Devise at least 5 (no

more than 10) questions on the Rosenhan

study.

Try to make them

challenging – some ideas:

They will mainly be knowledge based, but you

can include some

comprehension ones too.

WhatWho

WhereHowWhy

WhichExampleDifferentSimilar

Now:

• Pair up and quiz each other – help each other out if either of you is stuck!

• We will rotate in a little while

What did people find tricky?

Recap and QuestionsD.L. Rosenhan (1973)

• The ground breaking study :

“On being sane in insane places”

What was Rosenhan interested in?

The main aim was to test whether the classification

system that determined whether someone was sane or insane was reliable.

Can sane individuals be diagnosed as insane and admitted to hospital?

A secondary aim was see whether or not it is the characteristics of the patients that lead to diagnosis or the context itself.

i.e. once on the ward, will all behaviour be judged as abnormal, regardless?

CORE STUDY:ROSENHAN (1973)‘ON BEING SANE

IN INSANE PLACES’

APPROACH: INDIVIDUAL DIFFERENCESSTUDY: ROSENHAN (1973)

• TO UNDERSTAND THE BACKGROUND AND CONTEXT TO ROSENHAN’S STUDY• TO CRITICALLY CONSIDER DEFINITIONS OF ABNORMALITY• TO ANALYSE THE IMPLICATIONS OF THESE DEFINITIONS

Type 1 & 2 Errors

Type 1 Error

• Type I Error is a false positive, or when you reject the null hypothesis and it's actually true

Type 2 Error

• Type II error is a false negative, or when you accept the null hypothesis and it's actually false.

The volunteers

• EIGHT sane people– one graduate student – three psychologists – a paediatrician – a painter– Housewives– A psychiatrist (Rosenhan)

What did they do?

The procedure:

• telephoned 12 psychiatric hospitals for urgent appointments

• gave false name and address• complained of hearing unclear voices … saying

“empty, hollow, thud”

– Simulated ‘existential crisis’– “Who am I, what’s it all for?”

• This is because the symptoms, although clearly a sign of a mental disorder did not fit into a specific diagnosis well.

Study 1 (a) Participant observation 8 pseudo patients (5 male, 3 female) ‘normal’

people 3 psychologists, a paediatrician, a

psychiatrist, a painter and a housewife, a psychology graduate

Patients ‘self-referred’ Used fake names sought admission to 12 hospitals reported that they had been hearing voices

which said ‘empty’, ‘hollow’ and ‘thud’ – this was chosen as it was not necessarily a symptom of a specific disorder.

Once admitted patients behaved normally and observed the behavior of staff and genuine patients.

They had to persuade staff that they were ‘sane’.

Study 1 (b) Participant observation 4 hospitals pseudo patients approached members of staff

and asked. :pardon me, MR/Dr/Mrs X, could you tell me when I will be eligible for grounds privileges/…when will I be presented at the staff meeting/… when am I likely to be discharged?’ to measure staff response to patients.

 Study 2 Method: self-report – 10 point scale Asked to rate each patient who arrived Staff who were aware of the findings of Study 1 Warned that pseudopatients would present

themselves over the next three months. None did.

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

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 label

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?

• Yes – the real patients

What about the REAL patients?

• 35 out of 118 patients voiced their suspicions

On release -

• The pseudo-patients were diagnosed as

• Schizophrenia “IN REMISSION”

Rosenhan: The 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

Summary of findings:  All pseudopatients were admitted All bar one were diagnosed as schizophrenic, even until the

end and were discharged as ‘schizophrenic in remission’ Length of hospitalization ranged from 7-52 days (av 19

days) Many real patients detected that the pseudopatients were

not genuine patients 35/118 voiced suspicion Normal behavior was misinterpreted e.g. note taking.

Pacing corridors seen as a sign of anxiety. Average daily contact with medical staff ranged from 3.9-

25.1 mins (all low) Personal hygiene and waste evacuation often monitored.

WCs had no doors. Pseudopatients experiences powerlessness and

depersonalization.

Summary of findings:Study 1(b) The most common response to the question was either a brief response on the move, or no response at all.Few staff make eye contact with pseudopatients. Study 2193 patients reported for treatment.41 judged by at least one member of staff23 by at least one psychiatrist19 by at least two members of staffTo be pseudopatients (remember, there were none)

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

Homework

• Evaluate Rosenhan• Due next lesson