ETHICAL CONSIDERATIONS IN DIAGNOSIS RESEARCH SUPPORT ABNORM – NORMS & DIAGNOSIS #3 PART 4

ROSENHAN (1973)  Revisit notes from previous segment  Slater (2004) reports that she presented herself at several hospital with a single auditory hallucination, as Rosenhan’s pseudo-patients had done. She was not, however, admitted to any of the hospitals, but she was given prescriptions for drugs. This research may not seemingly support Rosenhan’s conclusions as Slater was not admitted to any of the hospital. But perhaps in a way it does support Rosenhan as she was still offered treatment (a Type 2 error). Perhaps drugs are just the ‘2004’ equivalent to the hospitalisation seen in 1973.

SZASZ 1974  Szasz’s claim : mental illness is a myth  mental illness involves problems of living, some of which may be moral in nature, while bypassing the debate about the meaning of the concept of illness.  Major impact on newer versions of the DSM

SCHEFF 1966  Book about the adverse effects of labeling:  Self-fulfilling prophecy:: Patients may begin to act as they think they are expected to act. They may internalise the role of ‘mentally ill patient’ and this could worsen their disorder.  Doherty (1975) points out that those who reject the mental illness label tend to improve more quickly than those who accept it  Distortion of behavior : Diagnosis of mental disorder tends to label the whole person- once the label of diagnosis is attached, then all the individual’s actions become interpreted in the light of the label.  Oversimplification: Labelling can lead to reification- making the classification a real, physical disorder, rather than just a descriptive term to help diagnosticians talk about patients  Prejudice: supported by Langer & Abelson (1974)

LANGER & ABELSON (1974)  “A Patient By Any Other Name …”  Procedure:  experiment,  behavioural and psychoanalytic clinicians watched a videotape of a job interview with the sound removed.  Half the therapists of each orientation had been told that the interviewee was a patient; the other half, that he was a job applicant.  After viewing the tape, participants responded to a series of open-ended questions about the interviewee that blind raters subsequently quantified along a 10-point scale of psychological adjustment.  Results:  Psychoanalytic therapists’ ratings were more negative for patients than for job applicants, whereas behavioural therapists’ ratings were comparable across experimental conditions.  Conclusions:  psychoanalytic therapists were biased by a mere label whereas behavioural therapists were apparently immune to this biasing effect, because behaviourist therapists are influenced by the behaviourist approach and are only interested in observeable behaviour.

FARINA ET. AL. (1980)  Aim : illustrates stigma and prejudice in diagnosis  Experiment#1  Procedure:  conducted in a naturalistic setting towards those labelled as mentally ill.  one member of a pair of male college students was (falsely) led to believe the other had been a mental patient  Results: he perceived the pseudo ex-patient to be inadequate, incompetent and not likeable.  Experiment#2  Procedure: one of a pair of interacting males made to falsely believe he was perceived as stigmatised by the other naïve participant.  Results: Just believing this was sufficient to lead him to behave in ways which caused the naïve participant to reject him, i.e. he behaved in a manner typical of the mentally ill because he felt the other person had him labelled as mentally ill.

OGUNSEMI ET AL 2008 – LABELING IN NIGERIA  Aim: effect of psychiatric label attached to an apparently normal person on the attitude of 144 final year senior med students  Procedure:  One-tailed Experiment, Group A received a description with a psychiatric label while Group B received same description without the label.  Findings:  Label elicited a negative attitude resulting in the students wanting to maintain a significant distance from the labeled person.

JENKINS-HALL & SACCO 1991 – ETHNICITY BIAS IN DIAGNOSIS  ‘ Effect of client race and depression on evaluations by white therapists‘  Procedure: white therapists being asked to watch a video of a clinical interview then to evaluate the female interviewee. There were four conditions representing the possible combinations of race and depression.  In one condition the woman was African American and nondepressed,  in another condition she was a white American and nondepressed.  In the other two conditions she was each of these races but depressed.  Results: Although the therapists rated the nondepressed African American and the white American in much the same way, their ratings of the depressed women differed in that they rated the African American woman with more negative terms and saw her as less socially competent than the depressed white American woman.

BROVERMAN ET AL 1970 – GENDER BIAS IN DIAGNOSIS?  Hypotheses:  (a) clinical judgments of the characteristics of a healthy, mature individual would differ as a function of the sex of the person judged and that  (b) behavioral characteristics that were regarded as healthy for an adult, sex unspecified, would be more often regarded as healthy for men than for women (i.e., following cultural stereotypes of gender differences).  Procedure: Questionnaire in which two types of scores were calculated: health scores and agreement scores. The health scores were based upon the assumption that traits selected for healthy adults would reflect the definition of mental health for all individuals.  Findings:  showed that clinicians' judgments of adult men's mental health did not differ significantly from their judgments of healthy adults, sex unspecified, whereas their judgments of adult women's mental health did differ significantly from judgments of healthy adult men and healthy adults sex unspecified.  These differences corresponded with cultural stereotypes of men and women that were widely held during that time.  Healthy adult women were described as different from both healthy adult men and healthy adults in that they were more "submissive," "less independent," "less aggressive," "less competitive," "more easily influenced," "more emotional," and "less objective."  The authors concluded that a double standard of mental health existed for women, in that for a woman to be seen as mentally healthy she must be feminine and not adult-like (i.e., not like a man).  Both female and male clinicians implicitly supported this standard.  clinicians when given instructions to "describe healthy, socially competent women" (p. 2) used fewer traits than when they were given instructions to" describe healthy, socially competent men" (p. 2). The traits found for healthy women were often viewed as less socially desirable than the traits listed for healthy men.