Study 2 - Asch (1955)
On Being Sane in Insane Places
Field of psychology: Individual Differences
1. CONTEXT AND AIMS
How do we define sane? How about insane? Is there a difference? How do we tell?
In PY1 we looked at some biological therapies. These therapies are based on the assumption that mental illness, like physical illness has its basis in biology. This concept is called the medical model of abnormality because it aims to treat psychological disorders as if they were physical illnesses.
A key feature of the medical model is that mental illnesses are diagnosed in much the same way as physical illnesses. The doctor (psychiatrist) identifies a set of symptoms in the patient and uses these to identify a disorder.
In the 1960s psychiatrists such as Foucault, Laing and Szasz launched the anti-psychiatry movement. They challenged the fundamental claims and practices of mainstream psychiatry, in particular the medical model of mental illness.
The anti-psychiatry movement questioned the validity of psychiatric diagnosis. What does this mean? (pg122)
Foucault (1961) cited the development of the concept of mental illness in the 17th and 18th centuries when unreasonable members of the population were locked away, institutionalised and subject to inhumane treatment (see drapetomania above). He argued that the label of “mental illness” was misused to keep control of people who were seen as a threat to society. Mental illness therefore is a social construct, with no legitimate basis in biology. They did not reflect quantifiable patterns of human behaviour, and which, rather, were indicative only of the power of the "sane" over the "insane".
What did Laing (1960) argue about schizophrenia?
Szasz (1960) argued that the medical model is no more sophisticated than believing in demonology (believing that mental illness is caused by demons) and that it is unhelpful to our understanding of psychiatric conditions. He suggested that the concept of mental illness was simply a way of keeping non-conformists from society.
David Rosenhan was influenced by the anti-psychiatric movement, and he too questioned the validity of the methods with which psychiatrists diagnosed mental disorders. He did not argue that mental illness did not exist, nor that people could suffer great anguish because of it.
In other words, depending upon the situation and environment a person is in, they may be judged to be sane or insane. His main question was “If sanity and insanity exist, how will we know them?” We may think that we can tell the normal from the abnormal, but the evidence for this is less than compelling.
· It is common to read about murder trials where the prosecution and the defence each call their own psychiatrists who disagree on the defendant’s sanity.
What does this suggest about the validity and reliability of diagnosis?
· There is much disagreement over the meanings of such terms as “sanity”, “insanity”, “mental illness” and “schizophrenia”. If experts cannot even agree on the definitions of such terms, how can they possibly use the concepts to determine the sane from the insane?
· Concepts of normal and abnormal are not universal. What is considered normal in one culture may be seen as bizarre in another.
Rosenhan wanted to investigate whether psychiatrists could distinguish between people who were genuinely mentally ill, and those who are not. He argued that the question of personality vs situation can be investigated by having ‘normal’ people (that is people who have never had serious psychiatric symptoms) seek to be admitted to a psychiatric hospital. The aim was to investigate whether it was the characteristics of the individual which lead to a diagnosis of mental illness, or whether the context (the psychiatric hospital- the “insane place”) would have a greater influence. There were two possible outcomes:
1. The pseudopatients would be identified as sane, and be discharged. If this were the case, we can assume:
2. The pseudopatients would not be identified as sane, and/or labelled as insane. This would mean:
2. PROCEDURES (pg123)
Who were the participants?
Research method used?
Naturalistic observation (not a field study, as there is no real IV and DV)
· Each of the pseudopatients called a hospital and asked for an appointment. On arrival, he/she told the staff at the hospital that they had been hearing voices saying words that included “empty” “hollow” and “thud”. These particular symptoms were chosen because of their similarity to existentialist symptoms (the meaningless of life) and their absence in the psychiatric literature of the time.
· Aside from the description of auditory hallucinations, each pseudopatient described their life events accurately (both good and bad) and invented no more symptoms. None of the pseudopatients had a history of psychiatric disturbance.
· The hospitals varied from old to new, some were research based and one was a private hospital.
Life in the Hospital
· Once in the hospital, the pseudopatients were instructed to behave normally, and other from some understandable nervousness and tension about being found out, they behaved as they would outside of the hospital.
· They spent their time talking to other patients and making notes of observations of life on the ward. Initially, notes were made in secret, but it soon became apparent that the staff did not really care.
· The pseudopatients secretly did not take their medication, but otherwise followed the rules of the ward, and behaved courteously and co-operatively.
· After the results of study 1 were published, staff in another hospital challenged Rosenhan claiming that this could not happen in their hospital. Rosenhan informed the hospital that in the next three months, one or more pseudopatients would present themselves.
· The staff were asked to rate one a 10 point scale their confidence that the person was genuinely ill (1 was high confidence, 10 was low). Judgements were obtained on 193 patients admitted for psychiatric treatment during this time.
· In fact, Rosenhan did not send any pseudopatients to the hospital.
· During study 1, Rosenhan conducted a mini experiment to see how the staff responded to pseudopatients. In four of the hospitals, the pseudopatients approached a member of staff with the following questions “Pardon me Mr X, could you tell me when I will be eligible for grounds privileges?” or “When am I likely to be discharged?” The pseudopatients asked as normally as possible, and tried not to ask the same staff member more than once in a day.
· As a control condition, a young woman approached staff members on the Stanford university campus, and asked them similar questions.
3. FINDINGS AND CONCLUSIONS (pg124-5)
· All of the pseudopatients were admitted to the hospital, and all but one of them was diagnosed as ___________________________ (the other was diagnosed as ______________________________)
· The range of stay was ___________________________________________.
· Eventually there were all discharged from the hospital, but with a label of schizophrenia in remission
· While the pseudopatients were at the hospital, their diagnosis was not questioned by the staff. The genuine patients at the hospital however regularly voiced their suspicions. They said that of the pseudopatients “You’re not crazy”, “You’re a journalist” or “You’re a professor checking up on the hospital”.
· The normal behaviour of the pseudopatients was interpreted as signs of their illness.
· All of the pseudopatients made notes as part of the observation. This was interpreted as an aspect of their madness. Nurses record state “Patient engages in excessive writing behaviour.”
Rosenhan’s description of a pseudopatient
Psychiatrist’s description of the pseudopatient
“One pseudopatient had a close relationship with his mother but was rather remote from his father during his early childhood. During adolescence and beyond however, his father became a close friend while his relationship with his mother cooled. His present relationship with his wife was characteristically warm and close. Apart from occasional angry exchanges, friction was minimal. The children had rarely been spanked.”
“This white, 39 year old male…manifests a long history of considerable ambivalence in close relationships, which begins in early childhood. A warm relationship with his mother cools during adolescence. A distant relationship with his father is described as becoming very intense. Affective (emotional) stability is absent. His attempts to control emotionality with his wife and children are punctuated with angry outbursts, and, in the case of the children, spankings. And while he says that he has several good friends, one senses considerable ambivalence in those relationships…
· The label of mental illness shaped the interpretation of personal circumstances. A good example of this is below.
· There was very limited contact time between the staff and patients. In one corner of the ward was a glass “cage” where the staff had their offices. The amount of time that the attendants spent out of the cage was 11.3%, and much of this time was spent doing chores that mingling with the patients.
· On average, the nurses emerged from the cage 11.5 times per shift
· The psychiatrists were rarely seen on the ward