Rosenham

Question 1

1. In Rosenhan’s study ‘sane in insane places’ the terms ‘type 1’ and ‘type 2’ errors were used.
   a) Explain what a type 2 error is. (2)

b) Suggest why health professional made type 2 errors in the original diagnosis of the pseudopatients. (2)

Answer 1

• A type 2 error is referred to as a false positive where a healthy person is wrongly diagnosed with a sickness.
• This is because doctors have a strong bias towards the ‘type 2 error’. It is more dangerous to misdiagnose illness than health, and err on the side of caution.

Question 2

2. In the study by Rosenhan pseudopatients’ were admitted to mental hospitals.
   a) Name two of the pseudopatients’ behaviours which were taken as evidence of abnormality. (2)

b) Outline one reason why it is difficult to define abnormality and normality. (2)

Answer 2

• Writing behaviour and sitting outside the cafeteria half and hour before lunchtime.
• Conceptions of normality and abnormality are not universal: what is considered normal in one culture may be seen as aberrant in another.

Question 3

3. Rosenhan (sane in insane places) suggested mental patients experienced powerlessness and depersonalisation.
   a) Give two examples to support this. (2)

b) Outline one possible explanation for the behaviour of staff in this study. (2)

Answer 3

Any two of the following:
Staff treated the patients with little respect:
• Punishing patients for small incidents
• beating them and swearing at them
• patients cannot initiate contact with staff
• personal privacy is minimal (e.g. staff can enter private rooms with no permission, no doors on toilets)
• anyone can read patients’ files (e.g. volunteers on wards)
• physical examinations can be conducted in semi-public rooms
• general activity conducted around patients as if they are invisible

Any one of the following:

1. Attitudes held by all of us towards the mentally ill, attitudes characterised by fear, distrust, and also benevolence. Our ambivalence leads to avoidance.
2. The hierarchical structure of the hospital. Those at the top have the least to do with patients, and their behaviour inspires the rest of the staff.
3. Lack of money, staff shortages and also the use of psychotropic drugs. Drugs convince staff that treatment is being conducted and therefore further patient contact is not necessary.

Question 4

4. Rosenhan used the phrase ‘stickiness of psychodiagnostic labels’?
   a) What did he mean by this phrase? (2)

b) Give one example how the label ‘schizophrenia’ affected the way pseudopatient’s behaviour was interpreted by staff. (2)

Answer 4

• Once a person is labelled ‘abnormal’, this means that all subsequent data about them are interpreted in that light. Labels are also self-fulfilling for psychiatrist and for the patients themselves.

• One pseudopatient who described a warm relationship with his mother but distant with his father and good relationships with wife and children, their behaviour was interpreted as ‘manifests a long history of considerable ambivalence in close relationships… affective stability is absent’.
• A psychiatrist suggested that a group of patients sitting outside the cafeteria before lunch was exhibiting the oral-acquisitive nature of their illness.

Question 5

5. In the study by Rosenhan, the pseudopateints were incorrectly diagnosed with schizophrenia. Give two possible explanations why the hospital made this mistake. (4)

Answer 5

• The failure to detect the pseudopatients’ sanity may be because the doctors have a strong bias towards the ‘type 2 error’ – they are more inclined to call a healthy person sick (a false positive, type 2 error) than a sick person healthy (a false negative, type 1 error). It is clearly more dangerous to misdiagnose illness than health, and err on the side of caution.

Question 6

6. Describe two independent variables that were tested in Rosenhans’ study of ‘sane in insane places’ and the effects of each of these variables. (4)

Answer 6

• IV1: made up symptoms of the pseudopatients.
• Effects: all pseudopatients were admitted and, bar one, diagnosed as schizophrenic; each one was eventually discharged with a diagnosis of ‘schizophrenia in remission’.
• IV2: false information
• Effects: over the 3 months 193 patients were admitted for treatment. None of them were actually pseudopatients but: 41 were judged to be pseudopatients by at least one member of staff, 23 were suspected by at least one psychiatrist and 19 were suspected by a psychiatrist and one other staff member.