C3: MH: Rosenhan - Sane In Insane Places

Question 1

Outline the overall aim.

Answer 1

Investigate whether psychiatric staff can reliably + accurately distinguish the sane from insane

Question 2

Aim of study 1

Answer 2

Can psychiatric staff distinguish sanity from insanity?

Question 3

Design of study 1

Answer 3

Field experiment, w/ research method of controlled pp observation (note taking)

Question 4

Participants of study 1

Answer 4

8 pps, 5 males + 3 females

Variety of jobs

Question 5

Setting of study 1

Answer 5

12 psychiatric hospitals (old + new) across 5 states

All public federal hospitals except one private

Question 6

Procedure of study 1

Answer 6

• Tried for admittance by claiming hearing voices: ‘empty, hollow, thud’
• gave false name and job, but all else true
• all but one diagnosed w/ schizophrenia, other was manic depression
• IV: which of 12 hosps pseudo patients tried to get into
• DV: whether or not they were admitted
• given roughly 2100 tablets in total, only took 2, disposed rest in toilets, found other tablets there
• took notes covertly then openly, questioned once
• bad treatment of patients, staff avoided them

Question 7

Results of study 1

Answer 7

• all pps behaviour interpreted in context of their disorder (labelling)
• all discharged w/ ‘schiz in remission’
• length of stays 7-52 days, avg 19
• 35 real patients voiced suspicions on pseudos
• hosps made type 1 errors (pps sane but hosps thought they were insane) - over diagnosing
• patients made powerless by loss of authority + control (med notes read by staff who shouldn’t, no doors on cubicles etc)
• patients depersonalised by not being treated as individuals (staff talked about them as if they weren’t there, adjusted bra in front of male pps etc)

Question 8

Conclusions of study 1

Answer 8

• only discharged w/ ‘schiz in remission’ shows stickiness of labels - stigmatised
• failure to detect pseudo pps = not due to quality of hosps / time available to observe pps / pps behaviour, but due to fact doctors would rather call healthy (sane) person sick (insane) that opposite

Question 9

Aim of study 2

Answer 9

Would staff reverse a diagnosis from insane back to sane?

Question 10

Design of study 2

Answer 10

Field experiment, w/ self report + observation

Question 11

Setting of study 2

Answer 11

Research + teaching hosp

Question 12

Procedure of study 2

Answer 12

• falsely warned hosp staff that one / more pseudo patient pps would attempt to gain admission over next 3 months
• staff rated each patient for being an impostor or not, on 10 point scale from 1 (impostor) to 10 (not imp, genuine)
• hospital knew throughout study about first study’s findings
• IV: false info
• DV: no. of patients staff thought were pseudo patient pps

Question 13

Results of study 2

Answer 13

• 193 patients admitted during 3 months of study 2, none were pseudos
• 41 rated (confidently) as pseudos by at least one staff member
• 23 suspected by one psychiatrist
• 19 suspected by one psychiatrist + one member of staff

Question 14

Conclusions of study 2

Answer 14

• hosp staff just being cautious (owing to study 1 results too)
• so here they were more likely to call a sick person healthy as trying to avoid doing opposite like study 1, so now a type 2 error (diagnosing sick (insane) as healthy (sane)) = under-diagnosing

Question 15

Evaluate research method

Answer 15

All field experiments
✅ pps in their normal situation so behaviour likely representative
✅ pps could be unaware they’re in study (staff) so demand characteristics less likely to be problematic than in lab exps
❌ control over extraneous variables = more diff than in lab, so less reliable + replication more diff
❌ pps likely to be unaware they’re in study (staff), raising ethical issues

Question 16

Evaluate ethics

Answer 16

❌ informed consent + consent in general = problem, especially in study 1, as staff unaware of experiment (but a few knew in study 2)
❌ deception used in study 1 as staff told pseudo patients ‘heard voices’, + in study 2 as staff told pseudos would admit themselves but didn’t
❌ harm + distress as was potentially harmful environment for pps (were treated badly by staff etc so overall depersonalised)
❌ right to withdraw was absent - once admitted they couldn’t leave, up to them to prove they should
❌ invasion of privacy - genuine patients may have felt their behaviour being recorded unfair
✅ confidentiality - ok, no names of staff / patients disclosed + no pps real names used

Question 17

Evaluate ecological validity

Answer 17

✅ High from naturalistic setting of 12 psychiatric hosps / wards + fact that pps were also staff who were unaware they were being observed so behaved normally
❌ Yet, also low as pps not genuine - so tried to behave normally but diff in strange hosp environment, also pps spent lots of time noting observations about ward, staff + patients - activity not normal for genuine patients

Question 18

Evaluate situational factors

Answer 18

❌ patients’ behaviour interpreted in context of illness
❌ findings highlight role of labelling
❌ label continues after discharge (stickiness) as stigma

Question 19

Evaluate reliability of diagnosis

Answer 19

✅ raised important Qs about reliability + validity of DSM regarding how to diagnose abnormal behaviour
✅ challenges assumptions of psychiatry
❌ criteria for disorders are vague + arbitrary
- if makes errors, it’s not reliable / valid
- rosenhan argues mental illness = social phenomenon, a consequence of labelling + that doctors + psychiatrists are more likely to make a type 2 error
- he believes if diagnosed insane, it’s down to hosp situation (you’re a schiz… this is a hosp… you act like one)
- it’s worse as carries ‘personal, legal + social stigmas which are diff to get rid of’ - stigmatisation + labelling

Question 20

Evaluate usefulness and practical applications

Answer 20

✅ brought DSM under research lens (so reliability later improved) as well as appalling conditions of psychiatric hosps, = lead to many hosps improving their philosophy of care