Klassische Experimente derPsychologie

On Being Sane in InsanePlaces

Author: D. L. Rosenhan (1973)

Presentation by:Student: Stavroula Vasiliadi

Professor: Michael Niedeggend

Contents

Criteria of Normal-Abnormal behaviour Rosenhan’s biography Rosenhan’s experiment Hypothesis Theoritical Propositions Method Results The normal are not detectably sane- Type I and type II errors The stickiness of psychodiagnostic labels The experience of psychiatric hospitalization Powerlessness and Depersonalization Recent Applications Critique Summary-Conclusion Bibliography

“Normality and abnormality are notuniversal. What is viewed as normal in oneculture may be seen quite aberrant inanother.”

Benedict (1934)

NORMAL ABNORMAL(Effective (Mental

functioning) illness)

“All behaviour can be seen to lie on a continuum with normal at one end, andabnormal at the other”

Distinguishing “normal” from “abnormal”behaviour:

CriteriaCortex of Behaviour

Persistence of Behaviour

Social Deviance

Subjective Distress

Psychological Handicap

Effect on Functioning

Are mental health professionals truly ableto distinguish between the mentally ill andthe mentally healthy?

What are the consequences of mistakes?

David L. Rosenhan

received his Bacelor ofArts degree in YeshinaUniversity

1953 Master Degree atColumbia University and5 years later his Ph.D inpsychology.

1970 joined the StanfordLaw School faculty

1972 RosenhanExperiment

ROSENHAN EXPERIMENT(1972)

Hypothesis

Do the characteristics that lead to psychologicaldiagnoses reside in the patients themselves or inthe environments and cortex in which observersfind them?

If the established criteria and the training mentalhealth professionals have received fordiagnosing mental illness are adequate, thenwould those professionals be able to distinguishbetween the insane and the sane?

Theoretical Propositions

Rosenhan proposed to have normalpeople admitted to psychiatric hospitalsand then determining whether they werediscovered to be sane and, if so, how?

If these “pseudopatients” were notdiscovered to be normal, this would beevidence that diagnoses of the mentally illare depend more from the situation thanfrom the patient.

Method

8 sane people (3 psychologists, a psychiatrist, apediatrician, a housewife and a painter) - 3women & 5 men

in 12 different hospitals in United States called the hospital and made an appointment all of them followed the same instructions changed their names and occupations complained only of hearing voices that said

“empty”, “hollow” and “thud” all subjects acted normally and gave truthful

information

Method

all except one admitted with the diagnoses of“schizophrenia”

apart from their nervousness the“pseudopatients“ behaved “normally” andcooperated with the staff and accepted allmedications (not swallowed)

all took notes of their experience

their aim was to convince the staff that theywere healthy enough to be discharged

Results

length of hospital stay: an average of 19 days( min. 7 max. 52)

no one of the “pseudopatients” was detected bythe hospital staff

1 was diagnosed with “schizophrenia” 7 were diagnosed with “schizophrenia in

remission” 35 out of 118 real patients voiced suspicions that

3 of the subjects were not actually mentally ill contacts between patients and staff were

minimal and often bizarre

The normal are not detectably sane

Rosenhan believed that this happened becauseof what statisticians call “type error 2”

What is the “type error 2” ? the error of accepting a hypothesis that

should have been rejected This error says that physicians are more incline to call a

healthy person sick than a sick person healthy. This isbecause it is better to err on the side of caution, tosuspect illness even among the healthy.

The difference between medical and psychiatricdiagnose is that psychiatric diagnoses carry thepersonal, legal and social stigma.

Type I and type II errors

Type I and type II errors

The stickiness of psychodiagnostic labels

When a patient is labeled as schizophrenicit becomes his/her central personality traitsand it colours all his/her behaviouralcharacteristics.

The label is so powerful that many of thepseudopatients’ normal behaviours wereoverlooked entirely or profoundlymisinterpreted.

Example from the Rosenhan’s researchof a pseudopatient’s stated history

The pseudopatient had had a close relationshipwith his mother but was rather remote from hisfather during his early childhood. Duringadolescence and beyond, however, his fatherbecame a close friend while his relationship withhis mother cooled. His present relationship withhis wife was characteristically close and warm.Apart from occasional angry exchanges, frictionwas minimal. The children had rarely beenspanked

The director’s interpretation of this rathernormal history

“This white 39-year-old male manifests a longhistory of considerable ambivalence in closerelationships which begins in early childhood. Awarm relationship with his mother cools duringhis adolescence. A distant relationship with hisfather is described as becoming very intense.Affective stability is absent. His attempts tocontrol emotionality with his wife and childrenare punctuated by angry outbursts and, in caseof the children, spankings. And while he says hehas several good friends, one senseconsiderable ambivalence embedded in thoserelationships also.”

The experience of psychiatrichospitalization

staff and patients are strictly segregated

those with the most power have least todo with patients and those with the leastpower are most involve with them

contacts between patients and staff areoften minimal

Pseudopatients test

the “pseudopatients” test to approach staffmembers and attempt to make a verbal contactby asking common questions

the most common response from the staff was abrief response to the question, offered while theywere “on the move” and with head averted or noresponse at all

pseudopatient: “Pardon me, Dr…..,could you tell me when I am eligible forground privileges?”psychiatrist: “Good morning, Dave. How are you today?”the doctor moved on without waiting for a response

Responses by Doctors and Staff toQuestions Posed by Pseudopatients

RESPONSE PSYCHIATRISTS(%)

NURSES ANDATTENDANTS(%)

Moves on, headaverted

71 88

Makes eye contact 23 10

Pauses and chats 2 2

Stops and talks 4 0.5

Powerlessness and Depersonalization

The absence of eye and verbal contact reflectavoidance and depersonalization

Powerlessness was evident everywhere:

The freedom of movement is restricted. Patients cannot initiate contact with the staff. Personal privacy is minimal. Patients personal history and anguish is available to any

staff member.

The Sources of Depersonalization

The attitude that all have toward thementally ill

(Fear, distrust, horrible expectations andbenevolent intentions)

The hierarchical structure of thepsychiatric hospital

(Patients do not spend much time ininterpersonal contact with doctoral staff and thismodel inspires the rest of the staff )

Recent Applications

Studies that have used Rosenhan’s research inchallenging the validity of diagnoses made by mentalhealth professionals

Thomas Szasz (early 1970):Mental illness are notdiseases, but problems in living that have social andenvironmental causes.

Wahl (1999): People feel the effects of the stigmasurrounding mental illness from various sources.

Biosvert & Faust (1999): The tolerance andunderstanding of mental illness is incrising.

Broughton & Chesterman (2001): People mayfabricate symptoms of mental illness (e.g.criminals)

Critique

Spitzer’s belief is that Rosenhan’s studydid not really invalidate psychologicaldiagnostic systems.(1976)

3 possible ways of detecting the sanity ofa “pseudopatient”:

Detecting sanity before admission Detecting sanity after admission The patient was no longer insane

1. Detecting sanity before admission

The symptom of hallucinations does havediagnostic signification even though there wasnot in the literature

The clinical picture includes not only thesymptom but also the desire to enter apsychiatric hospital.

From that is reasonable to conclude that thesymptom is a source of significant distress.

With all the other conditions ruled out there isonly one possible diagnoses left: Schizophrenia

2. Detecting sanity after admission

Diagnostic conditions are not alwayschronic and unremitting

Mental illnesses endure forever (APA’s DSM)The diagnoses of schizophrenia does not

mean that all the patient’s behavior isschizophrenic

3. The patient was no longer insane

The diagnoses “schizophrenic in remission”is extremely unusual because:

a) Patients with the diagnosis ofschizophrenia are rarely completelyasymptomatic when discharged.

b) The discharged diagnosis associatedwith the admission to the hospital withoutany reference to the condition of thepatient when discharged

Summary-Conclusion

Rosenhan“It is clear that we cannotdistinguish the sane fromthe insane in psychiatrichospitals.(…)In a morebenign environment, onethat was less attached toglobal diagnosis, theirbehaviours andjudgments might havebeen more benign andeffective.”

Spitzer has argued that

psychological diagnosticsystems are invalidated.

Such symptom variationin psychiatric disorders iscommon and does notmean that the staff wasincompetent in failing todetect the ruse.

Bibliography

Roger R. Hock, Forty Studies that ChangedPsychology, Pearson Prentice Hall, 2005, p.226-234

D.L.Rosenhan, On Being Sane in Insane Places,Science, New Series, Vol.179, No 4070, (Jan.19,1973), p.250-258

Robert L. Spitzer, More on Pseudoscience inScience and the Case for Psychiatric Diagnosis,Arch Gen Psychiatry, Vol.33, April 1976

Internet

Thank you for your attention