Context

How do we define sane? How about insane? Is there a difference? How do we tell?

Context

PY1: Biological therapiesMedical model of abnormalityPsychological illness=physical illness

Anti-psychiatry movementQuestioned the validity of psychiatric

diagnosedPsychiatry is used as a method of control

Context Foucault (1961)

Unreasonable members of population are locked away through diagnosis of mental illness○ Drapetomania

Laing(1960)Schizophrenia best understood in

terms of someone’s experience than as a set of symptoms

Szasz (1960)Medical model is useless and

dangerous

Context

Disagreement over “sanity” and “insanity”

Concepts of normality are not universal

Context

RosenhanDid not argue that mental illness did

not exist, nor that it could not cause suffering.

Diagnosis has more to do with the situation than the person

Psychiatrists in lawWhat does this suggest about

validity and reliability?

Aims

Can psychiatrists distinguish between people who are genuinely mentally ill and those who are not?

PseudopatientsTwo possible outcomes: what would we

conclude from these?

Procedure

Who were the participants? Who were the pseudopatients?

Read through and highlight the procedure

Fill in the gaps in the findings

Conclusions What is the main conclusion? (look back at

Rosenhan’s aim?)

“It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals. The hospital itself imposes a special environment in which the meaning of behaviour can easily be misunderstood. The consequences to patients hospitalized in such an environment – the powerlessness, depersonalization, segregation, mortification, and self-labelling – seem undoubtedly counter-therapeutic”.

Conclusions

Doctors more likely to make type 2 errors than type 1Makes sense for physical illnessWhat about for psychological illness?

What can we conclude from the behaviour of the staff towards the patients?

What do these results imply for mental health care?

Alternative evidence Slater (2004)

Presented herself to a number of hospitals with an isolated auditory hallucination

Given a diagnosis of psychotic depression, and sent home with medication

HoweverSlater had previously been

diagnosed with depressionWhat other issue here?

Alternative Evidence

Read the modern criteria for schizophreniaWould the pseudopatients be

diagnosed as schizophrenic today?

Sabin and Mancuso (1980)Pseudopatients would not get admitted

to hospital today as diagnosis has changed

Validity of Rosenhan? However...

Alternative evidence Have things really

changed?Still disagreement between

psychiatrists

Whaley (2001) Used inter-rater reliabilityAs low as +.11 for some

conditions

Alternative Evidence

Rosenhan concluded that the bias in the diagnosis rested with the situation in which the pseudopatients found themselves (the “insane place” of the hospital). What else could cause bias?

Loring and Powell (1988)Diagnosis influenced by race

Alternative Evidence Spitzer (1975) Took issue with

Rosenhan’s conclusionsPsychiatrists have to rely upon the

verbal reports of the patients who come to them for help.

It is not expected that an individual would try to trick their way into a psychiatric institution.

Would the conclusion be the same if it was a physical illness which was being faked?

Alternative Evidence

Spitzer (1976)Schizophrenia in remission is very

rarely applied to patients

What does this mean for Rosenhan?