Who's Crazy Here, Anyway?

Doctor
Title of Research: Who's Crazy Here, Anyway?
Date of Study: 1973
Name of Researcher: Rosenhan, D. L.
Theoretical Propositions:
Rosenhan asked whether psychiatrists diagnosed their patients by their actual problems or by the situations and contexts that the patients were in. He reasoned that if the psychiatrists had adequate criteria and training for diagnosis, they should be able to distinguish between the sane and insane. He proposed to find this out by admitting "pseudopatients" to psychiatric facilities and seeing if they would be discovered to be normal. If they were not, if would mean that the diagnoses are tied more to the situation than to the patient.
Method: The pseudopatients consisted of one graduate student, three psychologists, one pediatrician, one psychiatrist, one painter, and one homemaker. They sought admission to 12 psychological hospitals, in five states on both the east and west coast of the U.S. They acted and told truth about themselves, except for their fake symptom that they heard voices that said "empty," "hollow," and "thud." Once admitted, they acted as model patients and displayed no symptom of psychological illness.
Results:
All but one were admitted as schizophrenia patients, and they were told to stay an average of 19 days, ranging from 7 to 52 days. While none of the hospital's staff or doctors found out about the pseudopatients' true identity, 35 out of 118 real patients suspected them.
Regarding contacts between the patients and the staff, more than 75% of psychiatrists, nurses and attendants moved on when asked a normal question like "Could you tell me when I am eligible for grounds privileges?" Those that answered gave an unrelated response like "good morning, Dave. How are you today?"
Regarding medication, the eight psudopatients were given a total of 2,100 pills.
Another noticeable result was that many of the staff didn't seem to consider patients to be real people, a proof being a nurse unbottoning her uniform to adjust her bra in front of many male patients.
Significance of Findings:- Rosenhan found out two very important factors. First, the sane could not be distinguished from the “insane” in mental hospital settings. Rosenhan stated, “ The hospital itself imposes a special environment in which the meaning of behavior can be easily misunderstood.” Second, Rosenhan proved the danger of diagnostic labels. Once a person is labeled as having a certain psychotic disorder, such as schizophrenia, manic-depressive illness, etc, that label affects the person seriously. For example, that person went to job interview and the company first sees SCHIZOPHRENIA, on their resume, then they won’t be able to get a job because the interviewee had schizophrenia. Therefore, mental health facilities, crisis intervention centers, and behavior therapies tend to avoid labeling the symptoms. This does not mean every mental health profession has eliminated the labeling. However, many psychiatric labels are now used carefully so that, patients are not shock and offended.
Criticisms:- Rosenhan informed the hospital that he is going to test them during the next three month. During those three months, one or more pseudopatients would try to be admitted to their psychiatric unit. At the end of three months, 193 patients had been admitted. Of those, 41 were considered with high confidence to be pseudopatients by at least one staff member. 23 were suspected by at least one psychiatrist, and 19 were identified as pseudopatients by one psychiatrist and one other staff member. However, Rosenhan had not sent any pseudopatients to the hospital during the three-month period. Rosenhan stated, “ It indicates that the tendency to designate sane people as insane can be reversed when the stakes are high. But one this is certain: any diagnostic process that lends itself so readily to massive errors of this sort cannot be a very reliable one.” Rosenhan repeated this study several times in 12 hospitals. However, Spitzer has argued that the method that Rosenhan use is not accurate. He illustrated “ You could walk into a medical emergency room complaining of severe intestinal pain and you might get yourself admitted to the hospital with a diagnosis of gastritis, appendicitis, or an ulcer.” Also Spitzer pointed out that, “Although the pseudopatients behaved normally once admitted to the hospital, such symptom variation in psychiatric disorders is common and does not mean that the staff was incompetent in failing to detect the ruse.”
Recent Applications:- Thomas Szasz, a psychiatrist who has been a well- known critic of the concept of mental illness since the early 1970s. He said, “ mental illnesses are not diseases and cannot be properly understood as such, but rather must be seen as problems in living that have social and environmental causes.”
- In a study by Boisvert and Faust, subjects were about an employee who behaved in a violent manner toward his boss, and the employee was described as having been previously diagnosed with schizophrenia. The researchers predicted that subjects would be likely to attribute the violence to the employee’s personality.
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Edited By: Soo, Lydia, Yeonsu



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