A level psychology help

I'm a bit confused on how to structure extended writing responses (8, 16, 20 markers). I do Edexcel and so there isn't a lot online either.

For example this is an 8 mark answer I wrote for an assessment for which I got 4/8 :

Evaluate Rosenhan (8)
The aim of the study was to investigate whether psychologists can tell the difference between people who are sane and those that are insane. He also wanted to gain insight on the negative effects of being diagnosed as abnormal and institutionalised.

One strength of the study is the varied sample size.
For example 8 pseudo patients were sent to 12 hospitals from different states in the USA, this included an elite private hospital, university research facilities and rundown hospitals in rural areas, some were understaffed and some were overstaffed.
Therefore the use of the varied sample size of hospitals makes the study representative of wider hospital facilities. These results of the study represent a range of mental institutions so we can assume that their ideas of diagnosis of schizophrenia and bipolar disorder can be applicable to other hospitals within the USA.

However, the sample can be seen as ethnocentric as all 12 hospitals were from America only. They were located in 5 different states on the east and west coasts, some were supported by state funds and one of them by university funds.
Therefore, we cannot assume that other hospitals would have given the same diagnosis , so the findings of all pseudo patients getting admitted and 11 hospitals diagnosing schizophrenia and 1 with bipolar disorder cannot be applied to other countries. There can be cultural differences which can impact diagnosis e.g. in the USA the DSM is used but in the UK, the ICD is used, so there can be a difference in diagnosis in different countries, which lowers the generalisability of the study.

One strength is that Rosenhan had procedures put in place prior to the study. For example, he protected the identity of his patients. He gave them pseudonyms instead of their real names and they adopted fake identities and professions. This was to be sure that their label of being schizophrenic in remission did not affect them after the study. Also, Rosenhan was the first pseudo patient and was known about by the hospital administrator and chief psychologist. He also ensured pseudo patients needed to be discharged.
This shows that BPS guidelines were followed to some extent, as Rosenhan wanted to protect the pseudo patients from harm and keep their identities private to prevent the negative effects of being labelled as ‘abnormal’ which means that the that distress of pseudo patients was minimised as they could carry on with their normal lives after the study, giving the study good ethics.
However, ethics can be questioned as all pseudo patients were put in highly distressing environments that made all but 1 want to leave immediately, which breaks the protection from harm BPS guideline as pseudo patients endured emotional distress. The cost vs benefit in the study is questioned as pseudo patients were in distressing environments but the study led to a massive improvement in the standard of psychological treatment.

One weakness is that the findings are history specific.
For example, the pseudo patients remained in hospital from 7 to 52 days with an average of 19 days. The note taking behaviour and queuing outside the cafeteria 30 minutes before lunch were seen as symptoms of schizophrenia. They were released with a diagnosis of schizophrenia in remission. In the first 3 hospitals 35 out of 118 patients recognised that the pseudo patients were not actually ill.
Therefore, these results can be deemed history specific as the study took place in the 1970’s and so may not be applicable to today’s modern society. We cannot be certain that the treatment of patients would be the same today and also, whether the reliability of diagnostic systems has improved. It is likely that this would be completely different in mental hospitals today as new discoveries have been made and diagnostic systems have constantly been updated every 10 years. During the time of they study, the DSM 2 was used but today the DSM 5 is used so diagnosis may be different today which means the study lacks temporal validity.



Overall, Rosenhan's study has provided clinical psychology with useful applications. It has had an impact on the care system as Rosenhan found the hierarchical structures of hospitals can increase depersonalisation of patients. Therefore institutions have changed their working practices and focused their care of patients, changing the environment of the hospitals for good.

My teacher told me to include competing arguments for this question but I have included strengths and weaknesses so I don't really know how to improve this.

Does anyone have any advice on how I should structure the questions for top band?