2. D L ROSENHAN (1973) On being sane in insane places!

3. THE QUESTION……. If sanity and insanity exist How shall we recognise them? HL

4. BEFORE WE BEGIN……. 1Look at the list of behaviours 2Write down why you think each of these behaviours is abnormal or normal. spider Put your suggestions aside for a moment

5. SOME DEFINITIONS OF ABNORMALITY Stratton & Hayes (1993).. Abnormality IS Behaviour which deviates from the norm most people don’t behave that way Behaviour which does not conform to social demands most people don’t like that behaviour Behaviour which is maladaptive or painful to the individual its not normal to harm yourself

7. SPECIFICALLY……. Do the characteristics of abnormality reside in the patients? or in the environments in which they are observed?

8. THINK ABOUT THIS.. Does madness lie in the eye of the observer?

9. WHAT WAS ROSENHAN’S INTEREST? How reliable are diagnoses of abnormality? Will the same symptoms always be diagnosed in the same way?

10. THE ASTONISHING STUDY……….. ON BEING SANE IN INSANE PLACES…... D L Rosenhan (1973) What did he do? Who were involved?

11. THE BRAVE VOLUNTEERS……. EIGHT sane people! one graduate student three psychologists a paediatrician a painter housewives

12. WHAT DID THEY DO? THE PROCEDURE…………………….. telephoned 12 psychiatric hospitals for urgent appointment (in five USA states) arrived at admissions gave false name and address gave other ‘life’ details correctly

13. WHAT ELSE DID THEY DO? complained of hearing unclear voices … saying “empty, hollow, thud” Said the voice was unfamiliar, but was same sex as themselves Simulated ‘existential crisis’ “Who am I, what’s it all for?”

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. WHAT HAPPENED ON THE WARDS? The pseudo-patients were never detected All pseudo-patients wished to be discharged immediately BUT - they waited until they were diagnosed as ‘fit to be discharged’

16. 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 theory

17. THE PSEUDO-PATIENT’S OBSERVATIONS… If they approached staff with simple request (NURSES & ATTENDANTS) 88% ignored them (walked away with head averted) 10% made eye contact 2% stopped for a chat (1283 attempts)

18. THE PSEUDO-PATIENT’S OBSERVATIONS… If they approached staff with simple request (PSYCHIATRISTS) 71% ignored them (walked away with head averted) 23% made eye contact 2% stopped for a chat (185 attempts)

19. 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?

20. 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 !!

21. 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

22. PERHAPS THEY BEHAVED ‘ABNORMALLY’ Pseudo-patient’s visitors detected “No serious behavioural consequences” DID ANYONE SUSPECT?

23. WHAT ABOUT THE REAL PATIENTS? 35 out of 118 patients voiced their suspicions

24. ON RELEASE ………………... The pseudo-patients were diagnosed as Schizophrenia “IN REMISSION”

25. 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

26. 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)

27. HOW MANY OF THESE SUSPECTS WERE PSEUDO-PATIENTS?……... NONE No pseudo-patients were sent – the staff were rating their regular intake

28. 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

29. 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’

30. 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

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

32. QUESTIONS YOU SHOULD BE ABLE TO ANSWER... Methodology: This was a field experiment Who were the participants? Was this study ethical? If not why not?

33. QUESTIONS YOU SHOULD BE ABLE TO ANSWER……. Why might the reports of the pseudo-patients have been unreliable?

34. LOOK BACK AT YOUR ‘LIST’ OF ABNORMAL BEHAVIOUR ……... Can we devise some general rules to describe NORMAL and ABNORMAL behaviour

35. ROSENHAN ….. YOU MUST READ THIS STUDY It is one of the most influential studies in Abnormal Psychology If there are such things as SANITY and INSANITY HOW SHALL WE KNOW THEM?