Rosenhan (1973)

Question 1

Aim

Answer 1

Test reliability of mental health diagnosis to see if medical professionals could tell sane from insane in a clinical setting. And investigate the effect of labelling on medical diagnosis

Question 2

Procedure - initial study

Answer 2

-pseudo patients were observers, staff participants
- pseudo patients went to 12 psychiatric hospitals (in 5 US states) reported hearing voices saying “empty, hollow, thud”
- once admitted pseudopatinets behaved normally and kept records of observations

Question 3

Procedure - follow up study
Results

Answer 3

• hospitals were to expect pseudo patients (none were sent)
• staff rated every patient 1-10 (1 being fake)
• 41/193 patients wrongly reported as fake by at least one member of staff, 23 by at least one psychiatrist and 19 by one psychiatrist and one other staff member

Question 4

Procedure - mini experiment
Results

Answer 4

• pseudo patients approached a staff member in hospital grounds and asked a polite question about their releases
• responses were compared w a similar encounter between people on the Stanford university campus
• 4% of pseudopatients recieved and answer from a psychiatrist and 0.5% from a nurse
• 100% people on campus stopped to talk

Question 5

Results - initial study

Answer 5

• all pseudo patients were admitted (7 w SZ) most released w SZ remission
• length of stay 7-52 days (avg 19)
• 30% real patients were sus of pseudopatients

Question 6

Conclusion

Answer 6

Cannot distinguish sane from insane
Hospital environment created situational factors leading to depersonalisation and segregation
Overdiagnosis occured because clinicians avoided calling a sick person healthy (potential danger)
But in follow up study, staff erred in opposite way to avoid labelling a healthy person sick

Question 7

Generalisability

Answer 7

Used a range of hospitals - private, state run, old, new, well funded, under funded
However is the issue of time

Question 8

Reliability

Answer 8

Procedure was standardised
However, data from 9th patient wasn’t included as he didn’t follow procedure (asked wife to bring college work)
Another patient revealed he was going to be a psych professor to other patients
One developed a romantic rels w a nurse

As there was only one pseudopatients per hospital there is now way to check the data that each person recorded decreasing reliability

Question 9

Application

Answer 9

Huge impact on mental health care world wide
Psychiatric hospitals reviewed admissions procedures and how they trained staff to interact w patients
Major influence for DSM which defined mental illnesses more carefully w clear guidance for classification

Question 10

Validity

Answer 10

Ketty (1974) criticised it saying pseudo patients were faking an unreal mental condition, it couldn’t tell us anything about how people w genuine mental conditions are diagnosed - lacks eco validity

Weakness
- psychiatrists admitted them in flimsy evidence as they didn’t believe anyone would fake symptoms and would assume if they were seeking admission they had good reason to do so. Decreasing validity of conclusions

Question 11

Ethics

Answer 11

• Hospital staff & other patients were deceived, didn’t consent to be part of the study of to withdraw
• rosenhan did notify management of the hospital he went to and they consented
• confidentiality was protected, no hospital or staff were named
• study caused a crisis of public confidence in the American mental health system
• patients were forced to take medication