Who’s Crazy Here Anyway. Rosenhan, D. L Who’s Crazy Here Anyway? Rosenhan, D.L. (1973) On being sane in insane places. Science, 179, 250-258

What is psychopathology? Difference between normal and abnormal behavior is imperative in field of psychology. Psychopathology, or abnormal psychology, is the field concerned with the nature and development of abnormal behavior, thoughts, and feelings. This definition is the key variable in determining whether or not someone may be diagnosed as mentally ill.

What is psychopathology? (cont’d) Human behavior lies on a continuum; normal behavior on one end (AKA effective psychological functioning) and abnormal behavior on the other. Normal----------------------------------------Abnormal (effective functioning) (mental illness) Mental health professionals (i.e. clinical psychologists, psychiatrists, psychotherapists) determine where an individual’s behavior lies on this continuum according to one or more of the six following criteria.

Criteria 1) Bizarreness of the behavior: (odd or eccentric) a subjective judgment based on a situation, the context in which the behavioral pattern occurs 2) Persistence of the behavior: how often does the behavior occur 3) Social deviance: does the behavior violate societal norms, which are extreme and persistent

Criteria (cont’d) 4) Subjective distress: refers to an individual being aware of their psychological stress 5) Psychological handicap: individual finds it impossible to be satisfied with life due to psychological problems 6) Effect on functioning: the extent to which the behavior in question interfere with a person’s ability to live the life that he or she desires and that society will accept

Criteria (cont’d) Criteria at hand are based on judgments of mental health professionals. Questions at hand: Are mental health professionals capable of distinguishing between mentally ill and mentally healthy? What are the repercussions of a misdiagnosis? David Rosenhan studies these questions at hand.

Theoretical Propositions H1: The criteria leading to diagnoses reside in patients or in the contexts in which the mental health professionals find the patients. He believes the professionals should be able to distinguish between the insane and the sane. Proposed that in order to test professional ability, he has “normal people” seek admittance to psychiatric facilities to see whether or not they would be found to be mentally healthy.

Theoretical Propositions (cont’d) He referred to these subjects as ‘pseudopatients’. The subjects were to behave as they would outside of the facility. If these pseudopatients were not found to be normal, this would suggest that the diagnosis of the mentally ill are tied more to the situation than to the patient.

Method Eight subjects, including himself. Three women and five men (1 graduate student, 3 psychologists, 1 pediatrician, 1 psychiatrist, 1 painter, 1 homemaker). Admission to 12 psychological hospitals in five states, on east coast and west coast. All subjects were told to phone the hospital and set up an appointment. Once they arrived, they were told to state that they were hearing voices (empty, hollow, thud).

Method (cont’d) This was the only false information the pseudopatients provided. All other background information (excluding names and occupations) was truthful (i.e. families, social life). All subjects were admitted. Seven subjects were admitted with a diagnosis of schizophrenia. Once the subjects had been in the hospital, they displayed normal behavior. It was up to them to convince the staff they were well enough to leave.

Method (cont’d) During the subjects stay, they documented their experiences. At first, this was a discrete attempt, although this became useless seen as the note-taking behavior was considered a symptom of their diagnosis. They wished to be released as soon as possible, hence they cooperated completely with all requests of the staff and took medication as told (medication was not swallowed, rather flushed).

Results Duration of stay ranged from 7-52 days, with an average of 19 days. None of the subjects were detected as mentally healthy by the staff or mental health professionals. Upon release their files were noted as, schizophrenia in remission. Interestingly enough, although the staff was fooled, other patients were not. In three of the subjects hospitalizations, 35 out of 118 actual patients voiced such opinions that the subjects were not mentally ill.

Results (cont’d) A test made by pseudopatients was to approach staff members and make verbal contact by asking common questions, such as referring to their duration of stay or privileges. Response Psychiatrists MHA Moves on, head averted 71% 88% Makes eye contact 23% 10% Pauses and chats 2% 2% Stops and talks 4% 0.5%

Results (cont’d) When a subject did in fact elicit a response from a mental health professional, it was based on the emotional state of the subject, and most continued on. Although there was not much contact between the patients and the staff, there was never a lack of medication. Distributed to the subjects was a total of 2,100 pills (not swallowed). Many of the actual patients hardly ever took their medications.

Discussion Rosenhan’s study suggests that mentally healthy people cannot be distinguished from mentally ill. He believed that the staff’s judgment held influence as to how the patients were treated. Once they are admitted their individuality is essentially removed and they simply become a label. Rosenhan refers to this as the stickiness of the diagnostic label. Therefore, their personality trait becomes that of the label.

Discussion (cont’d) The moment there is a label attached to the patient, all behavior the patient takes part in is seen as a manifestation of their diagnosis. The staff tended to ignore the circumstances and attribute any behavior to the illness. This, so called, sticky label even affected the patients past history although they gave truthful accounts. The past history and behavioral interpretations were consistent with the diagnosis of the patient.

Significance of Findings Two compelling factors: A) mentally ill cannot be distinguished from mentally healthy in a hospital setting B) danger of diagnostic labels, eludes any other characteristics of the individual This type of Tx may become self-confirming. If an individual is being treated for a diagnosis, consistently, they will begin to behave in the manner expected of them.

Significance of Findings (cont’d) As a result of Rosenhan’s research, there has been a focus on the danger of applying labels. Mental health professionals have not rid labeling in patients, or clients, although they are used more cautiously in understanding their control.

Questions and Criticisms A psychiatric facility that heard of Rosenhan’s study was convinced they could not misdiagnose individuals. Rosenhan challenged this facility and informed them that he would be sending pseudopatients to their facility within a span of three months. The facility was given no information by Rosenhan as to when they would be arriving.

Questions and Criticisms (cont’d) Rosenhan told the staff members to rate the patients, on a 10 point scale, the likelihood they are pseudopatients. At the end of three months, 193 patients were admitted. By one staff member, at the least, 41 were considered in high confidence to be pseudopatients. Twenty-three were suspected by one psychiatrist. Nineteen were identified as pseudopatients by one psychiatrist and other staff member.

Questions and Criticisms (cont’d) Rosenhan had actually NOT sent in any pseudopatients whatsoever!!!!! We may view this as a self-fulfilling prophecy on behalf of the hospital. “ It indicates that the tendency to designate sane people as insane can be reversed when the stakes (in this case prestige and diagnostic ability) are high. But one thing is certain: Any diagnostic process that lends itself so readily to massive errors of this sort cannot be a very reliable one.” - Rosenhan

Questions and Criticisms (cont’d) Regardless of how many times Rosenhan replicated his research, there were disputing researchers. Spitzer (1976) argued that Rosenhan’s research did not truly invalidate psychological diagnoses. Admissions to hospitals are based on verbal reports, it would not be suspected that someone would deceit a mental health professional to go someplace they don’t belong.

Questions and Criticisms (cont’d) Spitzer noted that, although subjects portrayed normal behavior upon admittance, symptomatic reports are consistent with the disorders. Therefore, the staff were not incorrect in diagnosing the subjects.

Conclusion Labels will most likely always be utilized, as the mental health professionals benefit from them. They are an important role in effectively treating psychological disorders. Labels place embarrassment on individuals and stigmatize them. This is the aspect that should be dealt with. Nonetheless, Rosenhan’s study remains to be that of an influential one in psychology.

Further Questions What about those that are labeled and have carried this label with them through their everyday lives? Do these labels effect the way we act in, say, our careers? Are children effected by these labels in a school setting?

Follow-up Study Wahl, Otto F Follow-up Study Wahl, Otto F. Depictions of mental illnesses in children’s media Journal of Mental Health (June 2003), 12, 3, 249-258

Stigmatization At A Young Age Stigma interferes with people’s participation in society. The public places negative beliefs about those with mental illnesses. Seems that ideas and attitudes are learned over a period of time, beginning in childhood. Young children have adapted attitudes recognizing mental illness as less attractive than other health conditions. These may be seen as stereotypes.

Stigmatization At A Young Age (cont’d) Ninety-eight percent of American households have a television set, sometimes even more than one. Television is one of the earliest socializing agents in a child’s life. In America 2-11 year olds have the TV on for approximately 28 hours a week. TV viewing occupies more time than any other non-school activity. Among children it accounts for more than half of all leisure activities. Knowledge regarding mental illnesses come to children through the mass media depictions.

Wahl’s Research Through this research Wahl suggests that media images ingrain negative perceptions and attitudes toward people with mental illness. Children are exposed to this media and are learning these depictions.

Method Wahl reviews the depiction of mental illnesses in children’s media. Wahl & Roth (1982) focused mostly on adult media, at first, then gathered others research. Found that 1 in 11 prime time shows have a character labeled as having a mental illness. It has also been noted that those with mental illness were viewed as different, unsuccessful, socially unconnected, and unlikely to recover.

Method (cont’d) Gerber (1995) sampled nine seasons of Saturday morning programs (8AM-2PM), 394 programs total. Found that mentally ill characters fail twice as often as they succeed, highly likely to be killed, injured, or exploited. Beveridge (1996) studied Walt Disney films. He found that over a period of years, references to ‘madness’ appear. Beginning with Dumbo (1941), to Alice in Wonderland (1951), to Mary Poppins (1964), to Beauty and the Beast in (1992).

Method (cont’d) Hinted that the general message was, madness is something to fear. Wahl also noted that there are negative portrayals in books of the mentally ill. Found in the Harry Potter series, Harry is warned about an escaped prisoner that is ‘mad’. Also found in comic books that madness is something that turns good people into villains. (Batman’s opposite, The Joker, The Green Goblin in Spiderman. Identified popular songs with lyrics referring to mental illnesses. Numerous music videos featuring people in psychiatric hospitals and straightjackets.

Results After studying television shows, movies, cartoons, books, comics, music, and video games, Wahl found that references to mental illnesses are common and widespread. These references are more negative than positive. Images of these individuals express unattractive persons, violent behavior, and deviant behavior. Images are throughout children’s media. References toward illness are used mostly to ridicule.

Conclusion There’s a great deal of information regarding mental illnesses in children’s media. This information places a stigmatization on the mentally ill, and in a child’s mind this becomes Rosenhan’s “stickiness of the diagnostic label”. The child sees the character as ‘mad’ and attributes numerous characteristics. Such as violence, aggression, and fear inducing. Children are being shown that individuals with psychiatric disorders receive punishment rather than treatment. They are confined and isolated.

Further Questions If there continues to be a stigmatization on labels, how will this affect the numerous, and growing, amounts of children in public schools diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD)?