Being sane in insane places Rosenhan (1972) Like Zimbardo, stressed the importance of the SITUATIONS we find ourselves in. Background: problems with accurate diagnosis of mental illness. Aim: to find out if diagnosis is accurate or not and to find out if diagnosis is influenced by our situation.

Procedure 8 pseudopatients 12 psychiatric hospitals: wide variety. What happened? Presented symptoms: voices saying “empty”, “hollow”, “thud” N.B. Chosen because NO evidence of “existential psychosis” at all. Rosenhan himself was one of the pseudopatients.

Procedure Methodology? Participant observation. Problems? How do you think the pseudopatients felt? They only changed their names; otherwise they answered questions according to their real lives. If they were admitted, they were instructed to behave absolutely normally!

Results 11 admitted with a diagnosis of schizophrenia, 1 with a diagnosis of manic depression. Pseudopatients stayed in the institutions for an average of 19 days before being discharged (between 7 and 52 days.) All were discharged with a diagnosis of schizophrenia in remission.

Results Arguably, the most interesting results are to do with the observations made by the pseudopatients when “inside” Their sanity was more quickly noted by the real patients than by the professionals. Physicians/nurses spent very little time attending to the patients. Ill treatment of patients would only stop if a member of staff appeared, suggesting the mental patients were……? Other patients also dispensed with their medication down the toilet.

Results Behaviour tended to be interpreted according to the fact that they were inside a psychiatric hospital. E.g. “the patient engages in writing behaviour” Queuing early for meals: “the oral-acquisitive nature of the syndrome” Pacing the corridors was seen as a sign of nervousness.

Results Such a biased viewpoint also affected a pseudopatient’s case history after discharge. “This white 39 year old male…manifests a long history of considerable ambivalence in close relationships……Affective stability is absent…”. The facts were distorted to fit in with a popular theory about schizophrenia.

Results Moves on, head averted. 71% 88% Makes eye contact 23% 10% Response to initiated contact by patients e.g. “When am I likely to be discharged?” Psychiatrists Nurses Moves on, head averted. 71% 88% Makes eye contact 23% 10% Stops and talks 4% 0.5%

Think about these results How do think this made the patients feel? What was the reason for this response? Rosenhan spends some time discussing powerlessness, invisibility, and depersonalisation. He compared these results to some others found in a more ordinary environment, around the Campus and Medical School of Stanford University.

Type 1 and Type 2 errors In terms of the diagnosis, Rosenhan distinguishes between Type 1 and Type 2 errors. Type 1 is a false negative(-) Type 2 is a false positive(+) Which error was Rosenhan’s experiment investigating?

Results Stanford University University Campus University medical centre Question “Do you know where Fish Annex is? “Looking for an internist” “Looking for a psychiatrist” Makes eye contact 0% 11% Stops and talks 100% 78%

The second experiment How could Rosenhan test to see if Type 1 errors were being made? Psychiatrists and other professionals at a research and teaching psychiatric hospital were told to expect, over the next three months, some pseudopatients feigning mental illness…… Ethical issues?

Results Judgements were obtained on 193 patients who were admitted for treatment. 41 were thought, with high confidence, to be pseudopatients by at least one member of staff. 23 were suspected by psychiatrists 19 suspected by a psychiatrist and one other staff member. In fact, NO pseudopatients were sent at all

Evaluation What do YOU think of this study? Does it measure what it set out to? If not, why not? Ethical debate? Implications? Rosenhan writes of “the stickiness of diagnostic labels”. Usefulness……think DSM.. Finally, who was the sample?