Tuesday, July 25, 2017

Summary: On Being Sane in Insane Places - David Rosenhan - part 1 (first Rosenhan Experiment)

D.L.Rosenhan's "On Being Sane in Insane Places", also called the "Rosenhan experiment" is a critical study regarding the validity of psychiatric diagnosis.

The background for Rosenhan's study is the question of how can we tell sanity from insanity, arguing that there are many inconsistencies regarding the credibility and applicability of concepts of mental health and psychopathology which might be cultural dependent. Rosenhan holds that at the heart of the diagnosis of insanity lies one crucial issue: do the characteristics that lead to a diagnosis come from the patient of the surrounding context? Rosenhan suspects that the approach of determining the occurrence of mental condition based of a catalog of symptoms is not as objective as thought and is highly effected by the tendencies of the person doing the diagnosis.

In order to test his hypothesis Rosenhan thought of an experiment in which normal people are committed to mental institutions in order to see how they are diagnosed. If they are declared sane then the system can be trusted. But if "fakers" will be diagnosed as suffering from mental illness this will attest to a context related bias.

The first Rosenhan experiment

Rosenhan therefore devised two experiments for his study described in "On Being Sane in Insane Places". In the first experiment of the study eight sane people committed themselves to twelve psychiatric institutes without their crew being aware. Aside from Rosenhan himself the experiment included 3 psychologists, one psychology student, a pediatrician, a psychiatrist, a painter and a homemaker. Hospitals chosen for the experiment were also varied.

In their sessions the fake patients complained of auditory hallucinations in which very unclear voices utter vague words. The name, occupation and symptoms of the patients were made up but their personal history and behavior were authentic. None of them had any past of present pathological behavior.

The fake symptoms disappeared right after the patients were admitted, although some of the cases presented mild and passing anxiety. Patients acted inside the institution as they would act outside of it, and they were obviously motivated to be declared sane in order to be discharged. Nurse reports confirm that they were friendly, cooperative and did not exhibit any abnormal behavior.

The fake patients kept (first hidden and then overt) accounts of their experience. Fake patients in the first Rosenhan experiment spent 17 to 52 days in the institutions (an average of 19 days). They all displayed normative behavior but were all but one discharged with a diagnosis of "schizophrenia in remission". None of the files indicated any doubts regarding the diagnosis. Once diagnosed, nobody thought of second guessing the initial judgment. They were not thoroughly examined but not due to lack of time. The other real patients in the institute noticed that the fake patients were normal but the staff did not and they even thought them to be a researcher or journalist. Rosenhan concluded his first experiment in "On Being Sane in Insane Places" with the assertion that doctors tend to over-diagnose in order to be on the safe side and not miss a sick person. But this tendency can cause damage when adopted by psychiatrists due to the social and legal repercussions of a mental condition.   

The second Rosenhan experiment will be discussed in part 2 of the summary of "On Being Sane in Insane Places".

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