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 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

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 ROSENHAN’S 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 painter• housewives

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!!

• Discuss: How would YOU convince someone you are 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 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 ‘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 – 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

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

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 STUDY

• 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?