Key Research of Section A and B

Rosehan (1973) On being sane in insane places:

Aim: To investigate whether the sane can be reliably and accuratly distinguished from the insane. In study 1 this meant finding out whether normal, sane individuals would be admitted to psychiatric hospitals and to see if they would be discovered. For study 2 it meant examining whether genuine patients would be misidentified as 'sane' by various hospital staff

Study 1

Sample: 8 pseudopatients over age of 20 including Rosenhan, variety of proffessions (psychology graduate student in his 20s, psychologists, a pediatrician, a psychiatrist, a painter and a housewife), 3 pseudopatients were female, 5 male - all used false names and those with a mental health proffession changed their job to avoid attracting special attention from staff. Rosehan was the 1st pseudpatient and his involvement was only know to the hospital administrator and the cheif psychologist

Design and Procedure: Called hospital for appointment, pp arrived at admissions office and asserted they had been hearing voices whih were unclear but 'empty' 'hollow' 'thud' - these words were chosen by Rosenhan as they implied a crisis about their life - but at the time of the study there was no literaure linking these to a disorder. They all reported that the voice was unfamiliar but of the same sex - all other details of their lives were given truthfully (relationships/experiences). They entered the study understanding they had to be relased from the institution themselves by convincing staff they were sane. PPs behaved 'normally' and attempted to engage others in coversation - indicating to staff they were no longer experiencing any symptoms, they obeyed the rules and routines of the ward and pretended to take the medication prescribed without fuss. They found the experience distrssing/unpleasant but nursing staff were recorded as friendly and cooperative. This can be considered a Field Experiment - the IV was the 12 Hospitals (across the 5 different states), the DV was the admission of participants to the hospital, the diagnoses they recieved and recordings of experience on the ward. It was also a participant observation - researchers acted as patients while keeping a written record of their personal experience in the hospital. In 4 hospitals pps observed staff responses to a specific request, approached staff memeber and asked 'When am I likely to be discharged?' - responses were recorded and compared to a control condition at Stanford Unversity (asked a simple q)

Results: Successfully admittied to all 12 hosptials - despite not showing symptoms of 'insanity' when they were admitted they were not detected by hospital staff. Failure to recognise sanity was not related to the hospital - all except one recieved a diagnosis of schizophrenia and were discharged with 'schizophrenia in remission' - therefore they carry a label of mental illness. The length in the hospital ranged from 7-52 days with an average stay of 19 days, during the 1st 3 trials 35/118 genuine patients voiced suspicions about the sanity of pseudopatients, accusations like 'You're not crazy ... you're checking up on the hospital' but none of the staff raised concerns, R found a tendency towards type 1 errors in diagnosis when a healthy person is diagnosed as ill. He found that once admitted with a diagnosis of a mental illness behaviour of the pseudopatient was interpreted in light of their diagnosis  - 'stickiness of psychodiagnostic labels'. Examples of pathological from the observers experiences included: When pacing due to boredom - they were asked by a nurse if they were nervous, when recording notes about the ward - described by nurse as 'engaging in writing behaviour', when queing for lunch - described as demonstrating 'oral-acquisitive' nature of their conditions. The experience of hospitalisation was overwhelmingly negative and unpleasant, hospital staff avoided interaction with patients, average attendants spent 11.3% of their time seeking staff interaction, in case of both medical centres and hospitals experienced most depersonalisation from psychiatrists and more cooperation from lower ranking/less powerful staff and interns.

• Powerlessness was evident in each institution - plus restricted contact with staff, personal privacy was inadequate - patients rooms would be entered and examine by any member of staf without warning or justification, lack of confidentiality of case notes (patients notes read openly and casually by staff members who had no therapeutic imput with the patient) - personal hygiene and waste evactuation were monitored as cubicle had no doors, even inital examinations were conducted in a 'semi-public' room.
• Depersonalisation was also a key finding, instances where staff would engage in physical abuse of patients in the presence of others, but not in front of other staff as they could be 'credible witnesses' - in 1 instance a female nurse undid part of her uniform to adjust her bra in full view of male patients on a ward. 2100 pills were given to the pseudopatients (only 2 were swallowed) - many other patients also disposed of their medication but was not challenged by staff if they remained cooperative. R aruge that depersonalistation has several causes: 1. staff's treatment towards mentally affecting treatment (may have distrusted and feared patients whilst wanting to help them the combinaion of oppsed feelings = avoid interaction) 2. formal heirarchy - highest status had the least contact with Ps (Av daily contact with doctoral staff 6.8mins) they are role models to other staff - nurses and support staff could copy them
• Also financial pressures, staff shortage, over-reliance on medication countributes

• Rosenhan is highly critical of diagnostic labels 'counter-therapeutic', he is also critical of the enviroment that comes with labelling - psychiatric hospitals are 'speical enviroments in which the meaning of behaviour can be easily misunderstood'
• Instead of focusing on labelling the person 'insane' he supports alternative methods of treatment e.g. community mental health centres and behavioural therapy programmes - could reduce stigma associated with institutionalisation
• Also asserts that raising staff's awareness of the issues faced by psychiatric patients it could change the experience of hospitalisation, if they were pseudopatients then it could ncrease their sensitivity

Study 2:

Sample:  psychiatric staff at one teaching and research ospital who had been brifed on the finding of the main study and judgements were made on the 193 patients who were admitted for psychiatric treatment

Design and Procedure: staff were informed that sometime during the last 3 months 1 or more pseudopatients would attempt to gain admission to the hospital, every member of staff was asked to to rate each patient (at admission/ward) to te likelihood they were an imposter. There was a 10 point scale (1 reflected strong belief they were a pseudoaptient and 10 they were genuine)

Results: All staff that had close contact with the patient made judgements (attendants, nurses, psychiatrists, physicians, psychologists) - it was ound that 41 of the patients admitted in the 3 month period were rated with high confidence to be pseudopatients by at least 1 member of staff, 23 suspected by at least one psychiatrist , 19 by psychiatrist and one other member of staff.

There were actually NO pseudopatients - so the 2nd study supports Rosenhan's argument about the lack of reliability in diagnosis - psychiatric staff committed a type 2 error but identifying mentally ill patients as healthy

Conclusions: Challenges the idea that psychiatric proffessionals can see difference between sane/insane, he found: 1. Psychiatrists unable to reliable identify false pseudopatient, 2. fail to reliably identify insanity, 3. in 'insane' enviroment, behaviour is precieved in distorted manner which can maintain a diagnostic label

Gottesman (2010) Severe mental disorders in offspring with psychiatrically ill parents:

Aim: To examine how vulnerable the children of 2 parents with a mental illness are at dveloping a mental illness (sppecifically schizophrena and bipolar disorder)

Sample: Drawn from the population of 2.7million Danish people born before 1997 and had an identifiable parents, the data was sampled in 2007 so minimum age was 10 years old. 196 couples were selected who both had a diagnosis of schizophrenia and their 270 children AND 83 couples who had bipolar disorder and their 146 children - for comparison samples where only one parent who had a diagnosis were drawn

Design and Procedure: Type of study = cohort (involves looking at cohort of a population e.g. born between two dates) It is a natural experiment as it involves two or more naturally occurring groups. IV = parental schizophrenia or bipolar disorder, DV = diagnosis of any mental illness. IV was operationalised as the diagnosis was in accordance with the World Health Organisiation's system for classifaction and diagnosis of a mental disorder the ICD. The DV was also operationalised as the offspring recieving a diagnosis was according to ICD (International Classifaction of Disease) this represented a risk of developng mental illness from 10-52 years

Results: For both the risk of developing a mental illness was greater when two parents had a diagnosis, 27.3% of both parents having schizophrenia developed it by the age of 52, rising to 39.2% of schizophrenia related conditions, for one parent it was 7% and 11.9% for any (for neither its was 1.12% and 14.1).  Two bipolar was 24.95%, 36% for bipolar/depression, and 44.2% for any - one parent 4.4% for bipolar themselves and 9.2% for any.

Conclusion: having both parents with a serious mental illness is associated with a significantally increased risk of developing that disorder and a mental illness in general, having one parent with a diagnosis carries a lower risk - this provides useful information for genetic counselling (passing on genetic vulnerability to the offspring)

Szasz (2011) The myth of mental illness: 50 years later:

Aim: He revisits he famous essay 'The Myth of Mental Illness' and his book of the same name (1960, 1961) - he considers the current medicalisation of abnormal behaviours in the light of his earlier arguments

Method: Its an essay on psychiatry and how it effects those who experience mental health issues (does not involve participants or procedcure)

Findings: