2. On being sane in insane places Science 179 250-8

3. introduction  difficulty of judging what is 'normal'  varies over time / between societies  Rosenhan asked "If sanity and insanity exist, how shall we know them?" p250  research Q: if 'normal' people attempt admission will they be detected? / how?

4. the study: researchers (NOT participants!)  8 sane people attempted admission  graduate student; 3 psychologists; a paediatrician; a painter; a 'housewife'  telephoned for an appointment  12 hospitals; 5 US states  gave false names/addresses; otherwise correct details

5. the study: pseudo-symptoms  pseudo-patients (PPs) reported unfamiliar, same sex 'voices'  unclear but said 'empty'; 'hollow'; 'thud'  simulated 'existential crisis'  (who am I?; why am I here?)  NB no mention of 'existential crisis' in theories in psychosis

6. the study: after admission  stopped reporting symptoms ... but may have looked anxious!  took part in ward activities  kept notes  each had to get out by their own devices!

7. Results: hospitals' responses  NB hospital staff were the subjects (participants) of this experiment  none of the PPs were detected  all but one diagnosed as schizophrenic  NB not one clear symptom of this!  some other patients were suspicious (35/118 said so)

8. results: getting out  all pseudo-patients (PPs) wanted to get out ASAP!  remained in hospital 7 - 52 days (av 19)  discharged with 'schizophrenia in remission'

9. results: follow up study  a teaching and research hospital aware of study  told one or more pseudo-patients would seek admission in next 3m  c 1/10 suspected by 1 psychiatrist + one staff member  none had been sent

11. Results: general observations (1)  normal behaviour of PPs ignored or misinterpreted  note taking recorded as pathological in 3 medical records  e.g. 'Patient engages in writing behaviour'  [please engage in this behaviour in my lessons!]

12. results: general observations (2)  Rosenhan noted:  sane/insane behaviour overlap (such as depressed moods or anger)  in the study a psychiatrist was observed to note early queuing for lunch  told registrars [trainees] this was 'oral- acquisitive' syndrome  another interpretation: boredom in hospital!

13. results: PP observations  PPs approached staff with polite requests e.g. 'Pardon me Dr X, could you tell me when I will be presented at the staff meeting?  71% psychiatrists; 88% nurses totally ignored PP's Qs!  [comparative study U students - U staff virtually 100% responses]  nurses stayed in offices c90% of time  therapist-patient contact = < 7 mins per day

15. results: evidence of depersonalisation  no privacy, even in toilet (doors often removed)  medical records open to all staff, regardless of therapeutic responsibility  ward orderlies brutal in front of other patients; stop when other staff seen  = patients’ views valueless

16. results: medication  PPs given 2,100 tablets  only 2 swallowed  when some were flushed PPs spotted other patients' medication!  = cooperative patients' behaviour ignored

17. discussion (1)  Rosenhan claimed  "It is clear we cannot distinguish the sane from the insane in psychiatric hospitals" (p257)  seems to be overstating BUT  failure to detect sanity  follow up questionable detection of insanity

18. discussion (2)  depersonalisation and powerlessness  R said behaviours interpreted via expectations  R said better to discuss behaviours and causes  R noted real patients did not have PPs' comfort of false diagnosis