Transcript Rosenhan Core Study Slides

Devise at least 5
(no more than
10) questions on
the Rosenhan
study.
Try to make them
challenging – some
ideas:
They will mainly be
knowledge based,
but you can
include some
comprehension
ones too.
What
Who
Where
How
Why
Which
Example
Different
Similar
Now:
• Pair up and quiz each other – help each
other out if either of you is stuck!
• We will rotate in a little while
What did people find tricky?
Recap and Questions
D.L. Rosenhan (1973)
• The ground breaking study :
“On being sane in insane places”
APPROACH: INDIVIDUAL DIFFERENCES
STUDY: ROSENHAN (1973)
CORE STUDY:
ROSENHAN (1973)
‘ON BEING SANE IN
INSANE PLACES’
What was Rosenhan interested in?
The main aim was to test whether the classification
system that determined whether someone was sane or
insane was reliable.
Can sane individuals be diagnosed as insane and
admitted to hospital?
A secondary aim was see whether or not it is the
characteristics of the patients that lead to diagnosis or
the context itself.
i.e. once on the ward, will all behaviour be judged as
abnormal, regardless?
•
•
•
TO UNDERSTAND THE BACKGROUND AND CONTEXT TO ROSENHAN’S STUDY
TO CRITICALLY CONSIDER DEFINITIONS OF ABNORMALITY
TO ANALYSE THE IMPLICATIONS OF THESE DEFINITIONS
Type 1 & 2 Errors
Type 1 Error
• Type I Error is a false positive, or when
you reject the null hypothesis and it's
actually true
Type 2 Error
• Type II error is a false negative, or when
you accept the null hypothesis and it's
actually false.
The volunteers
• EIGHT sane people
– one graduate student
– three psychologists
– a paediatrician
– a painter
– Housewives
– A psychiatrist (Rosenhan)
What did they do?
The procedure:
• telephoned 12 psychiatric hospitals for urgent
appointments
• gave false name and address
• complained of hearing unclear voices … saying
“empty, hollow, thud”
– Simulated ‘existential crisis’
– “Who am I, what’s it all for?”
• This is because the symptoms, although clearly a
sign of a mental disorder did not fit into a specific
diagnosis well.
Study 1 (a)
 Participant observation
 8 pseudo patients (5 male, 3 female) ‘normal’ people
 3 psychologists, a paediatrician, a psychiatrist, a painter
and a housewife, a psychology graduate
 Patients ‘self-referred’
 Used fake names
 sought admission to 12 hospitals
 reported that they had been hearing voices which said
‘empty’, ‘hollow’ and ‘thud’ – this was chosen as it was
not necessarily a symptom of a specific disorder.
 Once admitted patients behaved normally and
observed the behavior of staff and genuine patients.
 They had to persuade staff that they were ‘sane’.
Study 1 (b)
 Participant observation
 4 hospitals
 pseudo patients approached members of staff and
asked. :pardon me, MR/Dr/Mrs X, could you tell me when
I will be eligible for grounds privileges/…when will I be
presented at the staff meeting/… when am I likely to be
discharged?’ to measure staff response to patients.
Study 2
 Method: self-report – 10 point scale
 Asked to rate each patient who arrived
 Staff who were aware of the findings of Study 1
 Warned that pseudopatients would present themselves over the
next three months.
 None did.
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
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 label
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?
• Yes – the real patients
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 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 SUSPECTS
were pseudo-patients?
• NONE
• No pseudo-patients were sent – the
staff were rating their regular intake
Summary of findings:
 All pseudopatients were admitted
 All bar one were diagnosed as schizophrenic, even until the end and were
discharged as ‘schizophrenic in remission’
 Length of hospitalization ranged from 7-52 days (av 19 days)
 Many real patients detected that the pseudopatients were not genuine
patients 35/118 voiced suspicion
 Normal behavior was misinterpreted e.g. note taking. Pacing corridors
seen as a sign of anxiety.
 Average daily contact with medical staff ranged from 3.9-25.1 mins (all
low)
 Personal hygiene and waste evacuation often monitored. WCs had no
doors.
 Pseudopatients experiences powerlessness and depersonalization.
Summary of findings:
Study 1(b)
The most common response to the question was either a brief response on
the move, or no response at all.
Few staff make eye contact with pseudopatients.
Study 2
193 patients reported for treatment.
41 judged by at least one member of staff
23 by at least one psychiatrist
19 by at least two members of staff
To be pseudopatients (remember, there were none)
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
Homework
• Evaluate Rosenhan
• Due next lesson