LECTURE 2: JANUARY 15TH, 2013
TOPIC: CHAPTER 4
➔ Review-Who Cares?
◦ Thought broadcasting
◦ Ideas of reference
◦ Auditory hallucinations
◦ Paranoid delusions
◦ Transinstitutionalization (Hospital → Jail)
◦ Efforts to protect the rights of the mentally ill can unfortunately....
◦ REFER TO LAST CLASS NOTE
➔ Case Vignette (Classification Diagnosis → topic) Paul Meehl's patient
◦ Teenage girl admitted to hospital for a 30-day forensic (psycho-legal) psychiatric
▪ in a fit of anger she hit her foster mother with a lamp which caused the skull to fracture
and a concussion.
▪ Runs away from home all the time
◦ She was a smoker
▪ Everyday at 3pm the nurse would give them their pack of smokes
▪ At 2:30 she asked for a smoke and the nurse said she had to follow the rules
▪ She had an episode (tantrum) and demanded her smoke
▪ Is this behaviour normal or abnormal?
• 29% of people in class feel that is normal
• 71% feel it is abnormal
◦ Some felt it was normal because if you take away smokes from someone with an
addiction they will react.
◦ Meehl said at the case conference
▪ “Wouldn't anybody act that way under those circumstances?”
▪ People disagreed and said people would not just throw themselves on the floor because
they do not want to wait 30 minutes for a smoke.
▪ Acting Out
• Behaviour is reflecting some underlying conflict
• It reflects her limited tolerance for frustration
• The court wanted to assess her frustration tolerance. So therefore she is making it
clear that she cannot follow rules and failed the test.
• She showed child-like behaviour.
• What does this all mean?
◦ Maybe the nurse is representing some kind of authority figure
▪ Maybe she displays anger when an authority figure establishes rules.
(Example: her foster mother, the nurse)
▪ Maybe her childhood experience held inconsistency in terms of affection
shown. Her needs were not met so she could never be sure she could get
what she wanted.
▪ People in her life may have promised her things but never followed through. ▪ Her behaviour is not normal. Would you have a tantrum if the Prof told you
to wait for your clicker?
➔ Dangers of Labelling
◦ Diagnosis is used much like a label
◦ Example: Go take care of that C section down the hall. That is an an example of calling a
patient by their procedure for instance. You would not say go deal with the anemic in the
◦ Rosenhan (1973) On Being Sane in Insane Places
▪ He had a bunch of graduate students pretend one symptom (hearing a thud)
▪ Presented themselves before a doctor
▪ Doctor in all cases admitted them to hospital on the basis of the single symptom
▪ It is an auditory hallucination in which they were faking
▪ If they were asked they denied having the symptom and there was no more faking
▪ After being admitted, they were being prescribed 100's of pills and it was not discovered
for many days that they were pseudo patients (fake).
▪ The fellow patients were able to identify them as normal
▪ Once you get a diagnosis, that label sticks
▪ It was about the fact that once they got the label there was no one checking up on them
▪ Nurses did not attend to them once labelled
▪ Careless diagnostic practice-lack of follow up to re confirm condition
▪ Criticism of staff conflict- need to humanize treatment
◦ International Classification of Diseases System from the World Health Organization
➔ Paul Meehl
◦ 1920-2002 (died of leukemia)
◦ Obtained his PhD-University of Minnesota 1946 and then was a faculty member there
◦ Strong interest in psychometrics (test development)
◦ 1962-president of theAPA
◦ Great titles for articles -Why never attend case conferences and Wanted:AGood Cookbook
◦ He wrote a classic text: Clinical versus Statistical Prediction
◦ 1996 APAlifetime contribution award
➔ Meehl's predictions-factors that will remain important for abnormal psychology
◦ Applied learning theory
◦ Behaviour genetics
◦ Descriptive clinical psychiatry
◦ Psychodynamic theory
◦ LOOK THESE UP FOR DETAILS OR REVIEW RECORDING
➔ Goals of Classification
◦ Basis for communication
◦ Information retrieval
◦ Descriptive system
◦ Make predictions ◦ Source of concepts with scientific theory
▪ Example: if all agree what they see is depression then once can develop theory and
➔ Classification is limited by unreliability: What are sources of inconsistencies?
◦ Subject (person) variance-different conditions different times**
▪ Alcohol inebriated
◦ Occasion variance-person is in different stages of same condition**
▪ Hyper manic state example
▪ Depression diagnosis
▪ Manic episode, then depressive episode. Both are part of a bi polar affective disorder.
◦ Information variance- different sources of information
▪ Teacher says a child is very hyper and the clinician sees the child and says the child is
behaving. The psychologist does testing. No hyper active behaviour but problem has
trouble paying attention so maybe the child has an attention deficit.
▪ Depending on the source of info you may come to different conclusions
▪ Need all the info
▪ This child may be labelled in terms of an IQ score (we are missing the picture)
▪ How many times does the white team pass the ball → 13 BUT because you just focused
on the counting you missed the moon walking bear. It is an awareness test. It is hard to
miss something you are not looking for.
▪ Example: psychological testing some just focus on the score and not the meaning.
◦ Observation variance-inter-rater reliability
▪ How you look at things
▪ Two people looking at the same thing will come up with the same conclusions
▪ Example: the teenage girl having a temper tantrum (71% agreed it was abnormal and
29% disagreed → this is inter rater reliability).
◦ Criterion variance-due to vagueness of classification system
▪ Diagnostic System
▪ DSM-IV (Diagnostic and Statistical Manual Version Four)
▪ The earlier classification systems were very vague which made it harder for people to
agree about things. If you are very specific it is easier in terms of identifying criteria and