APFCC+-+Rosenhan

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 * Theorist**: D. L. Rosenhan
 * Study** **of**: Problems with determining normality and abnormality.
 * Year**: 1973

Being sane in insane places, is it possible to detect insanity/abnormality in a mental institution. Sent volunteers into a mental asylum pretending to be patients, they were sane, but on average were in the facility for 19 days.
 * Summary:**

To illustrate experimentally the problems involved in determining normality and abnormality, particularly the poor reliability of the diagnostic classification for mental disorder at the time, and general doubts of validity, and the negative consequences of being diagnosed as abnormal and the effects of institutionalisation.
 * Aim**:

A field study. He had 8 volunteers (effectively confederates) they were **sane** **.** (3 women/5 men) They contacted 12 psychiatric hospitals for urgent appointments, gave false names and addresses. Complained of hearing ‘unclear voices’ saying ‘empty, hollow, thud’. They role-played an existential crisis ‘Who am I, what’s it all for?” All were admitted to hospital. All but **one** was diagnosed as suffering from schizophrenia. Once admitted the ‘pseudo-patients’ stopped simulating ANY symptoms, and were behaving normally. Took part in ward activities.
 * Procedures**:

Distortion of behaviour Their normal behaviour was misinterpreted, by the ward staff. Writing notes was described as - ‘the patient engaged in writing behaviour’ Pacing the corridors was seen as nervousness rather than boredom. Arriving early for lunch described as ‘oral acquisitive syndrome’. Behaviour distorted to ‘fit in’ with label.
 * Findings**:

Lack of monitoring Nurses stayed in ward offices 90% of the time. Each ‘real patient’ spent less than 7 minutes per day with psychiatric staff.

Powerlessness and depersonalisation Lack of rights, constructive activity, choice and privacy, plus both physical and verbal abuse from the attendants.

Length of stays The shortest stay was 7 days The longest stay was 52 days.

The average stay was 19 days, they had to stay until they convinced the staff they were sane.

On release On release the patients were diagnosed as being in remission rather than cured, they still had the label.

‘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.’
 * Conclusions:**

Lack of control groups, data analysis was mostly qualitative rather than quantitative.
 * Criticisms**:

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 labels.

Was this ethical? No, possible harm, lots of deception.

Why might the reports of the pseudo-patients have been unreliable? Self-reporting? They aren’t aware of everything that is going on in the hospital.
 * Further Information:**

Follow up study (2) The hospitals were told that one or more people would be attempting to access the hospital. Of the 193 patients that were assessed, 41 rated as pseudo-patient (by staff) 23 by psychiatrist and 19 by both. None of these suspects were the pseudo patients. No pseudo patients were actually sent.