Download ppt - Who’s Crazy Here Anyway? Rosenhan, D.L. (1973) On being sane in insane places. Science, 179, 250-258

Who’s Crazy Here Anyway?Who’s Crazy Here Anyway?Rosenhan, D.L. (1973)Rosenhan, D.L. (1973)

On being sane in insane places. On being sane in insane places. Science, 179, Science, 179, 250-258250-258

What is psychopathology?What is psychopathology?

Difference between normal and abnormal behavior is Difference between normal and abnormal behavior is imperative in field of psychology.imperative in field of psychology.

Psychopathology, or abnormal psychology, is the Psychopathology, or abnormal psychology, is the field concerned with the nature and development of field concerned with the nature and development of abnormal behavior, thoughts, and feelings.abnormal behavior, thoughts, and feelings.

This definition is the key variable in determining This definition is the key variable in determining whether or not someone may be diagnosed as whether or not someone may be diagnosed as mentally ill. mentally ill.

What is psychopathology? (cont’d)What is psychopathology? (cont’d) Human behavior lies on a continuum; normal Human behavior lies on a continuum; normal

behavior on one end (AKA behavior on one end (AKA effective psychological effective psychological functioningfunctioning) and abnormal behavior on the other. ) and abnormal behavior on the other.

Normal----------------------------------------AbnormalNormal----------------------------------------Abnormal(effective functioning) (mental illness)(effective functioning) (mental illness) Mental health professionals (i.e. clinical Mental health professionals (i.e. clinical

psychologists, psychiatrists, psychotherapists) psychologists, psychiatrists, psychotherapists) determine where an individual’s behavior lies on this determine where an individual’s behavior lies on this continuum according to one or more of the six continuum according to one or more of the six following criteria.following criteria.

CriteriaCriteria

1) Bizarreness of the behavior1) Bizarreness of the behavior: (odd or eccentric) a : (odd or eccentric) a subjective judgment based on a situation, the subjective judgment based on a situation, the context in which the behavioral pattern occurscontext in which the behavioral pattern occurs

2) Persistence of the behavior2) Persistence of the behavior: how often does the : how often does the behavior occurbehavior occur

3) Social deviance3) Social deviance: does the behavior violate societal : does the behavior violate societal norms, which are extreme and persistentnorms, which are extreme and persistent

Criteria (cont’d)Criteria (cont’d)

4) 4) Subjective distressSubjective distress: refers to an individual being : refers to an individual being aware of their psychological stressaware of their psychological stress

5) 5) Psychological handicapPsychological handicap: individual finds it : individual finds it impossible to be satisfied with life due to impossible to be satisfied with life due to psychological problemspsychological problems

6) 6) Effect on functioningEffect on functioning: the extent to which the : the extent to which the behavior in question interfere with a person’s behavior in question interfere with a person’s ability to live the life that he or she desires and ability to live the life that he or she desires and that society will acceptthat society will accept

Criteria (cont’d)Criteria (cont’d)

Criteria at hand are based on judgments of mental Criteria at hand are based on judgments of mental health professionals.health professionals.

Questions at hand: Are mental health professionals Questions at hand: Are mental health professionals capable of distinguishing between mentally ill and capable of distinguishing between mentally ill and mentally healthy? What are the repercussions of a mentally healthy? What are the repercussions of a misdiagnosis?misdiagnosis?

David Rosenhan studies these questions at hand.David Rosenhan studies these questions at hand.

Theoretical PropositionsTheoretical Propositions

HH11: The criteria leading to diagnoses reside in : The criteria leading to diagnoses reside in patients or in the contexts in which the mental health patients or in the contexts in which the mental health professionals find the patients. He believes the professionals find the patients. He believes the professionals should be able to distinguish between professionals should be able to distinguish between the insane and the sane.the insane and the sane.

Proposed that in order to test professional ability, he Proposed that in order to test professional ability, he has “normal people” seek admittance to psychiatric has “normal people” seek admittance to psychiatric facilities to see whether or not they would be found to facilities to see whether or not they would be found to be mentally healthy. be mentally healthy.

Theoretical Propositions (cont’d)Theoretical Propositions (cont’d)

He referred to these subjects as ‘pseudopatients’.He referred to these subjects as ‘pseudopatients’. The subjects were to behave as they would outside of The subjects were to behave as they would outside of

the facility. the facility. If these pseudopatients were not found to be normal, If these pseudopatients were not found to be normal,

this would suggest that the diagnosis of the mentally this would suggest that the diagnosis of the mentally ill are tied more to the situation than to the patient.ill are tied more to the situation than to the patient.

MethodMethod

Eight subjects, including himself. Three women and Eight subjects, including himself. Three women and five men (1 graduate student, 3 psychologists, 1 five men (1 graduate student, 3 psychologists, 1 pediatrician, 1 psychiatrist, 1 painter, 1 homemaker).pediatrician, 1 psychiatrist, 1 painter, 1 homemaker).

Admission to 12 psychological hospitals in five Admission to 12 psychological hospitals in five states, on east coast and west coast.states, on east coast and west coast.

All subjects were told to phone the hospital and set up All subjects were told to phone the hospital and set up an appointment. Once they arrived, they were told to an appointment. Once they arrived, they were told to state that they were hearing voices (empty, hollow, state that they were hearing voices (empty, hollow, thud).thud).

Method (cont’d)Method (cont’d)

This was the only false information the This was the only false information the pseudopatients provided. All other background pseudopatients provided. All other background information (excluding names and occupations) was information (excluding names and occupations) was truthful (i.e. families, social life).truthful (i.e. families, social life).

All subjects were admitted. Seven subjects were All subjects were admitted. Seven subjects were admitted with a diagnosis of schizophrenia.admitted with a diagnosis of schizophrenia.

Once the subjects had been in the hospital, they Once the subjects had been in the hospital, they displayed normal behavior. It was up to them to displayed normal behavior. It was up to them to convince the staff they were well enough to leave.convince the staff they were well enough to leave.


During the subjects stay, they documented their During the subjects stay, they documented their experiences. At first, this was a discrete attempt, experiences. At first, this was a discrete attempt, although this became useless seen as the although this became useless seen as the note-taking note-taking behaviorbehavior was considered a symptom of their was considered a symptom of their diagnosis. diagnosis.

They wished to be released as soon as possible, hence They wished to be released as soon as possible, hence they cooperated completely with all requests of the they cooperated completely with all requests of the staff and took medication as told (medication was not staff and took medication as told (medication was not swallowed, rather flushed).swallowed, rather flushed).

ResultsResults

Duration of stay ranged from 7-52 days, with an Duration of stay ranged from 7-52 days, with an average of 19 days.average of 19 days.

None of the subjects were detected as mentally None of the subjects were detected as mentally healthy by the staff or mental health professionals.healthy by the staff or mental health professionals.

Upon release their files were noted as, Upon release their files were noted as, schizophrenia schizophrenia in remissionin remission. .

Interestingly enough, although the staff was fooled, Interestingly enough, although the staff was fooled, other patients were not. In three of the subjects other patients were not. In three of the subjects hospitalizations, 35 out of 118 actual patients voiced hospitalizations, 35 out of 118 actual patients voiced such opinions that the subjects were not mentally ill.such opinions that the subjects were not mentally ill.

Results (cont’d)Results (cont’d)

A test made by pseudopatients was to approach staff A test made by pseudopatients was to approach staff members and make verbal contact by asking common members and make verbal contact by asking common questions, such as referring to their duration of stay questions, such as referring to their duration of stay or privileges. or privileges.

ResponseResponse PsychiatristsPsychiatrists MHAMHAMoves on, head averted 71Moves on, head averted 71% 88%% 88%

Makes eye contact 23Makes eye contact 23% 10%% 10%

Pauses and chats 2Pauses and chats 2% 2%% 2%

Stops and talks 4Stops and talks 4% 0.5%% 0.5%

Results (cont’d)Results (cont’d)

When a subject did in fact elicit a response from a When a subject did in fact elicit a response from a mental health professional, it was based on the mental health professional, it was based on the emotional state of the subject, and most continued on.emotional state of the subject, and most continued on.

Although there was not much contact between the Although there was not much contact between the patients and the staff, there was never a lack of patients and the staff, there was never a lack of medication. Distributed to the subjects was a total of medication. Distributed to the subjects was a total of 2,100 pills (not swallowed). 2,100 pills (not swallowed).

Many of the actual patients hardly ever took their Many of the actual patients hardly ever took their medications.medications.

DiscussionDiscussion

Rosenhan’s study suggests that mentally healthy Rosenhan’s study suggests that mentally healthy people cannot be distinguished from mentally ill.people cannot be distinguished from mentally ill.

He believed that the staff’s judgment held influence He believed that the staff’s judgment held influence as to how the patients were treated. Once they are as to how the patients were treated. Once they are admitted their individuality is essentially removed admitted their individuality is essentially removed and they simply become a label. Rosenhan refers to and they simply become a label. Rosenhan refers to this as the this as the stickiness of the diagnostic labelstickiness of the diagnostic label. . Therefore, their personality trait becomes that of the Therefore, their personality trait becomes that of the label.label.

Discussion (cont’d)Discussion (cont’d)

The moment there is a label attached to the patient, all The moment there is a label attached to the patient, all behavior the patient takes part in is seen as a behavior the patient takes part in is seen as a manifestation of their diagnosis. manifestation of their diagnosis.

The staff tended to ignore the circumstances and The staff tended to ignore the circumstances and attribute any behavior to the illness. attribute any behavior to the illness.

This, so called, sticky label even affected the patients This, so called, sticky label even affected the patients past history although they gave truthful accounts. past history although they gave truthful accounts.

The past history and behavioral interpretations were The past history and behavioral interpretations were consistent with the diagnosis of the patient.consistent with the diagnosis of the patient.

Significance of FindingsSignificance of Findings

Two compelling factors:Two compelling factors:

A) mentally ill cannot be distinguished from A) mentally ill cannot be distinguished from mentally healthy in a hospital settingmentally healthy in a hospital setting

B) danger of diagnostic labels, eludes any other B) danger of diagnostic labels, eludes any other characteristics of the individualcharacteristics of the individual

This type of Tx may become self-confirming. If an This type of Tx may become self-confirming. If an individual is being treated for a diagnosis, individual is being treated for a diagnosis, consistently, they will begin to behave in the manner consistently, they will begin to behave in the manner expected of them.expected of them.

Significance of Findings (cont’d)Significance of Findings (cont’d)

As a result of Rosenhan’s research, there has been a As a result of Rosenhan’s research, there has been a focus on the danger of applying labels. focus on the danger of applying labels.

Mental health professionals have not rid labeling in Mental health professionals have not rid labeling in patients, or clients, although they are used more patients, or clients, although they are used more cautiously in understanding their control. cautiously in understanding their control.

Questions and CriticismsQuestions and Criticisms

A psychiatric facility that heard of Rosenhan’s study A psychiatric facility that heard of Rosenhan’s study was convinced they could not misdiagnose was convinced they could not misdiagnose individuals. individuals.

Rosenhan challenged this facility and informed them Rosenhan challenged this facility and informed them that he would be sending pseudopatients to their that he would be sending pseudopatients to their facility within a span of three months. The facility facility within a span of three months. The facility was given no information by Rosenhan as to when was given no information by Rosenhan as to when they would be arriving.they would be arriving.

Questions and Criticisms (cont’d)Questions and Criticisms (cont’d)

Rosenhan told the staff members to rate the patients, Rosenhan told the staff members to rate the patients, on a 10 point scale, the likelihood they are on a 10 point scale, the likelihood they are pseudopatients.pseudopatients.

At the end of three months, 193 patients were At the end of three months, 193 patients were admitted. By one staff member, at the least, 41 were admitted. By one staff member, at the least, 41 were considered in high confidence to be pseudopatients.considered in high confidence to be pseudopatients.

Twenty-three were suspected by one psychiatrist.Twenty-three were suspected by one psychiatrist. Nineteen were identified as pseudopatients by one Nineteen were identified as pseudopatients by one

psychiatrist and other staff member. psychiatrist and other staff member.


Rosenhan had actually NOT sent in any Rosenhan had actually NOT sent in any pseudopatients whatsoever!!!!! We may view this as pseudopatients whatsoever!!!!! We may view this as a self-fulfilling prophecy on behalf of the hospital. a self-fulfilling prophecy on behalf of the hospital.

“ “ It indicates that the tendency to designate sane It indicates that the tendency to designate sane people as insane can be reversed when the stakes (in people as insane can be reversed when the stakes (in this case prestige and diagnostic ability) are high. this case prestige and diagnostic ability) are high. But one thing is certain: Any diagnostic process that But one thing is certain: Any diagnostic process that lends itself so readily to massive errors of this sort lends itself so readily to massive errors of this sort cannot be a very reliable one.” - Rosenhancannot be a very reliable one.” - Rosenhan


Regardless of how many times Rosenhan replicated Regardless of how many times Rosenhan replicated his research, there were disputing researchers. his research, there were disputing researchers.

Spitzer (1976) argued that Rosenhan’s research did Spitzer (1976) argued that Rosenhan’s research did not truly invalidate psychological diagnoses. not truly invalidate psychological diagnoses. Admissions to hospitals are based on verbal reports, it Admissions to hospitals are based on verbal reports, it would not be suspected that someone would deceit a would not be suspected that someone would deceit a mental health professional to go someplace they don’t mental health professional to go someplace they don’t belong.belong.


Spitzer noted that, although subjects portrayed Spitzer noted that, although subjects portrayed normal behavior upon admittance, symptomatic normal behavior upon admittance, symptomatic reports are consistent with the disorders. reports are consistent with the disorders.

Therefore, the staff were not incorrect in diagnosing Therefore, the staff were not incorrect in diagnosing the subjects. the subjects.

ConclusionConclusion

Labels will most likely always be utilized, as the Labels will most likely always be utilized, as the mental health professionals benefit from them. They mental health professionals benefit from them. They are an important role in effectively treating are an important role in effectively treating psychological disorders.psychological disorders.

Labels place embarrassment on individuals and Labels place embarrassment on individuals and stigmatize them. This is the aspect that should be stigmatize them. This is the aspect that should be dealt with.dealt with.

Nonetheless, Rosenhan’s study remains to be that of Nonetheless, Rosenhan’s study remains to be that of an influential one in psychology.an influential one in psychology.

Further QuestionsFurther Questions

What about those that are labeled and have carried What about those that are labeled and have carried this label with them through their everyday lives?this label with them through their everyday lives?

Do these labels effect the way we act in, say, our Do these labels effect the way we act in, say, our careers?careers?

Are children effected by these labels in a school Are children effected by these labels in a school setting?setting?

Follow-up StudyFollow-up StudyWahl, Otto F.Wahl, Otto F.

Depictions of mental illnesses in Depictions of mental illnesses in children’s mediachildren’s media

Journal of Mental Health (June 2003), Journal of Mental Health (June 2003), 12, 3, 12, 3, 249-258249-258

Stigmatization At A Young AgeStigmatization At A Young Age

Stigma interferes with people’s participation in Stigma interferes with people’s participation in society.society.

The public places negative beliefs about those with The public places negative beliefs about those with mental illnesses.mental illnesses.

Seems that ideas and attitudes are learned over a Seems that ideas and attitudes are learned over a period of time, beginning in childhood.period of time, beginning in childhood.

Young children have adapted attitudes recognizing Young children have adapted attitudes recognizing mental illness as less attractive than other health mental illness as less attractive than other health conditions. conditions.

These may be seen as stereotypes.These may be seen as stereotypes.

Stigmatization At A Young Age (cont’d)Stigmatization At A Young Age (cont’d) Ninety-eight percent of American households have a Ninety-eight percent of American households have a

television set, sometimes even more than one.television set, sometimes even more than one. Television is one of the earliest socializing agents in a Television is one of the earliest socializing agents in a

child’s life.child’s life. In America 2-11 year olds have the TV on for In America 2-11 year olds have the TV on for

approximately 28 hours a week.approximately 28 hours a week. TV viewing occupies more time than any other non-TV viewing occupies more time than any other non-

school activity. Among children it accounts for more school activity. Among children it accounts for more than half of all leisure activities. than half of all leisure activities.

Knowledge regarding mental illnesses come to Knowledge regarding mental illnesses come to children through the mass media depictions.children through the mass media depictions.

Wahl’s ResearchWahl’s Research

Through this research Wahl suggests that Through this research Wahl suggests that media images ingrain negative perceptions and media images ingrain negative perceptions and attitudes toward people with mental illness. attitudes toward people with mental illness. Children are exposed to this media and are Children are exposed to this media and are learning these depictions.learning these depictions.

MethodMethod

Wahl reviews the depiction of mental illnesses in Wahl reviews the depiction of mental illnesses in children’s media.children’s media.

Wahl & Roth (1982) focused mostly on adult media, Wahl & Roth (1982) focused mostly on adult media, at first, then gathered others research.at first, then gathered others research.

Found that 1 in 11 prime time shows have a character Found that 1 in 11 prime time shows have a character labeled as having a mental illness.labeled as having a mental illness.

It has also been noted that those with mental illness It has also been noted that those with mental illness were viewed as different, unsuccessful, socially were viewed as different, unsuccessful, socially unconnected, and unlikely to recover.unconnected, and unlikely to recover.


Gerber (1995) sampled nine seasons of Saturday Gerber (1995) sampled nine seasons of Saturday morning programs (8AM-2PM), 394 programs total.morning programs (8AM-2PM), 394 programs total.

Found that mentally ill characters fail twice as often Found that mentally ill characters fail twice as often as they succeed, highly likely to be killed, injured, or as they succeed, highly likely to be killed, injured, or exploited. exploited.

Beveridge (1996) studied Walt Disney films. He Beveridge (1996) studied Walt Disney films. He found that over a period of years, references to found that over a period of years, references to ‘madness’ appear. Beginning with Dumbo (1941), to ‘madness’ appear. Beginning with Dumbo (1941), to Alice in Wonderland (1951), to Mary Poppins (1964), Alice in Wonderland (1951), to Mary Poppins (1964), to Beauty and the Beast in (1992). to Beauty and the Beast in (1992).

Method (cont’d)Method (cont’d) Hinted that the general message was, madness is Hinted that the general message was, madness is

something to fear. something to fear. Wahl also noted that there are negative portrayals in Wahl also noted that there are negative portrayals in

books of the mentally ill. books of the mentally ill. Found in the Harry Potter series, Harry is warned Found in the Harry Potter series, Harry is warned

about an escaped prisoner that is ‘mad’.about an escaped prisoner that is ‘mad’. Also found in comic books that madness is something Also found in comic books that madness is something

that turns good people into villains. (Batman’s that turns good people into villains. (Batman’s opposite, The Joker, The Green Goblin in Spiderman.opposite, The Joker, The Green Goblin in Spiderman.

Identified popular songs with lyrics referring to Identified popular songs with lyrics referring to mental illnesses. Numerous music videos featuring mental illnesses. Numerous music videos featuring people in psychiatric hospitals and straightjackets.people in psychiatric hospitals and straightjackets.

ResultsResults

After studying television shows, movies, cartoons, After studying television shows, movies, cartoons, books, comics, music, and video games, Wahl found books, comics, music, and video games, Wahl found that references to mental illnesses are common and that references to mental illnesses are common and widespread.widespread.

These references are more negative than positive.These references are more negative than positive. Images of these individuals express unattractive Images of these individuals express unattractive

persons, violent behavior, and deviant behavior. persons, violent behavior, and deviant behavior. Images are throughout children’s media. References Images are throughout children’s media. References toward illness are used mostly to ridicule.toward illness are used mostly to ridicule.

ConclusionConclusion

There’s a great deal of information regarding mental There’s a great deal of information regarding mental illnesses in children’s media. This information places illnesses in children’s media. This information places a stigmatization on the mentally ill, and in a child’s a stigmatization on the mentally ill, and in a child’s mind this becomes Rosenhan’s “stickiness of the mind this becomes Rosenhan’s “stickiness of the diagnostic label”.diagnostic label”.

The child sees the character as ‘mad’ and attributes The child sees the character as ‘mad’ and attributes numerous characteristics. Such as violence, numerous characteristics. Such as violence, aggression, and fear inducing.aggression, and fear inducing.

Children are being shown that individuals with Children are being shown that individuals with psychiatric disorders receive punishment rather than psychiatric disorders receive punishment rather than treatment. They are confined and isolated.treatment. They are confined and isolated.

Further QuestionsFurther Questions

If there continues to be a stigmatization on If there continues to be a stigmatization on labels, how will this affect the numerous, and labels, how will this affect the numerous, and growing, amounts of children in public schools growing, amounts of children in public schools diagnosed with Attention-Deficit diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD)?Hyperactivity Disorder (ADHD)?