Wednesday, July 26, 2017

The Rosenhan Experiment Explained

The Rosenhan experiment is a study conducted in 1973 in order to examine the validity of psychiatric diagnosis. Researcher David Rosenhan suspected that psychiatric criteria applied in diagnosis are not as objective as believed but rather context and personally determined.

In order to test his hypothesis Rosenhan wanted to commit healthy people to mental institutions and see how they are treated (hence the title of his article: "On Being Sane in Insane Places"). His study included two experiments testing unknowing real hospitals. In his first experiment Rosenhan sent healthy people to fake psychiatric symptoms which disappeared after they were hospitalized. These fake patients continued to be treated as abnormal though they presented no symptoms and were in fact completely sane (for a detailed account of the experiment see our summary of "On Being Sane in Insane Places" part 1). After the results of the first experiment, the second Rosenhan experiment informed institutions that fake patients will come to them within a given time frame. Rosenhan asked the institutes to try and pick up on the impostors and though a relatively high number of patients were suspected to be sane, Rosenhan in fact never sent anyone (for a detailed account of the experiment see our summary of "On Being Sane in Insane Places" part 2).

What the Rosenhan experiment shows is not only the unreliability of mental diagnosis (and maybe medical diagnosis in general), but something much deeper. In his article Rosenhan talks about the problem of "psychiatric labeling", a phenomenon by which once someone is considered to be insane the way he is perceived and treated by his surroundings will work to fulfill that prophecy. In the most broader sense, the Rosenhan study demonstrates how once we have an initial verdict on someone or something, everything we see from that point on will be understood based on that initial judgment, be it misguided or not. Rosenhan's experiment pushed forward the anti-psychiatry movement and the discourse on psychiatric labeling, but its meaning and implications run much deeper. 

Recommended:

Tuesday, July 25, 2017

Summary: On Being Sane in Insane Places - David Rosenhan - part 2 (second Rosenhan experiment)

The second Rosenhan experiment

Hospitals that learned of the results of the first Rosenhan experiment (part 1 of the summary) described in "On Being Sane in Insane Places" could not believe that such errors can systematically occur. Rosenhan therefore devised a second experiment in which the local staff was notified in advance that within the upcoming three months a fake patient will try to get himself committed to their institute. All personal were requested to rate patients according to the chances that they are the fake patient. Reports were filled on 193 patients: 41 were rated a highly likely to be fake by at least one staff member, 23 were suspected by at least one psychiatrist and 19 were suspected by one psychiatrist and one staff member. In actual fact, no fake patients were ever committed to any of the hospitals as part of Rosenhan's study.  

The second Rosenhan experiment proves that the tendency for over-diagnosis can be reversed. Since 19 patients were suspected to be sane by a psychiatrist and a staff member, the credibility of diagnosis is undermined.

Rosenhan's study and psychiatric labeling

What the Rosenhan experiments shows is that once a person is labeled as deviant, all his actions will be labeled accordingly. The power of this labeling is so powerful that perfectly normal behaviors were ignored, misinterpreted or even coerced to fit the original diagnosis. Personal facts were distorted by professionals in order to fit in with schizophrenia. Even sadness or outbursts by the fake patients that were the result of being committed were misunderstood as being related to schizophrenia. Rosenhan's study also painted a very harsh image regarding the treatment of mental patients that are dehumanized by the staff that disregard their rights and treat them harshly.

Rosenahn concludes "On Being Sane in Insane Places" in wondering how many sane people are labeled and committed as mental patients. He claims that psychiatric labeling can have a life of its own with risk of becoming a self fulfilling prophecy in which even the person himself accepts the diagnosis and begins to act accordingly.

Books to have: 


  



Summary: On Being Sane in Insane Places - David Rosenhan - part 1 (first Rosenhan Experiment)

D.L.Rosenhan's "On Being Sane in Insane Places", also called the "Rosenhan experiment" is a critical study regarding the validity of psychiatric diagnosis.

The background for Rosenhan's study is the question of how can we tell sanity from insanity, arguing that there are many inconsistencies regarding the credibility and applicability of concepts of mental health and psychopathology which might be cultural dependent. Rosenhan holds that at the heart of the diagnosis of insanity lies one crucial issue: do the characteristics that lead to a diagnosis come from the patient of the surrounding context? Rosenhan suspects that the approach of determining the occurrence of mental condition based of a catalog of symptoms is not as objective as thought and is highly effected by the tendencies of the person doing the diagnosis.

In order to test his hypothesis Rosenhan thought of an experiment in which normal people are committed to mental institutions in order to see how they are diagnosed. If they are declared sane then the system can be trusted. But if "fakers" will be diagnosed as suffering from mental illness this will attest to a context related bias.

The first Rosenhan experiment

Rosenhan therefore devised two experiments for his study described in "On Being Sane in Insane Places". In the first experiment of the study eight sane people committed themselves to twelve psychiatric institutes without their crew being aware. Aside from Rosenhan himself the experiment included 3 psychologists, one psychology student, a pediatrician, a psychiatrist, a painter and a homemaker. Hospitals chosen for the experiment were also varied.

In their sessions the fake patients complained of auditory hallucinations in which very unclear voices utter vague words. The name, occupation and symptoms of the patients were made up but their personal history and behavior were authentic. None of them had any past of present pathological behavior.

The fake symptoms disappeared right after the patients were admitted, although some of the cases presented mild and passing anxiety. Patients acted inside the institution as they would act outside of it, and they were obviously motivated to be declared sane in order to be discharged. Nurse reports confirm that they were friendly, cooperative and did not exhibit any abnormal behavior.

The fake patients kept (first hidden and then overt) accounts of their experience. Fake patients in the first Rosenhan experiment spent 17 to 52 days in the institutions (an average of 19 days). They all displayed normative behavior but were all but one discharged with a diagnosis of "schizophrenia in remission". None of the files indicated any doubts regarding the diagnosis. Once diagnosed, nobody thought of second guessing the initial judgment. They were not thoroughly examined but not due to lack of time. The other real patients in the institute noticed that the fake patients were normal but the staff did not and they even thought them to be a researcher or journalist. Rosenhan concluded his first experiment in "On Being Sane in Insane Places" with the assertion that doctors tend to over-diagnose in order to be on the safe side and not miss a sick person. But this tendency can cause damage when adopted by psychiatrists due to the social and legal repercussions of a mental condition.   

The second Rosenhan experiment will be discussed in part 2 of the summary of "On Being Sane in Insane Places".

Books to have: 


Friday, July 21, 2017

The Nacirema Culture Explained

The Nacirema are a peculiar culture in North America. According to Horace Miner's account of them in his 1956 article "Body Ritual Among the Nacirema", one of their main characteristics is a highly negative sentiment towards the human body which is considered by them to be ugly and sick. Miner describes how the entire ritualistic practices of the Nacirema revolve around this core issue of the body. For example, every house of the Nacirema people has one or more shrines devoted to purifying the body, shrines containing charm-boxes full of supernatural substances aimed at keeping the body away from disease. The Nacirema have special medicine-men which hold secret knowledge of special substances. These medicine men also function in a central temple in which people undergo brutal practices aimed at "curing" them from illness. The Nacirema are also fascinated with their mouths, believing that they determine one's social status. For this hand they have holy mouth men which also perform elaborate and almost sadistic rituals on people's mouths. The Nacirema believe that parents bewitch their own children and therefore they have a special "shaman" charachter called a "listner" who exorcises them. Another interesting attribute of the Nacirema Miner points to is the practice of Nacirema men who scrape their faces with sharp instruments and the Nacirema women who bake their heads in ovens.

Miner's account of the Nacirema culture is in fact an ethnological satire. The Nacirema don't exist and they are in fact American culture (Nacirema in reverse). The shrines are explained as toilets, charm-boxes are medicine cabinets, medicine men are doctors, temples are hospitals, holy mouth men are dentists, men shave their faces while women dry their hair at beauty salons.

Miner's "Body Ritual Among the Nacirema" demonstrates the subject of cultural relativism and the argument that societies must be understood from their own context in order to be properly interpreted. On the other hand, Miner's alienated view of the "Nacirema culture" says a few very interesting things about American culture, unobservable from the inside. 

See also: "Body Ritual Among the Nacirema" / Miner - Analysis and Explanation 


These might also interest you:

Clifford Geertz: Thick Description: Toward an Interpretive Theory of Culture
Clifford Geertz – From the Native's Point of View
Purity and Danger by Mary Douglas

Good books to have on this topic:

     

  
    

"Body Ritual Among the Nacirema" / Miner - Analysis and Explanation

"Body Ritual Among the Nacirema"(link for text summary) is a sarcastic account of the none-existing "Nacirema" tribe which is actually American culture (Nacirema in reverse is American). Miner uses this satire to say a few things about the nature of ethnological work (and American culture).

In Miner's article the special domestic shrines the Nacirema use are bathrooms. The special charm-box is the medicine cabinet. Medicine men are obviously doctors while holy mouth men are dentists. The latipso is a hospital and the listener is a psychologist. Finally, the men scraping their face are shaving while the women baking their heads are putting them in salon hair dryers.

The meaning of Miner's "Body Ritual Among the Nacirema" is that if we distance ourselves and our point of view, a culture will always look peculiar to us. On the other hand, looked at from within, even the strangest customs and practices might seem completely reasonable and justifiable. "Body Ritual Among the Nacirema" is important because it demonstrates the problem of representation in ethnography. The purpose of article is to raise the question of how can we study a different culture from the outside and how can we understand our own culture from within. The article thus demonstrates the topic of cultural relativism, arguing that there is no one objective viewpoint from which to assess cultures, and that every culture should be understood and interpreted from the native's point of view.

Following Miner's article we can ask ourselves, as anthropologists, how should we approach the study of a particular society. If we are to distance ourselves and look at it as if we were aliens (like Miner does in regards to the Nacirema) we might gain one perspective that notices the hidden obvious and asks questions only someone from the outside can ask (see for example Alfred Schuzt's "The Stranger"). On the other hand, if we don't have the inner context of a society we might fail to understand the meaning of different things we see in it.
Many American will be insulted by Miner's account of them, and will justly claim that he fails to account for many factors in what he describes. On the other hand, an American reading "Body Ritual Among the Nacirema" can gain a new interesting understanding about body culture in American society and see banal everyday practices in a new light.

see also: The Nacirema Culture explained

These might also interest you:

Clifford Geertz: Thick Description: Toward an Interpretive Theory of Culture
Clifford Geertz – From the Native's Point of View

Purity and Danger by Mary Douglas
    

Good books to have on this topic:

     

  

Summary: "Body Ritual Among the Nacirema" / Horace Miner

"Body Ritual Among the Nacirema" by Horace Miner (1956) is an ethnological account of the Nacirema, a tribe located in North America. According to Miner, the Nacirema culture presents a highly developed market economy but with a main focus on ritual activity which focuses on the human body and its appearance of health. The Nacirema believe the body to be ugly and detestable and seek to avoid its uncleanliness through ritual and ceremony.

The houses of the Nacirema culture according to Miner have shrines devoted to this purpose, which also feature a status symbols. Ceremonies are performed privately and are seldom discussed with the exception being children which need to be socialized into the ritual. The Nacirema, according to Miner, have "charm-boxes" as the focal point of their shrines which are full of magical materials, distributed at the discretion of medicine men which use a secret old language. All materials are retained in the overflowing charm-boxer, and though the people of the Nacirema sometimes even forget their original purpose they still hang on to the materials, believing that they somehow protect them. The Nacirema use their shrine daily for the purpose of ablution, with the aid of pure holy water coming from the Water Temple.

The Nacirema also have "holy-mouth-men" which rank below the medicine men in social status. The holy-mouth-men are entrusted with taking care of the mouth, which is an object of obsession for the Nacirema who believe that it has "a supernatural influence on all social relationships". Miner also says that the Nacirema associate a healthy with moral characteristics. This is why the children of the Nacirema are brought up on the "mouth-rite", which Miner describes as inserting into the mouth a bundle of hog hairs along with magical powders and moving it around. The Nacirema also routinely seek the somewhat torturous practice of the mouth-men which exorcise their mouths using elaborate tools and supernatural substances.

The men of the Nacirema perform a daily ritual of scraping their face with a sharp instrument. Women on the other hand bake their heads in small ovens four times a month.
The medicine men of the Nacirema have imposing temples called latipso in which elaborate ceremonies are being held for seriously seek people, with the help vestal maidens. Miner writes that the Nacirema are eager to undergo ceremonies at the latipso, believing that it would keep them alive. These ceremonies come at a hefty cost of gifts and include being naked in the presence of others, something the Nacirema never do elsewhere.

Miner also describes a witchdoctor called the "listener" who can exorcise demons from bewitched people. The Nacirema  believe that parents, especially mothers, bewitch their own  children. The listener treats people simply by listening to their talk of themselves.

Towards the end of  "Body Ritual Among the Nacirema" Miner adds a few more characteristics of the tribe like "ritual fasts to make  fat people thin and ceremonial feasts to  make thin people fat" and a fixation with women breast size. On the other hand, intercourse is "taboo as a topic and scheduled as an act". Miner concludes that the Nacirema are "magic ridden people" whose survival is bewildering.  

Though Miner never discloses it in the article itself, "Body Ritual Among the Nacirema" is a satirical account of American society itself. The meaning of the satire will be discussed in the analysis part of our summary.  

See also: The Nacirema Culture explained

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These might also interest you:

Clifford Geertz: Thick Description: Toward an Interpretive Theory of Culture
Clifford Geertz – From the Native's Point of View
Purity and Danger by Mary Douglas



Good books to have on this topic:

     
  

Thursday, July 20, 2017

The Rules of Sociological Method / Durkheim - Summary

Emile Durkheim's "The Rules of Sociological Method" (1895) is an attempt the establish sociology as a science. Durkheim proclaims sociology as the science of social facts, distinctive features of social life that function as objects in their determination of one's reality and that therefore can be studies as objects (See our summary of Durkheim's "What is Social Fact?" for more details). Having objects in the form of social facts in not enough for sociology to be considered a science, and Durkheim adds the need for a method to be established (remember Descartesin his "Discourse on the Method").

In "The Rules of Sociological Method" Durkheim establishes society itself as an object of scientific inquiry, in a sense turning humanity's inquisitive gaze towards nature on itself (Horkheimer and Adorno will later argue in "Dialecticof Enlightenment" that this had dire results). Durkheim holds that if nature presents itself to science in the form of phenomena, then the same can be said about society. The phenomena in question for sociology are what Durkheim calls "social facts" which are forces that constrain and direct an individual's behavior. What Durkheim is basically saying is that our personal actions are always determined by internalized social factors, "facts", that we must study.   

After establishing the objects of sociology Durkheim devotes "The Rules of Sociological Method" to its methodology. Durkheim goes to great lengths in elaborating on the principles of sociological method. Since this is a short summary we will not go into great details but the gist of Durkheim's thought is that social facts must be considered "as things" - recognizable, observable, quantifiable and discussable. This is an attempt to fit sociology in with the requirements of positivism. For Durkheim the methodology of sociology must be made objective and society must be studied "from outside" in order to gain a scientific account of it.  

Additional article summaries by Emile Durkheim:

Emile Durkheim - Suicide
"The Genesis of the Notion of the Totemic Principle or Mana" – summary and review" - part 1 -2 -3
What is Social Fact?
Division of Labor in Society 
Elementary Forms of Religious Life
Moral Education
Types of Suicide according to Emile Durkheim
Anomie according to Durkheim


Suggested reading:   

 

Suicide / Durkheim - Summary and Analysis

The one main point of Emile Durkheim's seminal "Suicide" (1987) is that suicide, or any other personal act for that matter, is never a purely individual act bur rather one that incorporates social conditions. Thus suicide for Durkheim is the result of a certain type of relationship between an individual and society. "Suicide" is Durkheim's attempt to create a model case study that deals with what he calls "social fact" (see our summaries of Durkheim's What is Social Fact? or "The Rules ofSociological Method" for more details). These social facts work to determine an individual's life, and in some cases, his death by his own hands.

In "Suicide" Durkheim compares suicide rates of Protestants and Catholics, holding that Catholics kill themselves less. His explanation was that Catholicism offers its followers a stronger sense of social cohesion and a feeling of belongingness when compares with the more individualistic Protestants.

When studying the family Durkheim noted that men commit more suicide than women and that singles kill themselves more than people in relationships, people with children present even smaller rates of suicide. Durkheim also found that soldiers kill themselves more than civilians and that they do so more in peacetime than during war.  
These findings lead Durkheim to argue that suicide is prompted by social factors, and not only psychological ones. The relationship one has with his social world is determinative of his inner experience, and should these ties become problematic people might be driven to suicide. Durkheim feels that social integration and cohesion are important here, holding that the more you are comfortably bound with your social surrounding the less you are likely to kill yourself. One the other hand, being too close to society to the point of losing the self can also lead one to commit suicide.

Durkheim lists four types of suicide (see link for a detailed summary):  
Anomic suicide (see Anomie) is the result of the  destabilization and ultimate breakdown of ties to social reality, like in times of rapid change.
Egoistic suicide happens due to the loss of social ties and isolation from society, like in the case of old age.
Altruistic suicide is when someone willingly gives his life to society with which he indentifies completely. Soldiers dying for their country is an example.
Fatalist suicide for Durkheim is when someone is erased by society, losing all sense of self and agency. A prisoner killing himself is an example.  

Additional article summaries by Emile Durkheim:




Suggested reading:   

 

Types of Suicide according to Emile Durkheim - Summary


In his 1987 book "Suicide" Sociologist Emile Durkheim lists four possible reasons that can lead an individual to suicide:

Egoistic suicide - According to Durkheim, egoistic suicide occurs when someone loses the bonds that tie him to society. The term "egoistic" does not imply "selfish" but rather a condition in which someone's reality is only himself, lacking any ties to anyone else. In a regular condition we find ourselves in reality through our social position, our role, our relationships etc. When these are weakened or lost, says Durkheim, we are more prone to suicide.   

Anomic suicide - Anomic suicide is the result of a situation Durkheim defines as "Anomie". Anomie is the breakdown or guiding norms as the result of social detachment. Anomic suicide happens when someone feels he lacks a clear enough understanding of his reality. Times of rapid change (political, economical or social) are times in which we may find many people experiencing anomie, some of them will resort to anomic suicide.

Altruistic suicide - Somewhat opposed to anomic and egoistic suicide we can find what Durkheim calls "altruistic suicide". While the first two refer to a condition in which an individual's external ties are weakened, altruistic suicide is the result of these ties being very strong. In this type of suicide a person chooses to end his life under the impression that this will benefit his social group. An example of altruistic suicide can be Jihadist terrorists that are ready to give their lives for the sake of a perceived collective goal.  

Fatalistic suicide - For Durkheim, fatalistic suicide is the result of desperation, desperation caused by a sense of crushing social powers that erase the self. A condition in which the social structure denies the individual agency and a sense of control over his own life might result in fatalistic suicide.  

Anomie according to Durkheim - Definition and explanation


Anomie is a central concept in the social thought of Emile Durkheim. Anomie literally means a-nomos, "none-law". Durkheim uses the term of Anomie to refer to a condition in which an individual of a group loses the guiding norms which organize social discourse. It is a condition in which good and bad, right and wrong breakdown and become incoherent to such an extent that people no longer have guidelines through which to engage with reality. Durkheim's concept of Anomie is related to his understanding of the relationship between the individual and the social structure. Social norms regulate our behavior in a manner that makes us compatible with reality. In his seminal work, "Suicide" (1897), Emile Durkheim holds that the congruence of our held values with that of society is a precondition for happiness, since it assures us that are desires are constructed within the scope of available means for their satisfaction. The breakdown of norms (due to rapid historical changes such as modernity) lead to a mismatch between personal means and ends. When you want more than you can have reality seams alienated. The scale of things, the organizing principle of reality, breakdown and individuals struggle to make sense of their existence. Durkheim lists Anomie as one of the four possible reasons for suicide.