Distortion, Bias, and Ethical Informed Consent: Presentations of Etiological and Treatment Factors in Abnormal Psychology Textbooks

Abstract

Concerns have been made highlighting the need for true informed consent and choice when patients and/or parents are confronted with seeking treatment for severe emotional states and crises. Yet, psychosocial treatments are often derided or recommended only in conjunction with psychotropic medications because of the assumed biological basis of mental distress. At the same time, the benefits of medications are often inflated, whereas the harmful effects are drastically minimized or not reported at all. This misinformation is distributed to the public, and to patients, in part through the education of students and trainees. Early educational experiences can shape the thinking of trainees as they begin to formulate their respective approaches to clinical populations, and textbooks are a fundamental part of this education. The purpose of this study was to analyze popular abnormal psychology textbooks to evaluate their representation of the current scientific literature regarding psychopathology. Content areas that were explored were those related to depression, attention-deficit/hyperactivity disorder, and schizophrenia. Misrepresentations of the literature were pervasive in areas associated with biological findings. In addition, there were multiple omissions or biased statements related to psychosocial findings, distortions regarding the efficacy of and adverse effects of various treatments, and a lack of reports of the existence of effective alternative approaches to standard mental health care. Concerns regarding the dissemination of distorted and false information in higher education as it pertains to ethics and informed consent are discussed.

Hearing voices, but whose? Constructions of schizophrenia in introductory psychology textbooks

“…The dominance of biomedicine within the discursive constructions we explore above, which constructs schizophrenia as a biological disorder caused by genes and faulty brains, is consistent with findings across the literature (Cromby et al, 2008; Halter et al, 1992; Hunter, 2013; Joseph, 2000; Simon, 2006). Undergraduate students are not exposed to discourses that confront biomedical discourse (Snyder et al, 2019)—even the counter discourses we have identified above do not wholly dislodge the dominance of this frame.…”

“…Consequently, these constructions produced a particular outcome for PWDS: requiring treatment, primarily biomedical treatment within the psy-complex. While each textbook is quoted in our analysis, we have not identified in-situ which textbook each quote is sourced from or the specific page number on which the quote appears (see also Hunter, 2013). 1…”

“…Such approaches include hearing voices peer support groups (Longden et al, 2018), Open Dialogue (Bergström et al, 2022), and Soteria houses (Leendertse et al, 2023). Non-Western and nonbiomedical approaches to treatment differences are either disputed or constructed as unusual cultural practices, inferior to scientific Western treatment (see also Hunter, 2013). Engaging with Mad Studies theories calls textbook writers and lecturers to open new conversations with students that encourage them to explore tensions in these constructions-and to prioritise the voices of mad people in storying their experiences (Pagdon & Jones, 2023).…”

“…While MS is relevant for constructions of various experiences of mental distress and engagement with these in textbooks, we focused on constructions of schizophrenia. This diagnosis is often associated with problematic and limiting stereotypes and misinformation that may be replicated in psychology textbooks (Hunter, 2013; Joseph, 2000). Psychosis refers to a category of experiences often associated with schizophrenia, including sensory experiences and/or beliefs that others do not share and appearing out of touch with consensus reality (Cooke, 2017).…”

“…Psychosis is rarely presented “from within” (i.e., from the perspectives of people experiencing it), missing layers of understanding that stem from lived experience (Fredwall & Larsen, 2019; Jones & Shattell, 2016). Textbooks typically portray psychosis, schizophrenia, and associated symptoms through a biomedical lens (Cromby et al, 2008; Halter et al, 1992; Hunter, 2013; Joseph, 2000; Simon, 2006); thus, there may be disconnection between how people are described and how they feel, and between what they want and what they receive.…”