1. Devise at least 5 (no more than 10) questions on the Rosenhan study. Try to make them challenging – some ideas: They will mainly be knowledge based, but you can include some comprehension ones too. What Who Where How Why Which Example Different Similar

2. Now: Pair up and quiz each other – help each other out if either of you is stuck! We will rotate in a little while Pair up and quiz each other – help each other out if either of you is stuck! We will rotate in a little while

3. What did people find tricky?

4. Recap and Questions D.L. Rosenhan (1973) The ground breaking study : “On being sane in insane places”

5. What was Rosenhan interested in? The main aim was to test whether the classification system that determined whether someone was sane or insane was reliable. Can sane individuals be diagnosed as insane and admitted to hospital? A secondary aim was see whether or not it is the characteristics of the patients that lead to diagnosis or the context itself. i.e. once on the ward, will all behaviour be judged as abnormal, regardless? CORE STUDY: ROSENHAN (1973) ‘ON BEING SANE IN INSANE PLACES’ APPROACH: INDIVIDUAL DIFFERENCES STUDY: ROSENHAN (1973) TO UNDERSTAND THE BACKGROUND AND CONTEXT TO ROSENHAN’S STUDY TO CRITICALLY CONSIDER DEFINITIONS OF ABNORMALITY TO ANALYSE THE IMPLICATIONS OF THESE DEFINITIONS

6. Type 1 & 2 Errors

7. Type 1 Error Type I Error is a false positive, or when you reject the null hypothesis and it's actually true

8. Type 2 Error Type II error is a false negative, or when you accept the null hypothesis and it's actually false.

9. The volunteers EIGHT sane people – one graduate student – three psychologists – a paediatrician – a painter – Housewives – A psychiatrist (Rosenhan)

10. What did they do? The procedure: telephoned 12 psychiatric hospitals for urgent appointments gave false name and address complained of hearing unclear voices … saying “empty, hollow, thud” – Simulated ‘existential crisis’ – “Who am I, what’s it all for?” This is because the symptoms, although clearly a sign of a mental disorder did not fit into a specific diagnosis well.

11. Study 1 (a)  Participant observation  8 pseudo patients (5 male, 3 female) ‘normal’ people  3 psychologists, a paediatrician, a psychiatrist, a painter and a housewife, a psychology graduate  Patients ‘self-referred’  Used fake names  sought admission to 12 hospitals  reported that they had been hearing voices which said ‘empty’, ‘hollow’ and ‘thud’ – this was chosen as it was not necessarily a symptom of a specific disorder.  Once admitted patients behaved normally and observed the behavior of staff and genuine patients.  They had to persuade staff that they were ‘sane’.

12. Study 1 (b)  Participant observation  4 hospitals  pseudo patients approached members of staff and asked. :pardon me, MR/Dr/Mrs X, could you tell me when I will be eligible for grounds privileges/…when will I be presented at the staff meeting/… when am I likely to be discharged?’ to measure staff response to patients.

13. Study 2  Method: self-report – 10 point scale  Asked to rate each patient who arrived  Staff who were aware of the findings of Study 1  Warned that pseudopatients would present themselves over the next three months.  None did.

14. What happened? All were admitted to hospital All but one were diagnosed as suffering from schizophrenia Once admitted the ‘pseudo-patients’ stopped simulating ANY symptoms Took part in ward activities

15. How did the ward staff ‘see’ them? Normal behaviour was misinterpreted Writing notes was described as - – “The patient engaged in writing behaviour” Arriving early for lunch described as – “oral acquisitive syndrome” – Behaviour distorted to ‘fit in’ with label

16. How long did they stay in hospital? The shortest stay was 7 days The longest stay was 52 days The average stay was 19 days – They had agreed to stay until they convinced the staff they were sane. – Discuss: – How would YOU convince someone you are sane?

17. Were they treated in the same way as normal patients? 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!

18. What sorts of records did they keep? Nurses stayed in ward offices 90% of time Each ‘real patient’ spent less than 7 minutes per day with psychiatric staff

19. Perhaps they behaved ‘abnormally’ Pseudo-patient’s visitors detected “No serious behavioural consequences” DID ANYONE SUSPECT? Yes – the real patients

20. What about the REAL patients? 35 out of 118 patients voiced their suspicions

21. On release - The pseudo-patients were diagnosed as Schizophrenia “IN REMISSION”

22. Rosenhan: The follow up study A teaching & research hospital was told of the first study and warned that … Over the next three months ONE OR MORE pseudo-patient will attempt to be admitted

23. What happened? Staff members rated ‘new patients’ on scale 1 - 10 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)

24. How many of these SUSPECTS were pseudo-patients? NONE No pseudo-patients were sent – the staff were rating their regular intake

25. Summary of findings:  All pseudopatients were admitted  All bar one were diagnosed as schizophrenic, even until the end and were discharged as ‘schizophrenic in remission’  Length of hospitalization ranged from 7-52 days (av 19 days)  Many real patients detected that the pseudopatients were not genuine patients 35/118 voiced suspicion  Normal behavior was misinterpreted e.g. note taking. Pacing corridors seen as a sign of anxiety.  Average daily contact with medical staff ranged from 3.9-25.1 mins (all low)  Personal hygiene and waste evacuation often monitored. WCs had no doors.  Pseudopatients experiences powerlessness and depersonalization.

26. Summary of findings: Study 1(b) The most common response to the question was either a brief response on the move, or no response at all. Few staff make eye contact with pseudopatients. Study 2 193 patients reported for treatment. 41 judged by at least one member of staff 23 by at least one psychiatrist 19 by at least two members of staff To be pseudopatients (remember, there were none)

27. Rosenhan’s conclusion “It is clear that we are unable to distinguish the sane from the insane in psychiatric hospitals” – In the first study : We are unable to detect ‘sanity’ – In the follow up study : We are unable to detect ‘insanity’

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

29. Homework Evaluate Rosenhan Due next lesson