Mental Health


Defining Abnormality

Statistical infrequency (cognitive)

  • Persons trait, thinking or behaviour is classified as abnormal if it’s rare or statistically unusual
  • Individual has and IQ below/higher than average levels in society is abnormal.
  • Measured by standard deviation e.g. 68% population fall between 1SD either side of the mean and 95% fall between 2SD. Scores outside this range are unusual so 7.5% fall below and 2.5% above it.

Deviation of social norms (social)

  • Social norms are a set of rules for behaviour based on a set of moral and conventional standards within society
  • They are judged by the dominant culture (culturally relative – changes with the culture)
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Defining Abnormality

Failure to function adequately (biological and social)

  • From an individual’s point of view abnormality can be judged in terms of not being able to cope with day to day living
  • E.g. characteristics – suffering, danger to self, stands out, unpredictability and loss of control, irrationability and incomprehensibility, causes observer discomfort, violates moral and social standards

Deviation from ideal mental health (individual differences)

  • This judges mental health in the same way as physical health, a person requires certain attributes to be mentally healthy
  • Jahoda found 6 categories that were commonly referred as desirable for mental health e.g.good self image, drive to realize self potential, ability to cope with stress, being independent, having an accurate perception of reality, being able to adapt to changes in the environment.
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Weaknesses with the definition of abnormality

Statistical Infrequency: 

  • This definition fails to distinguish between desirable and undesirable behavior. For example, obesity is a statistically normal but not associated with healthy or desirable. Conversely high IQ is statistically abnormal but may well be regarded as highly desirable.
  • A weakness of the statistical infrequency definition is that it is culturally relative.  The reason for this is because one symptom of schizophrenia is claiming to hear voices.  However, this is regarded as desirable in some cultures.  Lee (1969) found that many Zulu women reported screaming to themselves for days or weeks as a response to unhappiness. 
  • Gender differences 


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Weaknesses with the definition of abnormality

Deviation from Socail Norms:

  • The most obvious problem with defining abnormality using social norm is that there is no universal agreement over social norms. Social norms are culturally specific.
  • Social norms have a time frame eg drink driving was once considered normal and being homosexual abnormal.

Failiure to Function Adequately:

  • One limitation of this definition is that apparently abnormal behaviour may actually be helpful, function and adaptive for the individual eg a person who has OCD of handwashing may find that the behaviour makes him cheerful, happy and better able to cope with his day.
  • Many people engage in behaviour that is maladaptive but we don’t see them as abnormal; smoking/drinking alcohol or skipping classes
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Rosenhan's Study of being Sane in Insane Places

Study One:


  • Do the characteristics of abnormality reside in the patients? Or in the environments in which they are observed?
  • He said ‘does madness lie in the eye of the observer? (are we looking at it objectively or being bias)
  • How reliable are diagnosis of abnormality? Will the same symptoms always be diagnosed in the same way? (DSM model testing validity and reliability)


If sanity and insanity exist, how shall we recognise them? 

Participants: Pseudo patients (regular people), 8 sane people, 1 graduate student, 3 psychologists (himself being one), a pasediatrician, a painter and a house wife.  Field setting & covert observation.

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Rosenhan's Study of being Sane in Insane Places


  • Telephoned 12 psychiatric hospital for urgent appointment in 5 USA states
  • Arrived at admissions and gave false names and addresses but gave other life details correctly.
  • They complained of hearing unclear voices saying ‘empty, hollow, thud’
  • Said the voices were unfamiliar but was the same sex as themselves
  • DSM model says if this occurred you have stimulated ‘existential crisis’ – ‘who am I, what’s it all for?’
  • All were admitted to hospital and all but 1 were diagnosed with schizophrenia
  • Once adimtted the pseudo patients stopped stimulating any symptoms but took part in ward activities. 
  • The pseudo patients were never detected and all wanted to be discharged immediately but waited until they were disagnosed as 'fit to be discharged' 
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Rosenhan's Study of being Sane in Insane Places

Results: Qualitative: 

  • Normal behaviour was misinterpreted as writing notes were described as ‘patient engaged in writing behaviour’
  • Arriving early for lunch described as ‘oral acquisitive syndrome behaviour distorted to fit in with DSM theory’
  • The loss of authority or control of individual has in making their own personal decisions (powerless)
  •  Patients rooms were entered without justification and case notes were read openly by casual staff and toilets had no doors
  • Loss of identity as staff did not treat them like individuals e.g. physical abuse of patients with other patients present, nurse undid part of uniform in front of male patient. 2100 tablets administered only 2 taken. (depersonalisation)
  • Type 1 error – diagnosed sane person as insane.
  • The control – used young female pps from Stanford Uni campus asked 6 questions and all staff stopped and answered all questions and made eye contact.
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Rosenhan's Study of being Sane in Insane Places

Results: Quantitative

  • If they approached staff with simple requests nurses and attendants – 88% ignored them by walking away with head averted, 10% made eye contact, 2% stopped for a chat and 1283 attempts were made
  • If they approached psychiatrists with a simple request – 71% ignored them by walking away with head averted, 23% made eye contact, 2% stopped for a chat and 185 attempts were made
  • Shortest stay was 7 days longest stay was 52 days average 19 days
  • Some agreed to stay until convinced staff they were sane
  • Given 2100 medication tablets that were flushed down the toilets
  • Noted real patients did the same but was ignored as long as they behaved themselves
  •  Nurses stayed in the ward offices 90% of the time
  • Each ‘real patient’ spent less than 7minutes per day with psychiatric staff
  • They had visitors and the visitors allowed them to stay there ‘no serious behaviour consequences’
  •  35 out of 118 real patients said there was nothing wrong with pseudo patients
  • When released the pseudo patients were diagnosed as schizophrenics ‘in remission’ (label followed them after they left) known as the stickiness of a label
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Rosenhan's Study of being Sane in Insane Places St


  • Participants were psychiatric staff
  • Contacted hospitals that had been briefed on main study
  • 193 patients admitted for psychiatric treatment

Design and Procedure:

  • Staff told over a 3 month period patients would attempt to gain admission to hospital
  • They were then asked to rate each patient either at addmission or on ward according to the likelihood they were an imposter 
  • 10 point scale was used. 1 = strong belief they were an imposter and 10 = strong belief the patient was genuine 
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Rosenhan's Study of being Sane in Insane Places St


  •  All staff had close contact or responsibility of patients used the scale included attendants, nurses, psychiatrists, physicians and psychologists
  • 41 of patients admitted in 3-month period rated high with high confidence to be pseudo patients by at least 1 member of staff of these 23 suspected by at least 1 psychiatrist and 19 were suspected by psychiatrist and another member of staff.
  • No pseudo patients actually presented themselves in this study. Lends evidence to Rosenhans argument about lack of reliability in diagnosis.
  • Committed type 2 error diagnosed mentally ill patients as healthy.

Conclusion: He found that:

  • Psychiatrists are unable to reliably identify sane pseudo patients
  • Psychiatrists also fail to reliably detect insanity
  • Within the ‘insane’ environment of the psychiatric hospital, and individual’s behaviour is perceived in a disturbed manner, which can maintain a diagnostic label.
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