D L ROSENHAN (1973) On being sane in insane places!

D L ROSENHAN (1973) On being sane in insane places!

THE QUESTION.If sanity and insanity exist How shall we recognise them?

HL

BEFORE WE BEGIN.1Look at the list of behaviours

2Write down why you think each of these behaviours is abnormal or normal. spiderPut your suggestions aside for a moment

SOME DEFINITIONS OF ABNORMALITYStratton & Hayes (1993) .. Abnormality ISBehaviour which deviates from the norm most people dont behave that way

Behaviour which does not conform to social demands most people dont like that behaviour

Behaviour which is maladaptive or painful to the individual its not normal to harm yourself

SPECIFICALLY.Do the characteristics of abnormality reside in the patients?

or in the environments in which they are observed?

THINK ABOUT THIS .. Does madness lie in the eye of the observer?

WHAT WAS ROSENHANS INTEREST?

How reliable are diagnoses of abnormality?

Will the same symptoms always be diagnosed in the same way?

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 painterhousewives

WHAT DID THEY DO?THE PROCEDURE..

telephoned 12 psychiatric hospitals for urgent appointment (in five USA states)arrived at admissionsgave 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 crisisWho am I, whats it all for?

WHAT HAPPENED? .. All were admitted to hospitalAll but one were diagnosed as suffering from schizophrenia

Once admitted the pseudo-patients stopped simulating ANY symptomsTook 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 misinterpretedWriting 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-PATIENTS OBSERVATIONSIf they approached staff with simple request(NURSES & ATTENDANTS)88% ignored them (walked away with head averted)

10% made eye contact2% stopped for a chat(1283 attempts)

THE PSEUDO-PATIENTS OBSERVATIONSIf they approached staff with simple request(PSYCHIATRISTS)71% ignored them (walked away with head averted)

23% made eye contact2% stopped for a chat(185 attempts)

HOW LONG DID THEY STAY IN HOSPITAL?The shortest stay was 7 daysThe longest stay was 52 days

The average stay was 19 daysThey had agreed to stay until they convinced the staff they were sane!!

Discuss: How would YOU convince someone you are sane?

WERE THEY TREATED IN THE SAME WAY AS NORMAL PATIENTS...Given total of 2100 medication tabletsthey 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-patients 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 will attempt to be admitted

WHAT HAPPENED.?Staff members rated new patients on scale 1 - 10 as how likely to be a fraud

193 patients assessed41 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?... NONENo pseudo-patients were sent the 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

ROSENHANS CONCLUSION.. It is clear that we are unable to distinguish the sane from the insane in psychiatric hospitalsIn the first study We are unable to detect sanityIn the follow up studyWe are unable to detect insanity

ROSENHANS 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 experiencesReal patients do not know the diagnosis is false & are NOT pretending

QUESTIONS YOU SHOULD BE ABLE TO ANSWER...Methodology: This was a field experiment

Who were the 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 ... Can we devise some general rules

to describe

NORMAL and ABNORMAL behaviour

ROSENHAN .. YOU MUST READ THIS STUDYIt is one of the most influential studies in Abnormal Psychology

If there are such things as SANITY and INSANITY HOW SHALL WE KNOW THEM?