D L Rosenhan 1973 On being sane in insane places

1. D L Rosenhan (1973)On being sane in insane places! You don’t have to be mad to work here. You don’t even have to be mad to be in here…

2. The Question……. Before we begin……. List two behaviours that YOU consider to be a sign of psychological abnormality this must be something you can see someone do Write down why you think each of these behaviours is abnormal

3. The Question……. If sanity and insanity exist How shall we recognise them? Specifically……. 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?

4. Defining Abnormality Rosenhan & Seligman (1989) A behaviour is likely to be seen as abnormal if it …. Appears Deviant – Violates moral/ideal standards most people don’t behave that way But deviant to whom? Statistical deviance Deviance from a social norm Homosexuality Causes the person Distress/Suffering Cause upset But to whom? Seems to be Dysfunctional/Maladaptive Interferes with daily life does not help the individual or the group Is potentially Dangerous To self or others Seems to be Irrational Makes no sense Appears Unconventional/vividness Out the ordinary and very noticeable Causes Observer discomfort You feel uncomfortable when you see it

5. Consequences If abnormality exists Needs to be treated Before it can be treated It needs to be diagnosed How do we diagnose disease Symptoms What you tell the doctor you are suffering from Subjective experience – I have a headache Signs The tests that the doctor does to you Objective facts – the X-ray has a shadow BUT in MENTAL ILLNESS only have SYMPTOMS Abnormality may only be a subjective experience which is used a method of social control

6. Some real life examples Jennifer Bill Liz Steve Early Therapy

7. The problem Is the diagnosis of an abnormal condition reliable? Would two doctors with the same patient give the same diagnosis Is the diagnosis of an abnormal condition valid? Are we really measuring mental states

8. Study 1 Aim To see if sane individuals can get diagnosed as insane Who was involved EIGHT sane people recruited by Rosenhan by ringing round his friends and asking if they were doing anything in October! one graduate student three psychologists (Including Rosenhan) a pediatrician a painter Housewives Some of them did the study more than once

9. Study 1 What did they DO? For five days they practiced Had to stop shaving, washing, and brushing teeth telephoned 12 psychiatric hospitals for urgent appointment (in five USA states) This was the SAMPLE A range of different hospitals Old and modern Well staffed and poorly staffed One was a private institution

10. Study 1 What did they DO? arrived at admissions gave false name and address gave other ‘life’ details correctly 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?” This was a symptom of schizophrenia not previously reported

11. Study 1 What happened? All were admitted to hospital All bar one were diagnosed as schizophrenia The seventh one was diagnosed as bi-polar Once admitted the ‘pseudo-patients’ stopped simulating ANY symptoms Took part in ward activities The agreement they made at the beginning of the study was that they would have to get out by their own devices Had to be diagnosed as ‘fit to be discharged’

12. What happened? On the ward The pseudo-patients were never detected by the staff The patients did think something was odd One patient said ‘You’re not crazy. You’re a journalist or a professor’

13. What happened? How did the ward staff see them? From the medical notes 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 This is called a confirmatory bias

14. Other features More evidence that they were treated normally... 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 !! 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

15. 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!! On release ………………... The pseudo-patients were diagnosed as Schizophrenia “IN REMISSION” Shows the doctors accepted that they did have schizophrenia

16. Study 2 Staff behaviour 4 Pseudo patients carried out a study They approached staff with simple request When will I be presented at the staff meeting? NURSES & ATTENDANTS 88% ignored them walked away with head averted 10% made eye contact 2% stopped for a chat 1283 attempts PSYCHIATRISTS 71% ignored them walked away with head averted 23% made eye contact 2% stopped for a chat 185 attempts Replicated in a university

17. Some questions Who were the participants in the study? The doctors and nurses What kind of study is it? A participant observation What is the IV in the small study The place the questions were asked What was the DV in the small study The response to the questions

18. The follow up study… (Study 3) A teaching & research hospital was told of the first study and they challenged Rosenhan that they would be able to spot his fakes Rosenhan agreed and warned that … Over the next three months ONE OR MORE pseudo-patient would attempt to be admitted

19. 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) How many of these SUSPECTSwere pseudo-patients? NONE No pseudo-patients were sent Staff were rating their regular intake

20. 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? 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’

21. Rosenhan’s study highlighted ... The depersonalisation and powerlessness of patients in psychiatric hospitals Not able to control everyday actions Not treated as an individual but as an illness ‘…the patient is deprived of many of his legal rights …his freedom of movement is restricted, he cannot initiate contact with staff … personal privacy is minimal, his personal history is available to any member of staff (including volunteers) who choose to read his file, and toilets may have no doors.’

22. Rosenhan’s study highlighted ... That behaviour is interpreted according to expectations of staff and that these expectations are created by the labels SANITY & INSANITY These psycho diagnostic labels are sticky Once you get a diagnosis everything is seen through the label Can stay with you for life (Schizophrenia in remission)

23. Rosenhan’s study highlighted ... 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 So what do you think about it?

24. Errors Type 1 A false positive Identifying someone as sick when they are well Type 2 A false negative Identifying someone as well when they are sick