5.3.1 - Rosenhan (1973) Flashcards
1
Q
6 x AO1
A
- The aim was to see if eight sane people who gained admission to 12 different hospitals would be found out as sane.
- A further aim was to figure out what the experience of being in such an institution was like and what it feels like to be viewed as insane.
- Each pseudo patient had been told they would have to get out by their own devices by convincing staff they were sane.
- They had daily visitors who indicated they were behaving normally. Results found that although they were not detected by staff, many visitors and other patients suspected there sanity with 35 out of 118 patients voicing their suspicions.
- The staff treated the participants in a way that was consistent with their diagnosis and frequently treated normal behaviour as abnormal.
- Visitors to the pseudo patients observed no serious behavioural consequences
2
Q
General Observations
x4
A
- senior staff have the least to do with the patients - less than 7 mins per day
- given total of 2100 meds tablets - only 2 ever swallowed, the rest either pocketed or flushed. As long as they cooperated the behaviour went unnoticed
- the experience was one of depersonalisation and powerless - deprived of human rights eg freedom of movement and privacy
- personal hygiene was monitored and many of the toilets did not have doors
3
Q
AO3 - Generalisability
2 S + 2W
A
- A strength was that Rosenhan suggested that the pseudo patients were a ‘varied’ group as they consisted of 8 sane people; Three women and five men - 2 graduate students, three psychologists, a paediatrician, a painter and a housewife. Therefore the findings could be said to be generalizable to the US population as it considered people from different backgrounds and ages
- However the sample size of 8 is very small and all but two were taken from a psychology related field with one of the pseudo patients being Rosenhan himself. Equally it is not clear whether there was any racial diversity in the sample. Therefore the sample was not as ‘varied’ as Rosenhan claimed and may not be representative of the US population
- a second strength is that Rosenhan used a range of 12 hospitals in five different U.S. states; Old/shabby and new, research orientated and not, well-staffed and poorly staffed, private, federal and university funded, with varied staff to patient ratios. Therefore the hospitals were generalizable to other psychiatric hospitals in the US and represents psychiatric care in those institutions in the 1970s
- however all the hospitals were in the US and therefore the results may not be generalised to other countries, even in the West which would have considered more similar to US hospitals in the 1970s. Therefore given the US health system is very different to other countries, their results are unlikely to be generalizable to other countries such as the UK and France which have mainly government funded institutions
4
Q
AO3 - Validity
x4
A
- This study took place in a real life context as the eight pseudo patients were admitted to the wards and believed by staff to be real patients throughout the study, and treated in a way that was consistent with their diagnosis, they were able to witness what it was really like to be a patient receiving psychiatric care in the 1970s. Therefore there is a high degree of ecological validity to the experiences of mental health patients on wards within US institutions
- Once admitted, the pseudo patients just had to be themselves, so it was unlikely that any treatment of them was due to their behaviour being similar to someone with mental illness. Real patience realised that the pseudo patients were not mentally ill, suggesting that their behaviour was validly ‘normal’. However, it could be argued that validity is low as the pseudo patients may have only recorded instances of negative interactions between staff and patients as they were all supporters of Rosenhan
- patients had very negative experiences in the psychiatric hospitals, their accounts do not describe the experience of real patients who did not have the comfort of believing that the diagnosis was false. Therefore, the experiences of the pseudo patients would have been very different from real patients that were sane and institutionalised for being insane, which reduces the validity of the results
- However, Rosenhan’s eight patients all said that they heard voices saying the same thing - hollow, empty and thud, but seven got diagnosed with schizophrenia and one with bipolar. He also showed that they could be diagnosed with schizophrenia for claiming to have one symptom. Therefore there is a lack of validity as the DSM’s classification system isn’t detailed enough on symptoms and criteria for each diagnosis as they all had the same symptoms but not the same or accurate diagnosis
5
Q
AO3 - Application to Society
x1
A
Another strength is that Rosenhan found the overwhelming experience of hospitalisation for the pseudo patients was one of depersonalisation and powerlessness. The patients were deprived of many human rights. Therefore this is application as it lead to the national improvement to many psychiatric units once the poor conditions patients were experiencing was recognised
6
Q
AO3 - Reliability
1S + 1W
A
- A strength is that Rosenhans study had well controlled procedures as participants gave the same symptom, complaining that they were hearing voices. They said the voice, which was unfamiliar and the same sex themselves, was often unclear but it said ‘empty’, ‘hollow’ and ‘thud’. Therefore the study can be replicated eg using the same procedures in different countries so that the results can be compared to different groups eg cultures, occupations which would increase the reliability of his findings
- However this study was carried out in 1973 in regards to issues with the DSM II but since publication there has been improvements and revisions made for DSM III and there were many improvements to the hospitals. Therefore even though the procedure could be replicated, this couldn’t be properly repeated in the present day as the existence of the current DSM V and the improvement of care in hospitals means that both the diagnosis of schizophrenia and the experience in institutions would not be replicated eg with more emphasis on care in the community and the use of a multi actual system in diagnosis
7
Q
AO3 - Ethics
x4
A
- A strength is that the study was ethical as the participants understood that they were trying to gain admission to the 12 hospitals to be found out to be sane and to experience institutions viewed as insane. Therefore the participants had informed consent as they understood the aims and procedures before agreeing to take part
- However the pseudo patients remained in hospital for seven up to 52 days with an average of 19 days. They were also given 2100 medication tablets of which two were swallowed. Therefore the study was unethical was the swallowing of two unnecessary medication was dangerous and the study wasted resources on false patients that could have been used to support another patient
- The only permission that was gained was for Rosenhan himself and that was only with the hospital administrator and the chief psychiatrist at one institution. Therefore the staff on the psychiatric wards were unable to give informed consent as they had no idea that they were being observed by the pseudo patience or taking part in the study
- However if the staff had been aware of the study, this would have changed their behaviour and it would not have been possible to accurately test the validity of the DSM. This was seen in the second study where, once a hospital was told to expect pseudo patients over a three month period, 193 patients were admitted and of those 41 were thought with a high level of confidence to be fake by at least one member of staff, despite being real patients
