Key assumptions of the area

1. 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 https://www.youtube.com/watch?v=D8OxdGV_7lo Watch 2ndhttps://www.youtube.com/watch?v=Vo8KgPduHXM Overview of the Key Study: turn sound off https://www.youtube.com/watch?v=31lFQPSt-ro

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? https://www.youtube.com/watch?v=KhwyYCg0BZA

6. "If sanity and insanity exist, how shall we know them?" Are asylums the best place to be for people with mental illness? https://www.youtube.com/watch?v=KhwyYCg0BZA

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. https://www.youtube.com/watch?v=57-c0y_T18E https://www.youtube.com/watch?v=D8OxdGV_7lo

8. 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

10. Background The medical model suggests that the cause of abnormality is biochemical, genetics, and/or brain abnormality • 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

11. The Medical Model • Assumes that psychological disorders are mentalillnesses • 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 biasourperception 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 https://www.youtube.com/watch?v=D8OxdGV_7lo

16. https://www.youtube.com/watch?v=3WXBdiJWE3c https://www.youtube.com/watch?v=KmuHBFmolpk

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. 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 • PSYCHIATRISTS71% 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 https://www.youtube.com/watch?v=KmuHBFmolpk

36. 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!!

37. 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 !!

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

39. 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… 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……….? 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)

45. Rosenhan (1973) Sane in Insane places

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

47. How many of these SUSPECTSwere pseudo-patients?……... 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? 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. “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 What did Rosenhan conclude?