Rosenhan (1973) Sane in Insane Places

Map to Spec – Page Studies in detail Describeevaluate a) Describe and evaluate Rosenhan (1973) “On being sane in insane places”

Map to Spec – Page Content reliability validity diagnosis c) Using the findings of studies, describe and evaluate reliability, validity and cultural issues with regard to the diagnosis of disorders (including use of Diagnostic and Statistical Manual (DSM)).

"If sanity and insanity exist, how shall we know them?"

In other words…. patients Do the characteristics of abnormality reside in the patients? or environments In the environments in which they are observed? Does madness lie in the eye of the observer?

Background classify A long history of attempting to classify abnormal behavior. medical model Most commonly accepted approach to understanding & classifying abnormal behavior is the medical model. Psychiatry Psychiatrists are medical doctors and regard mental illness as another kind of illness (in addition to physical) Beginning in the 1950s the medical model has used the Diagnostic and Statistical Manual of Mental Disorders (DSM) to classify abnormal behavior

The Medical Model psychological disorders mentalillnesses diagnosed & treated Assumes that psychological disorders are mental illnesses that need to be diagnosed & treated through therapy or medication

DSM-IV-TR authoritative classification scheme. The Diagnostic and Statistical Manual of Mental Disorders provides an authoritative classification scheme. Describes disorders Describes disorders and their prevalence without presuming to explain their causes

Labels diagnostic labels bias perception stigmatize Although diagnostic labels may facilitate communication and research, they can also bias our perception of people’s past and present behavior and unfairly stigmatize these individuals.

Background criticize 1960s - The anti-psychiatry movement (psychiatrists & psychotherapists) began to criticize the medical model Rosenhan Rosenhan was also a critic of the medical model – “Its a worrying thought that there could be thousands of people stuck in institutes that are just as ‘sane’ as we are.” unreliable His study can be seen as an attempt to demonstrate that psychiatric classification is unreliable

Background normal Difficulty of judging what is 'normal' time societies Varies over time / between societies sanityinsanity Rosenhan asked "If sanity and insanity exist, how shall we know them?" Research Q Research Q: if 'normal' people attempt admission to psychiatric hospitals, will they be detected? / how?

Aim reliably sane insane Test the hypothesis that psychiatrists cannot reliably tell the difference between people who are sane and those who are insane.

The Researchers Confederates (not the subjects) EIGHT sane people! Three women and five men One graduate student Three psychologists One pediatrician A painter A housewife A psychiatrist

Procedures 12 psychiatric hospitals 5 US states Telephoned 12 psychiatric hospitals for urgent appointment (5 US states) Arrived at admissions false names occupations Gave false names and occupations ‘life’ details correctly Gave other ‘life’ details correctly

So here’s my cunning plan. I’m going to send these people to a hospital and see what happens if they say they’ve got symptoms of madness.

symptom o What symptom could they use? why o And why?

Thud Hollow Empty They said their only symptom was hearing a voice, the same sex as they are, saying the following:

Procedures hearing voices Complained that they had been hearing voices same sex Unfamiliar and the same sex as themselves 'empty', 'hollow', 'thud Said 'empty', 'hollow', 'thud'. existential crisis symptoms Symptoms were partly chosen because they were similar to existential crisis symptoms (Who am I? What is it all for? – meaninglessness of one’s life) no mention Also chosen because there is no mention of existential psychosis in the literature.

Did they get let in? All All were admitted to hospital schizophrenia All but one were diagnosed as suffering from schizophrenia stoppedANY Once admitted the ‘pseudo-patients’ stopped simulating ANY symptoms ward activities Took part in ward activities

Procedures Kept notes Kept notes on their experiences secretly Did this secretly to begin with openly Then openly when they realised no one cared or paid any attention to them doing this

Findings never detected The pseudo-patients were never detected discharged immediately All pseudo-patients wished to be discharged immediately “fit to be discharged” BUT - they waited until they were diagnosed as “fit to be discharged”

How did the staff perceive them? misinterpreted Normal behavior was misinterpreted: - Writing notes described as -“The patient engaged in compulsive writing behavior” - Arriving early for lunch described as - “oral acquisitive syndrome” - Outburst from patient – never enquire what caused response ‘fit in’ Behavior distorted to ‘fit in’ with diagnosis/label

4 of the pseudo-patients carried out an observation on how patients were treated by staff…..

The pseudo-patients observations If patients approached staff with simple requests (NURSES & ATTENDANTS) 88% 88% ignored them (walked away with head averted) 10% made eye contact 2% stopped for a chat (1283 attempts)

The pseudo-patient’s observations If they approached staff with simple requests (PSYCHIATRISTS) 71% 71% ignored them (walked away with head averted) 23% made eye contact 2% stopped for a chat (185 attempts)

Observations 90% Nurses stayed in ward offices 90% of time 7 minutes per day Each ‘real patient’ spent less than 7 minutes per day with psychiatric staff

Powerlessness and Depersonalization Medical records were open to all staff regardless of status or therapeutic relationship with the patient Personal hygiene monitored Many of the toilets did not have doors Some of the ward orderlies were brutal to patients in front of other patients ~ would stop when another staff member approached This indicated that staff were credible witnesses but patients were not

How long did they stay in hospital? The shortest stay was 7 days The longest stay was 52 days 19 days The average stay was 19 days They had agreed to stay until they convinced the staff they were sane!!

Were they treated in the same way as normal patients medication tablets Given total of 2100 medication tablets They flushed them down the loos Noted that other patients did the same and that this was ignored as long as patients behaved themselves !!

Did anyone suspect? 35voiced suspicions 35 out of 118 patients voiced suspicions about the pseudo- patients - “You’re not crazy”, - “You’re a journalist”, -“You’re a professor, checking up on the hospital”

On Release The pseudo-patients were diagnosed with Schizophrenia “IN REMISSION”

So… Lack of monitoring Distortion of behavior Lack of normal interaction Powerlessness & depersonalization

Alice In Wonderland "But I don't want to go among mad people," Alice remarked. "Oh, you can't help that," said the Cat: "we're all mad here. I'm mad. You're mad.“ "How do you know I'm mad?" said Alice. "You must be,", "or you wouldn't have come here." "You must be," said the Cat, "or you wouldn't have come here."

Summarise IV What was the IV for this experiment? DV What was the DV for this experiment? experimental method What was the experimental method used?

Rosenhan: The follow up study… A teaching & research hospital heard of the first study – didn’t think they would make the same mistake They were warned that … Over the next three months ONE OR MORE pseudo-patient would attempt to be admitted

What happened……….? ‘new patients’ Staff members rated ‘new patients’ on scale as ‘how likely to be a fraud’ 193 patients ‘assessed’ 41 rated as a pseudo-patient (by staff) 23 rated as pseudo-patient (by psychiatrist) 19 rated as pseudo-patient (by both) 19 rated as pseudo-patient (by both)

AH HA HA HA! Just guess how many I’d really sent

How many of these SUSPECTS were pseudo-patients?……... NONE No No pseudo-patients were sent regular Staff were rating their regular intake

Summarise IV What was the IV in this study? DV What was the DV in this study?

What did Rosenhan conclude? Remember, his question was … Do the characteristics of abnormality reside in the patients?OR In the environments in which they are observed? Does madness lie in the eye of the observer?

Rosenhan’s conclusion….. “It is clear that we are unable to distinguish the sane from the insane in psychiatric hospitals” ‘sanity In the first study - We are unable to detect ‘sanity’ Type II error This is what’s known as a Type II error – diagnosing healthy people as sick insanity In the follow up study - We are unable to detect ‘insanity’ Type I error This is what’s known as a Type I error – diagnosing sick people as healthy

Rosenhan’s study highlighted: depersonalisation powerlessness The depersonalisation and powerlessness of patients in psychiatric hospitals behaviour is interpreted expectations labels That behaviour is interpreted according to expectations of staff and that these expectations are created by the labels SANITY & INSANITY

Another Rosenhan note…….. negative experience The pseudo-patients described their stay in the hospitals as a negative experience REAL This is not to say that REAL patients have similar experiences NOT Real patients do not know the diagnosis is false & are NOT pretending

Your Task Complete Dominoes activity in your groups – first to do it wins!

Your Task Exam conditions – past exam questions on methodology and findings of Rosenhan’s study Peer mark using mark scheme provided

Your Task Evaluate the study! In your groups consider one issue (G R A V E) How can the study be evaluated in terms of this issue? Are there strengths? Weaknesses? Both?