ALP 1.5 Ethics in diagnosis

The following lesson plan looks at ethical considerations in "factors that influence diagnosis." There are two potential questions that may be asked.  One focuses on ethics in research.  The other focuses on ethical considerations in diagnosis itself. Discussions of the stigma faced by those diagnosed with mental illness may lead to a CAS project.  For a suggested CAS project, or an in-class project, you may want to consider making a PSA about mental health stigma.

Reviewing ethical considerations

The following presentation reviews ethical considerations and asks students to apply them to research that we have already studied.

Ethics questions are particularly difficult because students tend to simply evaluate studies, rather than actually discuss the ethical considerations.  It is also important when students write about ethics, not to write about all of the different considerations.  A well focused essay that focuses on two ethical considerations will earn higher marks than an essay that attempts to address all of the ethical considerations for several studies.

Ethics in diagnosis

I have students read the section Ethics in diagnosis before doing this part of the lesson.

I then break students into two groups and give each of the groups one of the following questions:

  1. Why is diagnosis an important part of psychology?  What are its advantages?
  2. What ethical problems may result from a diagnosis of mental illness?

Each group should then brainstorm a list of responses to the their question.  Then, as a group, create a table that looks at both the pro's and cons of diagnosis through the lens of ethics.

Below is a potential response to this activity.

Pros and cons of diagnosis

Clients can get treatment

Makes communication between different health providers easier when discussing a patient.

Allows psychologists to carry out research by defining disorders and providing potential samples for study.

Patients are relieved that there are other people like them whom they can talk to for support.

Diagnosis often leads to greater family support, explaining that there is a valid reason for an individual's dysfunctional behaviours that often put a lot of stress on a family.

Helps the patient set goals for improvement.

Misdiagnosis may lead to drug treatments that could have negative effects on the individual.

Labels of mental illness may lead to feelings of low self-worth, increasing symptoms.

Labels of mental illness may lead to stigma and discrimination within the community. This may affect their employment and social relationships.

Diagnosis has been misused in the past to discourage dissent.  Examples include women fighting for the right to vote and political dissent in Eastern Europe.

Lack of objectivity - that is, controlling for one's own biases - can affect entire social groups through over-pathologization.

Task 1: Stigma and mental illness

Labeling theory argues that when we "label" someone with a mental illness, this has negative effects on the individual. These negative effects may actually lead to poor mental health. A lot of the early research on labeling looked at how a previous label influenced the objectivity of the doctor in making a diagnosis. Later theorists questioned the role of labels on social rejection and stigmatization.

Before looking at the research, take a look at the following PSA on stigma and mental illness.

Do some research

What does the video mean that people with mental illness suffer from discrimination? Take some time to do some searching on the Internet to find out the exact nature of this discrimination in your own country. Come back to the group with the statistics that you find. Why do you think that this type of discrimination happens?

Labeling theory: How would you know?

The following activity asks students to look more carefully at the question of whether diagnosis leads to labeling - which in turn, is a negative outcome.

Trying to determine whether a diagnosis is helpful or harmful to a patient is a difficult task.  Attached you will find a worksheet that has a series of studies done on the topic.  Ask students to read through the studies (many were in the on-line textbook) and then to rank the studies in order of validity.  Which study do they think is the strongest evidence for or against labeling theory? They should think about the TOK question - how do we know what we know?

Labeling theory ranking task

Debrief

During the debriefing, discuss with students what criteria they were using to make their decisions. You may also want to make some of the following points:

  • What is a "label?"  Does the 5HTT study really count as being "labeled?"  Is this a true diagnosis?
  • Do all the studies reflect how diagnoses are actually made?
  • Do all of the studies actually address the definition of labeling theory? 
  • Does the timing of the questionnaire/interview make a difference?  Before treatment?  After treatment?
  • To what extent was an individual's behaviours - e.g. social withdrawal - measured before the study was done?
  • Can cause and effect be established between the diagnosis itself and negative outcomes?
  • Most diagnosis is voluntary.  How does that fit in with the research and the theory?
  • There is a flaw with the label of diagnosis. How do co-workers, neighbors or friends find out about the diagnosis? Do people respond negatively to the individual because s/he shares a diagnosis? This is possible. But it is more likely that behaviours leading up the diagnosis had a greater effect on social rejection.

Going further

Anna Yakutenok sent me this very good Ted Talk which could lead to a class discussion or personal reflections as a take-home assignment.

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Comments 2

Anna Yakutenok 24 September 2018 - 09:58

youtube.com
my students found this TED talk interesting

John Crane 24 September 2018 - 14:00

Thanks, Anna. I have added it to the page above.