Rosenhan (1973) Flashcards
Aim
Challenge the diagnostic system for mental health, putting emphasis on the individual and source of symptoms to classify disorders
Devised system to see if some people could be admitted to psychiatric ward and find out what life is like in psychiatric hospital to raise awareness about conditions
Participants
Hospitals and psychiatrists
Researchers
8 Pseudo-patients (none with history of mental health)
5 women 5 men
One psychology graduate, 3 psychologists and others were a housewife, painter, psychiatrists and paediatrician
Procedure
Phone one of 12 hospitals across 5 USA state to make appointment about hearing voices
Heard “empty, hollow, thud”
Gave false name and job but kept everything about their life the same
Once admitted stopped faking symptoms and behaved normally
Observed life in ward and made notes of everything
Had to try to convince staff they were sane
Had visitors to ensure the ward did not change their mental state
What were the pseudo-patients admitted with
all schizophrenic except one with manic depression
how long did the psuedopatients stay in the wards for
average 19 days
Longest 52 days
Shortest 7 days
What was found about their sanity with staff and other patients
Sanity never detected by staff and discharged with schizophrenia in remission (would not keep someone with a broken leg in hospital till it heals)
1/3 of patients challenged pseudopatients
Staff pathologised normal behaviour (note-taking, nervousness, waiting outside lunch hall)
What did the pseudopatients find when they were ignored
71% of the time ignored
Eye contact made 23% of time
Verbal responses 2%
Worse for senior staff
185 reasonable questions asked to staff, none answered
Stop and talk = 4% psychiatrist, nurse 0.5%
6.8 mins a day
Defend psychiatrists
Psychiatrists tend to play it safe and go for most serious diagnosis before ruling out
Symptoms were voices and nervousness, and insisted to being in hospital -> released with no sign of schizophrenia, diagnosis wrong but got it right in the end
Gaining money (the more people in hospital)
Discharged with schizophrenia with remission
Follow up experiments procedure and findings
Redid study with psychiatric ward
Over 3 month period 193 patients admitted, 41 thought to be false and 19 false by two members
Rosenhan sent NO pseudopatients
Rosenhan concerned with effects of label conferred by diagnosis
Diagnostic label changed perception of person so all behaviour interpreted within label context
Strengths of study
+ Generalisable
Used many different types of institutions good/poor quality, new/old
+ Pseudopatients provide account of quality of care = lack of respect, occasional mistreatment, some threw medication away and no one noticed
Weaknesses of study
- Ethical
Only permission from Rosenhan, no staff in hospitals aware of ruse (only gained consent from 1 hospital BUT deception allowed if honesty would ruin results, with limited consequences, scientific - Actions affected amount of attention given to those genuinely ill
BUT only received 6.8 mins on average a day BUT Rosenhan did not know this going into the study so still immoral - one culture used diagnoses and treatment from 1970s USA, 5 states
Lauren Slater used Skinner Box
Support findings
Diagnosed with depression with psychosis and presented antipsychotic and antidepressant medication
Spitzer et al (2005)
73 respond, 86% categorically ruled out slater’s claims
1/3 prescribed antipsychotic, none antidepressant
Spitzer claimed Rosenhan research flamed
Ethical issues
Lack of consent
Could have affected genuinely ill patients
Only gained Rosenhan’s consent to partake in experiment
Generalisability weakness
Not generalisable to other cultures and times other than USA, early 70s
Findings may not accurately, represent diagnostic and treatment practices in different socio-cultural context
Sample strength
Diverse range of hospitals
Including research, teaching, private and older facilities
Spread over a large area -> good pop validity
Valuable insight into quality of care
Psychiatric hospitals highlighted issues such as lack of respect and occasional mistreatment of patients
Contributing to discussions on necessary improvements
Objective
Lots of measurements are objective such as eye contact made, some subjectivity and pseudo patience will tend to be scientificly attached to being tracked
Ethics
Psychiatric institutions were deceived
Informed consent, right to withdraw
Got permission of pseudopatients not hospitals
Could have harmed real patients time by wasting doctors and nurses time
But doctors and nurses kept anonymous
Reductionism
Medical model employed by DSM 2 was reductionistic
Having a checklist to diagnoseple was what allowed pseudopatients to get into medical hospital with single symptom of hearing empty hollow thud
Study did gather large amount of detail though
Nature vs nurture
Abnormality defined by DSM at time violating societal norms
If societal norms vary between places behaviours considered abnormal will also vary so culture does have an effect on the diagnosis of mhd
SOcial control
Being labelled with a MHD has been form of social control
Pseudopatients had to accept psychiatrists view of them before tthey were let out “I was crazy but im better now”
Use of psychological knowledge in society
Helpes psychiatric community recognise that their diagnostic system was flawed and in need of revision
Improved how patients were treated in hospitals
Psych as a science
Not all pseudopatients followed standardised procedures
Some of measures obective but others subjective and likely to be biased due to them feeling trapped
Hypothesis was specific, testable and falsifiable
Practical issues (methodology)
High pop validity good sample = old new, range of types of hospital in several states
Observers may have been biased because they felt trapped
Claimed pseudopatients only showed one symptom but some showed nervousness and asked to be admitted
Culture issues
Wide range of american instituions across 5 states, generalises well to particular culture
Only used institutions in USA so culturally biased
BUT study was to address flaws in DSM which was mainly used in america
Gender issues
Pts were psychiatric hospitals
Most doctors were likely to be male in 1970s, and females nurse
Psych understanding developed over time
Serious revisions and improvements of DSM
More valid diagnosis
Socially sensitive research
Lack of confidence in psychiatry
Led to people to not seek help with MHDs when they very much needed it for fear of being locked away
Undermining public trust in the profession, psychiatrists may have lsot confidence in themselve, making them worse at their job as a consequence
Comparisons of different themes
Based on medical model of diagnosing and treating mental illness
Contrasts psychodynamic approache where diagnosis and treatment are the same thing
Diagnosis is more thorough so arguable they would ave been less easily tricked than the clinicians in rosenhans study
