rosenhan 1973 Flashcards
his thoughts
can the sane be distinguished from the insane?
inspired by the antipsychiatry movement and wanted to challenge the use of diagnostic systems.
aims
- to see if sane people could be admitted to hospital.
- to investigate whether once in the hospital if they would be detected.
- wanted to see what life was like and raise awareness about conditions
procedure
8 pseudo patients including rosenhan
- mixture of graduates, housewives and other professions
- all assessed for history of mental illness
- patients attempted to gain admission to 12 different hospitals in the USA - some old some new, some well staffed some not
- they phoned for an appointment at admissions and said they could hear voices. the voices said: thud, empty and hollow.
- the patients gave a false name and job but all other details were true
all were admitted with sz apart from one who was diagnosed with manic depression with psychosis - after being admitted pseudo patients stopped simulating any symptoms
- they observed life on the ward and cooperated with staff.
- recorded experience by notes
- they were all told they would have to get out by their own devices by covincing staff they were sane.
results
their diagnosis at discharge was sz in remission
average stay 19 days
patients suspected pseudos were sane
- nurses ignored them
- minimal eye contact
- average daily contact was 6.8 mins
follow up results:
41 of 193 who were admitted were thought to be fake by at least one staff member
19 were thought to be fake by 2.
conclusions
rosenhan claims we cannot distinguish the sane from insane in psychiatric hospitals, calling into question the reliability of diagnosis.
- over diagnosis of psychiatric illness
- being discharged with label in remission shows how the label of mi may stick with people.
generalisability
:) a range of educational and occupational backgrounds were represented, along with a mix of males and females - rep of diagnosis.
:) they also ensured they used a range of 12 hospitals. therefore it represented diagnosis across America.
CA= however, 12 is a small sample for a big country. the sample was considered as ethnocentric
:( there’s been a lot of progress in mental health care since the 1970s so perhaps the results are time locked and cannot be generalised to psychiatric diagnosis and care today.
for example his pseudo patients were diagnosed using DSM2. todays DSM5 requires the patients to show 2 symptoms for at least 6 months.
:( only one hospital used in follow up
reliability
they worked to ensure that all patients went into study with same symptoms and therefore meant that they could replicate the study at a later date.
ca= that said, there have been subtle differences between the recordings of pseudo patients whilst in the institution which would mean that their assessments of life inside may not be consistent.
application
improvments in the DSM
this study had a huge impact on mental health care worldwide. out caused hospitals to review their admission procedures and how they trained their staff to interact. it started the move away from the dependancy on the chemical strait jacket of drugs to treat mental health. today the study is a compulsory part of training in psych nursing.
validity
:) study occurred in a natural setting. the nursed doctors used were unaware of the aims of the study and didn’t know they were part of it. meant it was not affected by demand characteristics.
this meant that an accurate perception of life in the hospital could be measured.
:) study took place in variety of real world psych hospitals - good ecological validity
:( pseudo patients were researchers and could have been subjective they may have written when they felt distressed. this means their data collection may not be valid.
:( ketty 1974 criticised saying tat because the pseudos were faking a mental condition it doesn’t tell us anything about how people with a genuine condition are diagnosed so the study lacks mundane validity.
ethics
:( patients nurses and doctors deceived and not told full aims of the study. also issues with consent and right to withdraw
:( the real patients realised they were fake and could begin to question their actual diagnosis. therefore this becomes a protection of harm issue
:) benefits of research may justify the costs because it led to changes in diagnosis.
