Rosenhan (1973) Sane in Insane places

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Rosenhan (1973) Sane in Insane places

• On being sane in insane places
• Science 179 250-8

psychlotron.org.uk Mark Souter
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Rosenhan (1973) Sane in Insane places

• introduction
• difficulty of judging what is 'normal'
• varies over time / between societies
• Rosenhan asked "If sanity and insanity exist, how
  shall we know them?" p250
• research Q if 'normal' people attempt admission
  will they be detected? / how?

psychlotron.org.uk Mark Souter
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Rosenhan (1973) Sane in Insane places

• the study researchers (NOT participants!)
• 8 sane people attempted admission
• graduate student 3 psychologists a
  paediatrician a painter a 'housewife'
• telephoned for an appointment
• 12 hospitals 5 US states
• gave false names/addresses otherwise correct
  details

psychlotron.org.uk Mark Souter
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Rosenhan (1973) Sane in Insane places

• the study pseudo-symptoms
• pseudo-patients (PPs) reported unfamiliar, same
  sex 'voices'
• unclear but said 'empty' 'hollow' 'thud'
• simulated 'existential crisis'
• (who am I? why am I here?)
• NB no mention of 'existential crisis' in theories
  in psychosis

psychlotron.org.uk Mark Souter
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Rosenhan (1973) Sane in Insane places

• the study after admission
• stopped reporting symptoms
• ... but may have looked anxious!
• took part in ward activities
• kept notes
• each had to get out by their own devices!

psychlotron.org.uk Mark Souter
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Rosenhan (1973) Sane in Insane places

• Results hospitals' responses
• NB hospital staff were the subjects
  (participants) of this experiment
• none of the PPs were detected
• all but one diagnosed as schizophrenic
• NB not one clear symptom of this!
• some other patients were suspicious (35/118 said
  so)

psychlotron.org.uk Mark Souter
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Rosenhan (1973) Sane in Insane places

• results getting out
• all pseudo-patients (PPs) wanted to get out ASAP!
  
• remained in hospital 7 - 52 days (av 19)
• discharged with 'schizophrenia in remission'

psychlotron.org.uk Mark Souter
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Rosenhan (1973) Sane in Insane places

• results follow up study
• a teaching and research hospital aware of study
• told one or more pseudo-patients would seek
  admission in next 3m
• c 1/10 suspected by 1 psychiatrist one staff
  member
• none had been sent

psychlotron.org.uk Mark Souter
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Rosenhan (1973) Sane in Insane places
psychlotron.org.uk Mark Souter
10
Rosenhan (1973) Sane in Insane places

• Results general observations (1)
• normal behaviour of PPs ignored or misinterpreted
  
• note taking recorded as pathological in 3 medical
  records
• e.g. 'Patient engages in writing behaviour'
• please engage in this behaviour in my lessons!

psychlotron.org.uk Mark Souter
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Rosenhan (1973) Sane in Insane places

• results general observations (2)
• Rosenhan noted
• sane/insane behaviour overlap (such as depressed
  moods or anger)
• in the study a psychiatrist was observed to note
  early queuing for lunch
• told registrars trainees this was
  'oral-acquisitive' syndrome
• another interpretation boredom in hospital!

psychlotron.org.uk Mark Souter
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Rosenhan (1973) Sane in Insane places

• results PP observations
• PPs approached staff with polite requests e.g.
  'Pardon me Dr X, could you tell me when I will be
  presented at the staff meeting?
• 71 psychiatrists 88 nurses totally ignored
  PP's Qs!
• comparative study U students - U staff virtually
  100 responses
• nurses stayed in offices c90 of time
• therapist-patient contact lt 7 mins per day

psychlotron.org.uk Mark Souter
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Rosenhan (1973) Sane in Insane places
psychlotron.org.uk Mark Souter
14
Rosenhan (1973) Sane in Insane places

• results evidence of depersonalisation
• no privacy, even in toilet (doors often removed)
• medical records open to all staff, regardless of
  therapeutic responsibility
• ward orderlies brutal in front of other patients
  stop when other staff seen
• patients views valueless

psychlotron.org.uk Mark Souter
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Rosenhan (1973) Sane in Insane places

• results medication
• PPs given 2,100 tablets
• only 2 swallowed
• when some were flushed PPs spotted other
  patients' medication!
• cooperative patients' behaviour ignored

psychlotron.org.uk Mark Souter
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Rosenhan (1973) Sane in Insane places

• discussion (1)
• Rosenhan claimed
• "It is clear we cannot distinguish the sane from
  the insane in psychiatric hospitals" (p257)
• seems to be overstating BUT
• failure to detect sanity
• follow up questionable detection of insanity

psychlotron.org.uk Mark Souter
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Rosenhan (1973) Sane in Insane places

• discussion (2)
• depersonalisation and powerlessness
• R said behaviours interpreted via expectations
• R said better to discuss behaviours and causes
• R noted real patients did not have PPs' comfort
  of false diagnosis

psychlotron.org.uk Mark Souter