D L ROSENHAN (1973) • On being sane in insane places!
Jan 04, 2016
BEFORE WE BEGIN…….
1Look at the list of behaviours
2Write down why you think each of these behaviours is abnormal or normal.
spiderPut your suggestions aside for a moment
SOME DEFINITIONS OF ABNORMALITY
Stratton & Hayes (1993) .. Abnormality IS• Behaviour which deviates from the norm • most people don’t behave that way
• Behaviour which does not conform to social demands • most people don’t like that behaviour
• Behaviour which is maladaptive or painful to the individual • its not normal to harm yourself
SPECIFICALLY…….
• Do the characteristics of abnormality reside in the patients?
• or in the environments in which they are observed?
WHAT WAS ROSENHAN’S INTEREST?
• How reliable are diagnoses of abnormality?
• Will the same symptoms always be diagnosed in the same way?
THE ASTONISHING STUDY……….. ON BEING SANE IN INSANE
PLACES…...
• D L Rosenhan (1973)
• What did he do?• Who were involved?
THE BRAVE VOLUNTEERS…… .
• EIGHT sane people!• one graduate student • three psychologists • a paediatrician • a painter• housewives
WHAT DID THEY DO?THE PROCEDURE……………………..
• telephoned 12 psychiatric hospitals for urgent appointment (in five USA states)• arrived at admissions• gave false name and address • gave other ‘life’ details correctly
WHAT ELSE DID THEY DO?
• complained of hearing unclear voices … saying “empty, hollow, thud”
• Said the voice was unfamiliar, but was same sex as themselves
• Simulated ‘existential crisis’• “Who am I, what’s it all for?”
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
WHAT HAPPENED ON THE WARDS?
• The pseudo-patients were never detected
• All pseudo-patients wished to be discharged immediately
• BUT - they waited until they were diagnosed as ‘fit to be discharged’
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 theory
THE PSEUDO-PATIENT’S OBSERVATIONS…
• If they approached staff with simple request• (NURSES & ATTENDANTS)• 88% ignored them • (walked away with head averted)
• 10% made eye contact• 2% stopped for a chat• (1283 attempts)
THE PSEUDO-PATIENT’S OBSERVATIONS…
• If they approached staff with simple request• (PSYCHIATRISTS)• 71% ignored them • (walked away with head averted)
• 23% made eye contact• 2% stopped for a chat• (185 attempts)
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?
ROSENHANTHE 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
WHAT DID ROSENHAN CONCLUDE?
• Remember .. His question was …• Do the characteristics of abnormality reside in the
patients?• or • In the environments in which they are observed?• Does madness lie in the eye of the observer
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
ANOTHER ROSENHAN NOTE……..
• The pseudo-patients described their stay in the hospitals as a negative experience
• This is not to say that REAL patients have similar experiences• Real patients do not know the diagnosis is false &
are NOT pretending
QUESTIONS YOU SHOULD BE ABLE TO ANSWER...
• Methodology: This was a field experiment
• Who were the participants?
• Was this study ethical? If not why not?
QUESTIONS YOU SHOULD BE ABLE TO ANSWER…….
• Why might the reports of the pseudo-patients have been unreliable?
LOOK BACK AT YOUR ‘LIST’ OF ABNORMAL BEHAVIOUR ……...
• Can we devise some general rules
• to describe
• NORMAL and ABNORMAL behaviour