Rosenhan conducted a famous study where sane individuals successfully gained admission to psychiatric hospitals by feigning auditory hallucinations. All were diagnosed with schizophrenia and their normal behavior was misinterpreted by staff. In a follow up study, hospital staff also could not distinguish real patients from those falsely claimed to be admitted. The study highlighted the depersonalization and powerlessness felt by patients when subjected to psychiatric labels and institutionalization rather than community-based care focused on behavior.

1. ROSENHAN (1973)
ON BEING SANE IN INSANE PLACES
(INDIVIDUAL DIFFERENCES APPROACH)

2. Aims
 Briefly describe the individual differences
approach
 Give a definition of abnormality
 Explain the problems with defining abnormality
 Hard to say what is normal
 Diagnosis may act as label, leading to discrimination
 List the key features of schizophrenia

3. The individual differences
approach
 Individual difference psychology examines
how people differ in their thinking, feeling
and behaviour. (The other approaches tend
to focus on similarities).
 For example, people can be classified
according to intelligence and personality
characteristics. Other areas studied might
include values and self-esteem.

4. WHAT IS ABNORMAL
BEHAVIOUR?

7. Joan of Arc

8. Rosenhan & Seligman: Criteria for diagnosing
abnormality
1. Suffering.
 But some people
(e.g.psychopaths) have
no concept of
suffering. And normal
people suffer too.

9. Rosenhan & Seligman: Criteria for
diagnosing abnormality
2.Maladapativeness.
 Behaviours that prevent people from living a
fulfilling life
 Example: fear of leaving the house prevents
them from doing anything

10. Rosenhan & Seligman: Criteria for
diagnosing abnormality
3.Vividness and unconventionality
 But unconventionality doesn’t always indicate
mental illness!

11. Rosenhan & Seligman: Criteria for
diagnosing abnormality
4. Unpredictability and loss of control

12. Rosenhan & Seligman: Criteria for
diagnosing abnormality
5. Irrationality and incomprehensibility
 We need to be careful when judging
someone’s behaviour as irrational – perhaps
their behaviour actually has a sensible cause.

13. Rosenhan & Seligman: Criteria for
diagnosing abnormality
6.Observer discomfort

14. Rosenhan & Seligman: Criteria for
diagnosing abnormality
7.Violation of moral and ideal standards
 E.g. committing murder.

15. Which of the 7 criteria occur in
normal people?
 All of them!
 So you can see it’s difficult to diagnose
someone as mentally ill.

16. Some definitions of
abnormality
Stratton & Hayes (1993) .. Abnormality is
behaviour which:
 deviates from the norm
 most people don’t behave that way
 does not conform to social
demands
 most people don’t like that behaviour
 is maladaptive or painful to the
individual
 It’s not normal to harm yourself

17. Problem with definining
abnormality….
 All of these features sometimes
appear in “normal” people, so it’s
difficult to diagnose someone as
mentally ill.
 Normality is also CULTURALLY
DEFINED..

18. Cultural definition of deviance

19. Categorising Mental Illness
 Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV)
 International Statistical Classification of
Diseases and Related Health Problems (ICD)

20. DIAGNOSIS OR LABELLING?

21. Social Stigma?
 Many people misunderstand and may even fear those
with a mental illness.
 Once a person has been diagnosed with mental illness,
they may face social stigma where they may be
misunderstood or even feared by others.
 They may find that their diagnosis labels them, so that
their ordinary behaviour is interpreted as a symptom of
illness.They may be discriminated against, for example
when seeking employment.
 However, mental illness is widespread. Frank Bruno, one
of the nations favourite Boxers who won the ABA
Heavyweight Championship at just 18 had to be
sectioned in 2003 for depression. This shows how
anyone can be affected by mental illness, whether
famous, successful or otherwise. Similarly Stephen Fry
suffers from bipolar disorder.

22. What is Schizophrenia?
 A serious mental disorder
 Positive Symptoms (additional to normal
behaviour) include: hallucinations,
delusions and thought disorder
 Negative Symptoms (reduction in
normal experiences or behaviour)
include flattened affect and lack of
motivation.

23. Schizophrenia: Case Study
 Gerald: a case study

24. WHAT DO YOU THINK IT
WOULD BE LIKE TO HAVE
SCHIZOPHRENIA?

25. How did it feel?
 If you had a mental illness how would you like
to be treated?

26. The Question
If sanity and insanity exist
How shall we recognise them?

27. Background summary
 Briefly describe the individual differences
approach
 Give a definition of abnormality
 Explain the problems with defining abnormality
 Hard to say what is normal
 Diagnosis may act as label, leading to discrimination
 List the key features of schizophrenia
 Explain how schizophrenia is usually treated.

28. D.L. Rosenhan (1973)
 The ground breaking study :
“On being sane in insane places”

29.  Approach: Individual Differences
 Definition: Examines how people differ in
their thinking, feeling, and behaviour.

30. Aim
 Overall:To see if psychiatrists could
differentiate between sane and insane
people.

31.  Intro to the study

32. Method: Field experiment, with
participant observation.
 Qualitative data –
rich and detailed
 High ecological
validity
 Fewer demand
characteristics
 Difficult to replicate
– lower reliability
 Difficult for
researcher to remain
objective – danger
of subjective
interpretation
 Time-consuming
 Ethical issues –
deception
 Lack of control over
confounding
variables.

33. Aims of the 3 studies
 Study one:To see if sane people could get
themselves admitted to psychiatric
hospitals
 Study two:To see if the hospitals, who had
been told they were going to be
approached by pseudo-patients, would be
able to tell the sane from the insane.
 Study three:To investigate patient/staff
contact

34. Study 1: Participants
 Hospital staff and patients
 Also: the participant observers: EIGHT
sane people
 one graduate student
 three psychologists
 a paediatrician
 a painter
 Housewives

35. Method
 Field experiment, with participant
observation.

36. Procedure: Study 1
 telephoned 12 psychiatric hospitals for urgent
appointments
 gave false name and address
 complained of hearing unclear voices … saying
“empty, hollow, thud”
 Simulated ‘existential crisis’
 “Who am I, what’s it all for?”
 Once admitted,they stopped simulating any
symptoms and took part in ward activities
 They took notes of their experiences while in the
hospital.

37. IV and DV
 Study 1:
 IV: Participants pretence to get
into hospital
 DV: Psychiatrists admission of
participants, and strength of
diagnostic label

38. Controls: Study One
 All Ps presented with the same symptom at
the various hospitals – ie reporting hearing
voices saying “empty”, “hollow”, or “thud”.
 All Ps behaved normally apart from this.

39. What happened?
 All were admitted to
hospital
 All but one were
diagnosed as suffering
from schizophrenia

40. 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 label

41. 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.
 Role play: How wouldYOU convince someone
you are sane?

42. 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!

43. 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

44. Perhaps they behaved ‘abnormally’
 Pseudo-patient’s
visitors detected
“No serious
behavioural
consequences”
 DID ANYONE
SUSPECT?

45. What about the REAL
patients?
 35 out of 118 patients voiced their suspicions

46. On release -
 The pseudo-patients were diagnosed as
 Schizophrenia “IN REMISSION”
 Labels are “sticky” – they remain with you
even when you are well.

47. Results: Study 1
 All pseudo-patients admitted to hospital.
 Normal behaviour was interpreted as insane.
 “Patient engages in writing behaviour”
 Patients were powerless
 No staff members suspected them, although 35 patients
voiced their suspicions.
 Evidence that their behaviour was in reality normal:
 Pseudo-patient’s visitors detected “No serious behavioural consequences”
 Pseudo-patients stayed in hospital between 7 and 52 days
(mean 19)
 Pseudo-patients recorded staff-patient interaction: noted that
nurses stayed in ward offices 90% of time, and each ‘real patient’
spent less than 7 minutes per day with psychiatric staff
 7 out of 8 diagnosed as schizophrenic.
 Discharged with diagnosis of “schizophrenia in remission”.
 “stickiness” of labels
 Labels as self-fulfilling prophecies

48. Conclusion: Study 1
 Psychiatrists could not detect sanity.

49. Study 2: Participants
 Hospital staff at a large teaching and
psychiatric hospital
 Opportunity sample
 Field experiment

50. Procedure: Study 2
 A teaching and psychiatric hospital that was
aware of the findings from study 1 was
informed that over the next 3 months one or
more pseudo-patients would try to get
admitted to their hospital.
 Each member of staff was asked to rate the
likelihood that the patients who sought to be
admitted were pseudo-patients.
 In reality, no pseudo-patients were admitted.

51. Study Two
 IV: False information given to
hospital
 DV: Number of patients that staff
suspect of being pseudo-patients

52. Controls: Study 2
 None

53. Results: Study 2
 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 at least
two members of staff)
 23 rated as pseudo-patient (by at least one
psychiatrist)
 19 rated as pseudo-patient (by a
psychiatrist and one other member of staff)

54. Conclusions: Study 2
 The staff were unable to detect insanity.

55. Study 3: Participants
 Doctors and staff in 4 of the hospitals used in
Study One
 Opportunity sample
 Method: Field experiment with participant
observation

56. Procedure: Study 3
 In 4 of the hospitals pseudo-patients
approached a member of staff and
asked~
 “Pardon me, Mr/Mrs/Dr X, could you tell me
when I will be eligible for ground privileges?”
 The pseudo-patient did this as normally
as possible and avoided asking the same
member of staff more than once a day.

57. Study 3: IV and DV
 IV: “Patient” or visitor
 DV: Level of contact between staff
and subject
 Control: Young female participant
stopped faculty members on university
campus and asked various questions eg
“I’m looking for a psychiatrist”.

58. Results: Study3
Psychiatric
Hospital
Psychiatric
Hospital
University
campus
Responses (%) Psychiatrists Nurses Faculty
Moves on, head
averted
71 88 0
Makes eye
contact
23 10 0
Pauses and
chats
2 2 0
Stops and talks
4 0.5 100
No. of
respondents
13 47 14
No. of attempts
185 1283 14

59. Conclusion: Study 3
 Patients are powerless while on the mental
ward
 The lack of eye contact between staff and
patients depersonalises the patients.

60. Type 1 vs Type 2 errors
 Type 1 error: False negative (diagnose a sick
person as healthy)
 Type 2 error: make a false positive choice
(diagnose a healthy person as sick)

61. Why did the doctors not realise that
the pseudo-patients were sane?
 Can’t blame…
 Quality of the hospitals
 Time available to observe them
 Their behaviour
 Recognised as sane by many PATIENTS!
 May be because doctors have a bias towardsType 2
errors ( false positives, where a healthy person is
diagnosed as sick) overType 1 errors (false
negatives, where a sick person is diagnosed as
healthy).
 Erring on the side of caution

62. 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’

63. 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

64. Powerlessness and
Depersonalisation
 Depersonalisation: Where people are not treated as unique individuals, worthy of
respect. Shown through the following:
 Patients were deprived of many human rights such as freedom of
movement and privacy. For example physical examinations were conducted
in semi-private rooms.
 Medical records were open to all staff members regardless of status or
therapeutic relationship with the patient
 Personal hygiene was monitored and many of the toilets did not have
doors.
 Some of the ward orderlies would be brutal to patients in full view of other
patients but would stop as soon as another staff member approached. This
indicated that staff were credible witnesses but patients were not.
 Staff treated patients will little respect, beating them and swearing at them for minor
incidents
 General activity around the patients was conducted as though they were invisible.
 Patients were unable to initiate contact with staff.
 This depersonalisation led to the patients feeling powerless.

65. Examples of depersonalisation
 Patients were deprived of many human rights such as freedom of
movement and privacy. They could not leave the hospital, and
physical examinations were conducted in semi-private rooms.
 Medical records were open to all staff members regardless of status
or therapeutic relationship with the patient
 Personal hygiene was monitored and many of the toilets did not
have doors.
 Some of the ward orderlies would be brutal to patients in full
view of other patients but would stop as soon as another staff
member approached. This indicated that staff were credible
witnesses but patients were not.
 Staff treated patients will little respect, beating them and swearing
at them for minor incidents
 General activity around the patients was conducted as though they
were invisible.
 Patients were unable to initiate contact with staff.

66.  This depersonalisation led to the patients feeling
powerless.

67. Rosenhan’s summary and
conclusion…
 We cannot distinguish the sane from the
insane all of the time.
 Hospitalisation for the mentally ill isn’t the
solution as it results in powerlessness,
depersonalisation, segregation, mortification
and self-labelling- all counter-therapeutic.

68. What do the results of this study
tell us about human behaviour?
 From the study we can infer that it is not always
possible for doctors to differentiate between sane
and insane people. Once given, a label of mental
illness creates expectations.
 This can be seen in Study 1, where 7 out of 8
researchers were diagnosed as schizophrenic, and in
Study 2, where both psychiatrists and staff members
evaluated sick people as healthy.
 Therefore it may be better to place abnormal
individuals in community healthcare to avoid the
institutional context. It may also be better to focus
on behavioural diagnoses rather than global labels
such as “schizophrenia”.

69. Practical applications
 Perhaps should increase number of criteria
used to diagnose mental illnesses.
 Reduce abuse of power in mental institutions
by staff – CCTV
 Change number of professionals needed to
diagnose disorders – can’t rely on just one
individual.

70. Ethics
 Deception?
 Informed consent?
 Withdrawal?
 Protection?
 Undermine confidence of doctors and nurses

71. Ecological Validity
 Very high ecological validity
 Process of being admitted to a hospital, the
experience of life in a hospital, and discharge,
was true to life.

72. Qualitative and Quantitative Data
 Quantitative data: numbers admitted and
discharged in Study 1; number of faulty
diagnoses made in Study 2; social interaction
data from Study 3.
 Qualitative data: experience of being in
hospital, feelings of powerlessness and
depersonalisation
 Problems with the qualitative data?

73. Longitudinal vs snapshot
 Study 1: 52 days
 Study 2:Took place over a 3 month period
 Long enough to see change over time.

74. Discussion question:
 Why might the reports of the pseudo-
patients have been unreliable?

75. Strengths and Weaknesses
Strengths Weaknesses
 High ecological validity
 Insightful
 Quantitative and qualitative
data – increases validity
 High validity – covert
observation
 Few demand characteristics – p’s
don’t know they’re being
studied – increases validity
 Reported same symptoms to
each hospital – increases
reliability
 Symptoms well-chosen – valid
way of testing reliability of
diagnostic systems
 Used a range of hospitals
 Unethical
 Ethnocentric
 Possibility of observer bias – P’s
knew aim of experiment –
Rosenhan was one of them!
Decreases validity
 Study 1: only 12 hospitals
 Study 2: only 1 hospital
 Unreliable: interactions after
intake not controlled
 Difficult to record details
accurately and promptly while
participating. Decreases validity.

76. Alternative method
 Send a self-report questionnaire to doctors giving
them scenarios (I’m hearing voices – hollow, thud,
empty) and asking on a scale of 1-10 how likely they
would be to put them into the hospital.
 Advantage: cheaper, easier, no ethical issues, more
representative (larger sample possible)
 Disadvantage: people will probably not give accurate
answers, either through lack of self-knowledge or
because they want to give the socially desirable
answer.
 Effect on results: results will be lower in validity but
more reliable.

77. Alternative method
 Conduct the study cross-culturally: eg UK,
USA,Australia
 Advantage: be able to see whether there are
cross-cultural differences and similarities
 Disadvantage: Expensive, time-consuming.
Ethical issues remain.
 Effect on the results: make the sample more
representative, therefore will be able to
generalise results.

78. The Simpsons
 Stark Raving Dad