Defining Psychological Abnormality

"If sanity and insanity exist how shall we know them?" David Rosenhan: 'On being sane in insane Places" (1973).

"How can you tell who's sane and who's insane?' Homer Simpson: 'Stark raving dad' (1991).

In 1973 the psychologist David Rosenhan rang up eight of his friends and asked them what they were doing for the next few weeks. This call launched one of the most famous psychological experiments ever conducted.

Rosenhan set out to investigate our ability to tell the 'normal' from the 'abnormal', the 'sane' from the 'insane'. The eight friends went to psychiatric hospitals in the US and pretended to be mentally ill by claiming to hear voices which said things like 'thud', 'hollow' and 'empty'. All eight were admitted, seven with a diagnosis of schizophrenia, and one with a diagnosis of manic depression.

As soon as they were admitted to the hospital they behaved normally and stated that they didn't hear voices any more. However, it took between 7 and 52 days before they were discharged with a diagnosis of schizophrenia or manic depression in remission.

This study called into question the ability of psychiatrists to accurately diagnose a mental disorder.

The video clips below are from the programme 'The Birth of Modern Psychiatry'. The first clip outlines Rosenhan's study.

(Any problems with Rosenhan's use of insane as a diagnostic category?)

This clip outlines a follow up study by Rosenhan and the development of a checklist system of identifying and diagnosing psychopathology based on signs and symptoms.

(You can watch more of this documentary here...)

In 1975 Robert Spitzer, a psychiatrist, wrote an article in the Journal of Abnormal Psychiatry which argued that the diagnosis of schizophrenia and manic depression in remission was very rare and indicated that the psychiatrists had accurately identified that the pretend psychotics in Rosenhans study did not have a mental disorder.

In 2003 Spitzer claimed that improvements in the way that psychiatrists diagnose a mental disorder meant that the experiment "could never be successfully repeated. Not in this day and age".

In 2004 the journalist and psychologist, Lauren Slater, decided to test Spitzer's claim. She went to eight acute psychiatric clinics and told the on call psychiatrists that she was hearing a voice which said 'thud'. None admitted her but almost every psychiatrist diagnosed psychotic depression and prescribed antipsychotic medication.

Link to a Guardian article on Lauren Slater's book,
Opening Skinner's Box: Great psychological Experiments of the Twentieth Century.

Link to a detailed analysis from the APS Observer of Slater's thud 'test'.

(How valid and reliable is Slater's 'test'?)

Norah Vincent has just published a book about her experience as an undercover journalist in a psychiatric unit. Like Slater she posed as a person with a serious mental disorder and kept a detailed journal of her time in an American public psychiatric unit, a private hospital and an alternative therapy centre.

Link to a review of Voluntary madness: My Year Lost and Found in the Loony Bin.

(Sounds like the plot of a film to me....)

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