Clinical classic study - Rosenhan (1973)

Question 1

What were the 2 aims of the Rosenhan classic study?

Answer 1

To investigate the reliability of mental health diagnosis by seeing whether 8 pseudo-patients would be detected as really being ‘sane’

To investigate what the experience of being insane in a mental institution is like

Question 2

What was the experimental design and who were the participants of the Rosenhan classic study?

Answer 2

Experimental Design: Field study and naturalistic covert unstructured observation

Participants: The staff and real patients being observed at the hospitals by the psuedopatients

Question 3

Who were the 8 observers in the Rosenhan classic study?

Answer 3

3 women and 5 men

• 3 x older established psychologists (including Rosenhan himself)
• A 20-year-old psychology graduate
• A paediatrician
• A psychiatrist
• A painter
• A housewife

Question 4

What were the locations of the Rosenhan classic study? (2 points)

Answer 4

12 psychiatric hospitals in 5 US East and West Coast states

Varied:
- Old/new
- High/low ratio of staff to patient
- Private/public
- Well-resourced/less well-resourced

Question 5

What was the procedure of Study 1 of the Rosenhan classic study? (3 steps)

Answer 5

1. All pseudo-patients claimed of hearing the voice of an unfamiliar same-sex person saying ‘empty’, ‘hollow’, and ‘thud’
2. Once admitted, pseudo-patients behaved usually as they would in real life and stopped simulating symptoms of abnormality - spoke to other patients and staff ordinarily and engaged in conversation in the corridors
3. Pseudo-patients were responsible for convincing doctors they were sane in order to get released.

Question 6

Rosenhan Results: Were the pseudopatients detected in Study 1? (3 points)

Answer 6

11/12 hospitals admitted patients with a diagnosis of Sz

71% of staff in the hospitals ignored the pseudo-patients

30% of ‘normal’ patients in the ward voiced opinions about ‘sane’ psuedo-patients - ‘You’re not crazy, you’re a journalist or professor’.

Question 7

What were the 4 other results of Study 1 of the Rosenhan classic study?

Answer 7

7 were labelled with a diagnosis of ‘SZ in remission’ while 1 was labelled as manic depressive (bipolar).

3 patients’ writing behaviour was seen as part of Sz psychopathology by the nurses

Length of hospital admission was 7-52 days - average of 19 days

2,100 pills in total were administered to pseudo-patients and only 2 swallowed

Question 8

What were the conclusions of Study 1 of the Rosenhan classic study? (3 points)

Answer 8

The sane cannot be distinguished from the insane at psychiatric hospitals

Distortion of facts:
Writing behaviour was interpreted as manifestations of disturbances related to compulsive behaviours seen in Sz patients

Diagnostic labelling:
+ Once labelled as Sz, pseudo-patients were stuck with the label
+ Doctors have a strong bias towards Type 1 (false positive) errors

Question 9

Rosenhan Conclusion: What 3 factors caused depersonalisation and powerlessness in mental hospitals?

Answer 9

A lack of eye contact and avoidance of patients

A hierarchal structure - doctors in senior positions have little contact with patients

Medication of patients

Question 10

How generalisable was the Rosenhan classic study? (2 points)

Answer 10

A range of hospitals across the East and West Coast of the USA were used - the findings and observations of mental health practices are not generalisable to those in Central America

Ethnocentric - treatment of patients in collectivist societies might be different

Question 11

Rosenhan - Gender & culture issues

Answer 11

No differences found between male and female participants in the study

Question 12

Rosenhan - Reductionism

Answer 12

Patients’ symptoms reduces to voices in the head and writing behaviour

Question 13

What were the 3 ethical strengths of the Rosenhan classic study?

Answer 13

Pseudo-patients gave informed consent to partake and be admitted to the psychiatric hospitals

Their confidentiality was maintained by the use of ‘pseudonyms’ and fake occupations/ employment

To avoid physical harm, pseudo patients were trained on how to avoid taking medication by pocketing or depositing drugs in the toilet

Question 14

What were the 3 ethical weaknesses of the Rosenhan classic study?

Answer 14

Psuedo patients underestimated how long it would take to be discharged- there was ‘no right to withdraw’

Hospital staff didn’t give informed consent for this study - could be left distressed and questioning their work, which could negatively impact real patients

Rosenhan was criticised for protecting his own personal interests - for his admission, the hospital manager knew Rosenhan was a pseudo-patient

Question 15

Rosenhan - nature-nurture

Answer 15

More nurture as diagnosis was based on culture and societal norms rather than biology

Question 16

How applicable to real life is the Rosenhan classic study? (4 points)

Answer 16

Psychiatric hospitals used findings to review their admission procedures and staff training for patient interaction

Led to them:
+ Moving away from medicalisation as a treatment for mental illness
+ Realising that clinical diagnosis could be improved by reducing the labelling of patients and Type I errors

The study is taught as part of compulsory training for nurses and psychiatrists at university

Contributed to reform ofDSM-IV(1994) -’hearing voices’ for Sz patients was changed from 1 month to 1-6 months

Question 17

Rosenhan - Decades (Time)

Answer 17

May be even more relevant in today’s society in demonstrating dangers of misdiagnosis

Question 18

How reliable was Study 1 of the Rosenhan classic study? (3 points)

Answer 18

Standardised procedure - all pseudo-patients claimed they were hearing the same words ‘(’hollow, empty, thud”)

High inter-rater reliability - several different wards in different hospitals repeatedly gave the same misdiagnosis of Sz

Objective, quantitative measures like the number of days spent in hospital used - other researchers could conduct a similar study and check for consistency of findings

Question 19

How is the Rosenhan classic study internally valid? (3 points)

Answer 19

1. Pseudo-patients behaved normally as soon as they were admitted
   + Their behaviour being interpreted as ‘abnormal’ could only be due to clinical misinterpretation - makes the study a valid measure of clinical diagnosis
2. None of the wards were aware that someone was trying to gain admittance under false pretenses
   + Their diagnosis and treatment can be seen as being valid
3. Pseudo-patients had to gain release by their own actions, not by external intervention
   + The perception of the pseudo-patients as ‘recovered’ is likely to be valid

Question 20

How is the Rosenhan classic study not internally valid? (2 points)

Answer 20

Seymour Ketty (1974) has criticised Rosenhan, claiming that the pseudo-patients were faking an unreal mental condition

He believed the study doesn’t tell us anything about how people with genuine mental health conditions are diagnosed or treated

Question 21

How ecologically valid was the Rosenhan classic study? (3 points)

Answer 21

The range of hospitals means that the results of this study can be directly applied to real-life healthcare systems

The real participants, doctors and nurses were observed in their real-life working environment - increased mundane realism

Pseudo-patients used their own backstories (e.g relationships, partners, kids)

Question 22

Rosenhan - Science

Answer 22

Less scientific due to fewer controls in hospital setting and use of qualitative data

Question 23

Rosenhan - Social control

Answer 23

Participants felt helpless and had no control - were deindividualated as such

Question 24

Rosenhan - Socially sensitive research

Answer 24

Issues of labelling and stigma when not in fact insane

Question 25

Rosenhan - Themes

Answer 25

Primarily based around the medical (biological) model of explaining and treating mental illness