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On Being Sane In Insane Places

The aim of this study was to test the hypothesis that psychiatrists cannot reliably notify the difference between those patients who are sane and the ones who are insane.

Procedure

The study contains two parts.

The main research is an exemplory case of a field test. The manipulation (Independent variable) was the comprised symptoms of pseudo patients, the based mostly variable was the psychiatrists' diagnostic admission of the pseudo patient and diagnostic labelling. The analysis also engaged participant observation, since, one accepted, the pseudo patients retained written records of how the ward all together run, as well as the way the personally were cured.

The first part of the study involved eight sane people (a psychology graduate scholar in his 20s, three psychologists, a paediatrician, a psychiatrist, a painter, and a 'housewife') attempting to gain admission to 12 different clinics, in five different says in the USA. There were three women and five men.

These pseudo-patients telephoned a healthcare facility for a scheduled appointment, and arrived at the admissions office complaining that they had been hearing voices. They said the words, which was unfamiliar and the same making love as themselves, was often unclear but it said 'vacant', 'hollow', 'thud'. These symptoms were partly chosen because these were much like existential symptoms (Who am I? What is it all for?) which occur from concerns about how meaningless your life is. These were also chosen because there is no mention of existential psychosis in the books.

The pseudo patients offered a incorrect name and job (to protect their health and employment documents), but all other details they gave were true including general ups and downs of life, connections, situations of life background and so on.

After they had been accepted to the psychiatric ward, the pseudo patients halted simulating any symptoms of abnormality. However, Rosenhan do remember that the pseudo patients were anxious, possibly because of fear of being coverage as a fraud, and the novelty of the situation.

The pseudo patients needed part in ward activities, talking with patients and staff as they might typically. When asked how these were feeling by staff these were fine no much longer experienced symptoms. Each pseudo patient had been told they would have to get out by their own devices by convincing staff these were sane.

The pseudo patients spent time writing records about their observations. Primarily this was done secretly although as it became clear that nobody was bothered the take note taking was done more openly.

In four of the hospitals the pseudo patients completed an observation of behaviour of personnel towards patients that illustrate the experience to be hospitalised on the psychiatric ward. The pseudo patients contacted an employee member with a question, which took the following form: 'Pardon me, Mr/Mrs/Dr X, would you notify me when I am presented at the personnel getting together with?'. (or '. . . when am I likely to be discharged?'). See table 1.

In order to compare the results Rosenhan completed a similar research at Stanford University or college with students asking university staff a simple question.

Results

All of the pseudo patients disliked the knowledge and wished to be discharged immediately.

None of the pseudo patients was recognized and all but one were admitted with a diagnosis of schizophrenia and were eventually discharged with a prognosis of 'schizophrenia in remission' This identification was made without one clear sign of this disorder. They continued to be in hospital for 7 to 52 times (average 19 days), Visitors to the pseudo patients noticed 'no serious behavioural consequences'. Although they were not detected by the personnel, many of the other patients suspected their sanity (35 out of the 118 patients voiced their suspicions). Some patients voiced their suspicions very vigorously for example 'You're not crazy. You're a journalist, or a professor. You're checking through to the medical center'.

The pseudo patients' normal behaviours were often viewed as areas of their supposed illness. For example, medical records for three of the pseudo patients proved that their writing was viewed as an aspect of these pathological behavior. 'Patient engages in writing behavior'. Rosenhan notes that there surely is a massive overlap in the behaviours of the sane and the crazy. We all feel depressed sometimes, have moods, become angry and so forth, however in the context of your psychiatric clinic, these everyday individuals encounters and behaviours were interpreted as pathological.

Another example of where behavior was misinterpreted by staff as stemming from within the individual, as opposed to the environment, was when a psychiatrist pointed to a group of patients waiting beyond your cafeteria around 30 minutes before lunchtime. To several registrars (trainee psychiatrists) he recommended that such behavior was characteristic of an oral-acquisitive syndrome. However, a more likely reason would be that the patients got little to do, and mostly of the things to predict in a psychiatric hospital is a meal.

In four of the hospitals the pseudo patients completed an observation of behaviour of personnel towards patients that demonstrate the experience of being hospitalised on the psychiatric ward. The results were compared with a university analysis. In the college or university study, almost all the requests were acknowledged and taken care of immediately unlike the psychiatric hospital where in fact the pseudo patients were cured as if these were invisible. See stand 1.

Table 1: Responses of staff towards pseudo patients requests

Response

Percentage making connection with patient

 

Psychiatrists

Nurses

Moves on with mind averted

71

88

Makes eyes contact

23

10

Pauses and chats

2

4

Stops and talks

4

0. 5

Rosenhan noted that experience of hospitalisation for the pseudo patients was one of depersonalisation and powerlessness.

Powerlessness and depersonalisation were noticeable in the ways in which the patients were deprived of several human rights such as liberty of motion and privateness. Medical records were open to al workers regardless of position or therapeutic relationship with the patient and personal hygiene was watched and many of the toilets did not have doors. A number of the ward orderlies would be brutal to patients in full view of other patients but would stop when another staff member approached. This mentioned that staff were credible witnesses but patients were not.

It was approximated that the pseudo patients received a total of 2, 100 medication tablets, though only two were swallowed. The others were either pocketed or flushed down the toilet. Often, when the pseudo patients stopped at the toilets to dispose of their tablets they found the medication of other patients that got already been positioned there. So long as the patients were co-operative, then their behavior went unnoticed.

The files the pseudo patients experienced made about the amount of time the nurses stayed in the ward offices was about 90 per cent of the time and the number of times medical staff arrived onto the ward, and the amount of time put in with psychiatrists, psychologists, registrars etc was, typically, under seven minutes each day.

The Secondary Study

Procedure/Method

In the supplementary study, the personnel of a teaching and research clinic, which was aware of the first review, was falsely informed that through the next 90 days one or more pseudo patients would try to be admitted to their hospital. Staff members were asked to rate on a 10-point range each new patient as to the likelihood of them being truly a pseudo patient.

This fake information was the manipulated unbiased variable, and the centered variable was the amount of patients which staff subsequently suspected to be pseudo patients.

Results/Findings of the Extra Study

The table implies that many patients of the private hospitals regular consumption were judged to be pseudo patients. For example, around ten % of these regular consumption was judged by one psychiatrist and another employee to be pseudo patients.

Table 2: Judgement of all admissions patients as to the likelihood they are pseudo patients

Number of patients judged

193

Number of patients confidently judged as pseudo patients by at least one personnel member

41

Number of patients suspected by one psychiatrist

23

Number of patients suspected by one psychiatrist AND an added staff member

19

Explanation

Rosenhan promises that the study shows that psychiatrists cannot reliably tell the difference between people who are sane and the ones who are insane.

The main test illustrated a failure to detect sanity, and the secondary study demonstrated a failure to identify insanity.

Rosenhan explains that psychiatric brands tend to stick in a way that medical labels do not which everything a patient will is interpreted relative to the diagnostic label once it's been applied.

He suggested that instead of labelling a person as crazy we should focus on the individual's specific problems and behaviours.

Evaluation of the Procedure

Strengths

The participant observation recommended that the pseudo patients could go through the ward from the patients' perspective while also retaining some degree of objectivity.

The study was a type of field experiment and was thus quite ecologically valid whilst still handling to regulate many variables including the pseudo patients' behavior.

Rosenhan used a variety of hospitals. These were in different Areas, on both coasts, old/shabby and new, research-orientated and not, well staffed and improperly staffed, one private, federal or college or university funded. This enables the leads to be generalised.

Weaknesses

The hospital personnel was deceived - this is, of course, unethical. Although Rosenhan did not conceal the titles of hospitals or personnel and attemptedto eliminate any signs which might lead with their identification

Rosenhan did remember that the encounters of the pseudo-patients can have differed from that of real patients who did not contain the comfort of knowing that the medical diagnosis was wrong.

Perhaps Rosenhan was being too much on psychiatric clinics, especially when it's important to allow them to play safe in their prognosis of abnormality since there is always an outcry when a patient is let out of psychiatric good care and enters trouble. If you were to visit the doctors complaining of belly aches how would you expect to be cured?

Doctors and psychiatrists will make a sort two error (that is, more likely to call a healthy person sick and tired) when compared to a type one error (that is, diagnosing a sick and tired person as healthy)

When Rosenhan performed his research the psychiatric classification in use was DSM-II. However, since then a fresh classification has been unveiled which was to address itself basically to the complete problem of unreliability - especially unclear conditions. It is argued that with the newer classification DSM-III, launched in the 1980s, psychiatrists would be less inclined to make the errors they did. The DSM happens to be in its fourth model (DSM-IV)

Evaluation of Explanation

The study demonstrates both the limitations of classification and importantly the appalling conditions in many psychiatric hospitals. This has stimulated much further research and has lead to numerous institutions improving their philosophy of care.

Rosenhan, like other anti-psychiatrists, is arguing that mental illness is a public phenomenon. It really is simply a outcome of labelling. That is an extremely persuasive argument, although many people who have problems with a mental disease might disagree and say that mental disease is an extremely real problem

ASSESSMENT QUESTIONS

Complete on a separate sheet of newspaper: THIS SHOULD BE COMPLETED IN CLASS AND THE EVALUATION SECTION FINISHED FOR Research.

  1. What information did the pseudo patients supply the psychiatrists?
  2. What diagnosis were they given?
  3. How long were the pseudo patients in clinic for?
  4. Once accepted, how have the pseudo patients behave?
  5. Give TWO examples of how the staff interpreted the behaviour of the patients (be specific).
  6. How did the real patients interpret the behaviour of the pseudo patients?
  7. Summarise the findings of the analysis the following stand:

Responses to demand made to psychiatrists

 

Reponses to demands designed to nurses and attendants

 

Amount of your energy spent with psychologists, psychiatrists etc.

 
  1. What observations did the pseudo patients make relating to medication directed at other patients?
  2. Rosenhan commentary that the major connection with the pseudopatients was one of "powerlessness and depersonalisation". Explain what this term means.
  3. In regards to the second area of the study:
  4. What does the staff members have to do?
  5. What were the results from this study?
  6. How many pseudo patients do Rosenhan send to a healthcare facility on the three month period?
  7. Write a short conclusion outlining the conclusions that can be drawn from both parts of this study. Utilize the conditions "labelling" and "expectations" in your overview.

EVALUATING THE STUDY

  1. What are the advantages and weaknesses of these research methods in the context of the analysis? (handled observation and field study)
  2. The sample: How were both samples unique? So how exactly does this affect any conclusions drawn from the study?
  3. Ethical Issues: What should have concerned the analysts and just why? How might they may have dealt with these issues?
  4. What does indeed this study reveal about the relative ramifications of personality and situation on behaviour?
  5. Ecological Validity: To what extent can we generalise the findings from this analysis to everyday situations?
  6. Application/Effectiveness; How valuable was this research?
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