On Being Sane in Insane Places
"On Being Sane in Insane Places" is an article by David L. Rosenhan that was published in the journal Science in 1973 and describes an experiment in which eight healthy "pseudopatients" were admitted to twelve psychiatric inpatient units in five states by feigning psychotic auditory hallucinations - hearing unfamiliar voices of the same sex saying "empty", "hollow" and "thud". The study concluded "It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals" and also illustrated the dangers of depersonalization and labelling in psychiatric institutions. It suggested that the use of community mental health facilities which concentrated on specific problems and behaviors rather than psychiatric labels might be a solution and recommended education to make psychiatric workers more aware of the social psychology of their facilities. The pseudopatients were a psychology graduate student in his twenties, three psychologists, a pediatrician, a psychiatrist, a painter and a housewife. None had a history of mental illness. After being admitted, the experimental subjects acted normally and did not display any obvious psychopathology. Subjects were to remain as inpatients until they were discharged by the staff at their hospitals, who were not privy to the experiment and believed the subjects to be real psychiatric patients. Their stays ranged from 7 to 52 days and the average was 19 days, all being discharged as schizophrenic "in remission". While the staff failed to identify sanity, in the first three hospitalisations notes of patient responses were kept and 35 of the total of 118 patients did express a suspicion that the pseudopatients were sane. In a followup provoked by skepticism at the original results, staff at research and teaching hospitals who knew of them were told that they would see pseudopatients seeking admission over a three month period. For 193 patients admitted during this time, 41 were "alleged with high confidence" to be pseudpatients by at least one staff member, 23 by at least one psychiatrist and 19 by one psychiatrist and one other staff member. No pseudopatients from the research group actually saught admission. This led to a conclusion that "any diagnostic process that lends itself too readily to massive errors of this sort cannot be a very reliable one". Studies by others found similarly problematic diagnostic results. Temerlin split 25 psychiatrists into two groups and had them listen to an actor acting in the picture of mental health. One group was told that the actor "was a very interesting man because he looked neurotic, but actually was quite psychotic" while the other was told nothing. Sixty percent of the former group diagnosed psychoses, most often schizophrenia, while none of the control group did so. Loring and Powell gave 290 psychiatrists a transcript of a patient interview and told half of them that the patients were black and half white and concluded of the results that "Clinicians appear to ascribe violence, suspiciousness, and dangerousness to black clients even though the case studies are the same as the case studies for the white clients".
External linkText of On Being Sane In Insane Places. Rosenhan, DL. Science 179(1973):250-258
Additional referencesTemerlin, MK. "Suggestion Effects in Psychiatric Diagnosis." Journal of Nervous and Mental Disease 147(1968):349-353Loring, M and B Powell. "Gender, Race and DMS-III." Journal of Health and Social Behavior 29(1988):1-22
|
|
