View
215
Download
2
Category
Preview:
Citation preview
On being sane in insane places
Science 179 250-8
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?
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
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
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!
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)
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'
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
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!]
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!
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
self-initiated contact by psuedo-patients with psychiatrists, nurses and attendants
0 10 20 30 40 50 60 70 80 90 100
move on with headaverted
makes eye contact
pauses and chats
stops and talks
psychiatrists nurses and attendants
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
results: medication PPs given 2,100 tablets only 2 swallowed when some were flushed PPs spotted
other patients' medication! = cooperative patients' behaviour
ignored
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
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
Recommended