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2. I. Background to Study A. Key terms for this study – 1. Insanity = Unsoundness of mind sufficient in the judgment of a civil court to render a person unfit to maintain a contractual or other legal relationship or to warrant commitment to a mental health facility. – 2. pseudopatients = the name for the stooges (including Rosenhan) that went into the mental hospitals to conduct participant observation 2

3. I. Background to the study – 3. Type I Error = rejecting the null hypothesis (there is no difference) when it is in fact true. For example a test tells you that you have a disease when in fact you do not. This is also known as a “false positive” – 4. Type II Error = accepting the null hypothesis when in fact it is not true. This would be taking a test and finding out you do not have a disease when in fact you do? 3

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5. So here’s my cunning plan. We’re all going to go to a hospital and see what happens if we say we’ve got symptoms of madness.

6. II. Aim and Design A. The Aim and Hypothesis – 1. Rosenhan hypothesized that psychiatrists cannot reliably tell the difference between people who are sane and insane – 2. If this is true then the entire classification system and perhaps the medical model must be rejected for lack of validity – 3. A 2 nd Aim was to describe the conditions in the hospitals Rosenhan “…do the salient characteristics that lead to diagnoses reside in the patients themselves or in the environment and contexts in which observers find them? 6

7. II. Aim and Design – Study 1 B. Design to test the H 1 (hypothesis) – 1. pseudo-patients who report hearing voices present themselves at mental hospitals complaining of hearing voices a. If they gain admission then the Dx (diagnosis) system is flawed b. The IV = false symptoms c. The DV’s = admission to hospital and Dx 7

8. II. Aim and Design – Study 2 – 2. A second experiment was conducted to see if the reverse was true. For this exp they told a hospital that pseudo-patients would be checking in but none ever did a. The IV was the false claim that a sane person would be trying to gain admission b. The DV was the # of patients suspected 8

9. 3. In a 3 rd study conducted simultaneously in 4 of the hospitals the pseudo-patients approached the staff with a simple request for info a. IV The type of staff member doctor/nurse b. DV = behaviors such as eye contact, pause and chat etc. c. This portion of the study can be considered a Field experiment

10. Thud Hollow Empty We’ll say our only symptom is hearing a voice, the same sex as ourselves, saying the following:

11. Sample. The pseudo-patients a. 8 people including Rosenhan himself b. Report hearing voices saying “empty” “hollow” and “thud” c. These words were meant to represent an existential crisis, not a psychotic experience d. With the exception of the first trial in which the hospital knew Rosenhan was there the subsequent hospitals and staff were blind to this fact 11

12. II. Aim and Design 4. The hospitals a. 12 hospitals representing a generalizable sample b. 5 different states from West coast to East coast 5. Type of experiment a. Naturalist/field experiment b. Participant observation 12

13. III. Procedures for Exp 1 A.Patients called for an appointment B.Gives false name and occupation C.Arrives at admission complaining of hearing voices saying, “empty, hollow and thud” D.Voices were unfamiliar and same sex as patient E.All other parts of patients histories were true and correct 13

14. F.Did not show outward signs of psychopathology (or so they believed) G.As soon as they were admitted, patients STOPPED simulating any symptoms of abnormality H.Although nervous, they behaved normally toward other patients and staff I.Complied with orders (took meds but did not swallow) 14

15. J.Answered staff questions saying they felt fine K.Spent their time writing down their observations about the ward, patients and staff L.At first the journaling was secret, but no one cared or said anything so they openly took notes M.They were admitted without knowing how long they would be there N.They knew discharge would come after convincing the staff that they were sane 15

16. IV. Results Exp 1 A. The Normal are not Detectably Sane – 1. None were ever detected – 2. All but 1 admitted with a Dx of Schizophrenia 16

17. – 3. Discharged with Dx of Schizophrenia in remission a. This doesn’t mean you no longer have schizophrenia but instead means that the symptoms are no longer prominent. b. It is implied that the symptoms can and will return and that you are still “sick” – 4. Length of hospitalization was 7- 52 days with an avg length of 19 days – 5. During first 3 hospitalizations 35 out of 113 patients voiced suspicions saying they were journalists or professors 17

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19. B. The experience of Psychiatric Hospitalization – 1. Staff and patients strictly segregated..even eat in different areas – 2. Staff spends only 11.3% of the time outside of the glass “cage.” They only come out for required activities. – 3. Nurses “mingled” with the patients that the percentage was too small to even report. – 4. On avg only left the cage 11.5 times per shift during the day and only 9.4 x for night shifts – 5. More power = less time with patients (ie doctors nurses less, custodians more 19

20. C. Powerlessness and Depersonalization – 1. Beatings – 2. Verbal abuse – 3. No eye contact – 4. Ignoring direct questions – 5. Beating patients for direct questions – 6. Bathrooms without doors – 7. Nurse changed in front of male patients as if they were not even there 20

21. So, psychiatrists had a tendency to diagnose us as insane when we weren’t. What do you think a great next step would be in research terms? MAD! CLEARLY SCHIZOPHRENIC!

22. This presentation contains copyrighted material under the educational fair use exemption to the U.S. copyright law” “This presentation contains copyrighted material under the educational fair use exemption to the U.S. copyright law” 22 Rosenhan 1973 On Being Sane in Insane Places Science Vol 179 page250-258 VIDEO 3

23. V. Exp 2 Procedures and Results A. Rosenhan in attempt to see if people who were truly reporting for problems would be diagnosed as faking ran a 2 nd experiment – 1. He told a hospital who had heard about his experiment and claimed it couldn’t have happened at their hospital that he would be sending a fake patient to the hospital – 2. HE NEVER DID (I really like his devious nature) 23

24. I AM a good doctor! I AM worth my massive salary! This hospital has sharpened up its act about diagnoses and, Dr Rosenhan, I detected with a HIGH DEGREE of confidence 41 patients you sent me pretending they were insane when I could tell they were perfectly SANE.

25. – 3. Each member of the staff was asked to rate the patients they came into contact with on a 10 point scale on how much they believed the patient was a pseudo-patient B. Results – 1. 193 patients were admitted during the 3 month period – 2. 41 patients were confidentially alleged to be fake by at least 1 staff member 25

26. – 3. 23 were suspected by at least 1 psychiatrist – 4. 19 were suspected by at least 1 psychiatrist and 1 other staff member – 5. So it seems not only can the hospitals not distinguish a sane person from an insane person, but they also can not distinguish truly sick patients from sane ones. 26

27. 27 Results of Study 3

28. C. Why were they not detected? – 1. Could not be due to lack of time. Average stay was 19 days – 2. Could not be due to the fact that they were not acting sanely. In fact many of the patients knew right away – 3. Could not be due to quality of hospital or location – 4. It must be because doctors are predisposed toward making type II disorders D. Labels ARE STICKY 28

29. VI. Evaluation A. Theoretical Issues – 1. Does mental illness actually exist? a. Some like Thomas Szasz believe there is no such thing as mental illness. b. Others go so far as to say the Dx of schizophrenia is a violent act perpetrated by the medical community (The conspiratorial model) 29

30. – 2. Labeling may explain behavior after Dx but how do you explain the behaviors prior to Dx that led the person to seek help? – 3. In defense of classification a. Kendell (1983) Claims all patients has attributes at 3 levels – Those shared with ALL other psychiatric patients – Those shared only with SOME other psychiatric patients – Those that are unique to them b. It is those that are only shared by some that allow us to classify. In other words people with depression have different characteristics than those with anxiety 30

31. c. Several studies done where psychiatrist/psychologists use similar criteria they show impressive inter-rater reliability in their B. Methodological Issues – 1. Field study/naturalistic observation a. Not an experiment even though there were IV’s and DV’s. b. Only one group/condition so no cause and effect relationship established. 31

32. – 2. The sample – a. Are the pseudo-patients or the hospitals the “sample? b. How did Rosenhan attempt to create generalization with the sample of hospitals? – 3. Data a. Quanitative Data – see chart on slide 17 b. Qualitative data included the pseudo-patients notes and recollections of what happened 32

33. C. Ethical issues – 1. Were the stooges (pseudo-patients) put under undue stress? – 2. The doctors and hospitals were unaware and therefore were deceived. This violates certain ethical principles but could it have been done otherwise? 33

34. D. Ecological Validity and Reliability – 1. Field studies generally have more ecological validity a. Fact that staff didn’t know makes their reactions and interactions with the patients more likely to be typical. b. As with all field studies you lose control. Can we be sure that the patient acted as sane as they thought they were acting? – 2. Reliability of psuedo-patient reports a. Relying on psuedo-patient notes and recollections could limit the reliability of this data b. Would two pseudo-patients have inter-rater reliability? 34

35. E. Situational for Dispositional attributions – 1. What does the study show about the impact of labels on how others interpret our behavior – 2. Was it unreasonable for the doctor to suspect something was really wrong? How often do patients show up at hospitals with fake symptoms just to see how the doctor will diagnose them. – 3. How do you explain disturbed behavior that occurs prior to hospitalization 35