Rosenhan (1973)

Question 1

Aim

Answer 1

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

Question 2

Participants

Answer 2

Hospitals and psychiatrists

Question 3

Researchers

Answer 3

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

Question 4

Procedure

Answer 4

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

Question 5

What were the pseudo-patients admitted with

Answer 5

all schizophrenic except one with manic depression

Question 6

how long did the psuedopatients stay in the wards for

Answer 6

average 19 days
Longest 52 days
Shortest 7 days

Question 7

What was found about their sanity with staff and other patients

Answer 7

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)

Question 8

What did the pseudopatients find when they were ignored

Answer 8

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

Question 9

Defend psychiatrists

Answer 9

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

Question 10

Follow up experiments procedure and findings

Answer 10

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

Question 11

Strengths of study

Answer 11

+ 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

Question 12

Weaknesses of study

Answer 12

• 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

Question 13

Lauren Slater used Skinner Box

Answer 13

Support findings
Diagnosed with depression with psychosis and presented antipsychotic and antidepressant medication

Question 14

Spitzer et al (2005)

Answer 14

73 respond, 86% categorically ruled out slater’s claims
1/3 prescribed antipsychotic, none antidepressant
Spitzer claimed Rosenhan research flamed

Question 15

Ethical issues

Answer 15

Lack of consent
Could have affected genuinely ill patients
Only gained Rosenhan’s consent to partake in experiment

Question 16

Generalisability weakness

Answer 16

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

Question 17

Sample strength

Answer 17

Diverse range of hospitals
Including research, teaching, private and older facilities
Spread over a large area -> good pop validity

Question 18

Valuable insight into quality of care

Answer 18

Psychiatric hospitals highlighted issues such as lack of respect and occasional mistreatment of patients
Contributing to discussions on necessary improvements

Question 19

Objective

Answer 19

Lots of measurements are objective such as eye contact made, some subjectivity and pseudo patience will tend to be scientificly attached to being tracked

Question 20

Ethics

Answer 20

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

Question 21

Reductionism

Answer 21

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

Question 22

Nature vs nurture

Answer 22

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

Question 23

SOcial control

Answer 23

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”

Question 24

Use of psychological knowledge in society

Answer 24

Helpes psychiatric community recognise that their diagnostic system was flawed and in need of revision
Improved how patients were treated in hospitals

Question 25

Psych as a science

Answer 25

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

Question 26

Practical issues (methodology)

Answer 26

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

Question 27

Culture issues

Answer 27

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

Question 28

Gender issues

Answer 28

Pts were psychiatric hospitals
Most doctors were likely to be male in 1970s, and females nurse

Question 29

Psych understanding developed over time

Answer 29

Serious revisions and improvements of DSM
More valid diagnosis

Question 30

Socially sensitive research

Answer 30

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

Question 31

Comparisons of different themes

Answer 31

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