Mental Health Nurse: Bias, Labelling & Therapeutic Optimism

Ever wondered what would happen if some actors got themselves admitted to an Institution? Stuart is here to talk about an experiment where just this occurred and explain what we can learn from it.

Topics Covered In This Article

Introduction

The First Experiment

Findings Of The Experiment

Another Study

What Can We Learn?

The Expectation Of Recovery

Final Thoughts

Introduction

In 1973, David Rosenhan, a researcher in California, did a quite remarkable experiment.

He collected around half a dozen Actors, or Psychologists, and persuaded them to participate in one of the most entertaining hoaxes I've ever heard of.

The First Experiment

He asked them all to pretend that they'd begun to hear a voice, just a single voice, which said things like "empty," "thud," and "hollow."

These words were chosen particularly because they didn't really represent any disorder per se that would be recognized in the psychiatric manuals.

The most you could say about them was that there was some form of existential crisis, and of course, there is no existential psychosis as such in any of the diagnostic protocols.

These half a dozen confederates went around to state hospitals in America and requested an appointment for evaluation.

Once there, they repeated the story of the voice saying, "empty, hollow, thud," and got themselves admitted.

And once they were on the ward, they began to behave perfectly normally and dropped any pretence to hear any voices and never referred to them again.

The point of the experiment was to see how the psychiatric institutions of the time would treat them and what they would make of these absolutely sane people.

In fact, the study is entitled, "On Being Sane in Insane Places."

Findings Of The Experiment

What was very interesting was that normal behaviour on the part of these half a dozen confederates was seen to be pathological.

For example, a number of them wrote down elements of their experience.

This was translated in the Nursing notes as some form of pathological writing behaviour.

Other confederates became very bored.

It's a low-stimulus environment with very little to occupy themselves, and as many people would in that situation, they took to walking up and down the corridors in the hospital.

This became a pathology in itself.

It was odd, walking.

The point of the study is to demonstrate that once we give someone a psychiatric label we don't just expect them to live down to it.

We interpret what they do as living down to it, whether it's actually relevant or not.

Another Study

There's another famous study, done by Rosenhan and Jacobson.

It's known as the "Oak School Experiment," where students who were new to the school were randomly assigned an IQ rating.

Some of the students were seen to be particularly academically gifted and others weren't.

The teachers were told which of the students were bright and which were not bright.

And the kids were tested with real IQ tests both at the beginning of the academic school year and at the end of the same academic school year.

And what they found was that the kids who were labelled as bright had indeed done better than all of the children.

There was a huge difference in improvement between the children identified as bright and the children who were categorized as not bright.

Remember, there's no real difference in these kids.

They were randomly assigned the label.

And there were not told about the label.

More than that, it seems that those children who were seen as bright, if they began to fall behind the teachers would assume that that was due to some sort of emotional problem.

If they were having difficulties, perhaps there was something going on at home and they were given additional support.

When the children who were classified as not bright, did well, they were seen to be cheating, or copying, or behaving badly in some other way and were actually punished by the teachers in various ways.

Not necessarily overtly punished but treated differently so that they learned to behave differently and children in the not so bright group actually began performing less well at school in keeping with the expectations of the teacher.

What Can We Learn?

Now, why are these two studies important in Mental Health?

Well, the first one, I think it's obvious.

It demonstrates that labelling, is a dangerous thing to do.

Particularly if we are working with people with a view to their recovery, because by labelling them we make it difficult for them to be seen as recovered.

The Oak School experiment demonstrates that actually recovery itself is more difficult because people conform to the expectations laid upon them.

And that's why in, in my work, in Mental Health I regularly talk about this thing called Therapeutic Optimism.

The Expectation Of Recovery

We need to not just believe that recovery is possible.

We need to expect that the people we work with will recover, even though that recovery often can only be observed as a series of very, very small steps.

But that's okay because an accumulation of small steps can turn into giant strides.

Just as the task of either Social Care or Healthcare in Mental Health is to do relatively simple things repeatedly and well, then the task of recovery involves making small steps consistently.

And people can always take the next small step.

If you want, your service uses your Patients whatever term you use.

Final Thoughts

If you want these people to recover, you must believe that they can recover, you must support the belief that they can recover.

And you must encourage those incremental small steps.

I'm Stuart Sorenson, I'm a Mental Health Nurse and trainer.

Thank you for watching.