1. Key assumptions of the area Main methods of research (C.O.S.E.)
Exit Question: The 5 areas and 2 perspectives in Psychology
Key assumptions of the area
Main methods of research (C.O.S.E.)
How it stands on each debate
2 pieces of research
Behaviourist, Biological, Cognitive, Developmental, Individual Differences, Psychodynamic, Social

2. "If sanity and insanity exist, how shall we know them?"
Prep (and cover work) for Friday 8/6/18
Match the questions to the answers
Watch 1st
Watch 2nd
Overview of the Key Study: turn sound off

3. "If sanity and insanity exist, how shall we know them?"
If I labelled you as ‘needing support’, would this change you in any way?

4. "If sanity and insanity exist, how shall we know them?"
Can you diagnose people with an illness (mental or physical) by using a checklist?

5. "If sanity and insanity exist, how shall we know them?"
Who prefers to be labelled with a mental health disorder: the patient or the psychiatrist?

6. "If sanity and insanity exist, how shall we know them?"
Are asylums the best place to be for people with mental illness?

7. "If sanity and insanity exist, how shall we know them?"
Aim
To summarise the aim, procedure, findings and evaluation of Rosenhan’s (1973) study.
Learning Objectives
Understand the context of mental illness and the history of defining abnormality and the way in which mental illness is classified and diagnosed.
Describe the Rosenhan (1973) study and appreciate how it relates to the topic area in terms of the reliability and validity of the diagnosis of mental illness.
Apply issues and debates such as generalisability, reliability and validity, ethical issues and usefulness of research.

8. Does madness lie in the eye of the observer?
Do the characteristics of abnormality reside in the patients? or
In the environments in which they are observed?
Does madness lie in the eye of the observer?

9. Exit Question: the Statistical Tests
Test of association (Correlation)
Spearman’s Rho
Test of difference, nominal data and independent measures
Chi2
Test of difference, nominal data and repeated measures design
Binomial S test
Test of difference, ordinal / interval data and independent measures
Mann Whitney U
Test of difference, ordinal / interval data and repeated measures
Wilcoxon T

10. Background
A long history of attempting to classify abnormal behaviour.
Most commonly accepted approach to understanding & classifying abnormal behaviour is the medical model.
Psychiatry
Psychiatrists are medical doctors and regard mental illness as another kind of illness (in addition to physical)
Beginning in the 1950s the medical model has used the Diagnostic and Statistical Manual of Mental Disorders (DSM) to classify abnormal behaviour
The medical model suggests that the cause of abnormality is biochemical, genetics, and/or brain abnormality

11. The Medical Model
Assumes that psychological disorders are mental illnesses
that need to be diagnosed
& treated through medication or surgery or ECT

12. DSM-V
Labels
The Diagnostic and Statistical Manual of Mental Disorders provides an authoritative classification scheme.
Describes disorders and their prevalence without presuming to explain their causes
Although diagnostic labels may help communication and research, they can also bias our perception of people’s past and present behaviour and unfairly stigmatize these individuals.
CRAZY!

13. Background
1960s - The anti-psychiatry movement (psychiatrists & psychotherapists) began to criticize the medical model
Rosenhan was also a critic of the medical model – “Its a worrying thought that there could be thousands of people stuck in institutes that are just as ‘sane’ as we are.”
His study can be seen as an attempt to demonstrate that psychiatric classification is unreliable

14. Background Difficulty of judging what is 'normal'
Varies over time / between societies
Rosenhan asked "If sanity and insanity exist, how shall we know them?"
Research Q: if 'normal' people attempt admission to psychiatric hospitals, will they be detected? / how?

15. Background

17. Aim
Test the hypothesis that psychiatrists cannot reliably tell the difference between people who are sane and those who are insane.

18. The Researchers Confederates (not the subjects)
EIGHT sane people!
Three women and five men
One graduate student
Three psychologists
One pediatrician
A painter
A housewife
A psychiatrist
Pseudo-Patients!

19. Procedures
Telephoned 12 psychiatric hospitals for urgent appointment (5 US states)
Arrived at admissions
Gave false names and occupations
Gave other ‘life’ details correctly

20. So here’s my cunning plan
So here’s my cunning plan. I’m going to send these people to a hospital and see what happens if they say they’ve got symptoms of madness.

21. What symptom could they use?
And why?

22. They said their only symptom was hearing a voice, the same sex as they are, saying the following:
Thud
Hollow
Empty

23. Procedure Complained that they had been hearing voices
Unfamiliar and the same sex as themselves
Said 'empty', 'hollow', 'thud'.
Symptoms were partly chosen because they were similar to existential crisis symptoms (Who am I? What is it all for? – meaninglessness of one’s life)
Also chosen because there is no mention of existential psychosis in the literature.

24. Did they get let in? All were admitted to hospital
All but one were diagnosed as suffering from schizophrenia
Once admitted the ‘pseudo-patients’ stopped simulating ANY symptoms
Took part in ward activities

25. Procedure Kept notes on their experiences
Did this secretly to begin with
Then openly when they realised no one cared or paid any attention to them doing this

26. Procedure The pseudo-patients were never detected
All pseudo-patients wished to be discharged immediately
BUT - they waited until they were diagnosed as “fit to be discharged”

27. How did the staff perceive them?
Normal behaviour was misinterpreted:
Writing notes described as -“The patient engaged in compulsive writing behaviour”
Arriving early for lunch described as - “oral acquisitive syndrome”
Outburst from patient – never enquire what caused response
Behaviour distorted to ‘fit in’ with diagnosis/label

28. 4 of the pseudo-patients carried out an observation on how patients were treated by staff…..

29. The pseudo-patient’s observations
Who has said ‘hello’ to you this morning?
Who has looked you in the eye to talk to you?
Which member of staff has stopped to talk with you this week?

30. The pseudo-patient’s observations
If patients approached staff with simple requests (NURSES & ATTENDANTS)
88% ignored them (walked away with head averted)
10% made eye contact
2% stopped for a chat
(1283 attempts)

31. The pseudo-patient’s observations
If they approached staff with simple requests
PSYCHIATRISTS 71% ignored them (walked away with head averted)
23% made eye contact
2% stopped for a chat
(185 attempts)
Nurses stayed in ward offices 90% of time
Each ‘real patient’ spent less than 7 minutes per day with psychiatric staff

32. Powerlessness and Depersonalization
Medical records were open to all staff regardless of status or therapeutic relationship with the patient
Personal hygiene monitored
Many of the toilets did not have doors
Some of the ward orderlies were brutal to patients in front of other patients ~ would stop when another staff member approached
This indicated that staff were credible witnesses but patients were not

33. How many words can you make from this phrase?
Rosenhan’s On being sane in insane place
20 words = good
30 words = great
40 words = fabulous

34. Starter Task: Rosenhan’s Facebook Page

36. How long did they stay in hospital?*
07/16/96
The shortest stay was 7 days
The longest stay was 52 days
The average stay was 19 days
They had agreed to stay until they convinced the staff they were sane!! * ##

37. Were they treated in the same way as normal patients...*
07/16/96
Given total of 2100 medication tablets
They flushed them down the loos
Noted that other patients did the same and that this was ignored as long as patients behaved themselves !! * ##

38. 35 out of 118 patients voiced suspicions about the pseudo-patients
Did anyone suspect?
35 out of 118 patients voiced suspicions about the pseudo-patients
“You’re not crazy”
“You’re a journalist”
“You’re a professor, checking up on the hospital”

39. Schizophrenia “IN REMISSION”
On Release
The pseudo-patients were diagnosed with
Schizophrenia “IN REMISSION”

40. So… Lack of monitoring Distortion of behaviour
Lack of normal interaction
Powerlessness & depersonalization

41. Quick Questions What was the IV for this experiment?
What was the DV for this experiment?
What was the experimental method used?

43. Rosenhan: The follow up study…*
07/16/96
A teaching & research hospital heard of the first study – didn’t think they would make the same mistake
They were warned that …
Over the next 3 months ONE OR MORE pseudo-patient would attempt to be admitted * ##

44. What happened……….? *
07/16/96
Staff members rated ‘new patients’ on scale as ‘how likely to be a fraud’
193 patients ‘assessed’
41 rated as a pseudo-patient (by staff)
23 rated as pseudo-patient (by psychiatrist)
19 rated as pseudo-patient (by both) * ##

45. Rosenhan (1973) Sane in Insane places

46. Just guess how many I’d really sent.......
AH HA HA HA!
Just guess how many I’d really sent

47. How many of these SUSPECTS were pseudo-patients?……...*
07/16/96
NONE
No pseudo-patients were sent
Staff were rating their regular intake * ##

48. Quick Questions What was the IV for this 2nd experiment?
What was the DV for this 2nd experiment?
What was the experimental method used?

49. What did Rosenhan conclude?*
07/16/96
Remember, his question was …
Do the characteristics of abnormality reside in the patients? OR
In the environments in which they are observed?
Does madness lie in the eye of the observer? * ##

50. What did Rosenhan conclude?*
07/16/96
“It is clear that we are unable to distinguish the sane from the insane in psychiatric hospitals”
In the first study - We are unable to detect ‘sanity’
This is what’s known as a Type I error – false positive - diagnosing healthy people as sick
In the follow up study - We are unable to detect ‘insanity’
This is what’s known as a Type 2 error – diagnosing sick people as healthy – false negative * ##

51. Rosenhan’s study highlighted:*
07/16/96
The depersonalisation and powerlessness of patients in psychiatric hospitals
That behaviour is interpreted according to expectations of staff and that these expectations are created by the labels SANITY & INSANITY * ##

52. Another thing Rosenhan noted ...*
07/16/96
The pseudo-patients described their stay in the hospitals as a negative experience
This is not to say that REAL patients have similar experiences
Real patients do not know the diagnosis is false & are NOT pretending * ##

53. Rosenhan: Possible conclusions
Psychiatric diagnosis is extremely inaccurate and the sane cannot be distinguished from the insane in psychiatric hospitals.

54. Rosenhan: Possible conclusions
Hospitals seem to be special environments where behaviour gets easily distorted and patients are treated in a way which continues any problems they may have rather than providing the kind of environment which would help and support them.

55. Rosenhan: Possible conclusions
Patients in psychiatric hospitals experience powerlessness and depersonalisation.

56. Rosenhan: Possible conclusions
Significant labelling in producing expectations and influencing behaviour;
once a patient has been labelled ‘insane’, all subsequent behaviour is seen in the light of the label given.
This was shown by the fact that patients were discharged with the label ‘Schizophrenia in Remission’.

57. Rosenhan: Possible conclusions
Institutionalisation in psychiatric hospitals has negative effects on the in-patients.
Mental health workers are insensitive to the feelings and emotions of psychiatric patients.

58. Rosenhan: Possible conclusions
The DSM had poor reliability.
The diagnosis of mental illness can be influenced by the situation an individual finds themselves in

59. Understanding Rosenhan
3 minutes to prepare
Concision is important
30 seconds to feedback

60. Understanding Rosenhan
Highlight 1 -2 words phrases per box to summarise it

61. Starter Task: Rosenhan*
07/16/96
State 3 quantitative findings from Rosenhan’s study * ##

62. Starter Task: Rosenhan*
07/16/96
State 3 qualitative findings from Rosenhan’s study * ##

63. Evaluating Rosenhan

64. Evaluation: Research Method: Field Experiment*
07/16/96
Although high in ecological validity, there is a lack of control which could make the results less valid. For example, differences in staff could affect the results. * ##

65. Evaluation: Generalisable?*
07/16/96
12 hospitals were used across 5 states so could be said to be fairly representative, but not to the rest of the world. This is a problem as it lacks population validity. * ##

66. Evaluation: Reliable? Valid?*
07/16/96
Reliability and validity are methodological issues.
This means that the WAY in which research is done (methodology) might have issues with it being consistent and/or true. * ##

67. Internal validity Internal reliability Test re-test reliability*
07/16/96
External Validity
Concurrent validity
Test re-test reliability
Split half reliability
Construct validity
Criterion validity
Internal validity
Population validity
External reliability
Ecological validity
Inter- rater reliability
Face validity * ##

68. Evaluation: Reliable? *
07/16/96
The process of being admitted to, and then released from the hospitals was consistent across all of the pseudo-patients, so it has high internal reliability. * ##

69. Evaluation: Reliable? *
07/16/96
 Participant observations are not very reliable, as they may miss observing behaviours. But they do allow the collection of highly detailed data without the problem of demand characteristics (good construct validity). * ##

70. Evaluation: Valid? *
07/16/96
 The process of being admitted to, and then released from the hospitals was very true to real life, so it has high ecological validity. * ##

71. Evaluation: Ethics *
07/16/96
The hospital staff was unaware of the pseudo patients so were deceived. It is debateable whether or not this was acceptable deceit. * ##

72. Evaluation: Ethics *
07/16/96
The pseudo patients were told to stay in hospital until they were released, so could be said to have been unable to withdraw from the study. They could also have suffered harm. * ##

73. Relating the Debates to Rosenhan*
07/16/96
The 8 debates are:
1. Nature/nurture
2. Freewill/Determinism
3. Reductionism/Holism
4. Individual/Situational Explanation
5. Usefulness of Research
6. Ethical Considerations
7. Conducting Socially Sensitive Research
8. Psychology as a Science * ##

74. Relating the Debates to Rosenhan*
07/16/96
Nature / nurture
3 key terms of the debate * ##

75. Relating the Debates to Rosenhan*
07/16/96
Nature / nurture
What perspective does Rosenhan have? * ##

76. Relating the Debates to Rosenhan*
07/16/96
Free will v determinism
3 key terms of the debate * ##

77. Relating the Debates to Rosenhan*
07/16/96
Free will v determinism
What perspective does Rosenhan have? * ##

78. Relating the Debates to Rosenhan*
07/16/96
Reductionism v Holism
3 key terms of the debate * ##

79. Relating the Debates to Rosenhan*
07/16/96
Reductionism v Holism
What perspective does Rosenhan have? * ##

80. Relating the Debates to Rosenhan*
07/16/96
Individual v Situational
3 key terms of the debate * ##

81. Relating the Debates to Rosenhan*
07/16/96
Individual v Situational
Why does this study how a situational explanation? * ##

82. Relating the Debates to Rosenhan*
07/16/96
Usefulness of the research
research is useful if it (D.R.U.G.V.)
develops therapies, interventions, preventative action or treatments
provokes further research in the field
progresses understanding beyond previous findings
is generalisable to a wide population
is valid so that results are accurate * ##

83. Relating the Debates to Rosenhan*
07/16/96
Usefulness of the research
research is useful if it (D.R.U.G.V.) develops action, provokes further research, progresses understanding, is generalisable, is valid
Which core study is the most useful / least useful? * ##

84. Evaluation: usefulness*
07/16/96
Rosenhan came up with a new definition of abnormality (F2FA)
Useful for hospital staff - treat patients with better, spend more time with them & don't interpret all behaviour in terms of the illness.
DSM was updated.
Diagnoses nowadays are more rigorous & more symptoms over a longer period have to be shown to be diagnosed. * ##

85. Relating the Debates to Rosenhan*
07/16/96
Usefulness
How has
Rosenhan’s study
been useful? * ##

86. Relating the Debates to Rosenhan*
07/16/96
Socially sensitive research can S.C.A.R.
Subject to social norms
Controversial
Able to shape the law / policy
Risking stereotyping and prejudice * ##

87. Relating the Debates to Rosenhan*
07/16/96
Socially sensitive research can S.C.A.R.
Subject to social norms
Controversial
Able to shape the law / policy
Risking stereotyping and prejudice
Identify 3 topics which are socially sensitive * ##

88. Relating the Debates to Rosenhan*
07/16/96
Socially sensitive research
Why is Rosenhan’s study socially sensitive? * ##

89. Relating the Debates to Rosenhan*
07/16/96
Psychology as a science
Falsifiable
Objective
Replicable
Quantitative data
Experiments * ##

90. Relating the Debates to Rosenhan*
07/16/96
Psychology as a science
Falsifiable – yes – R tried to prove himself wrong with the 2nd study
Objective – no – covert participant observation
Replicable – yes
Quantitative data – some
Experiment – yes – field * ##

91. Individual (Dispositional) v Situational Explanations of Behaviour
Discuss the individual / situational explanations debate. Use Core Studies to support your answer. [15]

92. Writing strong 15 mark answers
Point
Explanation
Example
Conclusion
Challenge
1 paragraph

93. Writing strong 15 mark answers
Point
Explanation
Example
Conclusion
Challenge 3
15 mark answer

95. Discuss the individual / situational explanations debate
Discuss the individual / situational explanations debate. Use Core Studies to support your answer. [15]

96. Paper 3 – 10 mark essay style questions
Explain how the research by … can be applied to … [10]
5 marks for AO1 KNOWLEDGE of the study
5 marks for AO2 APPLICATION to the question
This means you can pre-prepare answers for these.

97. Paper 3 – 10 mark essay style questions
5 marks for KNOWLEDGE of the study
Know the summary of the study:
Aim
Sample
Procedure
Results
Conclusions
WHERE POSSIBLE
Write your summary of Rosenhan’s study

98. Assessment Objectives: How the Marks are Awarded
AO1 Knowledge & Understanding
the amount of relevant material presented,
where low marks are awarded for brief or inappropriate material
and high marks for accurate and detailed material

99. Assessment Objectives: How the Marks are Awarded
AO2 Application of Knowledge
the level and effectiveness of critical commentary
where low marks are awarded for superficial consideration of a restricted range of issues and
high marks for a good range of ideas and specialist terms, and effective use of material addressing a broad range of issues

100. Assessment Objective 2: Identify why this achieved 15 marks
Practice assigning marks

101. Validity and Reliability of Diagnosis*
07/16/96
With reference to Rosenhan (1973), discuss the reliability of categorising and diagnosing mental disorders. [10]
With reference to Rosenhan (1973), discuss the validity of categorising and diagnosing mental disorders. [10] * ##

102. Validity and Reliability of Diagnosis*
07/16/96
With reference to Rosenhan (1973), discuss the validity of categorising and diagnosing mental disorders. [10]
Validity = truth / true
Concurrent validity
Predictive (Criterion) validity
Comorbidity * ##

103. Validity and Reliability of Diagnosis*
07/16/96
With reference to Rosenhan (1973), discuss the reliability of categorising and diagnosing mental disorders. [10]
Reliability = consistency
Inter-rater reliability
Test retest reliability * ##