Assess the extent to which the DSM can be considered accurate (20)
Mental health disorders can’t be diagnosed the same way as physical health issues - they are
diagnosed through clinicians’ interpretations of behaviours and symptoms. Therefore, to make this
process more standardised, experts have written comprehensive lists of already known mental
disorders and symptoms forming the DSM. one strength of the DSM is that it can be considered
accurate as research by Brown (2002) suggested that there is good/excellent reliability in the DSM
when it comes to diagnosing mood and anxiety disorders. However, the diagnoses of PTSD have
poor reliability due to disorders overlapping, therefore suggesting that the DSM may not always be
accurate, and is more accurate for some disorders than others.
Furthermore, despite the standardised criteria of the DSM clinicians have subjective judgments
according to how they look at symptoms, which is largely due to their training and experience. For
example, some might be able to be more inclined to diagnose depression than schizophrenia, due to
depression being more common, giving clinicians greater confidence. One strength of the DSM is that
research from Rosenhan suggested that clinician factors were not a problem in terms of consistency
of diagnoses, since 8 pseudopatients were diagnosed with schizophrenia using the DSM, suggesting
the DSM is reliable and not affected by clinician factors/subjectivity. However, a weakness of the DSM
is that the diagnoses from Rosenhan were consistently inaccurate, as none of the pseudopatients
actually had symptoms of hallucinations, but this was not noticed by the psychiatrists in the
institutions. This was perhaps due to the diagnostic label and the bias of clinicians in interpreting their
behaviour, e.g. ‘note-taking behaviour’ was seen as abnormal, so this might in fact support the idea
that clinician factors lead to inaccuracy when using the DSM to diagnose.
Another issue is concurrent validity, which is when the diagnosis is consistent between 2 systems, for
example, the DSM is cross-referenced to the coding system of the ICD to ensure both diagnose
someone with, for example, an anxiety disorder. This was the thinking behind the changes from DSM
IV to DSM 5, in which the new DSM replicated the family-based classification of disorders seen in the
ICD-10, partly to help with concurrent validity. One weakness of the DSM is that Ward (1962) found
that 2 psychiatrists gave inconsistent diagnoses due to a range of factors, one being problems with
the classification system. Therefore suggesting that older DSMs may indeed have been inaccurate
and lacked concurrent validity. However, a strength of the DSM is that Hoffman (2002) conducted a
computer structured interview on prison inmates who were diagnosed with alcohol and drug abuse,
and found that the DSM gave an accurate and reliable diagnosis, suggesting concurrent validity in
recent DSMs is better.
Finally, cultural issues with accurate diagnosis may be that the DSM is made by Western culture,
which may lead to inaccuracies when used for different cultures or countries. This is supported by
Davidson and Neale, who found Asian-Americans were wrongly diagnosed by the Western
classification system. This is because they were showing withdrawn behaviour, which is actually
desirable by the Asian-American culture, therefore implying cultural issues cause inaccuracies in DSM
diagnosis, which is a weakness of the DSM. However, Andrews found that 68% of diagnoses using
the DSM are accurate, therefore suggesting it is accurate and perhaps not subject to cultural issues.
In conclusion, research by Brown, Rosenhan, Hoffman, and Andrews have shown that diagnosis with
the DSM can be considered accurate, reliable, and valid for some disorders. However, Brown and
Rosenhan also suggest the DSM is not accurate for PTSD and due to clinician factors, as well as
Davidson suggesting that cultural issues are a problem. Many believe that with each new DSM
version, accuracy has been improved showing the development of psychology over time. However,
DSM 5 represents the break away from the holistic multiaxial structure of DSM IV, which many
clinicians do not trust, leading to its reduced popularity and perceived accuracy.
,Evaluate the classic study by Rosenhan (20)
Rosenhan wanted to investigate whether the sane can be distinguished from the insane. He also
wanted to challenge the diagnostic system. Rosenhan also wanted to find out what life was like in a
psychiatric hospital and raise awareness about conditions. One strength of Rosenhan’s study is that
the research took place in a range of hospitals in America and involved a task of diagnoses made by
real clinicians, which is similar to real-life behaviour. Therefore the findings that diagnostic labels
cause a person’s behaviour to be interpreted in light of that label do reflect real-life behaviour, so
results have ecological validity. However, a weakness of Rosenhan’s study is that it can lack validity
as the pseudopatients claimed to have had symptoms they did not have, e.g. ‘hearing voices’.
Therefore the finding that diagnostic labels cause a person’s behaviour to be interpreted in light of that
label does not have validity
The sample consisted of 8 pseudopatients, 3 women and 5 men, who had no history of mental health
disorders. Each had to call 12 hospitals, claiming that they were ‘hearing voices’. All were admitted to
institutions with a diagnosis of schizophrenia, except one who was admitted with manic depression
with psychosis. One strength of Rosenhan’s study is that the study was generalisable. The sample
consisted of a range of hospitals such as research, teaching, etc, spread over a large geographical
area, which is representative of hospitals in the USA. Therefore the findings that diagnostic labels
cause a person’s behaviour to be interpreted in light of that label is generalisable and is
representative of all hospitals in the USA. However, a weakness of Rosenhan’s study is that in some
ways it lacks generalisability since the sample was only tested in one culture - America. Therefore it is
not generalisable or representative of society and findings of diagnostic labels, therefore, cannot be
generalisable to cultures other than the USA in the early 1970s.
The average stay of the pseudopatients was 19 days, the shortest ebing 7 days and the longest being
52 days. Patients suspected that the pseudopatients were sane. The staff treated the pseudopatients
in a way that was consistent with their diagnosis. There was depersonalisation of the patients by staff
- 71% of the time pseudopatients were ignored by the staff. One strength of Rosenhan’s study is that
the study has been replicated to achieve similar results, demonstrating reliability. Research by Lauren
Slater replicated this research, she presented herself at 9 emergency rooms claiming that she was
‘hearing voices’, she was diagnosed with depression with psychosis and prescribed antipsychotics,
supporting Rosenhan’s findings. However, a weakness is that Spitzer challenged the findings of
Rosenhan and Slater. He sent a detailed description based on Slater’s account of her methodology to
431 psychiatrists and asked them to make a diagnosis. 86% of those who responded categorically
ruled out the diagnosis Slater claims she was given. Spitzer claims Rosenhan and Slater’s research
are both flawed and sensationalist, causing harm by creating doubt about the treatment of mental
health.
Rosenhan concluded that we cannot reliably distinguish the sane from the insane. One strength of
Rosenhan’s study is that the study was reliable. The symptoms the pseudopatients claimed to hear
voices saying ‘empty, thud, dull’, allowing for replication to reconfirm results and giving some
reliability. However, a weakness of Rosenhan’s study is that the study broke the guideline of informed
consent as Rosenhan gained consent for his own admission from the hospital administrator and the
chief psychologist in one institution, however, none of the other staff in any of the other hospitals were
aware of the research going on, therefore, it was unethical.
To conclude, Rosenhan’s study is generalisable and reliable, also it is a good study since it has
practical application, as it can be used to help raise awareness in society and potentially lead to
improvements in mental health care. However, the study has broken ethical guidelines, as doctors
spent more time with pseudopatients rather than genuine patients, this could have reduced the quality
of the care for the real patients received thereby exposing them to harm.
, Assess the neurochemical explanation of schizophrenia (20)
The neurochemical explanation mainly focuses on high levels of dopamine in the synapse of the
neurons in the brain. Raised dopamine levels can be caused by increased dopamine release into the
synapse. People with schizophrenia may also have increased sensitivity to dopamine, as there are
more dopamine receptors on the dendrite of the neurons, so more can be detected. It is also believed
that people with schizophrenia have a higher proportion of D2 receptors, which have a higher affinity
to dopamine and bind more easily. One strength of the neurochemical explanation of schizophrenia is
that there is research evidence by Lieberman et al, who found that 75% of patients with schizophrenia
show new symptoms or an increase in psychosis after using drugs such as amphetamines, which
increase levels of dopamine in the brain. Supporting the neurochemical idea, a link between high
dopamine and schizophrenia. However, a weakness is that this explanation does not consider
cognitive factors that contribute to schizophrenia such as the inability to filter out cognitive noise or
faults with metarepresentation, leading to hallucinations, whereas cognitive explanations considered
both dopamine and cognitive effects so arguably is more holistic.
Although the dopamine hypothesis is more often thought to explain positive symptoms, some
research suggests that increased dopamine levels in different areas of the brain are linked with
positive and negative symptoms. High dopamine in the mesolimbic system may contribute to positive
symptoms, whereas high dopamine in the mesocortical system is linked with negative symptoms. One
strength of the neurochemical explanation is that PET scans show that drugs that block dopamine
receptors reduce symptoms in more than 90% of patients if the drugs were administered early on in
the development of the disorder. Supporting the link between high dopamine levels and
schizophrenia, supporting the neurochemical explanation. However, on the other hand, it took several
days for the symptoms to reduce, despite the fact that the receptors are blocked immediately,
suggesting there are other factors causing schizophrenia other than high dopamine levels.
Recent research suggests that it might not only raise dopamine levels that cause schizophrenia.
Some research suggests that there is a strong link between low levels of glutamate and psychotic
symptoms, including schizophrenia. This might be because glutamate interacts with dopamine and
serotonin levels and these interactions contribute to symptoms. One strength of the neurochemical
explanation is that there is strong evidence from Carlsson as the study has strong practical
application. The findings into reviewing studies that show the link between levels of glutamate and the
symptoms of schizophrenia led to serious implications for the future treatments developing for
schizophrenia, supporting the neurochemical explanation of schizophrenia. However, a weakness is
that these findings from Carlsson’s study have weak validity as the data collected is secondary data,
seeing as it was a meta-analysis. This, therefore, means the data collected is not specific enough to
Carlsson’s aim, challenging the neurochemical explanation.
To conclude, there is supporting evidence in the form of Lieberman et al, Randrup & Munkvad, and
Carlsson, and since these involve empirical and objective methods such as PET scans and laboratory
research, the explanation is deemed scientific, therefore has good validity. However, the explanation
and research are flawed for a variety of reasons including the use of secondary data, criminal
research that doesn’t generalise, antipsychotics not working for those with chronic schizophrenia, and
amphetamines psychosis not resembling the full range of schizophrenia symptoms. Furthermore, it is
reductionist, since it reduced this complex disorder to mainly one neurochemical, without considering
the range of interactions between cognitive, social, and environmental factors that contribute to
schizophrenia.
