P3 - M.H - ROSENHAN

Question 1

ROSENHAN - Aims

Answer 1

• To test the diagnostic system used by hospital staff to identify mental illness.
• To document the experiences of psychiatric hospitalisation.

Question 2

ROSENHAN - Sample

Answer 2

• The sample were those who were being observed, i.e. doctors, nurses and patients at the two institutions (across five different states on the East and West coast of the USA).
• So, NOT the pseudo-patients!

Question 3

ROSENHAN - Experiment 1

Answer 3

• 8 pseudo-patients (Confederates)
• 3 women and 5 men – gave fake names
• Rang up 12 different hospitals stating that they were hearing voices in their head.
• ‘empty’, ‘hollow’ and ‘thud’ in an unclear, unfamiliar voice of someone the same gender as them
• All of the pseudo-patients were admitted. All but one were diagnosed as schizophrenic, the other diagnosed as manic depressive.
• Once they were in the hospital they stopped simulating symptoms and responded normally to instructions.

Question 4

ROSENHAN - Experiment 1 Results

Answer 4

• Once inside the hospitals their normal behaviours were perceived as being reflective of their illness.
• E.g. note taking seen as obsessive writing behaviour, and queuing was seen as oral acquisitive syndrome.
• On average, the pseudo-patients were in the mental homes for 19 days before being able to leave.
  min 7 days – max 52 days.
• The real patients recognised them as frauds.
• The pseudo-patients were now participant observers.
• Recording everything they saw and experienced.
• Treatment of those who are mentally ill is different to treatment of those with a physical ailment or disability and is viewed negatively, even by professionals.
• When pseudo-patients asked ‘When am I likely to be discharged?’ the professionals would often ignore them and treat them in an offhand manner.
• Patients felt powerless and depersonalised.
• Their labels had ‘stuck’.

Question 5

ROSENHAN - Recordings

Answer 5

Contact - Psychiatrists in R.’s study - Nurses & attendants in R.’s Study

Moves on, head averted - 71% - 88%
Makes eye contact - 23% - 10%
Pauses & Chats - 2% - 2%
Stops & Talks - 4% - 0.5%
No. of Respondents - 13 - 47
No. of Attempts - 185 - 1,283

Question 6

Comparison studies

Answer 6

• Rosenhan’s findings were compared to responses to a young female student approaching a faculty member at university asking questions such as:
• ‘Pardon me, could you direct me to Encina Hall?’
• Do you teach here?’
• Everybody answered the questions and no one ignored her – this was in stark contrast to how the pseudo-patients were treated.

Question 7

ROSENHAN - Experiment 2

Answer 7

• Many mental institutions criticised Rosenhan’s experiment and said it wouldn’t happen at their hospital.
• Rosenhan informed a large hospital that at least one new patient would be trying to gain admittance over the next three months as a test of how rigorous their diagnosis procedures were.
• However, in this time no pseudo-patients tried to gain admittance.

Question 8

ROSENHAN - Experiment 2 Results

Answer 8

• 41/193 patients were judged by at least one member of staff as being fake.
• 23 were rated highly confident by at least one psychiatrist and 19 by a psychiatrist and by at least one other member of staff.

Question 9

ROSENHAN - Conclusions

Answer 9

• Rosenhan suggests we cannot distinguish the sane from the insane in psychiatric hospitals.
• DSM-2 was not valid (not accurate in diagnosis) or reliable (not consistent in spotting sane or insane but was consistent in diagnoses – 11/12 diagnosed as schizophrenic). This led to many changes for later versions.

Question 10

ROSENHAN - Usefulness

Answer 10

Exposed the need for reform to the DSM-2 & difficulty in differentiating the sane from the insane.
* Made an impact on the DSM and exposed the Mental Hospital System & Conditions

Question 11

ROSENHAN - Ethics

Answer 11

• Severe Psychological harm to psudo patients who were put into the Psyciatric hospitals
• Psudo patients were made aware of the aims and experience of the experiment beforehand
• The Psyciatric hospital workers did not consent to or know that their actions were being recorded, and therefore also could not withdraw

Question 12

ROSENHAN - Validity

Answer 12

• The experience in a Psyciatric hospital would have been different to a sane and mentally ill individual, and so the conditions may effect mentally ill people worse
  *

Question 13

ROSENHAN - Sample Bias

Answer 13

Only in the US (in 5 states); Ethnocentric
However some diversity between different states

Question 14

ROSENHAN - Generalisable?

Question 15

ROSENHAN - Applications

Question 16

Pilot Study

Answer 16

• Fake Uni Student asked for Directions from a Uni Student or Staff member
• Observation
• Recorded eye contact, stopping to talk, answering their Q.s
• Compared it to treatment to Pseudopatients

Question 17

Pseudopatients

Answer 17

• 3 were Psychologists
• 3 Women, 5 Men
• Admitted for 7 - 52 days
• 7 got Schizophrenia diagnosis, 1 Manic Disorder (UNRELIABILITY - Gave Same Symptoms)
• Hearing the same 3 words is not enougfh to diagnose Schizophrenia

Question 18

Participant Observation

Answer 18

• Labelled as ‘Obsessive Writing Behaviour’ for taking notes
• Most of the Time, the staff were mostly in ‘the cage’ - a locked work room
• 11.3%/7 mins average of their time spent talking to Patients
• Called Queing for meals ‘Oral Inquisitive Disorder’
• Normal Behaviours through the label of Mental Illness seen as part of their Condition

Question 19

Exp. 2

Answer 19

193 ppl admitted, 41 suspected of faking
Used as a Quant 10 point scale
19 times, more than 1 staff was wrong on the same person
3 month period, 1 large hospital

Question 20

What did Susan Callahan prove about the Rosenhan study?

Answer 20

That the ENTIRE THINK was FAKE
Only bring this up in Evaluations

Question 21

AIM

Answer 21

• GENERAL: To investigate the reliability and validity of diagnosing mental illness (using DSM).
• PILOT Study: To investigate how the patient-staff contact compares with student-faculty member contact.
• Study 1: To Investigate whether Sane people would be Misdiagnosed using DSM-2
• Study 2: To Investigate whether labelled Insane people would be Mislabelled Sane because they were expecting to receive Pseudo-Patients

faculty = a Uni department

Question 22

Pilot Study - PROCEDURE

Answer 22

• Participant Observation was used
• Field Experiment
• Sample: Opportunity Sampling, Staff Members

Question 23

Experiment 1 - PROCEDURE

Answer 23

• Participant Observation was used
• Field Experiment
• Sample: Staff in the 12 Hospitals, Opportunity for who was available in the Hospital
• Material: Diary,
• Standardised Instruction: Script (‘Hollow’, ‘Empty’, ‘Thud’ - deliberately not violent), Do not take medication, Record Staff Patient Contact (unstructured instruction), told truth about everything else about them
  1. All 8 were admitted (7 Schizophrenia, 1 Manic Depression)
  2. Treated Poorly: ave. 11.3% patient interaction, Only 4% of staff stopped & talked to, dehumanised (went to the toilet infront of them) & depersonalised (referred to as number)

Question 24

Experiment 2 - PROCEDURE

Answer 24

• Participant Observation was used
• Field Experiment
• Sample: Staff in the 12 Hospitals, Opportunity for who was available in the Hospital
• 10 point scale
  1. 41 were suspected strongly for being a PseudoPatient by at least 1 member of staff - 23 suspected by doctors, some cases multiple doctors agreed

Question 25

FINDINGS

Answer 25

• Study: Type 1 Error
• Study 2: Type 2 Error

Question 26

CONCLUSIONS

Answer 26

• DSM should be improved
• Mental Illness is a ‘Sticky Label’ - be careful with labelling somebody as it changes how everybody interacts with them (Tries to Reverse Stigma)
  *

Question 27

Socially Sensitive

Answer 27

Tries to (and helps) to reverse the Stigma surrounding Mental Health