On Being Sane in Insane Places Research Essay Julia De Angelis Due Date: 4th March 2015 Teacher: Gareth Rees 'On being sane in insane places' is a study by David Rosenhan in 1973 which attempted to test the reliability of psychiatric diagnoses and the treatment of those in psychiatric hospitals. He tested this by conducting a study in which eight 'sane' people attempted to gain admission into different psychiatric hospitals. They organised psychiatric appointments in which during their interviews they complained of hearing voices repeating the words "empty", "thud" and "hollow". Seven of the pseudo-patients were admitted under the diagnosis of schizophrenia and one under the diagnosis of manic depressive psychosis. Once admitted …show more content…
pseudo-patients began to act 'normal' and no longer exhibited symptoms. All noted down their experiences and later were released under the diagnosis of 'schizophrenia in remission'. A study’s research must consist of a suitable method and must be ethical, reliable and valid.(Kelley, Clark, Brown, Sitzia, 2003). In Rosenhan's study (1973), Rosenhan fails to recognize the many faults within his study in terms of these aspects. Furthermore, the study continues to make unreliable conclusions in the way in which Rosenhan generalises his results. Methodology ‘On Being Sane in Insane Places’ (Rosenhan, 1973) is a field study which uses covert participant observation to gather its results. Rosenhan’s aim was to scrutinise the use of psychiatric labels whilst also investigating the experience of a patient in a psychiatric hospital. The strengths of using a field study are its ability to gather both quantitative and qualitative data (McLeod, 2007). Field studies are theoretically thought to be beneficial due to the experiments occurring in natural settings (Crane, Hannibal, 2009 p.27). As part of his research, Rosenhan (1973) used eight pseudo-patients, five of which had psychological training, to comment on their experience in psychiatric hospitals. The remaining participants consisted of a paediatrician, a painter, and a housewife. Their time in hospital ranged from 7 to 52 days. During this time patients were required to document their experiences in the hospitals. In Rosenhan's study, ‘On Being Sane in Insane Places’ (Rosenhan,1973) there are several discrepancies in its methodology. The method used by Rosenhan (1973) to collect data, lacks "mundane realism" (Ketty,1974) as the experiences of the actual psychiatric patients would have differed from the pseudo-patients, who had the reassurance that their diagnosis and admittance was false.
The notes gathered by the pseudo-patients were used to conclude how patients experience a psychiatric ward. However, the pseudo-patient's perceptions were biased as they do not reflect the needs and perceptions of actual patients. Rosenhan (1973) makes assumptions about what patient's consider is 'quality care' from a biased view, rather than establishing criteria that reflected authentic experiences of psychiatric patients. The study can be seen to have low ecological validity as it can be argued that the pseudo-patients aren't really insane therefore it may have been difficult for them to behave "normally" in the hospital environments. (Spitzer, …show more content…
1976) As part of the study, pseudo-patients were asked by Rosenhan (1973) to exhibit "normal" behaviour once admitted to the hospital. However, pseudo-patient's constantly taking notes was not perceived as normal behaviour (Spitzer, 1976). This in turn may have impacted the interaction of the staff. This view is supported by Hunter (1973) who argues that: "The pseudo-patients did not behave normally in the hospital. Had their behaviours been normal, they would have walked to the nurses' station and said, 'Look, I am a normal person who tried to see if I could get into the hospital by behaving in a crazy way or saying crazy things. It worked and I was admitted to the hospital, but now I would like to be discharged from the hospital' ". Reliability The study's use of covert observational studies can be unreliable as it may be difficult for the observer- who is also the participant, to capture all the essential information without losing some of the validity of the study (Li, 2008).
It would have been difficult to take notes on all the aspects of the ward, forcing the pseudo-patients to make selections of what to record, introducing bias in the qualitative information collected. It would have been difficult to analyse all the data produced, especially when it is an unstructured observation, which would make comparisons between the hospitals and staff difficult. Furthermore, Rosenhan (1973) did not take into account common psychiatric practice, which required psychiatrists to admit a patient based on possible mental illness. Studies have shown that doctors and psychiatrists are more likely to make a type two error (call a healthy person sick) than a type one error (diagnosing a sick person as healthy) (Kirk, Kutchins,
1992). The Rosenhan study (1973) is not consistent as pseudo-patients are placed in different hospitals, resulting in their experiences not being able to be standardised. The pseudo-patients experiences are not consistent as the time spent in the hospitals varied. Data collected from the pseudo-patient that stayed 52 days in comparison to the pseudo-patient whom stayed 7 days would have been skewed. The quantity of data is imbalanced as it reflects one pseudo-patients experience more than another's. Validity Rosenhan (1973) concludes that based on his research "It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals"(Rosenhan, 1973). However, the pseudo-patients were required to falsely exhibited symptoms of schizophrenia. Spitzer, Davis & Weiner (1976) agree that Rosenhan's conclusion was invalid as from the information available to the psychiatrist; schizophrenia was the most reasonable diagnosis. This view is supported by Seymour Ketty (1974) where he states that: “If I were to drink a quart of blood and, concealing what I had done, had come to the emergency room of any hospital vomiting blood, the behaviour of the staff would be quite predictable. If they labelled and treated me as having a bleeding peptic ulcer, I doubt that I could argue convincingly that medical science did not know how to diagnose that condition.” The psychiatrists would not have expected to be receiving false patients; therefore they would have taken the symptoms seriously. Generalisation The findings of the study state that psychiatric hospitals often label the ‘sane’ incorrectly ‘insane’. This cannot be globally generalised as the studies sample size was small, with only eight pseudo-patients and twelve hospitals involved in the study. The sample of hospitals included solely facilities within the United States, yet Rosenhan (1973) uses his findings to generalise both the ability of psychiatric wards to diagnose mental illnesses and the conditions within. Ethical issues The principles and codes of ethics must be followed by researchers when conducting research to ensure that participants' physical and psychological welfare is protected during and after an experiment is conducted.(Bulmer, 1982, Diener, 1978, p.55) Consent Doctors, nurses and the other patients did not give their consent to take part in the study and did not know they were being observed. Protection of participants The pseudo-patients were all placed in unfamiliar settings- which may have caused distress and which was outside "ordinary life".(McLeod,2007) This breaches the protection of participants ethical guidelines which state that the researches must ensure that those taking part in research must be protected from physical and mental harm.(McLeod, 2007) Deception The pseudo-patients deliberately deceived hospital staff claiming they heard voices; again, violating ethical guidelines that state any deception must not cause distress. (McLeod,2007) Withdrawal The actual patients and the staff were not aware of the study and did not give their consent to be included in the study, and consequently did not have the option to withdraw from the experiment. In addition, the pseudo-patients agreed to forego their right to withdraw from the experiment, with their exit being to be discharged from the hospital for no longer having a mental illness. This also demonstrates a breach of ethics as participants must be aware of their right to stop participating in the study. (McLeod, 2007) Conclusions The design of Rosenhan's study 'On Being Sane in Insane Places'(1973) has many errors in its methodology, reliability, validity and ethics. The methodology used causes the study to contain a lack of realism and enables the use of observer bias when collecting the data, skewing the results. The study also fails to show reliability and validity in its inconsistent methods, as the sample sizes used were small and did not vary greatly. Rosenhan’s procedures continuously breached the ethical principles. This should have been considered prior to the study, with the research not beings carried out until sufficient changed were made. The conclusions made by Rosenhan were dangerous generalisations of the psychiatric system and caused the public to view psychiatric practices negatively (Spitzer,1976). To ensure that the study limited its errors it should have recorded the experiences of the actual patients on whom the study was measuring rather then recording the experiences of pseudo-patients.
In the book “The Mad Among Us-A History of the Care of American’s Mentally Ill,” the author Gerald Grob, tells a very detailed accounting of how our mental health system in the United States has struggled to understand and treat the mentally ill population. It covers the many different approaches that leaders in the field of mental health at the time used but reading it was like trying to read a food label. It is regurgitated in a manner that while all of the facts are there, it lacks any sense humanity. While this may be more of a comment on the author or the style of the author, it also is telling of the method in which much of the policy and practice has come to be. It is hard to put together without some sense of a story to support the action.
In 1978, Susan Sheehan took an interest in Sylvia Frumkin, a schizophrenic who spent most of her life in and out of mental hospitals. For more than two years, Sheehan followed Sylvia around, observing when Sylvia talked to herself, sitting in on sessions with Sylvia’s doctors, and at times, sleeping in the same bed as Sylvia during her stay at the psychiatric centers. Through Sheehan’s intensive report on Sylvia’s life, readers are able to obtain useful information on what it’s like to live with this disorder, how impairing it can be for them, and the symptoms and causes to look out for; likewise, readers can get an inside look of how some mental hospitals are run and how a misdiagnosis can negatively impact someone’s life.
As medical advances are being made, it makes the treating of diseases easier and easier. Mental hospitals have changed the way the treat a patient’s illness considerably compared to the hospital described in One Flew Over the Cuckoo’s Nest.
The Yellow Wallpaper as a Guide To Insanity "There comes John, and I must put this away- he hates to have me write a word" (p659). As evident by the above quote, Gilman places the narrator of "The Yellow Wallpaper" as secluded as she could be; she is placed in a large house, surrounded only by her husband and by little help (Jennie), when it is unfortunately clear that her relationship with her husband is based on distance and misunderstanding: "It is so hard to talk with John about my case, because he is so wise, and because he loves me so"(p 663). Gilman further confines her narrator as it becomes clear that the poor soul has absolutely no one to talk to; that is, no one who can understand her. The narrator is cornered by her loved ones, she is isolated from the world under her husband-doctor orders, she is thus physically confined to her shaky mental realm. The next aspect of the narrator that zooms us into her state is her tone: "I really have discovered something at last..
Forcing someone to take medication or be hospitalized against their will seems contrary to an individual’s right to refuse medical treatment, however, the issue becomes complicated when it involves individuals suffering from a mental illness. What should be done when a person has lost their grasp on reality, or if they are at a risk of harming themselves or others? Would that justify denying individuals the right to refuse treatment and issuing involuntary treatment? Numerous books and articles have been written which debates this issue and presents the recommendations of assorted experts.
...s that the DSM can also falsely determine ones specific mental health, showing the struggle between diagnosing someone with genuine disorders and excessively diagnosing individuals.
Mental illness has been around as long as people have been. However, the movement really started in the 19th century during industrialization. The Western countries saw an immense increase in the number and size of insane asylums, during what was known as “the great confinement” or the “asylum era” (Torrey, Stieber, Ezekiel, Wolfe, Sharfstein, Noble, Flynn Criminalizing the Seriously Mentally Ill). Laws were starting to be made to pressure authorities to face the people who were deemed insane by family members and hospital administrators. Because of the overpopulation in the institutions, treatment became more impersonal and had a complex mix of mental and social-economic problems. During this time the term “psychiatry” was identified as the medical specialty for the people who had the job as asylum superintendents. These superintendents assumed managerial roles in asylums for people who were considered “alienated” from society; people with less serious conditions wer...
For many decades the mentally ill or insane have been hated, shunned, and discriminated against by the world. They have been thrown into cruel facilities, said to help cure their mental illnesses, where they were tortured, treated unfairly, and given belittling names such as retards, insane, demons, and psychos. However, reformers such as Dorothea Dix thought differently of these people and sought to help them instead. She saw the inhumanity in these facilities known as insane asylums or mental institutions, and showed the world the evil that wandered inside these asylums. Although movements have been made to improve conditions in insane asylums, and were said to help and treat the mentally ill, these brutally abusive places were full of disease and disorder, and were more like concentration camps similar to those in Europe during WWII than hospitals.
In 1950s the construction of new psychiatric centres took place in order to treat people with mental disorders. Local authorities provided financial resources to sustain these establishments of psychiatry. Apparently those psychiatric centres were treating the patients in unappropriated ways and inhuman acts as well as demanding them to remain inside the psychiatric centres for the rest of
The BBC documentary, Mental: A History of the Madhouse, delves into Britain’s mental asylums and explores not only the life of the patients in these asylums, but also explains some of the treatments used on such patients (from the early 1950s to the late 1990s). The attitudes held against mental illness and those afflicted by it during the time were those of good intentions, although the vast majority of treatments and aid being carried out against the patients were anything but “good”. In 1948, mental health began to be included in the NHS (National Health Service) as an actual medical condition, this helped to bring mental disabilities under the umbrella of equality with all other medical conditions; however, asylums not only housed people
Since Pat Barker's Regeneration is set in a mental hospital, it seems fitting that questions about mental disease and the definition of sanity should be raised. At the very start of the book, Rivers and Bryce are discussing the case of Siegfreid Sassoon, a dissenting officer of the British army. As they discuss his diagnosis of "neurasthenia," Barker is laying the groundwork for one of Regeneration's many themes: no one is completely qualified to judge the sane from the insane, for insanity finds its way into us all. The ambiguity surrounding the definition and treatment of neurasthenia offers just a glimpse into the ever-changing and highly subjective world of mental evaluation.
In today’s society, the stigma around mental health has caused many people to fear seeking medical treatment for problems they are dealing with. With an abundance of hateful outlooks and stereotypical labels such as: crazy, psycho, and dangerous, it is clear that people with a mental illness have a genuine reason to avoid pursuing medical treatments. Along with mental health stigma, psychiatric facilities that patients with a mental health issue attend in order to receive treatment obtain an excessive amount of unfavorable stereotypes.
Our group members feel that Rosenhan’s “On Being Sane in Insane Places” is an important topic for psychology majors to explore because of the impact it had on Psychology. This study highlighted the fact that diagnostic labels linger beyond the presence of symptoms. It also showed the lack of attention patients were receiving from the staff at psychiatric hospitals in the time period the experiment was conducted. Beyond the experiment itself, it led to further research which was important to the
Ossa-Richardson, Anthony. Possession or Insanity? Two Views from the Victorian Lunatic Asylum 74: 553-575. Print.
The development of the world has lots of good advantages for men; but besides all these it has also bad effects, too; as the illnesses and most importantly the mental illnesses. As the centuries go on our responsibilities get much harder and this causes stress and some other mental diseases, too, to some people and this makes a danger; but I'm not talking about the ones who are consciously in mental hospitals. The main idea is that, we call the people who are in these hospitals insane; but maybe they are saner than the ones who are out in the society because the ones who are consciously in these hospitals are the ones who are aware of them and willing to be healed. However, the ones who are out in the society, who are among us and we don't notice, are not aware of their true reality. The ones who are aware of it are not the ones who are real insane and the society's duty is not to avoid insanity but to help the ones who are in that kind of situation and to help them.