them to be viewed in ways that remove all individuality. The attitude created is that if they are there, then they must be crazy. More important is what Rosenhan refers to as the stickiness of the label. That is, when a patient is labeled as schizophrenic, it becomes his or her central characteristic or personality trait.
From the moment, the label is given and the staff knows it, they perceive all of the patient’s behavior as stemming from that label. The hospital staff tended to ignore the situational pressures on patients and saw only the behavior relevant to the pathological traits assigned to the patients. Remember that all the subjects gave honest accounts of their pasts and families. The results pointed out two crucial factors. First, it appeared that the sane could not be distinguished from the insane in mental hospital settings.
Second, Rosenhan demonstrated the danger of diagnostic labels. Once a person is labeled as, having a certain psychological condition that label overcomes all of his or her other characteristics. The worst part of this sort of treatment is that it can become self-confirming. That is, if a person is treated in a certain way consistently over time, he or she may begin to behave that way. Out of Rosenhan’s work grew greater care in diagnostic procedures and increased awareness of the dangers of applying labels to patients.
Courtney from Study Moose
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