Clinical - Rosenhan (1973)

Question 1

Aim of study

Answer 1

Wanted to demonstrate that psychiatrists were unable to distinguish sane from insane
Aimed to provide evidence to support the idea that mental disorders don’t lie with the individual, rather with the person making the disorder

Question 2

Experiment technique/ methodology

Answer 2

Participant observation
Observers were pseudo patients who entered the hospital as patients. They observed and recorded what they saw inside the hospital

Question 3

Sample

Answer 3

Pseudopatients - 3 females and 5 males (including Rosenhan)
A psychology student, paediatrician, psychiatrist, painter, housewife and three psychologists
Presented themselves with the same symptoms

Question 4

How did the sample present themselves to the hospital

Answer 4

Purported to hear a same-sex, unfamiliar voice that was unclear
Voice said ‘empty’, ‘hollow’, ‘thud’
These terms are not normally linked to schizophrenia
Pseudonyms (fake names) given to pseudopatients, also gave false information and medical history

Question 5

Hospitals approached by pseudopatients

Answer 5

Approached a total of 12 hospitals in 5 states on both the East and West coasts (some pseudopatients went to more than one hospital)
Hospitals varied: old, new, well-staffed, under-staffed, one was a private facility

Question 6

Procedure - initial study

Answer 6

Once admitted, pseudopatients behaved normally
In order to be released, they had to convinced hospital staff that they were normal. So they behaved cooperatively, followed orders and chatted with other patients.
They kept a record of their observations (later publically since the staff paid little attention to the patients’ activities)

Question 7

Procedure - follow-up study

Answer 7

After initial study, some hospitals wanted to show that this wouldn’t happen in their workplace.
Rosenhan agreed to send more pseudopatients to see if they would be identified (no pseudopatients were actually sent)
Staff had to rate every patient on a scale of 1-10 based on their self-confidence that the patient was a fake

Question 8

Procedure - follow up study

Answer 8

Pseudopatients approached a staff member in hospital grounds, asked a courteous question about their release
Responses compared with a similar encounter between people on Stanford University campus

Question 9

Findings - initial study

Answer 9

All pseudopatients admitted to hospitals. 7 diagnosed with schizophrenia, 1 with bipolar
When released, labelled ‘schizophrenia in remission’
Length of hospitalisation ranged for 7-52 days, 19 day average
30% of patients on the ward voiced suspicion about the pseudopatients (thought they were journalists, etc.)

Question 10

Findings - follow up study

Answer 10

At least one member of staff (e.g. nurse, psychiatrist) wrongly reported with high confidence that 41/193 patients were fake
23/193 reported by at least one psychiatrist
Further 19 were thought to be fake by at least one psychiatrist and one other staff member

Question 11

Findings - mini experiment

Answer 11

Only 4% of the pseudopatients received an answer from a psychiatrist and only 0.5% from a nurse
On university campus, 100% of lecturers/ faculty members stopped to talk if asked a courteous question

Question 12

Conclusions - hospital environment

Answer 12

‘We cannot distinguish the sane from the insane in psychiatric hospitals’ - Rosenhan
Hospital environment created a set of situational factors which led to depersonalisation and segregation, people were seen as insane
Staff was not inherently cold, but it was the environment which led to less distorted perceptions of the patients

Question 13

Conclusions - over diagnosis of psychiatric illness

Answer 13

Clinicians avoided calling a sick person healthy since it was potentially dangerous
However, in follow-up study, staff erred in the opposite direction to avoid labelling a healthy person as sick

Question 14

High generalisability

Answer 14

Pseudopatients were sent to a range of different hospitals (old, new, well staffed, understaffed, public, private) this makes the findings generalisable to hospitals regardless of status

Question 15

Low generalisability

Answer 15

Ethnocentrism: Americans, different cultures approach mental health differently (e.g. in some cultures, hearing voices is considered a blessing)
Time-capsulated: this study was done in 1973, the findings had also heavily influenced psychology, leading to the development and reevaluation of the DSM

Question 16

High reliability

Answer 16

All pseudopatients entered the hospital complaining of the same symptoms (hearing voices which say ‘empty’, ‘hollow’, ‘thud’) they were all (but one) admitted for schizophrenia, they all went to different hospitals. This shows that most experienced the same things in different places.

Question 17

Low reliability

Answer 17

Pseudopatients did not always follow the rules. One pseudopatients tried having a romantic relationship with a nurse, another revealed that he was a psychology student and had his wife drop off his homework. This suggests that it may have affected the findings of this study.
Demand characteristics: pseudopatients may had only recorded the things they were looking out for (e.g. abuse)

Question 18

Application - DSM

Answer 18

Led to changes made to the DSM-III
DSM called for changes to address the issues raised by Rosenhan.
Arguably this study paved the way for critical reforms to the diagnostic process

Question 19

Application - anti-psychiatry movement

Answer 19

Major influence on the attitudes towards the medical approach of mental illness
This study supported the growing discontent with he medical psychiatric approach to diagnosis in the 60s.
Demonstrated that diagnosis of mental states were invalid.
Argued that labels were sticky (e.g. pseudopatients were released with ‘schizophrenia in remission’ - they will forever be labelled schizophrenic)
Drew attention for the need to have a reform in psychiatry and avoid misuse of diagnostic labels

Question 20

High validity

Answer 20

Ecological validity - naturalistic observations
Staff were unaware pseudopatients were researchers, behaviour could be more natural (instances of physical abuse observed)

Question 21

Low validity

Answer 21

May have only recorded instances of negative interactions as they all supported Rosenhan’s aim
Questions internal validity of study

Question 22

Ethical issues

Answer 22

Clinicians made to feel incompetent (psychological harm), real patients may have been discriminated against by believing that they were fake.
Reputation of psychiatry damaged, potential vulnerable people failed to seek suport