Transcript DL Rosenhan

A / AS Psychology.. Key Studies
• Abnormal Psychology
• Key study
• D L Rosenhan (1973)
D L Rosenhan (1973)
On being sane in insane
places!
The Question…….
If sanity and insanity exist
How shall we recognise them?
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?
Before we begin…….
• 1 List two behaviours that YOU
consider to be a sign of
psychological abnormality
• 2 Write down why you think each of
these behaviours is abnormal
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
Look at your examples:
• Did your examples fall into those three
categories?
• Can you think of any other useful
definitions of abnormality?
Categorising Mental Illness
• Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV)
• International Statistical Classification of
Diseases and Related Health Problems
(ICD)
Diagnoses or Labelling?
What is Schizophrenia?
• A serious mental disorder
• Positive Symptoms (additional to normal behaviour)
include: hallucinations, delusions and thought disorder
• Negative Symptoms (reduction in normal experiences
or behaviour) include unusual emotional responses
and lack of motivation.
What do you think it would be
like to have Schizophrenia?
How did it feel?
• If you had a mental illness how would you
like to be treated?
The Question
If sanity and insanity exist
How shall we recognise them?
What was Rosenhan’s interest?
• How reliable are diagnoses of
abnormality?
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 pediatrician
– a painter
– A housewife
– Psychiatrist
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!!
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?
What about the REAL patients?
• 35 out of 118 patients voiced their
suspicions
On release ………………...
• The pseudo-patients were diagnosed as
• Schizophrenia “IN REMISSION”
Rosenhan
The 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
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 SUSPECTS
were pseudo-patients?……...
• NONE
• No pseudo-patients were sent
– 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
– (Remember Zimbardo)
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?
Questions YOU should be able to
answer…….
• Why might the reports of the pseudopatients have been unreliable?
Look back at your ‘list’ of abnormal
behaviour ……...
• How can we devise some general rules
to describe
NORMAL and ABNORMAL behaviour
Rosenhan …..
YOU must read this study up
• It is one of the most influential
studies in Abnormal Psychology
• If there are such things as
• SANITY and INSANITY
• HOW SHALL WE KNOW THEM?
On being sane in insane places...
• D L Rosenhan (1973)
THE END