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

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