Welcome to "What is Mental Health?" (OCR A Level Psychology H569)
Welcome to your study notes for Section A: Issues in Mental Health within Component 3 (Applied Psychology). This section is a compulsory part of your exam (accounting for 35 marks in the 2-hour paper). Don't worry if psychological definitions and clinical terms feel a bit overwhelming at first — we will break everything down step-by-step with clear examples, memory aids, and key pointers so you feel fully confident!
In this chapter, we will explore three central questions:
1. How did people throughout history try to explain and treat psychological problems?
2. How do modern psychologists decide what is "normal" versus "abnormal"?
3. How reliable and accurate is psychiatric diagnosis in the real world (featuring the classic study by David Rosenhan, 1973)?
1. Historical Views of Mental Health
Long before modern neuroscience or clinical therapy existed, societies tried to understand why people behaved in unusual or distressing ways. In OCR Psychology, you need to know three key historical views:
A. The Supernatural View
• Core Explanation: In ancient and medieval times, mental illness was believed to be caused by supernatural forces — such as evil spirits, demonic possession, witchcraft, or divine punishment for moral wrongdoing.
• Treatments: Because the cause was seen as spiritual, the "cure" was physical or spiritual extraction. Common methods included exorcisms and trepanning (the surgical practice of drilling or scraping a hole into the skull to allow trapped evil spirits to escape).
• Everyday Analogy: Imagine thinking a broken smartphone is possessed by a ghost, so instead of fixing the software, someone punches a hole through the screen to let the ghost out!
B. The Humoural View (Hippocrates)
• Core Explanation: The ancient Greek physician Hippocrates moved away from superstitions and suggested that mental health was biological. He proposed that the body contains four essential bodily fluids, known as humours:
1. Blood
2. Yellow bile
3. Black bile
4. Phlegm
According to this theory, good physical and mental health relies on these four humours being in perfect balance. If they become unbalanced, illness results. For example, an excess of black bile was believed to cause melancholia (deep depression and sadness).
• Treatments: Diets, bloodletting, purging, or lifestyle changes designed to restore balance among the four humours.
C. The Hospital / Asylum Movement
• Core Explanation: During the 18th and 19th centuries, society shifted towards segregating and institutionalising individuals with mental health issues. Specialized institutions called asylums were built.
• Reality: Although asylums were initially intended as safe places of care and moral treatment, they quickly turned into overcrowded "warehouses" where patients were locked away from society, often enduring punitive, unhygienic, and neglectful conditions.
Key Takeaway for Historical Views: Explanations evolved from spiritual forces (Supernatural / Trepanning) to early biological imbalances (Hippocrates / Four Humours) to institutional segregation (Asylums).
---2. Defining Abnormality
How do psychologists draw the line between eccentric behavior and psychological disorder? OCR identifies four specific definitions of abnormality that you must know:
1. Statistical Infrequency
• Definition: Behavior is abnormal if it is numerically rare or falls outside the typical distribution of the general population.
• How it works: Human traits often follow a normal distribution curve (a bell curve). Individuals who fall at the extreme ends are considered statistically abnormal.
• Example: General intelligence (IQ). The average IQ is \(100\). An individual scoring below \(70\) falls into the bottom \(2.5\%\) of the population and may be diagnosed with an intellectual disability.
• Limitation to keep in mind: Some rare traits are highly desirable (e.g., an IQ over \(130\) or Olympic athleticism), while common behaviors (like mild anxiety or depression) are statistically frequent yet still distressing.
2. Deviation from Social Norms
• Definition: Behavior is abnormal if it goes against the explicit (written laws) or implicit (unwritten societal rules) expectations of a particular culture or community.
• Example: Walking down a busy street shouting at strangers or wearing inappropriate clothing to a formal funeral violates unwritten social norms.
• Limitation to keep in mind: Social norms change over time (historical context) and differ across cultures (cultural relativism).
3. Failure to Function Adequately
• Definition: A person is considered abnormal if they are unable to cope with the daily demands of everyday living (such as maintaining personal hygiene, holding down a job, or feeding themselves).
• Rosenhan and Seligman (1989): Suggested specific signs indicating failure to function, including unpredictability (loss of control over behavior) and maladaptiveness (behavior that interferes with personal well-being and goals).
• Everyday Analogy: A car is failing to function adequately when it won't start in the morning or breaks down on the road, preventing you from getting where you need to go.
4. Deviation from Ideal Mental Health
• Definition: Proposed by Marie Jahoda (1958). Instead of looking for what makes someone "ill", Jahoda identified what makes a person psychologically "well". If someone fails to meet these ideal standards, they deviate from mental health.
• Jahoda's 6 Criteria:
1. Positive attitude towards self: Having high self-esteem and self-acceptance.
2. Growth and Self-actualization: Striving to reach one's full potential.
3. Resistance to stress: Developing effective coping mechanisms to handle stressful life events.
4. Autonomy: Being independent, self-reliant, and able to make decisions on one's own.
5. Accurate perception of reality: Seeing the world realistically rather than through a distorted lens.
6. Environmental mastery: Being adaptable, able to work, love, solve problems, and adjust to new situations.
Memory Tip for Jahoda's 6 Criteria — Remember "PRAISE":
• P = Positive attitude towards self
• R = Resistance to stress
• A = Autonomy
• I = Individual growth / Self-actualization
• S = Sight of reality (Accurate perception of reality)
• E = Environmental mastery
3. Classification Systems: DSM-5-TR and ICD-11
To diagnose mental disorders consistently, clinicians use standardized diagnostic manuals:
• DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision): Produced by the American Psychiatric Association (APA). It is primarily used in the United States and focuses exclusively on mental health disorders.
• ICD-11 (International Classification of Diseases, 11th Revision): Produced by the World Health Organization (WHO). It is used globally and covers all physical diseases as well as mental and behavioral disorders.
Crucial Exam Distinction: Reliability vs. Validity
Students often mix these two terms up, but getting them right is vital:
• Reliability = Consistency: Do different psychiatrists reach the same diagnosis for the same patient? (Inter-rater reliability).
• Validity = Accuracy: Does the diagnosis reflect a real, distinct disorder that the patient actually has? (Does the classification system measure what it claims to measure?).
4. Key Research: Rosenhan (1973)
Study Details: "On being sane in insane places"
Aim:
To test whether the sane can be distinguished from the insane, and to investigate the reliability and validity of psychiatric diagnosis in real-world psychiatric hospitals.
Sample:
• 8 pseudo-patients (fake patients), consisting of 5 men and 3 women, including Rosenhan himself.
• They included a variety of professions (e.g., psychologists, a housewife, a painter, a pediatrician).
Procedure:
• The pseudo-patients sought admission to 12 different psychiatric hospitals across 5 US states (ranging from old, underfunded facilities to modern, private clinics).
• During their clinical intake assessment, they claimed they had been hearing unfamiliar voices of the same sex saying three specific words: "empty", "hollow", and "thud".
• These symptoms were chosen deliberately because they evoked existential meaninglessness and had no known link to psychotic literature.
• Aside from faking their name, job, and auditory hallucinations, all other personal history and relationships were described accurately.
• Crucial Step: Immediately upon being admitted to the psychiatric ward, the pseudo-patients stopped simulating all symptoms, reported feeling fine, and behaved completely normally. They obeyed ward routines and engaged in conversations.
Findings:
• Admission: All 8 pseudo-patients were admitted. All but one were diagnosed with Schizophrenia (one was diagnosed with manic-depressive psychosis).
• Length of Stay: Pseudo-patients remained hospitalised for an average of 19 days (ranging from 7 to 52 days).
• Discharge Diagnosis: When released, none were declared "cured"; they were discharged with a diagnosis of "Schizophrenia in remission".
• Patient Detection: While clinical staff failed to detect them, actual psychiatric patients were suspicious! Across the hospitals, 35 out of 118 real patients voiced suspicions (e.g., "You're not crazy. You're a journalist or a professor checking up on the hospital").
• The "Stickiness of Labels": Once a diagnostic label was applied, all normal behaviors were misinterpreted through the lens of mental illness:
— When pseudo-patients wrote notes in their journals, staff recorded this in nursing charts as "patient engages in writing behavior" (viewing it as a pathological symptom).
— Waiting outside the cafeteria early was labeled as "oral-acquisitive syndrome" rather than simply being hungry.
Rosenhan's Conclusion:
Psychiatric diagnosis lacked validity because staff could not distinguish the sane from the insane in a hospital environment. The psychiatric label creates a self-fulfilling prophecy where all behavior is filtered through the expectation of abnormality.
5. Summary and Common Exam Pitfalls
Quick Review Summary
• History: Supernatural (demons / trepanning) \(\rightarrow\) Humours (imbalance of 4 fluids / Hippocrates) \(\rightarrow\) Asylums (containment / warehousing).
• 4 Definitions: Statistical Infrequency, Deviation from Social Norms, Failure to Function Adequately (Rosenhan & Seligman), Deviation from Ideal Mental Health (Jahoda's 6 criteria).
• Manuals: DSM-5-TR (APA / US focus) and ICD-11 (WHO / global).
• Rosenhan (1973): 8 pseudo-patients, 12 hospitals, heard "empty", "hollow", "thud". Stayed an average of 19 days. Diagnosed with Schizophrenia in remission. Demonstrated the "stickiness of labels" and challenged diagnostic validity.
Common Mistakes to Avoid in Exam Answers
• Wrong Manual Versions: Always write DSM-5-TR and ICD-11. Do not refer to outdated editions like DSM-IV or ICD-10.
• Misquoting the Three Words: The voice said precisely "empty", "hollow", and "thud". Do not invent or add other words.
• Sample Size Error: Do not say "Rosenhan went to a hospital alone." There were 8 pseudo-patients tested across 12 different hospitals.
• Confusing Reliability and Validity: Rosenhan showed that doctors consistently diagnosed Schizophrenia (showing high reliability), but were wrong about whether the pseudo-patients were actually ill (showing low validity).
• Incomplete Jahoda List: Be ready to state all 6 criteria for ideal mental health using the PRAISE mnemonic.