Context  How do we define sane? How about insane? Is there a difference? How do we tell?

Context  PY1: Biological therapies Medical model of abnormality Psychological illness=physical illness  Anti-psychiatry movement Questioned the validity of psychiatric diagnosed Psychiatry is used as a method of control

Context  Foucault (1961) Unreasonable members of population are locked away through diagnosis of mental illness ○ Drapetomania  Laing(1960) Schizophrenia best understood in terms of someone’s experience than as a set of symptoms  Szasz (1960) Medical model is useless and dangerous

Context  Disagreement over “sanity” and “insanity”  Concepts of normality are not universal

Context  Rosenhan Did not argue that mental illness did not exist, nor that it could not cause suffering. Diagnosis has more to do with the situation than the person  Psychiatrists in law What does this suggest about validity and reliability?

Aims  Can psychiatrists distinguish between people who are genuinely mentally ill and those who are not?  Pseudopatients Two possible outcomes: what would we conclude from these?

Procedure  Who were the participants?  Who were the pseudopatients?  Read through and highlight the procedure  Fill in the gaps in the findings

Conclusions  What is the main conclusion? (look back at Rosenhan’s aim?)  “It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals. The hospital itself imposes a special environment in which the meaning of behaviour can easily be misunderstood. The consequences to patients hospitalized in such an environment – the powerlessness, depersonalization, segregation, mortification, and self-labelling – seem undoubtedly counter-therapeutic”.

Conclusions  Doctors more likely to make type 2 errors than type 1 Makes sense for physical illness What about for psychological illness?  What can we conclude from the behaviour of the staff towards the patients?  What do these results imply for mental health care?

Alternative evidence  Slater (2004) Presented herself to a number of hospitals with an isolated auditory hallucination Given a diagnosis of psychotic depression, and sent home with medication  However Slater had previously been diagnosed with depression What other issue here?

Alternative Evidence  Read the modern criteria for schizophrenia Would the pseudopatients be diagnosed as schizophrenic today?  Sabin and Mancuso (1980) Pseudopatients would not get admitted to hospital today as diagnosis has changed  Validity of Rosenhan? However...

Alternative evidence  Have things really changed? Still disagreement between psychiatrists  Whaley (2001) Used inter-rater reliability As low as +.11 for some conditions

Alternative Evidence  Rosenhan concluded that the bias in the diagnosis rested with the situation in which the pseudopatients found themselves (the “insane place” of the hospital). What else could cause bias?  Loring and Powell (1988) Diagnosis influenced by race

Alternative Evidence  Spitzer (1975) Took issue with Rosenhan’s conclusions Psychiatrists have to rely upon the verbal reports of the patients who come to them for help. It is not expected that an individual would try to trick their way into a psychiatric institution.  Would the conclusion be the same if it was a physical illness which was being faked?

Alternative Evidence  Spitzer (1976) Schizophrenia in remission is very rarely applied to patients What does this mean for Rosenhan?