Classic Study : Rosehan (1973)

Question 1

Aims

Answer 1

• whether people who pose as mentally ill would be detected as being sane
• to test the reliability of mental health diagnosis
• to investigate the effect of labelling on medical diagnosis

Question 2

Sample

Answer 2

• pseudopatients = the observer (3 female 5 males) with jobs like psychology students, psychiatrists housewife etc
• participants = the staff and patient in 12 psychiatrists hospital in 5 different states in USA

Question 3

Procedure

Answer 3

• pseudopatients complained to hospital about the same symptom (heading unfamiliar voice of same sex saying “empty” “thud” “hollow”- not related to schizophrenia)
• after admitted they behaved normally and stopped reporting voices and requested to be discharged
• pseudopatients had notepad to record what they saw and heard covertly but if detected they’d carry on recording overtly
• pseudopatients were to be “pagans of cooperation” by following orders and being polite whilst disposing of medication

Question 4

Follow up study

Answer 4

• Some hospital wanted to see if this would happen in their hospital
• rosenhan said pseudopatients would admit over next 3 months but never actually did
• 193 patients were real but 41 rated as a pseudopatient by staff, 23 by psychiatrists, 19 by both
• clinicians avoided calling a “healthy” person sick

Question 5

Mini experiment

Answer 5

• pseudo patient approached staff with scripted question e.g. “when am I likely to be discharged?”
• staff answer and body language were recorded
• 4% got answer from psychiatrist, 0.5% from nurse

Question 6

Results

Answer 6

• all pseudopatients were admitted, 7 diagnosed with schizophrenia, 1 with bipolar, none of staff thought they were healthy
• Took up to 52 day to be discharged, average = 19 days
• 7 had schizophrenia in remission when discharged (they have it but symptoms have stopped)
• 30% of patients voiced suspicion about pseudopatients
• pseudopatients observed staff abusing patients, patients refusing meds, depersonalisation of patients (no doors on toilet)

Question 7

Conclusions

Answer 7

• we cannot distinguish the same from the insane in psychiatric hospitals
• hospital environment led to depersonalisation and segregation which makes pseudopatients seem insane
• wealthier people more likely to get diagnosed with milder problems = class affects diagnosis
• tendency towards false positives in normal diagnosis but more false negatives when the stakes were high e.g. when diagnosis is being assessed
• psychiatric hospitals are psychologically mortifying

Question 8

Generalisability

Answer 8

• small sample (12 hospitals) for a country as big as USA - anomalies can skew results so not generalisable
• there has been a lot of ethical and medical progress since 1970s so not representative of psychiatric diagnosis and care today so not generalisable
• pseudopatients diagnosed with DSM-2 but we’re on DSM-5 now so not representative

Question 9

Reliability

Answer 9

• pseudopatients didn’t follow all the same standardised procedures e..g one had a romantic relationship w nurse so not reliable findings
• Slater (2004) = replicated Rosenhan, went to 9 emergency rooms and also given a misdiagnosis of “psychotic depression” so rosehsn reliable
• Spitzer, Lilienfield and Miller (2005) = 74 emergency rooms replicating Rosenhan but only 3 diagnosed with psychotic depression so not reliable results

Question 10

Validity

Answer 10

• Ketty (1974) = pseudopatients were faking an unreal mental condition so it doesn’t tell us how people with genuine conditions are diagnosed so lacks ecological validity
• Spitzer (1976) = schizophrenia in remission was recognition that the pseudopatients behaviour was unusual, not that they couldn’t tell sane from insane

Question 11

Ethics

Answer 11

• staff were deceived and nurses didn’t give consent and had no right to withdraw
• Rosenhan protected peoples confidentiality
• contributed to a crisis of public confidence in US mental health system
• told chiefs of hospital and got lawyers for pseudopatients to get them out if needed

Question 12

Application

Answer 12

• caused psychiatric hospitals to review this admission procedure and how to train staff to interact with patients
• moved away from dependency on drugs to treat mental health
• major influence on DSM versions e.g. DSM-5 says you need to display 6 months of symptoms to be diagnosed with schizo