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