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SOC313: ROSENHUN READING March 6, 2013  We can not tell the normal from the abnormal  In court, psychiatrists try to find out the defendants sanity  Great deal of conflict on reliability, utility, and „sanity‟ „insanity‟ „mental illness‟ and „schizophrenia‟  Abnormality and normality are not universal  What is viewed normal in one culture may not be in another  Can sane be distinguished from the insane?  To figure out this question, we need to ask if diagnosis are in the patients or the environment  Belief that patients present symptoms that differentiate the sane from the insane this is questioned  Psychiatric diagnoses, in this view, are in the minds of the observers and are not valid summaries of characteristics displayed by the observed  Psychiatric diagnosis betrays little about the patient but much about the environment in which an observer finds him  In this article, 8 sane people gain secret access to mental hospitals Pseudopatients And Their Setting  Pseudopatients is the researcher pretending to be a patient  The presence of pseudo patients and the nature of the re-search program was not known to the hospital staff only the hospital administrator and chief psychologist  Hospital environment varied- some had good staff patient ratios, some were research oriented  One hospital was a privately funded hospital, most were supported by state or federal funds while one is funded by a university  One researcher pretended that he was hearing voice and the voices were saying “empty” “hollow” and “thud”. These symptoms are derived from the painful concerns about the meaninglessness of ones life  Belief that it means the person believes “my life is empty and hollow”  Choice of these symptoms is determined by the absence of existential psychoses  The only made up thing was there name, vocation, employment  No further altercations of history, or circumstance were made  Relationships with parents and siblings, with spouse and children, with people at work and in school, consistent with the aforementioned exceptions, were described as they were or had been  Frustrations and upsets were described along with joys and satisfactions  Upon admission to the psychiatric ward the pseudo patient ceased simulating any symptoms of abnormality  There was a brief period of mild nervousness and anxiety, since none of the pseudo patients really believed that they would be admitted so easily  Feared they would be exposed as frauds and embarrassed  They behaved normally. They spoke to patients and staff as they would ordinarily and engaged in conversation  When asked by staff how he was feeling, he indicated that he was fine, 1 SOC313: ROSENHUN READING March 6, 2013 that he no longer experienced symptoms  He responded to instructions from attendants, to calls for medication (which was not swallowed), and to dining-hall instructions  Made observations and wrote them down in the ward (these observations were not secret because no one cared)  Entered hospital with no knowledge of when they would be discharged  They could only get out by convincing the staff that he was sane  Experienced stress in the hospital and which motivated them to act sane and to cooperate by being “friendly”, “cooperative” and “no abnormal indications” The Normal Are Not Detectably Sane  Despite there show of sanity, they were never detected  Each was discharged with schizophrenia in remission  Labeled schizo, they were stuck with that label  To be discharged, they must be in “remission”; but he was never seen as sane  Failure to recognize sanity… 1. Cannot be attributed to the quality of the hospital because several of the hospitals were considered excellent and in good condition 2. Not because they didn‟t have enough time to observe the patients because hospitalization was from 7-52 days with an average of 19 days o They were not carefully observed! o This is due to failure of traditions within the hospital than lack of opportunity 3. Failure was not due to the fact that they were not behaving sane there visitors or other patients could not detect serious behavioral consequences  Patients could detect the pseudopatients sanity  35/118 patients said “your not crazy, you‟re a professor or journalist” (because they took notes)  Patients were reassured by the pseudo-patient's insistence that he had been sick before he came in but was fine now, some continued to believe that the pseudopatients was sane throughout his hospitalization  Patients recognized normality when the staff did not  Failure to detect sanity may be because of their bias to type 2 error  More inclined to call a healthy person sick (a false positive, type 2) than a sick person healthy (a false negative, type 1)  More dangerous to misdiagnosis illness than health  Better to be cautious to suspect illness even among the healthy 2 Part Of The Study  Study was conducted to see if the tendency towards diagnosing the sane insane could be reversed  Staff was told that one or more pseudopatients would be admitted and they were asked to rate each patient who presented according to the likelihood they were a pseudopatient  All staff were asked to make judgment 2 SOC313: ROSENHUN READING March 6, 2013  41 patients were alleged, with high confidence, to be pseudopatients by at least one member of the staff. Twenty-three were considered suspect by at least one psychiatrist. One psychiatrist and one other staff member suspected nineteen  Any diagnostic process that lends itself so readily to massive errors of this sort cannot be a very reliable one The Stickiness Of Psychodiagnostic Labels  This research has to do with labeling theory  Being labeled schizophrenic, there is nothing the pseudopatient can do to overcome this label  That there are "central" personality traits (such as "warm" versus "cold") which are so powerful that they markedly color the meaning of other information in forming an impression of a given personality  "Insane," "schizophrenic," "manic-depressive," and "crazy" are probably among the most powerful of such central traits  Once a person is designated abnormal, all of his other behaviors and characteristics are colored by that label.  That label is so powerful that many of the pseudopatients' normal behaviors were overlooked entirely or profoundly misinterpreted  Diagnoses were in no way affected by the relative health of the circumstances of a pseudo-patient's life. Rather, the reverse occurred: the perception of his circumstances was shaped entirely by the diagnosis  One man had a normal family life but the hospital distorted his life outcomes to fit with a schizo case  They said he was ambivalent in his relationships but, every human relationship has ambivalence and he had a normal amount  Meaning ascribed to his verbalizations (that is, ambivalence, affective instability) was determined schizophrenia. An entirely different meaning would have been ascribed if it were known that the man was "normal” Writing  No one questioned them taking notes, only once, when a staff member didn‟t want them to write down the medication they are taking  Their writing was interpretative by nurses as apart of their pathological behavior  Because they are in a hospital, they are disturbed and the writing is seen as a manifestation of that disturbance, perhaps a subset of compulsive behavior that are correlated with schizophrenia  Psychiatric diagnosis caused by the environment is blamed on the patie
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