Normality vs. Abnormality
The concept of abnormality plays a big part in mental professionals diagnoses for determining if someone is mentally ill. Psychologists and psychiatrists must determine if a patient is mentally ill by studying the context and persistence of their behavior. Their diagnoses essentially determines the type of treatment the patient will receive. The question is, are mental health professionals able to distinguish between the mentally ill and mentally healthy?
This is where David Rosehan comes into play. He studied mental hospitals and questioned whether the characteristics that determine psychological diagnosis lay in the patients alone, or in the settings in which those doctors find them. He wanted to test the ability of mental doctors to accurately distinguish between patients. To do so, he set out to send normal ‘pseudopatients’ to seek entrance into psychiatric hospitals to see if the doctors who diagnosed them would be able to see that they were actually mentally healthy (Hock, 2009, p. 229).
Rosehan’s goal was to study how the doctors and their staff treated these pseudopatients after they exhibited normal behavior (Hock, 2009, p. 229). If they were unable to recognize that nothing was really psychologically wrong with these patients, then it would provide evidence that those who diagnose the mentally ill rely more on the situation they find the patients in rather than the patients themselves (Hock, 2009, p. 229).
Rosehan gave the task to eight pseudopatients (participants) to seek admission to 12 different mental hospitals in 5 different states. All the participants followed the same instructions. Prior to being admitted into a mental hospital, they set up an appointment and upon their arrival, they explained to the doctors that they were hearing voices that said “empty,” “hollow,” and “thud” (Hock, 2009, p. 229). Besides this one abnormal “symptom,” the pseudopatients behaved normally.
With this in mind, all participants were accepted into the hospitals, and seven out of eight of them were diagnosed with schizophrenia.The main task for the participants was to be let out of the hospitals as soon as possible, and to act as normal as possible and cooperate with the hospital staff. The way the pseudopatients were being treated by the staff after their diagnosis, however, was what Rosehan wanted to observe.
Contact between the staff and pseudopatients was at a minimum. When the pseudopatients would ask staff members normal questions (this was a task specifically for the study), the responses they would receive were very interesting. Their questions would be disregarded for the most part, and more frequently would a staff member just move on with no response than actually make eye contact or have a verbal discussion with the pseudopatient. Interestingly enough, even though there was barely any verbal contact between the staff and the participants, there was no issue in the amount of medication being prescribed to them.
The findings of Rosehan’s study indicate that even licensed psychologists, psychiatrists, and mental health professionals are at many times unable to differentiate between who is ‘normal’ or ‘abnormal’ in mental hospitals. Rosehan thinks this is due to a hindered judgment of one’s behavior on the staff’s part (Hock, 2009, p. 231).
Subsequent evaluations and applications of Rosehan’s study provide more analysis for how mental health professionals diagnose their patients. Psychiatrist Thomas Szasz, for example, argues that mental illnesses are not diseases, and that they should be viewed as “problems in living” that are caused by social and environmental factors (Hock, 2009, p. 234).
Also, a study that used Rosehan’s as its main reference contends that there are cases of people faking symptoms of a mental illness (Hock, 2009, p. 234). This is important when we consider criminals in a trial and if they try to beat a case against them by pretending to have a mental illness that would excuse their behavior. Thinking about this, we can see how important it is for mental health professionals to be able to accurately determine who is mentally ill and who is not.
Once someone is admitted into a mental facility, the staff of that facility already has a preconceived notion of who those patients are as people. They disregard them as being humans, in all actuality. Rosehan found that in the mental institution setting, the patient’s diagnosis essentially becomes their most prominent characteristic to the hospital staff. That is, anything the patient says or does will be thought by the staff to be a behavioral manifestation of the psychological label they have been given (Hock, 2009, p. 231).
Rosehan’s study, therefore, was groundbreaking in that it proved that the ‘sane’ could not be recognized apart from the ‘insane’ in a mental hospital setting.
Forty Studies that Changed Psychology by Roger R. Hock (2012)
© 2013 Ameera Nassir