D L Rosenhan (1973)

1. D L Rosenhan (1973) On being sane in insane places!

2. The Question……. If sanity and insanity exist How shall we recognise them?

3. Specifically……. • 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?

4. 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

5. What was Rosenhan’s interest? • How reliable are diagnoses of abnormality?

6. The astonishing study………..On being sane in insane places…... • D L Rosenhan (1973) • What did he do? • Who were involved?

7. The brave volunteers…… . • EIGHT sane people! • one graduate student • three psychologists • a paediatrician • a painter • Housewife • Psychiatrist

8. 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

9. 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?”

10. 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

11. 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’

12. 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

13. 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)

14. 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)

16. 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!!

17. 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 !!

18. 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

19. Perhaps they behaved ‘abnormally’ • Pseudo-patient’s visitors detected “No serious behavioural consequences” • DID ANYONE SUSPECT?

20. What about the REAL patients? • 35 out of 118 patients voiced their suspicions

21. On release ………………... • The pseudo-patients were diagnosed as • Schizophrenia “IN REMISSION”

22. 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 would attempt to be admitted

23. 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)

24. How many of these SUSPECTSwere pseudo-patients?……... • NONE • No pseudo-patients were sent • Staff were rating their regular intake

25. 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

26. 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’

27. 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

28. 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 • (Remember Zimbardo)

29. Questions YOU should be able to answer... • Methodology - • This was a participant observation • Who were the OTHER participants? • Was this study ethical? If not why not?

30. Questions YOU should be able to answer……. • Why might the reports of the pseudo-patients have been unreliable?

31. Rosenhan ….. • It is one of the most influential studies in Abnormal Psychology • One Flew over the Cuckoo's nest was based on Rosenhan’s findings. Watch the film! • Read the original study in the shared area