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Rosenhan (1973) Sane in Insane places . On being sane in insane places Science 179 250-8 . psychlotron.org.uk Mark Souter. Rosenhan (1973) Sane in Insane places. introduction difficulty of judging what is 'normal' varies over time / between societies

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Rosenhan 1973 sane in insane places

Rosenhan (1973) Sane in Insane places

On being sane in insane places

Science 179 250-8

psychlotron.org.uk Mark Souter


Rosenhan 1973 sane in insane places1
Rosenhan (1973) Sane in Insane places

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?

psychlotron.org.uk Mark Souter


Rosenhan 1973 sane in insane places2
Rosenhan (1973) Sane in Insane places

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

psychlotron.org.uk Mark Souter


Rosenhan 1973 sane in insane places3
Rosenhan (1973) Sane in Insane places

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

psychlotron.org.uk Mark Souter


Rosenhan 1973 sane in insane places4
Rosenhan (1973) Sane in Insane places

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!

psychlotron.org.uk Mark Souter


Rosenhan 1973 sane in insane places5
Rosenhan (1973) Sane in Insane places

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)

psychlotron.org.uk Mark Souter


Rosenhan 1973 sane in insane places6
Rosenhan (1973) Sane in Insane places

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'

psychlotron.org.uk Mark Souter


Rosenhan 1973 sane in insane places7
Rosenhan (1973) Sane in Insane places

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

psychlotron.org.uk Mark Souter


Rosenhan 1973 sane in insane places8
Rosenhan (1973) Sane in Insane places

psychlotron.org.uk Mark Souter


Rosenhan 1973 sane in insane places9
Rosenhan (1973) Sane in Insane places

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!]

psychlotron.org.uk Mark Souter


Rosenhan 1973 sane in insane places10
Rosenhan (1973) Sane in Insane places

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!

psychlotron.org.uk Mark Souter


Rosenhan 1973 sane in insane places11
Rosenhan (1973) Sane in Insane places

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

psychlotron.org.uk Mark Souter


Rosenhan 1973 sane in insane places12
Rosenhan (1973) Sane in Insane places

psychlotron.org.uk Mark Souter


Rosenhan 1973 sane in insane places13
Rosenhan (1973) Sane in Insane places

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

psychlotron.org.uk Mark Souter


Rosenhan 1973 sane in insane places14
Rosenhan (1973) Sane in Insane places

results: medication

  • PPs given 2,100 tablets

  • only 2 swallowed

  • when some were flushed PPs spotted other patients' medication!

  • = cooperative patients' behaviour ignored

psychlotron.org.uk Mark Souter


Rosenhan 1973 sane in insane places15
Rosenhan (1973) Sane in Insane places

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

psychlotron.org.uk Mark Souter


Rosenhan 1973 sane in insane places16
Rosenhan (1973) Sane in Insane places

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

psychlotron.org.uk Mark Souter


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