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1. Discuss the concepts of normality and abnormality
In the context of abnormal psychology, the way the term “abnormality” is defined is a factor influencing the diagnosis of mental illnesses. Behavior is rated on a scale ranging from normal to abnormal, and cultural context is a major determinant of this rating. When classifying behavior as dysfunctional, the severity and duration of that behavior are taken into account in the evaluation of abnormality. It is essential to recognize that the criteria defining what is considered "abnormal" varies with time. There are different ways to determine whether a behavior is abnormal. It can be defined as a deviation from a social norm, as dysfunctions in daily functioning, or in how much distress it causes.
The first definition of “abnormal” defines abnormality as a behavior that doesn’t conform to the social norms of a given society. This definition is called conceptual. The second definition states that a behavior is appropriate as long as it doesn't affect how well a person functions on an individual or social level. Therefore, unless they result in malfunction, behaviors that could be considered "unusual" are not strictly abnormal. Finally, according to the distress definition of abnormality, a behavior is abnormal if it causes an individual to experience discomfort in their daily lives.
One study discussing the concepts of normality and abnormality is Rosenhan’s study. The study aimed to investigate the validity of psychiatric diagnosis as well as to determine the consequences of institutionalization. The procedure used was that the researchers analyzed 12 hospitals in five different states across the USA. Eight pseudo-patients acted, telling the doctors that they were hearing voices. In 1973, based on the DSM II, this would have been considered a clear sign of schizophrenia. However, once they were admitted to the hospital, they started acting "normally". The results were that all of the pseudo-patients were admitted and 7/8 of the patients were diagnosed with schizophrenia. They were discharged after an average of 19 days, however, 6/8 of the patients were discharged with schizophrenia in remission. They also noted that their normal behavior was "abnormal". Additionally, during hospitalization, participants experienced very little contact with the doctors and staff. There was also a lack of eye contact and personal connection with the nurses. The conclusion was that we cannot distinguish the sane from the insane in psychiatric hospitals. The strengths of the study were that ecological validity was high since the study took place in a natural environment. The study was highly influential in promoting change in hospital practice and protecting the rights of patients. It also raised awareness about the way diagnoses are made and treatments in mental hospitals. And finally, it showed that there is confirmation bias when health professionals notice behaviors and believe they are in line with the diagnosis. The limitations of the study were that the study was unethical as no consent was given by the hospital staff. Also, deception was used for people. They did not debrief hospitals on the findings or allow them to withdraw. Only one disorder was studied (schizophrenia) so it is not possible to say that diagnostic systems are invalid. The patients were taking data on how they were being treated. This is not objective and also not reliable. There is no evidence to confirm how they were treated by the staff.
Another study is the Li-Repac study. The study aimed to test the role of cultural stereotyping in diagnosis, comparing the diagnoses of both white and Chinese-American therapists of both white and Chinese-male subjects. The procedure of the study was using semi-structured interviews and videotaping. There were ten patients in the study (five European American and five Chinese) all of whom had been diagnosed with mental illness. All of the Chinese subjects were born either in China or Hong Kong. They were asked questions on how they were feeling. The clinicians were five European-American and five Chinese-American males, all recruited through personal contact with the researcher. The five European-American clinicians reported no previous contact with Asian clients. The clinicians were randomly assigned videos to rate for normality. Each rater would rate four videos - two of European American patients and two of Chinese patients. They were asked to fill in an inventory to describe both personal traits and signs of pathology. The results were that European-American clinicians saw the Chinese patients as more depressed and lower in self-esteem than did the Chinese-American raters. European-American clinicians saw Chinese patients as less socially competent and as having less capacity for interpersonal relationships than did Chinese-American clinicians. Chinese-American clinicians reported more severe pathology than did the European-American clinicians when judging quiet clients. The study concluded that such results indicate that diagnosis is not necessarily a neutral process and that it is important to include cultural considerations in the diagnostic process. The strength was that the study was controlled for cultural differences, these variables would not affect diagnosis. The study’s limitations were that there was a small sample size, which made it hard to generalize the findings. There was no pretest of stereotyping, and the videotaped patients had different disorders. There was a significant variation in the number of adjectives checked by each rater and the white therapists had no previous experience in treating Asian patients.
The main goal of abnormal psychology is to define abnormality and use it to assess an individual's mental health. However, there isn't a single, accepted definition for these terms. Our concept of what defines abnormal keeps changing as a result of globalization, changing norms in society, and updated diagnostic guides that take into account new medical knowledge.
Another study is Bolton’s study. The study aimed to investigate if Western diagnosis of depression or PTSD is accepted by the local community as a valid description of their response to trauma (Rwandan genocide). The procedure used was investigating the response of two rural areas in Rwanda to a tragic event. As part of the study, three interviews were done. During the first free listing session, participants created an extensive list of terms related to mental health conditions and symptoms in the area. The next step was conducting key informant interviews to find community members, such as elders and local leaders, who had expertise in mental health concerns. Following that, pile sorting was carried out with a deck of cards that included both recognized mental health symptoms and those included in the DSM criteria for depression. Researchers asked traditional healers to group the cards according to similarities. Later, a questionnaire designed to determine the prevalence of depression in the community included these locally recognized symptoms. The results were that following the genocide, individuals reported their experiences with depression and PTSD in detail, linking the tragic events to their illnesses. They also brought attention to "local" symptoms that are not included in traditional diagnostic criteria. After a questionnaire was created, 93 members of the community were found to have mental health problems. After completing the recently standardized questionnaire, 30 of the people who were diagnosed by local healers as having agahinda gakabije symptoms tested positive for depression symptoms. The strengths were that using an emic approach in clinical practice means taking into account how cultural factors influence a person's health and helping doctors to properly customize treatments. Triangulating data adds credibility to the findings. However, there are drawbacks since this method lacks external verifiability because it depends on identifying which Western illness matches with locally specified issues. Moreover, the generalizability of emic techniques is limited to the particular group under study. Additionally, the method ignores how cultures are dynamic and complex, making them difficult to define or quantify.
Standardized psychiatric diagnosis has many notable benefits. It enhances reliability by guaranteeing uniform diagnoses from many psychiatrists for the same patient. Standardization also makes it possible for everyone to get suitable therapies. A more effective diagnosis process is provided by shortened checklists, and research into successful therapies is enhanced by the operationalized definition of illnesses. There are significant disadvantages to classification systems though. It is possible to oversimplify and reduce the complexity of human behavior to labels by ignoring cultural and social aspects. The medicalization of mental illness has the potential to increase stigma, and the possibility of overdiagnosis raises questions about how the guide may affect public opinion and healthcare choices.
3. Discuss validity and reliability in diagnosis
For a classification system to be reliable , it should be possible for different clinicians to use the same system , to arrive at the same diagnosis for the same individual. So the reliability of a diagnosis is whether two or more psychiatrists using the same classification system make the same diagnosis. Although diagnostic systems now use more standardized assessment techniques and more specific diagnostic criteria , the classification systems are far from perfect.
One study discussing reliability in diagnosis is Regier’s study.
For a classification system to be valid , it should be able to classify a pattern of symptoms that can lead to an effective treatment. The question of the validity of a diagnosis is complex. The psychiatrist is often highly dependent on the self-reported data from the patient. In addition, judging the validity of a diagnosis, by the effectiveness of a treatment , is problematic. Treatments make assumptions about the origins of a disorder , the diagnosis could be correct, but the treatment could be ineffective. On the other hand, an individual may show significant improvement over time, but it may not be due to the treatment. This would mean that although the individual improved , this was not due to a valid diagnosis.
One study discussing validity in diagnosis is Bolton’s study.
There are doubts about the reliability and validity of the diagnosis. Medical professionals differ in how long it takes to diagnose abnormalities, and they may also differ in their diagnoses because of clinical biases, which lead to differing conclusions about patients, perhaps as a result of stereotyping, which is the overgeneralization of a population based on limited data. So, it's important to keep in mind that while a diagnosis is a crucial first step toward therapy and recovery, it can be affected by factors that put doubt on its reliability and validity. Therefore, it can be beneficial to look for a second or third opinion or use alternative diagnostic techniques to make sure that the optimal diagnosis and treatment approach are chosen for a psychiatric disease.
5. Ethical Considerations in factors in studies researching factors influencing diagnosis
Informed consent
One study is Regier’s study.
The right to withdraw is an important ethical principle in studies … that ensures participants have the freedom to discontinue their participation at any time without facing negative consequences. This right allows individuals to maintain control over their involvement in a study and protects their autonomy and well-being.
One study is Bolton’s study.
6. Discuss the role of one or more clinical biases in diagnosis
Clinical biases are cognitive biases that take place when a clinician is trying to make a diagnosis and label a behavior. One type of clinical bias is the confirmation bias. Confirmation bias is the tendency for people to seek or evaluate evidence to support their ideas and opinions, impacting decision-making. It states that individuals tend to favor information that agrees with their opinions and subconsciously disregard information that challenges them, or they may interpret ambiguous information in a way that supports preexisting beliefs
One study … is Rosenhan’s study.
Another clinical bias is cultural bias. Since sociocultural factors play a role in defining psychological problems, diagnosing them requires an awareness of different sociocultural contexts. This implies that any evaluations of "abnormality" made in a clinical setting are influenced by cultural norms. While culture can also affect coping mechanisms and an individual's decision to seek a diagnosis and treatment for a psychological disease (DSM-5), the main cause of clinical bias is cultural differences between the patient and the clinician.
One study … is the Li-Repac study
Examining the impact of biases in diagnosis is crucial, even if some studies lack validity and generalizability. The majority of research provides insight into how biases may affect diagnosis, offering useful information that is utilized to improve manuals like the DSM-5. Thus, understanding the role of these biases improves the labeling of mental disorders and enhances the reliability of treatments. In conclusion, clinical biases play an important role in the diagnosis of abnormal behavior. Therefore, it is important to perform consistent research to assist clinicians in making accurate diagnoses.
7. Ethical Considerations in Diagnosis
The majority of the ethical concerns surrounding diagnosis are related to labeling and its implications. Labeling is the process of defining a person's identity completely based on their illness after a diagnosis. This eventually results in stigmatization. A stigma is a mark of disgrace that suggests an individual is a member of a group that is seen negatively by society. Despite their complex identities that go beyond the diagnosis, such individuals are impacted by the weight of society's perceptions, which creates a barrier that prevents them from being accepted and integrated into the larger community.
One study that … is Bolton’s study. Another study that … is Li-Repac’s study
Diagnosing mental illnesses has various benefits. Firstly, it facilitates clients' access to suitable treatment, advancing their path to recovery. Additionally, it makes interactions between professionals more efficient and easier. By providing a deeper understanding of different mental health conditions, diagnosis can also help research. It assists patients on their journey to recovery by facilitating goal-setting and reinforcing family support. However, this practice has its drawbacks. Misdiagnosis can lead to inappropriate drug treatments that may potentially harm individuals. The labels associated with mental illness may amplify symptoms and impact a person's self-worth. Furthermore, the discrimination and stigma caused by these labels may severely compromise patients' lives by isolating and marginalizing them. Additionally, there is the possibility that the subjective interpretation of clinicians could result in an overpathologization of natural actions, unnecessarily medicalizing the patient. It is therefore important to consider both positive and negative aspects, including ethical considerations, of diagnosis.
