A / AS Psychology.. Key Studies

• Abnormal Psychology

• Key study

• D L Rosenhan (1973)

D L Rosenhan (1973)

On being sane in insane places!

                      

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?

Before we begin…….

• 1 List two behaviours that YOU consider to be a sign of

psychological abnormality

• 2 Write down why you think each of these behaviours is abnormal

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

Look at your examples:

• Did your examples fall into those three categories?

• Can you think of any other useful definitions of abnormality?

What was Rosenhan’s interest?

• How reliable are diagnoses of abnormality?

The astonishing study……….. On being sane in insane places…...

• D L Rosenhan (1973)

• What did he do?

• Who were involved?

The brave volunteers…… .

• EIGHT sane people!

– one graduate student

– three psychologists

– a paediatrician

– a painter

– Housewive

– Psychiatrist

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

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?”

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

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’

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

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)

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)

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!!

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 !!

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

Perhaps they behaved ‘abnormally’

• Pseudo-patient’s visitors detected “No serious behavioural consequences”

• DID ANYONE SUSPECT?

What about the REAL patients?

• 35 out of 118 patients voiced their suspicions

On release ………………...

• The pseudo-patients were diagnosed as

• Schizophrenia “IN REMISSION”

RosenhanThe 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 would attempt to be admitted

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

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

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’

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

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

– (Remember Zimbardo)

Questions YOU should be able to answer...

• Methodology -

• This was a participant observation

• Who were the OTHER participants?

• Was this study ethical? If not why not?

Questions YOU should be able to answer…….

• Why might the reports of the pseudo-patients have been unreliable?

Look back at your ‘list’ of abnormal behaviour ……...

• How can we devise some general rules

• to describe

• NORMAL and ABNORMAL behaviour

Rosenhan ….. YOU must read this study up

• 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?

On being sane in insane places...

•D L Rosenhan (1973)THE END