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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. 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

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  1. Rosenhan (1973) Sane in Insane places On being sane in insane places Science 179 250-8

  2. 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?

  3. 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

  4. 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

  5. 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!

  6. 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)

  7. 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'

  8. 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

  9. Rosenhan (1973) Sane in Insane places

  10. 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!]

  11. 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!

  12. 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

  13. Rosenhan (1973) Sane in Insane places

  14. 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

  15. 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

  16. 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

  17. 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

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