Rosenhan (1973) Sane in Insane places On being sane in insane places



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Rosenhan (1973) Sane in Insane places

  • On being sane in insane places

  • Science 179 250-8


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?



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



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



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!



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)



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'



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



Rosenhan (1973) Sane in Insane places



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!]



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!



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 = < 7 mins per day



Rosenhan (1973) Sane in Insane places



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



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



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



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




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