Who’s
Crazy
Here
Anyway?
Peter Grayson
Background
•How does one distinguish between the psychological diagnoses of
normal and abnormal behavior?
•Dividing line is not at all clear:
NORMAL
ABNORMAL
(EFFECTIVE
FUNCTIONING)
(MENTAL ILLNESS)
•Where does a person’s behavior lie on the line?
•Context of behavior, persistence of behavior, social deviance, subjective
distress,
psychological handicap, effect on functioning.
Experiment
•David Rosenhan - Very provocative study.
•Do the characteristics that lead to psychological diagnoses stem from the
patients themselves or from the situations in which the observers
discovered their patients?
•Trained professionals should be able to distinguish.
•8 pseudopatients (including Rosenhan) were to gain admittance to a
mental hospital and pose as having a mental illness. In the hospital,
pseudopatients acted normally; cooperated with staff, took medications.
1973 - 1975.
During the experiment...
•Pseudopatients’ stays: 7 to 52 days.
Avg: 19 days.
•Not one pseudopatient was discovered as sane by doctors/nurses.
•Other “real” patients could tell.
•Bizarre confrontations between pseudopatients and doctors:
Response
Psychiatrists
Nurses/Attendants
Moves on/head averted
71%
88%
Makes eye contact
23%
10%
Pauses, chats
2%
2%
Stops, talks
4%
0.5%
Significance
•In hospital, normal people cannot be distinguished from mentally ill.
•Diagnostic labels.
•If “labeled” with a condition, that label eclipses all other characteristics of
the patient.
•If labeled with schizophrenia, doctors will view patient as “the
schizophrenic”.
•Due to Rosenhan, psychiatric labels are used carefully.
respect their power demands.
Treated with the
Controversy/Criticisms
•Some hospitals doubted that diagnostic mistakes could be made.
•Rosenhan informed hospitals:
Over next three months, one or more
pseudopatient would enter hospital. Doctors should rate which patients
they suspected. 41 out of 193 were suspected by doctors.
•In reality, Rosenhan hadn’t sent a single pseudopatient.
•Are psychological diagnoses really valid?
Recent Applications
•Broughton and Chesterman - 2001
•Man sexually assaults teenage boy, questioned and displayed various
psychotic behaviors. All were faked.
•As with Rosenhan’s pseudopatients, mental health professionals
assumed the accuracy of the patient’s statements.
•Broughton and Chesterman: “We have to be careful that criminals are not
able to fake mental illness as a get-out-of-jail-free card”.