Rosenhan Flashcards
Aim
To reveal the deep flaws within the process of psychiatric diagnosis. He investigated the validity and the reliability of diagnosis of mental illness by seeing if 8 sane pseudopatients who gained admission to 12 different hospitals would be found to be sane.
Procedure
12 hospitals - some well-staffed, some under-staffed, some private, some old, some new
- Psychiatric hospital with the same symptom - same-sex, unfamiliar voice saying ‘empty’, ‘hollow’, ‘thud’
- Once admitted, pseudopatients acted normally.
- Follow up - promised to send more pseudopatients but none were sent - staff rated 1-10 for fakeness.
- Mini experiment- Pseudopatients asked a staff member in the hospital grounds a courteous question about their release. Similar process repeated in stanford uni.
Findings
- 7-52 days, Average stay - 19 days - Sz ‘in remission’
- 30% of patients on the ward voiced suspicion about the pseudopatients
- 1/5 patients were reported as fake by at least one member.
- Only 4% of pseudo patients received answer from doctor, 78% in comparison on university campus
Conclusion
We can’t distinguish the sane from the insane in psychiatric hospitals.
Triplet 1- Application to psychiatric wards
App tmproving quality of care in psychiatric wards. notable patient-staff segregation, with staff only spending 11.3 mins per day on average ‘outside of the cage’.
+Measures would be implemented as a response to these findings to increase patient staff interaction
Spitzer et al (2005) sent her account to 431 psychologists with pseudopatients presenting the same symptoms. 73 responded and 86% ruled out diagnosis.
-Shows that Rosenhan’s research is flawed and potentially sensationalist. Low credibility of Rosenhan’s study, and suggests a negative impact on society by fear mongering.
Triplet 2- generalisability
The study used 12 hospitals spanning across 5 states on the east and west coast, the institutions being of a wide variety (old, new, well-staffed, under-staffed, private and non-private).
+Gen to US
-Limited to US
Couplet 3- standardised procedures
Pseudopatients all said they were hearing voices which were unclear, but seemed to be saying ‘empty’ ‘hollow’ or ‘thud’.
+ All 8 participants used this same standardised procedure, easily replicated, improving reliability.
Triplet 4- external reliability
This experiment was a field experiment, as it took place in a naturalistic hospital setting.
+representative of staff everyday life, providing ecological validity
-little control over measures once the pseudopatients were actually admitted, greater potential for confounding variables to affect the treatment, leading to inconsistency in treatment.
Triplet 5- observation techniques (ethics 1)
The observation of the staff was non-participant and covert, meaning no staff knew of their observation.
+Necessary to prevent demand characteristics, as if staff knew the aim of the study they may have changed their behaviour in fear of losing their job status
-Violates informed consent guidelines
Triplet 6- effect on real patients (ethics 2)
Pseudopatients may have affected the amount of attention given to genuinely mentally ill patients.
-This could have potentially reduced their quality of care, and hindered their recovery.
+Testimonies of pseudopatients claim staff only had limited contact with the pseudopatients, 6.8 minutes per day on average per pseudopatient, suggesting this is unlikely
Conclusion (in its entirety)
Overall, Rosenhan’s study clearly displays an unmistakable mark on society through its demonstration of the flaws in psychiatric diagnosis. It is ethically weak, and can be used to improve participant experience and treatment in psychiatric hospitals, and monitoring staff and patients to ensure patient-staff interaction is at an adequate level to provide genuine care to patients. To improve the generalisability of this study, Rosenhan could replicate in other countries to see if the findings are consistent in other cultures, rather than just the USA.
