Rosenhan

Question 1

Name of study

Answer 1

On Being Sane in Insane Place

Question 2

Date of research

Answer 2

1973

Question 3

Aims

Answer 3

Investigate:

1. The reliability of psychiatric diagnostics
2. If Psychiatrists could tell the difference between sane and insane
3. If diagnosis of insanity is situational or dispositional
4. Could sane people be admitted into an institution

Question 4

Context (names only)

Answer 4

Laing 1960
Szasz 1960
Foucault 1961

Question 5

Foucault context

Answer 5

1961

• Treatment of MI = inhumane (cold showers + straightjackets)
• concepts of sanity and insanity = constructed by society

Question 6

Laing context

Answer 6

1960

-Schizophrenia = due to experiences not symptoms

Question 7

Szasz context

Answer 7

1960

• Medical model = unhelpful w/ psychiatric conditions
• Concept of MI = exclude non-conformists from society

Question 8

Procedures - the people

Answer 8

• 5 men + 3 women
• Including Rosenhan
• Various ages and occupations
• No personal or family history of MI

Question 9

Procedures - institutions

Answer 9

• 12 institutions across 5 states of US
• Wide range (modern/old)
• Only one was private
• Pseudopatients called and asked for an appointment

Question 10

Procedures - symptoms

Answer 10

• voices saying “hollow” “empty” and ‘thud”
• symptoms of meaningless of life and schizophrenia
• described all life events (good and bad) accurately

Question 11

Procedures - on the ward

Answer 11

• 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

Question 12

Procedures summary STUDY 1 (4)

Answer 12

1. The people
2. Institutions
3. Symptoms
4. On the ward (actions)

Question 13

Procedures STUDY 2

Answer 13

• 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

Question 14

Procedures STUDY 3

Answer 14

• 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

Question 15

Findings STUDY 1 - admission

Answer 15

• All admitted + all for S except 1
• 7-52 days average = 19
• Discharged S in remission
• Given total of 2100 tablets

Question 16

Findings STUDY 1 - staff

Answer 16

• 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

Question 17

Findings STUDY 1 - on ward

Answer 17

• 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

Question 18

Findings STUDY 2

Answer 18

• 193 patients admitted
• 41 - Staff = Psp
• 23 - Psychists = Psp
• 19 - Both = Psp
• NONE were sent!

Question 19

Findings STUDY 3

Answer 19

• 4% Psychists stopped
• 0.5% Nurses stopped
• 2% of each group stopped and chatted

Question 20

Findings summary

Answer 20

• STUDY 1 - Admission / Staff contact / On ward
• STUDY 2 - Number of PsPs judged by staff/Psychists/both
• STUDY 3 - % stopped staff/Psychists

Question 21

Conclusions summary (4)

Answer 21

1. Type 1 and 2 errors
2. Psychodynamic labels
3. Powerlessness and Depersonalisation
4. Overall conclusions

Question 22

Conclusions - Type 1 and 2 errors

Answer 22

• Psychists failed to detect PsP’s sanity
• Clearly sane
• Doctors biased to type 2 errors b/c type 1 = more dangerous

Question 23

Conclusions - Psychodynamic labels

Answer 23

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

Question 24

Conclusions - Powerlessness and Depersonalisation

Answer 24

• 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

Question 25

Conclusions - overall

Answer 25

• 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

Question 26

Alternate Evidence - summary

Answer 26

1. Slater 2004
2. Spitzer et al 1975
3. Lewis 1990

Question 27

Alternate Evidence - Slater 2004

Answer 27

• 2004
• Replicated
• 9 psych ERs
• “Thud”
• Previous despression
• Diag psych depress + given anti psychotics

Question 28

Alternate Evidence - Slater FOR/AGAINST + WHY

Answer 28

SUPPORTS Rosenhan

• Proves if Psychists dont know still diag. + treat
• Psychists can’t always diag. MI

Question 29

Alternate Evidence - Spitzer et al. 1975

Answer 29

• 1975
• Challenge Slater
• 74 ER psychs Slater’s case descript
• Asked for diag + treatment recommends
• 3 said psych depress
• 1/3 prescribed meds

Question 30

Alternate Evidence - Spitzer et al. FOR/AGAINST + WHY

Answer 30

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

Question 31

Alternate Evidence - Lewis 1990

Answer 31

• 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

Question 32

Alternate Evidence - Lewis FOR/AGAINST + WHY

Answer 32

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