rosenhan (1973) sane in insane places on being sane in insane places science 179 250-8...

Rosenhan (1973) Sane in Insane places

On being sane in insane places

Science 179 250-8

psychlotron.org.ukMark Souter


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?



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



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



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!



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)



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'



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



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!]



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!



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



self-initiated contact by psuedo-patients with psychiatrists, nurses and attendants

0 10 20 30 40 50 60 70 80 90 100

move on with headaverted

makes eye contact

pauses and chats

stops and talks

psychiatrists nurses and attendants



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



results: medication • PPs given 2,100 tablets • only 2 swallowed • when some were flushed PPs spotted other

patients' medication! • = cooperative patients' behaviour ignored



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



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


rosenhan (1973) sane in insane places on being sane in insane places science 179 250-8...

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