BUSI 230Project 1 InstructionsBased on Larson & Farber sectio.docx

BUSI 230
Project 1 Instructions
Based on Larson & Farber: section 2.1
Use the Project 1 Data Set to create the graphs and tables in
Questions 1–4 and to answer both parts of Question 5. If you
cannot figure out how to make the graphs and tables in Excel,
you are welcome to draw them by hand and then submit them as
a scanned document or photo.
1. Open a blank Excel file and create a grouped frequency
distribution of the maximum daily temperatures for the 50 states
for a 30 day period. Use 8 classes. (8 points)
2. Add midpoint, relative frequency, and cumulative frequency
columns to your frequency distribution. (8 points)
3. Create a frequency histogram using Excel. You will probably
need to load the Data Analysis add-in within Excel. If you do
not know how to create a histogram in Excel, view the video
located at: http://www.youtube.com/watch?v=_gQUcRwDiik. A
simple bar graph will also work.
If you cannot get the histogram or bar graph features to work,
you may draw a histogram by hand and then scan or take a
photo (your phone can probably do this) of your drawing and
email it to your instructor. (8 points)
4. Create a frequency polygon in Excel (or by hand). For help,
view http://www.youtube.com/watch?v=7Q-KdmDJirg(8 points)
5. A. Do any of the temperatures appear to be unrealistic or in
error? If yes, which ones and why? (4 points)
B. Explain how this affects your confidence in the validity of
this data set. (4 points)
Project 1 is due by 11:59 p.m. (ET) on Monday of Module/Week
1.

International Journal o f Clinical and Health Psychology (2014)
14, 216-220
International Journal
of Clinical and Health Psychology
w w w .elsevier.es/ijchp
THEORETICAL ARTICLE
The end of mental illness thinking?
Richard Pemberton3 *, Tony Wainwrightb
<DCrossMark
ELSEVIER
DOYMA
a University o f Brighton, United Kingdom
b University o f Exeter, United Kingdom
Received 26 May 2014; accepted 15 June 2014
A vailable on lin e 9 July 2014
KEYWORDS A b s tra c t M ental he alth th e o ry and p ra
ctice are in a s ta te o f sig nifica nt flu x . This th e o re t-
Diagnosis; ic a l a rtic le places th e position taken by th e
British Psychological Society Division o f C linical
F o rm u la tio n ; Psychology (DCP) in th e c o n te x t o f c u
rre n t p ra ctice and seeks to c ritic a lly exam ine some o f
DSM-5; th e key fa cto rs th a t are d rivin g these transfo rm a
tion s. The im petus fo r a co m p le te overhaul
W e llb e in g ; o f existing th in k in g comes fro m th e m a n
ife stly poor perform ance o f m e n ta l health services in

T h e o re tic a l s tu d y w hich those w ith serious m e n ta l
health problem s have reduced life expectancy. It advocates
using th e advances in our understanding o f th e
psychological, social and physical mechanisms
th a t underpin psychological w e llb e in g and m e n ta l
distress, and re je c tin g th e disease m odel o f
m e n ta l distress as p a rt o f an ou td a te d paradigm .
Innovative research in genetics, neuroscience,
psychological and social th e o ry provide th e p la tfo rm fo r
changing th e w ay we con ceptualise,
fo rm u la te and respond to psychological distress a t both co
m m u n ity and in d iv id u a l levels.
© 2014 Asociación Española de Psicologia Conductual.
Published by Elsevier España, S.L. A ll
rights reserved.
¿El f in d e p e n s a r e n e n fe rm e d a d m e n ta l?
Resumen La te o ría y la p rá ctica de la salud m e n ta l se
encuentran en un m om ento de cam -
bios significativos. El o b je tiv o de este a rtic u lo te ó ric o
es m ostrar la posición adoptada por la
British Psychological Society Division o f Clinical Psychology
(DCP) en e l co n te x to de la p rá ctica
a ctu a l, tra ta n d o de analizar de fo rm a c rític a algunos de
los fa ctore s clave que im pulsan estos
cambios. La necesidad de una revisión co m p le ta de los plan
te am ie ntos actuales procede del
m al fu n cio n a m ie n to de los servicios de salud m e n ta l
en los que las personas con graves p ro b -
lemas de salud m e n ta l han reducido la esperanza de vida. Se
aboga por e l uso de los avances
en los conocim ientos de los mecanismos psicológicos, sociales
y físicos que sustentan e l b ie n -
estar psicológico y la angustia m e n ta l, rechazando e l m

odelo de enferm edad de la ésta como
p a rte de un paradigm a ob soleto. Los avances de la
investigación en ge nética, neurociencia,
* Corresponding author. University o f Brighton, Brighton, BN2
4AT, United Kingdom.
E-mail address: [email protected] (R. Pemberton).
http://dx.doi.Org/10.1016/j.ijchp.2014.05.003
1697-2600/© 2014 Asociación Española de Psicologia
Conductual. Published by Elsevier España, S.L. All rights
reserved.
PALABRAS CLAVE
D iagn óstico ;
F o rm u la c ió n ;
DSM-5;
B ie n e sta r;
E stud io te ó ric o
The end of mental illness thinking? 217
psicología y teoría social proporcionan la plataforma para
cambiar la manera en que concep-
tualizamos, formulamos y respondemos al sufrim iento
psicológico, tanto a nivel comunitario
como individual.
©2014 Asociación Española de Psicología Conductual.
Publicado por Elsevier España, S.L. Todos
los derechos reservados.
There is a p o w e rfu l m ovem ent in tra in , w hich is seeing
old ideas in m ental health being replaced as new scien-
tific advances, including in epigenetics (Toyokawa, Uddin,

Koenen, & Galea, 2012), neuroscience (fo r exam ple in child
developm ent) (Riem e t a l., 2013) and psychological under-
standing o f cognitive mechanisms underlying m ental distress
(Susan & Edward, 2011). M ental health is increasingly under-
stood as a public health issue (World Health Organisation,
2010) and research on incom e in e q u a lity has c le a rly
shown
th e lin k w ith expressions o f m ental distress (Wilkinson Et
P ickett, 2010). This paper addresses one aspect o f this
change, in w hich w e advocate abandoning th e o utdated 'd is
-
ease m o d e l’ o f m ental distress and th e developm ent o f
new
ways in w hich we can bring to g e th e r a ll th e elem ents o f
a
person’s experience in order to help them most e ffe c tiv e ly ,
and fo llo w s th e pub lica tio n by th e Division o f C linical
Psy-
chology o f th e B ritish Psychological Society on classification
o f behaviour (Awenat e t a l., 2013).
The United Kigdom context
Due to th e im p a ct o f a u ste rity on com m unities and ser-
vices across th e w hole o f th e Unted Kingdom, m ental
health
services are under severe stress and increased pressure.
The governm ents program m e o f 'h e a lth service lib e ra tio
n ’
(D epartm ent o f H ealth, 2010) has changed the way th a t
services are funded. Power has shifted to doctors w orking
in com m unity settings and away fro m centralised decision-
making. The people who use services have been p u t a t th e
h e a rt o f policy making and every o th e r p a rt o f th e
system
is being to ld th a t th e re is to be " n o decision about me

w ith o u t m e” . Budgets fo r social care have been d ra m a ti
c a lly reduced and m ental health service funding has been
c u rta ile d . The tra d itio n a l near monopoly o f th e N
ational
Health Service is being replaced by a much more m ixed econ-
omy o f providers. Many services are being p u t out to te n d e
r
and are s ta rtin g to be provided by N on-Governm ental Orga-
nisations (NGO’s) and p riva te fo r p ro fit companies. These
changes have been highly p ro b le m a tic b u t also have
resulted
in significant challenges to historic patterns o f pra ctice and
have brought forw ard new providers and new ways o f w o rk -
ing. The governm ent agenda o f 'P a rity o f Esteem’ w hich is
designed to increase e q u ity o f resources betw een m ental
and physical health care services has h e lp fu lly highlighted
th e very significant reduction in life expectancy fo r peo-
ple very serious m ental health d iffic u ltie s (Royal College o
f
Psychiatry, 2013).
There has been a consistent demand, by those who
experience distress, fo r more psychologically based m ental
health care (Hicks e t a l., 2011). In England th is has resulted
in a new program m e o f psychologically driven care. More
people are now seen in th e im proving access to psychologi-
cal therapies program m e (IAPT) than are seen in secondary
m ental health care (IAPT, 2012). This program m e has in large
p a rt been lead by C linical Psychology. The program m e was
in itia lly fo r people w ith a n xie ty and depression in th e
com -
m u n ity but has since developed a range o f service redesign
arms in to the areas o f psychosis, long te rm physical con-
ditio n s, and m ental health services fo r ch ildren and young
people.

The service user and recovery movements have been
gaining p o litic a l strength and m a tu rity (Centre fo r M
ental
H ealth, 2003). Peer recovery w orkers and recovery colleges
are becoming comm onplace. In th e la tte r you do not need to
take on th e id e n tity o f a p a tie n t to receive support and
guid-
ance to manage w hatever th e issue th a t is causing concern
and distress. The w hole basis o f exp e rt professional p ractice
and pow er is being questioned in new and challenging ways.
The Diagnostic and Statistical Manual version
5 (DSM-5) debate
The recent DCP co n trib u tio n to the debate concerning
DSM-5
(Awenat e t a l., 2013) has been to release a s ta te m e n t
calling
fo r a very d iffe r e n t approach; one th a t does not deny the
im portance o f biology and physical factors b u t w hich calls
in to question th e e x te n t to which disease based models
have
led us up a conceptual and pra ctice blind alley. The in tro -
duction to th e sta te m e n t says. 'The DCP is o f th e view
th a t it
is tim e ly and a p p ro p ria te to a ffirm pu b licly th a t th e
cu rre n t
classification system as ou tlin ed in DSM and the In te rn a tio
n a l
C lassification o f Diseases (ICD), in respect o f th e fu n c tio
n a l
p sychiatric diagnoses, has significant conceptual and e m p ir-
ica l lim ita tio n s , consequently th e re is a need fo r a
paradigm
s h ift in re la tio n to th e experiences th a t these diagnoses

re fe r to , tow ards a conceptual system w hich is no longer
based on a 'disease’ m o d e l’ .
The s ta te m e n t needs to be read in th e co n te x t o f th e
DCP
good p ra ctice guidance on th e use o f psychological fo rm u
-
la tio n (DCP, 2011). This guidance states th a t psychological
fo rm u la tio n starts from the assumption th a t 'a t some level
i t a ll makes sense’ . From th is perspective mood swings,
hearing voices, having unusual beliefs can a ll be understood
as psychological reactions to cu rre n t and past life e x p e ri-
ences and events. They can be rendered understandable in
th e c o n te x t o f an in d iv id u a l’s p a rtic u la r life
history and the
personal meaning th a t th e y have constructed about i t and
218 R. Pemberton and T. Wainwright
w ithin th e ir cultural context. While this assumption in any
individual case may turn out to need review, it provides a
healthy starting point.
Illustrating the sea changes in thinking in this field, a
recent paper (Forgeard e t al., 2011) records the discussions
o f a distinguished group of American researchers and prac-
titioners (Aaron Beck, Richard Davidson, Fritz Henn, Steven
Maier, Helen Mayberg, and Martin Seligman) concerning the
current understanding of depression and how people who
experience this condition can best be helped. One contrib-
utor, Steven Maier’s summed up the view: "We need to set
rid o f our current categories because they do not inform us
about the best way to tre a t people” .

They took to some degree as a starting point the US
National Institute fo r Mental Health’s current Strategic Plan
(Insel, 2008) which has laid down the challenge of bring-
ing together the current scientific understanding of brain
and mind w ith practice, something it regards as sadly lack-
ing at present w ith the contemporary diagnostic framework.
Forgeard et al. (2011) report th a t "d esp ite decades o f
research on the etiology and trea tm en t o f depression, a
significant proportion o f the population is affected by the
disorder, fa ils to respond to treatm ent and is plagued by
relapse” (p. 1). This fact, together w ith the relatively poor
treatm ent success of any therapy, is referred to by Seligman
(2011) as T h e d irty little secret of drugs and therapy’ (p. 45)
is part of the recurring theme of the problem o f using the
current classification system, rather than one which looks
at how brains, minds and people (not forgetting people are
social) work.
It is useful here to quote the NIMH 2008 strategic plan
(Insel, 2008) to be clear what a fundamental change is being
articulated:
” The urgency o f this cause cannot be over-stated. The
President’s New Freedom Commission on Mental Health,
which examined the need fo r reform o f the mental
health care system, concluded th at the problems o f
frag- m entation, access, and q ua lity o f mental health
care were so great th a t nothing less than transform a-
tion would suffice. With several large-scale clinical trials
completed by NIMH, we can add th a t fo r too many peo-
ple w ith mental disorders even the best o f current care is
not good enough. To f u lly address these issues, we must
continue to (a) discover the fundam ental knowledge
about brain and behavior and (b) use such discover-
ies to develop b e tte r tools fo r diagnosis, preem ptive
interventions, more e ffe ctive treatm ents, and improved

strategies fo r delivering services fo r those who provide
d irect m ental health care. These activities p oint toward
NIMH’s u ltim a te goal, which is not m erely to reduce
symptoms among persons w ith mental illness, but also
to promote recovery among this population and tangibly
improve th e ir q u a lity o f l i f e " (p. H i)".
And fu rthe r on:
"C urrently, the diagnosis o f mental disorders is based
on clinical observation—identifying symptoms th a t tend
to cluster together, determ ining when the symptoms
appear, and determ ining w hether the symptoms resolve,
recur, or become chronic. However, the way th a t men-
ta l disorders are defined in the present diagnostic
system does not incorporate current inform ation from
integrative neuroscience research, and thus is not o p ti-
mal fo r making scientific gains through neuroscience
approaches. It is d iffic u lt to deconstruct clusters o f com-
plex behaviors and a tte m p t to link these to underlying
neurobiological systems. Many mental disorders may be
considered as fa llin g along m u ltip le dimensions (e.g.,
cognition, mood, social interactions), w ith tra its that
exist on a continuum ranging fro m normal to extrem e”
(p. 9).
The need for a paradigm shift
The DCP call for a paradigm shift is not a denial of the
embodied nature of human experience or the complex rela-
tionship between social, psychological and biological factors
but instead calls for a system th at acknowledges the grow-
ing evidence o f psychosocial causal factors in many types of
mental distress.

To speak of a paradigm shift could be seen as something of
a cliché. However, we have used this term very deliberately
as it does sum up the pivotal moment we find ourselves in;
but the necessary change is not inevitable, and the form
of change may or may not be the one we would envis-
age. Such is the nature of paradigms. In the very successful
book on science Chalmers (2013) gives a very useful account
o f the debates which surround the ideas of how science
progresses and the meaning of scientific facts. The contem-
porary assumptions concerning mental distress-for example
the serotonin d eficit theory of depression-are deeply rooted
in the minds of mental health professionals. The idea th a t
depression and other diagnoses are real things is simi-
larly strongly believed. This is similar, in our view, to the
assumptions that the earth was the centre of the universe
in pre-Copernican days. There was much to commend the
ide a-th e sun rose in the morning and set at night and clearly
w ent round the earth. Critiques o f these ways of reasoning,
together w ith the vested interests in maintaining the cur-
rent views o f mental disorder (Goldacre, 2009, 2012) have
shown how im portant the required change is. Our account is
only one aspect-another example which Goldacre has been
advocating is the Alltrials project (w w w .alltrials.net) aiming
to provide at last an honest account o f the effectiveness of
drug and other therapies.
A DCP project e ntitled 'Beyond psychiatric diagnosis’
aims to outline the first principles o f an evidence-based
conceptual alternative to psychiatric diagnosis which w ill
provide a more effective basis fo r reducing complexity by
grouping similar types o f experience together. While biol-
ogy plays a mediating role in all human experiences, mental
distress is not best understood as disease process, and this
particular paradigm has comprehensively failed in the field
of psychiatry. Rather than assuming th a t human thoughts,
feelings and behaviours can be theorised in the same way as

body parts, the p roject w ill draw on the large body of knowl-
edge about psychosocial causal factors in mental distress. It
w ill describe the first steps towards identifying patterns and
pathways which can be used to inform the co-construction
of individual narratives and formulations based on personal
meaning. This w ill provide a sounder and more productive
basis fo r developing interventions, carrying out research,
The end of mental illness thinking? 219
planning services and empowering service users to make
changes in th e ir lives. It w ill also have implications for social
policy and issues o f social justice.
Another approach which may have m erit comes from so-
called 'transdiagnostic’ models (Dudley, Kuyken, & Padesky,
2011). These argue th at we can begin to make sense of an
individuals distress through an understanding o f underlying
psychological mechanisms. Rather than starting w ith a set
o f symptoms and trying to find a way in which they hang
together, i t sets out to explore how a particular psychologi-
cal experience is mediated across many d iffe re n t diagnostic
groups. Poletti and Sambataro (2013) fo r example, have
looked a t how delusional ideas function from a cognitive and
neuropsychological perspective in schizophrenia, bipolar
disorder, m ajor depressive disorder and neurological disor-
ders stroke, and neurodegenerative diseases. Here there is
a clear account o f an experience which can lead to con-
siderable distress and anxiety and an understanding of the
underlying mechanisms and possible ways to help alleviate
the problem.
Seligman (2014) takes this further, and in a discussion
of transdiagnostic models uses the example of smallpox

to show th a t before Jenner discovered th at there was an
infective agent, it was simply a description o f symptoms.
Afterwards there was a mechanism-the germ theory. He
makes the point th a t this was a landmark change-and led to
a paradigm shift in understanding infectious diseases and
th e ir treatm ent. He goes on to say about mental health
diagnostic systems however:
"T h e underlying processes are therein called
"transdiagnostic.” Transdiagnostic o f what?
"Transdiagnostic” assumes th a t the disorders have
a re a lity th a t is illu m in ated by these processes. But this
puts the cart before the horse. In a post-Jenner world,
what is real are the underlying processes and what
are mere way stations (fictions?) are the "d iso rd e rs.”
"C om orbid” smacks o f ju s t the same anachronism. Two
diagnostic categories, mere congeries o f symptoms, are
"co m o rb id ” i f they share the same underlying process.
But i f i t is the underlying process th a t is real, and the
"d isorde rs” convenient way stations to the process,
"co m o rb id ” vanishes into thin a ir ” (p. 2).
What then is the way forward?
Kinderman (2013) has cogently argued th at we need aban-
don the disease model and adopt a psychosocial model in
its place. He argues th a t we need to stop diagnosing non-
existent illness. In the place o f diagnosis we need to base
planning fo r individuals and services on a simple list of peo-
p le ’s difficulties and to recognize our primary role lies in
supporting th e ir wellbeing. Despite its many lim itations the
positive psychology movement (Seligman, 2011) is correct
in its assertion th a t we have been overly preoccupied w ith
deficits and deficiencies and th at we need to approach psy-
chologically distress by building on peoples strengths. We
need to significantly reduce our ever-increasing reliance

on psychotropic medication and instead o ffe r redesigned
psychosocial services than aim fo r recovery and personal
agency.
From yet another perspective the World Health Organisa-
tion International Study o f Schizophrenia (ISOS) on recovery
among people given a diagnosis o f schizophrenia is also
instructive (Hopper, Harrison, Janea, & Sartorius, 2007;
Mason, Harrison, Croudace, Glazebrook, & Medley, 1997;
Mason, Harrison, Glazebrook, & Medley, 1996). This research
found, contrary to expectations, much better recovery rates
in less developed (by which you could perhaps read less
prescribing and western psychiatric approaches) than in so
called 'advanced’ countries. This work has never been satis
fa cto rily absorbed by the mental health system in the United
Kigdom but it provides another strong evidence-based chal-
lenge to the contemporary approaches.
Whitaker (2010), a science journalist has made a study
o f the impact o f the way we currently provide services, and
extensively quotes from the ISOS studies: He provides chap-
te r and verse th a t in the United States, and probably also in
the United Kingdom there is a mental health epidem ic-a
public health problem largely caused by the system we
have in place. He also describes some services th a t seem to
making real progress in putting some innovative and ground-
breaking ideas into practice. One o f these is based in West-
ern Lapland and is called Open Dialogue and it has recently
been introduced in the UK (Open Dialogue, 2014). This
approach draws on a number o f theoretical models, includ-
ing systemic fam ily therapy, dialogical theory and social
constructionism and has echoes of some very early work on
crisis intervention in the United Kingdom (Scott, 1973).
Conclusions

Mental Health theory and practice is at a crossroads. The
language and categories we use to to describe psycholog-
ical distress are changing and as evidenced by the furore
over DSM-5 are being challenged from all sides. The complex
interplay between the physical, the psychological, the social
and cultural is always likely to be controversial and prone to
change. We however have argued th at it is tim e th at the cur-
rent disease-based systems are replaced. We advocate using
the advances in our understanding of the psychological,
social and physical mechanisms that underpin psychological
wellbeing and mental distress to change the way we respond
a t a community an individual level. These new insights need
to be incorporated into practice and research. Central to the
way we move forward w ill be the role and power of people
experiencing mental health difficulties. As McKnight (1995)
says "Revolutions begin when people who are defined as
problems achieve the power to redefine the problem” (p.
16). We need to be careful th at we don’ t ju st replace dis
ease based frameworks w ith overly restrictive psychological
ones. Success w ill include social inclusion in the local com-
munity, friendships w ithin and outside of the mental health
system, and purpose in life.
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Sheet1Data Set for Project 1Maximum Temperatures by Statein
the United Statesfor the month of August, 2013State NameMax
Temps in August
2013AL97AK97AZ45AR100CA49CO109CT93DE91FL102GA9
9HI90ID97IL97IN93IA100KS111KY93LA97ME93MD97MA97
MI91MN109MS97MO97MT90NE108NV111NH93NJ108NM106
NY93NC100ND88OH91OK108OR97PA93RI104SC97SD93TN9
9TX104UT106VT91VA102WA93WV91WI90WY99
Sheet2
Sheet3

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