3. VII. Special focus: how good is diagnosis of
mental illness?
A. How do hospitals decide who is "really insane" and
"really sane"?
• the hospital has to first decide if u are actually
insane or not (how well they do it is the challenge)
• but the diagnoses sometimes depends on the
social environment of the hospital
4. VIII. Being Sane in Insane Places: Study 1
A. Could hospitals distinguish "pseudo-patients" from "real" patients
B. 8 sane people gained admission to 12 different hospitals
• length of stay in hospital 7-52 days and 19 on average
• vague symptoms - hearing voices
• lied about the name and jobs but everything else was the truth
C. Results
• they were all diagnosed for schizophrenia
• but they were all drugged so they could not give results so they
stopped taking the pills because they were not observed while they
took the drugs
• so their normal behavior proved that they were insane!!!
• the main finding of the study was that at no time or any personnel of
the hospital recognized they were sane
• Ironically the patients knew they were fake!! lol
• hospital failed because the doctors operate with a strong bias
towards illness
• they also assumed that normal people who go to a mental hospital
have a problem
•
5. IX. Being Sane in Insane Places: Study 2
A. Hospitals were angry, felt tricked
B. Researcher gave them another chance, challenged
them to distinguish pseudo-patients from real
patients for the next 3 months
C. Results
• they found lots of sane people
• BUTT-THEY NEVER SENT ANY SANE PEOPLE
• this happened because they were looking for sanity
and thats what they found
6. X. Other major finding
A. Once a person was diagnosed mentally ill, the label
influenced the interpretation of all behavior, even
normal behavior
• they were taking notes on the walls and the staff
called that insane behavior! (the staff never read
what they wrote)
7. XI. Conclusions
A. Doc‘s diagnoses were reasonable given their
limited knowledge of the patient
• they also had very little time
• hospitals can be fooled because the patient’s
experiences cannot be verified cz it depends on the
patients self report
B. BUT a diagnostic process that results in such
massive errors is not very reliable
C. Docs have a bias toward active treatment
• when in doubt, give the treatment even if the illness
in not understood hoping that it might work (as
long as it wont harm)
8. I. Diagnostic and Statistical Manual of the American
Psychiatric Association, version 4, revised (DSM IVR)
A. DSM II - "neuroses", "Oedipal conflicts”
• they were meta concepts (concepts that are not observable)
• oedipal conflict - young boy comes into conflict with his father
because dad has mom
• oedipus was the guy who killed his father and married to his mother
• so get to man, he identifies with dad to become a male but froid
thought all the young boys who did not have a dad were
homosexuals
• WOMEN- electra complex- little girl wants dad - mom in the way-
penis envy- so young girl becomes like mother and makes her
feminine
• test for masculine identity - men who take baths are not real men
only the ones who take showers
B. DSM III - behavioral description of mental illness
• homosexuality was considered a mental illness
C. DSM IV - refined and improved
9. II. Post Traumatic Stress Disorder (PTSD)
– part of dsm 4
– also called battle fatigue, not its the actual or imagined experience of a
traumatic event
– imagined event - 911 - everyone saw the tv footage and buildings
collapsing and people dying - people that watched and imagined as if
they were there so psychiatrists worried that a lott of people will come
down with ptsd
– good news - did not happen - just very few eg the emergence workers,
the clean up workers and direct family ( turns out that closeness makes
a huge difference)
A. Diagnosis
B. World Trade Center
10. III. Definition of Epidemiology
– oldest branch of medical research
A. Study of distribution of disease
B. In different populations
C. Study of healthy people as well as sick
D. invidence vs prevelence (imp)
• incidence - no of new cases in a short period of time
• prevelance - the total no of cases at a given time
11. IV. Terminology
A. Incidence
B. Prevalence
C. Chronic disease like diabetes
1. Prevalence higher than incidence
D. Acute disease like common cold
1. Prevalence approximately equal to incidence
– HIV is now a chronic disease because it lasts forever
12. V. Uses of epidemiology
A. History of health of populations
1.
Japanese immigrants to US, changes in diet and
coronary heart disease (CHD)
B. Diagnose mental health of a community
1. Three Mile Island
– theres a nuclear generating power plant
– there was a nuclear accident there in 1981
– CDC - center for disease control - sent a team that studied
anxiety of the people around the event
– finding - the closer you were the more anxious u were
and the longer it took u to get over it
2. Survey of mental health in America using DSM III
13. C. Study operation of health care services
1. Emergency room
» they have a triage
» life threatning problem - take you right away
» serious but not life threatning cases - you get
second priority
» non serious cases - wait for hourss
D. Estimate individual risks of disease
1. Insurance actuaries - mathematical models of your risk of
dying - take all your info and then decide how much to charge
you for premium for life insurance - generate very accurate
number of how much you will live
14. E. Describe natural history and course of
disease
1. Transmission of infectious agent requires 5
elements
a. Infected source
b. Agent of infection
c. Susceptible host
d. Site of exit from source
e. Site of entry into host
15. Stephen Hansell, Ph.D.
Department of Sociology
Institute for Health Research
http://sakai.rutgers.edu
shansell@rci.rutgers.edu
609-203-2830
