Rosenhan Flashcards
Name of study
On Being Sane in Insane Place
Date of research
1973
Aims
Investigate:
- The reliability of psychiatric diagnostics
- If Psychiatrists could tell the difference between sane and insane
- If diagnosis of insanity is situational or dispositional
- Could sane people be admitted into an institution
Context (names only)
Laing 1960
Szasz 1960
Foucault 1961
Foucault context
1961
- Treatment of MI = inhumane (cold showers + straightjackets)
- concepts of sanity and insanity = constructed by society
Laing context
1960
-Schizophrenia = due to experiences not symptoms
Szasz context
1960
- Medical model = unhelpful w/ psychiatric conditions
- Concept of MI = exclude non-conformists from society
Procedures - the people
- 5 men + 3 women
- Including Rosenhan
- Various ages and occupations
- No personal or family history of MI
Procedures - institutions
- 12 institutions across 5 states of US
- Wide range (modern/old)
- Only one was private
- Pseudopatients called and asked for an appointment
Procedures - symptoms
- voices saying “hollow” “empty” and ‘thud”
- symptoms of meaningless of life and schizophrenia
- described all life events (good and bad) accurately
Procedures - on the ward
- Acted normally
- Didn’t take their medication
- Followed all other rules
- Talked to patients
- Took covert notes
- Had to get out by their own means
Procedures summary STUDY 1 (4)
- The people
- Institutions
- Symptoms
- On the ward (actions)
Procedures STUDY 2
- Institution challenged Rosenhan
- Said in 3 months he’d send up to 3 PsPs
- Staff rate /10 confidence all new patients are MI
- 1 = confident PsP
- 193 patients judged
- No PsPs sent
Procedures STUDY 3
- Treatment of patients
- “Pardon me Mr/Mrs/Dr X when am i likely to be discharged?”
- Didn’t ask the same person more than once per day
Findings STUDY 1 - admission
- All admitted + all for S except 1
- 7-52 days average = 19
- Discharged S in remission
- Given total of 2100 tablets
Findings STUDY 1 - staff
- Limited contact
- Average staff spent 11.3% time with patients
- Nurse out of cage 11.5 times/shift
- Psychists on ward 6.7 times/day
Findings STUDY 1 - on ward
- Nurses thought writing was part of pathological behaviour
- 35/118 other patients said “you’re not crazy”, “You’re a journalist” or “You’re a professor checking up on the hospital
- Given total of 2100 tablets
Findings STUDY 2
- 193 patients admitted
- 41 - Staff = Psp
- 23 - Psychists = Psp
- 19 - Both = Psp
- NONE were sent!
Findings STUDY 3
- 4% Psychists stopped
- 0.5% Nurses stopped
- 2% of each group stopped and chatted
Findings summary
- STUDY 1 - Admission / Staff contact / On ward
- STUDY 2 - Number of PsPs judged by staff/Psychists/both
- STUDY 3 - % stopped staff/Psychists
Conclusions summary (4)
- Type 1 and 2 errors
- Psychodynamic labels
- Powerlessness and Depersonalisation
- Overall conclusions
Conclusions - Type 1 and 2 errors
- Psychists failed to detect PsP’s sanity
- Clearly sane
- Doctors biased to type 2 errors b/c type 1 = more dangerous
Conclusions - Psychodynamic labels
The effect of a label on perceptions of people
- Asch 1946 - central personality traits powerful effect on we see someone’s personality
- Abnormal label = all actions = abnormal
- e.g. S in remission - still S but temp sane
- MI not like PI - can’t ever fully recover
Conclusions - Powerlessness and Depersonalisation
- Study 3 shows patients treated w/ little respect
- Atmosphere of powerlessness
- Conditions poor - toilets w/out doors
- Lack of privacy - anyone could read files
- Drs diagnosed without being sure
Conclusions - overall
- Found sane couldn’t be differed from insane
- Hospitals for MI -> Labels, powerlessness and depersonalisation
- Need other ways to treat MI
- MI people sometimes detect MI before MH profs
Alternate Evidence - summary
- Slater 2004
- Spitzer et al 1975
- Lewis 1990
Alternate Evidence - Slater 2004
- 2004
- Replicated
- 9 psych ERs
- “Thud”
- Previous despression
- Diag psych depress + given anti psychotics
Alternate Evidence - Slater FOR/AGAINST + WHY
SUPPORTS Rosenhan
- Proves if Psychists dont know still diag. + treat
- Psychists can’t always diag. MI
Alternate Evidence - Spitzer et al. 1975
- 1975
- Challenge Slater
- 74 ER psychs Slater’s case descript
- Asked for diag + treatment recommends
- 3 said psych depress
- 1/3 prescribed meds
Alternate Evidence - Spitzer et al. FOR/AGAINST + WHY
AGAINST BOTH
- 71/74 didn’t diag
- only 1/3 gave meds
- Psychists wary of misdiag.
- Won’t prescribe for the sake of it
- Psychists will admit when unsure
Alternate Evidence - Lewis 1990
- 1990
- Diagnosis unreliability
- Pists shown case history (violence)
- Treatment + if criminal proceedings needed
- 1/2 told black Afro Carribean, 1/2 told white
- Black = more likely to treat w/ drugs + criminal
- MH profs biased by social stereotypes
Alternate Evidence - Lewis FOR/AGAINST + WHY
SUPPORTS
- Something simple like ethnicity causes misdiag.
- Symptoms didn’t change - diag. shouldn’t
- MH profs biased by social stereotypes
- Diag. systems biased towards certain people
