Post on 04-Jan-2016
BEFORE WE BEGIN…….
1Look at the list of behaviours
2Write down why you think each of these behaviours is abnormal or normal.
spiderPut your suggestions aside for a moment
SOME DEFINITIONS OF ABNORMALITY
Stratton & Hayes (1993) .. Abnormality IS• Behaviour which deviates from the norm • most people don’t behave that way
• Behaviour which does not conform to social demands • most people don’t like that behaviour
• Behaviour which is maladaptive or painful to the individual • its not normal to harm yourself
SPECIFICALLY…….
• Do the characteristics of abnormality reside in the patients?
• or in the environments in which they are observed?
WHAT WAS ROSENHAN’S INTEREST?
• How reliable are diagnoses of abnormality?
• Will the same symptoms always be diagnosed in the same way?
THE ASTONISHING STUDY……….. ON BEING SANE IN INSANE
PLACES…...
• D L Rosenhan (1973)
• What did he do?• Who were involved?
THE BRAVE VOLUNTEERS…… .
• EIGHT sane people!• one graduate student • three psychologists • a paediatrician • a painter• housewives
WHAT DID THEY DO?THE PROCEDURE……………………..
• telephoned 12 psychiatric hospitals for urgent appointment (in five USA states)• arrived at admissions• gave false name and address • gave other ‘life’ details correctly
WHAT ELSE DID THEY DO?
• complained of hearing unclear voices … saying “empty, hollow, thud”
• Said the voice was unfamiliar, but was same sex as themselves
• Simulated ‘existential crisis’• “Who am I, what’s it all for?”
WHAT HAPPENED? ………..
• 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
WHAT HAPPENED ON THE WARDS?
• 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’
HOW DID THE WARD STAFF ‘SEE’ THEM?
• Normal behaviour was misinterpreted• Writing notes was described as -• “The patient engaged in writing behaviour”
• Arriving early for lunch described as • “oral acquisitive syndrome” • Behaviour distorted to ‘fit in’ with theory
THE PSEUDO-PATIENT’S OBSERVATIONS…
• If they approached staff with simple request• (NURSES & ATTENDANTS)• 88% ignored them • (walked away with head averted)
• 10% made eye contact• 2% stopped for a chat• (1283 attempts)
THE PSEUDO-PATIENT’S OBSERVATIONS…
• If they approached staff with simple request• (PSYCHIATRISTS)• 71% ignored them • (walked away with head averted)
• 23% made eye contact• 2% stopped for a chat• (185 attempts)
HOW LONG DID THEY STAY IN HOSPITAL?
• 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!!
• Discuss: How would YOU convince someone you are sane?
WERE THEY TREATED IN THE SAME WAY AS NORMAL PATIENTS...
• 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 !!
WHAT SORTS OF RECORDS DID THEY KEEP …….?
• Nurses stayed in ward offices 90% of time
• Each ‘real patient’ spent less than 7 minutes per day with psychiatric staff
PERHAPS THEY BEHAVED ‘ABNORMALLY’
• Pseudo-patient’s visitors detected “No serious behavioural consequences”
• DID ANYONE SUSPECT?
ROSENHANTHE FOLLOW UP STUDY……………..
• A teaching & research hospital was told of the first study
• and warned that …• Over the next three months ONE OR MORE
pseudo-patient will attempt to be admitted
WHAT HAPPENED……….?
• Staff members rated ‘new patients’ on scale 1 - 10 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)
HOW MANY OF THESE SUSPECTSWERE PSEUDO-PATIENTS?……...
• NONE• No pseudo-patients were sent – the staff were
rating their regular intake
WHAT DID ROSENHAN CONCLUDE?
• 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
ROSENHAN’S CONCLUSION…..
• “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’• In the follow up study• We are unable to detect ‘insanity’
ROSENHAN’S STUDY HIGHLIGHTED ...
• 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
ANOTHER ROSENHAN NOTE……..
• 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
QUESTIONS YOU SHOULD BE ABLE TO ANSWER...
• Methodology: This was a field experiment
• Who were the participants?
• Was this study ethical? If not why not?
QUESTIONS YOU SHOULD BE ABLE TO ANSWER…….
• Why might the reports of the pseudo-patients have been unreliable?
LOOK BACK AT YOUR ‘LIST’ OF ABNORMAL BEHAVIOUR ……...
• Can we devise some general rules
• to describe
• NORMAL and ABNORMAL behaviour