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rosenham Flashcards

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1
Q

what was the aim of rosenham?

A

wanted to test the reliability of a mental health diagnosis, to see if medical professionals could tell the sane from insane

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2
Q

was it an experiment?

A

no an observation

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3
Q

who were the participants?

A

staff and patients at the 12 hospitals

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4
Q

where were the hospitals?

A

in five states on the east and west coast of the US

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5
Q

who knew about the pseudo patients?

A

the hospital administrator and chief psychologist

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6
Q

how many pseudo patients were they and who were they?

A

8 (3 women and 5 men)

confederates

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7
Q

was rosenham a pseudo patient?

A

yes

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8
Q

what was the procedure?

A

-pseudo-patients called the hospital and asked for an appointment
-arrived at the admissions office saying that they were hearing voices
-voices were unclear but seemed to be saying ‘empty’, ‘hollow’ or ‘thud’
-words were chosen as they seem to place emphasis on the person’s life
-Other than changing their name or profession, their personal history was accurate
There was no existence of any previous or current pathological behaviour
Once admitted, the pseudo-patients stopped displaying any symptoms of abnormality. Some were nervous, not having believed that they would be so easily admitted, but otherwise they would behave as they ‘normally’ would. They were given medication that they did not swallow, responded to staff and chatted to other patients. Each was told that they would have to convince staff that they were ‘sane’ in order to be released. Rosenhan measured how many days it took for their release to take place. All but one wanted to be released immediately, so they all complied to acting ‘normally’ and abiding the instructions from staff. The pseudo-patients made notes of observations about their time on the ward. Initially these were done in private but then out in the openness of the ward when it was realised that the staff were not suspicious of the behaviour.

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9
Q

how would patients have to be released?

A

convince staff that they were sane?

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10
Q

what did patients act like when they were admitted?

A

normal

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11
Q

what did staff do once in the wards?

A

took notes

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12
Q

were notes taken in the open?

A

only once they were sure staff were not suspicious

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13
Q

what words were chosen as the voices?

A

thud empty and hollow

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14
Q

what was changed about the patients information?

A

just the name and occupation, all personal background stayed the same

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15
Q

how did patients get in touch with the hospital?

A

called them up

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16
Q

what did patients report?

A

hearing voices

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17
Q

what did rosenham measure?

A

how many days it took to be released

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18
Q

were patients given drugs?

A

yes but did not swallow

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19
Q

what were the results of the study?

A

All bar one pseudo-patient was diagnosed with schizophrenia (the other with bipolar depression).
All were admitted to the hospitals
Each was discharged with a diagnosis of schizophrenia ‘in remission’ (i.e. symptoms were not present at the time of release)
The length of hospitalisation varied from 7-52 days,
an average of 19 days.

pseudo-patients were never detected
No records or behaviour by hospital staff showed that there were any doubts over the authenticity of the patients
Visitors and other patients recognised that some of the pseudo-patients were ’sane’. During the first three hospitalisations 35 out of 118 patients on the admissions wards voiced their suspicions, such as ‘you’re not crazy. You’re a journalist or a professor’

20
Q

what were the patients diagnosed with?

A

11 schizophrenia and 1 manic depression

21
Q

what was the average days stayed in the hospital?

A

19

22
Q

who many days did it vary by?

A

7-52

23
Q

were patients detected?

A

no, no evidence or records that staff doubted authenticity

24
Q

how many of the patients on the ward voiced their concerns?

A

35/118

25
Q

what did real life patients say?

A

‘you’re not crazy’

you’re a journalist’

26
Q

how many were admitted to hospitals?

A

8

27
Q

what did rosenham conclude?

A

Failure to detect sanity may be because doctors are more likely to favour a TYPE 2 error (they are more likely to diagnose a healthy person as sick) than a TYPE 1 error (than a sick person as healthy)
less dangerous
This certainly works for medicine but is not necessarily the case for psychiatry as once a person is labelled as being mentally ill, it is very difficult to shift the label
The fact that some of the patients noticed the pseudo-patients were ‘sane’ when the staff did not raises important questions
It may be argued that the results seem to suggest that diagnosis is reliable as all but one individual was given a diagnosis of schizophrenia when presenting similar symptoms
discharge of schizophrenia in remission when they were not actually suffering from any known disorder (affects reliability)
It is interesting to note that many of the pseudo-patients behaviours were interpreted by staff as being in line with the symptoms of the disorder they had been diagnosed with
Rosenhan believed that once given a label, all normal behaviours are overlooked e.g. their note taking was seen as an aspect of their pathological behaviour. Staff wrote in one patient’s notes: ‘Patient engages in writing behaviour’.

28
Q

what is a type 2 error?

A

diagnose a healthy person as sick

29
Q

what is a type 1 error?

A

diagnosing a sick person as healthy

30
Q

what error did the doctors make?

A

type 2

31
Q

why did they make this type of error?

A

considered less dangerous?

32
Q

wat is the problem with a type 2 error in mental health?

A

hard to move the stigma

33
Q

why was it thought that even when behaving normally they weren’t let out?

A

once given a label all normal behaviour is overlooked

34
Q

is reliability good?

A

could be said to be as all same diagnosis but didn’t have it

35
Q

what was the aim of his second study?

A

to investigate if the tendency to diagnose to sane as insane could be reversed

36
Q

what was the procedure of his second experiment?

A

Another hospital had heard of the findings of the first part of the study and did not believe the results would have occurred in their hospital
So Rosenhan informed the staff that in the next 3 months, 1 or more pseudo-patients would try to again to gain entry to the hospital
Each member of staff was asked to rate every patient (either at admission or on the ward) who wanted admission on a scale from 1-10 in terms of whether they thought the patient was real or fake
A score of 1 reflected a high level of confidence that the patient was fake. Over the 3 months, 193 patients tried to gain admission

37
Q

why did a second experiment take place?

A

they said that results in first one wouldn’t happen in theirs

38
Q

what did rosenham inform hospital? (ex2)

A

that he would send 1 or more pseudo patients in over the course of three months

39
Q

what were staff asked to do in the exp 2?

A

rate patients on scale of 1-10 of how real they were (1 being fake)

40
Q

how many patients tried to gain admission exp2?

A

193

41
Q

how many patients did rosenham send in? 2

A

none

42
Q

how may patients were judged as fake? 2

A

41

43
Q

how may were suspected by one psychiatrist?

A

23

44
Q

what is the conclusion? 2

A

The results demonstrate issues with the reliability and validity of diagnosis and strongly suggests that it is not possible to detect the sane from the insane as staff members were not able to identify that none of the patients were actually pseudo-patients

45
Q

what do the results demonstrate?

A

issues with reliability and validity

46
Q

when did the study take place?

A

1973

clinical psychology (25 decks)

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