Section A: Issues in mental health — OCR A-Level Psychology
Test yourself on Section A: Issues in mental health with OCR A-Level practice questions.
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Section A: Issues in mental health explained
This section covers the historical context of mental health, including historical views of mental illness like demonic possession.
Read the full explanation
Defining abnormality involves four definitions: statistical infrequency, deviation from social norms, failure to function adequately, and deviation from ideal mental health. Categorising mental disorders relies on diagnostic manuals to standardise criteria. Rosenhan (1973) 'On being sane in insane places' investigated the validity of psychiatric diagnosis by sending pseudopatients into hospitals. Students must also describe the characteristics of an affective disorder, a psychotic disorder, and an anxiety disorder, detailing their specific clinical symptoms.
The medical model – The biochemical explanation of mental illness; The genetic explanation of mental illness; Brain abnormality as an explanation of mental illness. Gottesman et al. (2010) Disorders in offspring with two psychiatrically ill parents. Biological treatment of one specific disorder.
The medical model treats mental illness as having physical causes. Students must understand the biochemical explanation of mental illness, the genetic explanation of mental illness, and brain abnormality as an explanation of mental illness. The key research is Gottesman et al. (2010) 'Disorders in offspring with two psychiatrically ill parents', a Danish register study showing that genetic loading increases diagnostic risk for schizophrenia and bipolar disorder. Finally, students must explore the biological treatment of one specific disorder, such as using antipsychotic medication to block dopamine receptors in schizophrenia, evaluating its effectiveness and potential side effects.
Alternatives to the medical model – The behaviourist explanation of mental illness; The cognitive explanation of mental illness; One from: the humanistic explanation of mental illness, the psychodynamic explanation of mental illness, the cognitive neuroscience explanation of mental illness. Szasz (2011) The myth of mental illness: 50 years later. Non-biological treatment of one specific disorder.
Alternatives to the medical model propose that mental illness stems from learning, faulty thinking, unconscious conflict, blocked growth, or neural dysfunction. Behaviourists treat symptoms as conditioned responses acquired by association. Cognitive accounts locate problems in faulty thinking, like Beck's negative triad. Students must also study one optional explanation: psychodynamic (unconscious conflict), humanistic (blocked self-actualisation), or cognitive neuroscience (brain network dysfunction). Szasz (2011) argues mental illness is a metaphor for problems in living, criticising coercive psychiatry. Non-biological treatments apply these theories, such as using cognitive behavioural therapy to challenge irrational beliefs in depression.
Your focus
- Describe historical views of mental illness and evaluate definitions of abnormality.
- Explain the process of categorising mental disorders and describe the characteristics of affective, psychotic and anxiety disorders.
- Analyse Rosenhan's (1973) study on the validity of psychiatric diagnosis.
Show all 9 objectives
- Describe the biochemical, genetic, and brain abnormality explanations of mental illness.
- Evaluate Gottesman et al. (2010) in terms of its register-based design and findings on diagnostic risk.
- Explain the mechanism and application of one biological treatment for a specific mental disorder.
- Outline the behaviourist, cognitive, and one optional alternative explanation of mental illness.
- Discuss Szasz's (2011) arguments regarding the myth of mental illness and the medicalisation of behaviour.
- Describe the procedure and rationale of one non-biological treatment for a specific mental disorder.
Section A: Issues in mental health exam tips
Marking Points
- Credit for Rosenhan (1973) described with its procedure and numbers: eight pseudopatients presented at twelve hospitals reporting a voice saying empty, hollow and thud, all were admitted, and they remained on average 19 days although they behaved normally from admission onwards.
- Credit for the finding that staff reinterpreted ordinary behaviour to fit the label, recording note taking as writing behaviour, and for the follow up in which a hospital warned to expect pseudopatients judged 41 of 193 real referrals to be fakes when none had been sent.
- Credit for definitions of abnormality evaluated rather than listed, such as statistical infrequency classifying a very high reasoning score as abnormal, or deviation from social norms shifting with culture and era.
- Credit for symptom pictures given in clinical language: persistent low mood and loss of interest for an affective disorder; positive symptoms like hallucinations beside negative symptoms like avolition for a psychotic disorder; and marked, persistent fear with avoidance for an anxiety disorder.
- Credit for stating what categorising mental disorders is for, that agreed criteria raise agreement between clinicians, while the key study attacks validity, which is a separate claim about whether the label describes anything real.
- Credit for Gottesman et al. (2010) described as a design: Danish national psychiatric and civil registers were linked so that over two million people could be followed, allowing researchers to identify cohorts based on parental diagnoses and track offspring diagnoses without relying on volunteers.
- Credit for reading the figures correctly: where both parents had been admitted with schizophrenia, 27.3% of their children were diagnosed with schizophrenia, falling to 7% with one affected parent and 0.86% where neither parent was affected, with a comparable gradient for bipolar disorder.
- Credit for the conclusion the numbers support: risk rises steeply with genetic loading, but most children of two affected parents never received that diagnosis. This indicates genetic vulnerability, though the study measures diagnostic risk rather than environmental stressors.
- Credit for biochemical evidence handled as evidence: amphetamine, which raises dopamine activity, can produce psychotic symptoms, and drugs blocking dopamine receptors reduce them.
- Credit for one named biological treatment of one specific disorder with a mechanism and evidence, for example, the atypical drug clozapine for schizophrenia acting on dopamine and serotonin receptors, helping patients who respond to nothing else but requiring regular blood monitoring.
- Credit for Szasz (2011) stated as a claim with reasons: illness properly names bodily pathology, so mental illness is a metaphor taken literally, and psychiatric diagnosis judges behaviour against social norms rather than a lesion.
- Credit for a behaviourist explanation with a mechanism, such as Watson and Rayner conditioning fear by pairing a rat with a loud noise, extended by Mowrer's two-process account where avoidance maintains fear.
- Credit for a cognitive explanation using terms precisely: the cognitive triad, faulty information processing, or the activating event, irrational belief and consequence.
- Credit for the chosen optional explanation: psychodynamic (unconscious conflicts between id, ego, and superego), humanistic (conditions of worth blocking self-actualisation), or cognitive neuroscience (neural correlates of cognitive deficits).
- Credit for one named non-biological treatment of a specific disorder with its procedure, for example, cognitive behavioural therapy (CBT) for depression, combining thought records to challenge irrational beliefs with behavioural activation.
Examiner Tips
- 💡Questions here often ask you to outline one definition of abnormality and then evaluate it, so pair every definition with a single limitation you can state in one sentence.
- 💡Where a short case is given, name the family of disorder and justify it from the symptoms printed in the stimulus rather than asserting the diagnosis.
- 💡Key research questions reward design detail, so be able to say that this evidence came from whole population registers and why that beats a clinic sample recruited after diagnosis.
- 💡Treatment questions expect you to say what the treatment does not do, so keep a line ready that medication manages symptoms but leaves the circumstances a person returns to untouched.
- 💡You need only one of the three optional explanations, so learn the psychodynamic, humanistic, or cognitive neuroscience explanation thoroughly with a mechanism attached.
- 💡Questions often ask you to compare an alternative with the medical model, so hold one prepared line on cause and one on treatment so the comparison is explicit.
Common Mistakes
- Saying the study proved psychiatrists are incompetent. The pseudopatients lied about a symptom, and a clinician who cannot verify a reported voice is behaving reasonably in admitting.
- Writing that the pseudopatients were discharged as cured. They were discharged with their admission diagnosis in remission (e.g., schizophrenia in remission), which leaves the label in place.
- Describing depression in everyday words such as feeling sad, when the marks come from clinical features plus the requirement that they persist and impair functioning.
- Reporting register figures as though they showed the disorder to be inherited outright. Correction: A rate of 27.3% means nearly three quarters of the highest risk group were not diagnosed with that disorder; frame it as an increased risk or vulnerability.
- Confusing a correlate with a cause. Correction: Enlarged ventricles are found in patients who have usually been medicated for years, so the abnormality may follow the illness or its treatment rather than produce it.
- Naming a drug without saying what it does at the synapse or specifying the disorder it treats. Correction: Always specify the neurotransmitter mechanism and the specific disorder to provide a basis for evaluation.
- Treating Szasz (2011) as an empirical study with a sample and results. It is an essay/argument, evaluated on its reasoning and ethical implications.
- Collapsing the behaviourist and cognitive explanations into a single therapy without ever stating a cognitive cause of the disorder.
- Choosing a treatment and describing only its aims without specifying the disorder. Credit comes from linking the procedure (e.g., thought records) to a specific disorder like depression.