Individual Differences

Individual Differences Core Study: On being sane in insane places (D.L.Rosenhan 1973)

The Question… • If sanity and insanity exist how shall we recognise them?

Specifically… Rosenhan was interested in… Testing the hypothesis that psychiatrists cannot reliably tell the difference between people who are sane and people who are insane.

Study one - AIM To see if sane individuals who presented themselves to a psychiatric hospital would be diagnosed as insane

What did he do (procedure)? The Pseudopatients: 8 ‘normal’ people (including Rosenhan, 5 men and 3 women) • Attempted to gain admission to 12 different hospitals across the USA.

Procedure continued • Pseudopatients telephoned for an appointment. • On arrival gave false names but gave true details of their family, their background and recent life experiences

Procedure continued… They all complained of hearing an unfamiliar, same sex voice which said ‘empty’, ‘hollow’ and ‘thud’ They were all sane! These were chosen because they indicated an existential crisis (Who am I?) a previously unreported symptom of schizophrenia.

What happened? • Once admitted to the ward, pseudopatients ceased to show any symptoms of abnormality. • They secretly didn’t take their medication but otherwise followed the normal routine.

What happened on the ward? • They spoke to staff and patients as they would ordinarily. • They spent time writing notes on their observations (openly) • Carried out observations of the behaviour of staff towards patients (4 hospitals)

How long did they stay in hospital? • The shortest stay was 7 days • The longest day was 52 days • The average stay was 19 days • They all agreed to stay until they convinced staff they were sane!

On release…. • All were discharged with a diagnosis of ‘schizophrenia in remission’

Explanation • The failure to detect the pseudopatients’ sanity may be because doctors have a strong bias towards the ‘type 2 error’ –

Type 2 error = doctors are more likely to call a healthy person sick • Type 1 error = doctors are more likely to call a sick person healthy • Which do you think is more dangerous?

Study 2 - AIM To see if the tendency towards diagnosing the sane as insane could be reversed

Experiment 2 • Took place in a hospital where staff had heard about first experiment but thought they would not make the same error • Rosenhan told them that some of the patients presenting at the clinic for the next 3 months would be pseudo patients. • Doctors/nurses had to rate likelihood of a patient being ‘pseudo’ but to treat all appropriately

Results • 193 patients admitted for treatment over 3 months • 41 were judged to be pseudopatients by at least one staff member • 23 patients were suspected by at least one psychiatrist • 19 patients were suspected by a psychiatrist & one other staff member

However.…… There were no pseudo patients!

Explanation The hospital staff were now making more type 1 errors (calling a sick person healthy) because they were trying to avoid making type 2 errors.

Study 3 • To investigate patient-staff contact • In 4 of the hospitals pseudopatients approached a staff member with the question ‘Pardon me, Mr/Mrs/Dr X, could you tell me when I will be eligible for grounds privileges?’ • This was done as normally as possible

The pseudopatient’s observations The most common response was a brief reply as the member of staff continued without pausing and making no eye contact. 4% of the psychiatrists & 0.5% of the nurses stopped; 2% in each group actually paused and chatted.

Discussion point 1 • Stickiness of labels – the results show the effect of a ‘label’ on our perceptions of people. Normal behaviour was misinterpreted. • What examples can you think of from the study which demonstrate this?

Discussion Point 1 • Stickiness of labels • Writing….seen as aspect of pathological behaviour. • ‘Patient engages in writing behaviour’ • Arriving early for lunch • Behaviour was distorted to fit with theory.

Discussion Point 2 • Experience of psychiatric hospitalisation • For example…Nurses stayed in the ward offices about 90% of the time • Staff spent under 7 minutes with patients per day on average.

Discussion Point 3 • Powerlessness & depersonalisation • Patients were deprived of movement & privacy • Some of the ward orderlies were brutal to patients but stopped as other staff approached • Pseudopatients were given 2,100 tablets (only 2 swallowed)

Individual Differences