Understanding Psychopathology

• Psychopathology is the branch of psychology concerning the study and treatment of mental illnesses.
• Mental illness is a significant area of study within psychology.

Context and Abnormal Behavior

• The determination of what is "normal" versus "abnormal" is fundamental in psychology.
• The definition of abnormality is key in diagnosing mental illness, which affects treatment.
• Behavior exists on a continuum from effective psychological functioning to psychological disorder.
• Mental health professionals determine where a behavior falls on this continuum.

Criteria for Determining Abnormality

• Context of Behavior: Behaviors can be bizarre in one situation but normal in another.
• Persistence of Behavior: Occasional abnormal behavior does not indicate mental illness.
• Social Deviance: Behavior that radically violates societal expectations can be considered as evidence for mental illness.
• Subjective Distress: Awareness of one's psychological difficulties is a sign of disorder.
• Psychological Handicap: Difficulty being satisfied with life because of psychological problems.
• Effect on Functioning: Interference with a person's ability to live the life they desire.
• Judgments by mental health professionals determine diagnosis; questions remain regarding their accuracy.

Rosenhan's Study: "Who's Crazy Here, Anyway?"

• Rosenhan questioned whether diagnoses are based on patient characteristics or situational context.
• He tested if professionals could distinguish the mentally ill from the healthy.

Method of Rosenhan's Study

• Eight participants (pseudopatients) were recruited, including Rosenhan himself.
• They sought admission to 12 psychological hospitals across five states.
• They complained of hearing voices saying "empty," "hollow," and "thud."
• They behaved normally otherwise, giving truthful information (except for name/occupation).
• All were admitted, most with a diagnosis of schizophrenia.
• Once inside, they dropped the symptoms and behaved normally.
• They took notes openly, which staff interpreted as a symptom.
• They cooperated and accepted medication (discarded).

Results of Rosenhan's Experiment

• Hospital stays ranged from 7 to 52 days (average 19 days).
• None of the pseudopatients were detected by staff.
• Upon release, diagnoses were "schizophrenia in remission" but not cured.
• Other real patients voiced suspicions about the pseudopatients.
• Contacts between patients and staff were minimal and often bizarre.
• Pseudopatients were given a total of 2,100 pills, which they disposed of.

Discussion of the Results

• Trained professionals often cannot distinguish the normal from the mentally ill in hospitals.
• Rosenhan attributed this to the influence of the psychiatric hospital setting.
• The attitude created is "If they are here, they must be crazy".
• Patients are not seen as individual people.
• "Stickiness of the diagnostic label": a diagnosis becomes the patient's central trait.
• Staff members perceive all behavior to stem from the diagnosis.
• Hospital staff tended to ignore situational pressures on patients.
• Diagnostic labels colored interpretation of patients' histories.

Significance of Rosenhan's Work

• The study revealed that the "sane" could not be distinguished from the "insane" in hospitals.
• Rosenhan demonstrated the danger of diagnostic labels.
• Labels eclipse other characteristics, and behavior is seen as stemming from the disorder.

Impact on Diagnostic Procedures

• Rosenhan's work led to greater care in diagnostic procedures.
• There was an increased awareness of the dangers of applying labels.
• There was a decrease in patients confined to mental hospitals because of medications & community mental health facilities.
• Labels are now used more carefully and treated with respect.

Questions and Criticisms of Rosenhan's Work

• Hospital staff doubted mistakes could be made in their hospital.
• Rosenhan informed a hospital staff that pseudopatients would seek admission.
• Staff rated patients on likelihood of being pseudopatients.
• 41 patients were suspected, but Rosenhan had not sent any pseudopatients.
• It indicates the tendency to designate sane people as insane can be reversed when stakes are high.
• Any diagnostic process that lends itself to massive errors cannot be reliable.
• The initial study was replicated several times with similar results.
• Spitzer argued that the methods used by Rosenhan appeared to invalidate psychological diagnostic systems, but, in reality, they did not.

Recent Applications and Continued Controversies

• Studies use Rosenhan's research in challenging diagnoses by mental health professionals.
• Szasz contends mental illnesses are "problems in living" with social/environmental causes, and not diseases.
• Szasz makes the case that the crazy talk exhibited by some who have been diagnosed with a mental illness "is not a valid reason for concluding that a person is insane”.
• Recent study examined how some people purposely fabricate symptoms of mental illness.
• Inventing symptoms is a fundamental issue, especially when complicated by socio-legal issues.
• Survey of mental health patients revealed feeling stigmatized and trying to conceal disorders.
• One study suggested that we are to interpret impairment of the mentally ill in society similar to our perception of those with other types of defined disabilities.
• One researcher argues psychiatric labeling systems should be abolished altogether.
• Timimi argues that these labels are not useful or valid and that the stigma stemming from them is harmful.
• Diagnostic codes are necessary for reliability, consistency, and insurance coverage.

Conclusion regarding Psychopathology

• There will be an increase in tolerance and understanding of psychological disorders.
• Improvement in diagnosing disorders; however, it is more "art" than "science".
• There will never be an abandonment of labels because it is an important part of the diagnosis and further treatment.
• Work is needed to continue to take the "stigma", embarrassment, and shame out of the labels.