Rosenhan Flashcards
Context and Aims of Rosenhan
Laing: Mental Health is best described in terms of an individuals experiences rather than a list of symptoms
Szasz: institutionalisation is a method of expelling those who won’t conform to society.
The ICD by the (WHO) and the DSM (APA) are two methods of diagnosis by psychiatrists, during the period of Rosenhan’s study were used short term, since then there have been adaptations
Rosenhan intended on finding out whether psychiatrists could distinguish between real and fake ‘psuedopatients’
In discovering this he would he could determine whether the mental health system was reliable at diagnosis
Procedure of Rosenhan
There were 8 pseudopatients, 3 psychologists, 1 psychiatrist, 1 psychology student, 1 housewife, 1 paediatrician and a painter/decorator
12 Hospitals ranging from Public, Private, University, Old, New
Some of the hospitals had better staff to patient ratios than others.
The pseudo-patient called the hospital and asked for an appointment, once they went to the hospital they reported hearing a voice, of the same sex as them say a word like ‘hollow’ ‘empty’ and ‘thud’.
Patients gave accurate descriptions of their mental state and once admitted they all acted normally.
Pseudo-patients accepted but did not take medication which they were given.
They reported no further symptoms when asked about their mental states.
In three of the hospitals pseudo-patients recorded when patients had their doubts
Within this study Rosenhan conducted a mini study in four of the experiments, instructing pseudo-patients to ask questions regarding when they will be discharged, they were not to ask the same member of staff more than once a day.
Rosenhan also conducted a follow up to the original study, with one hospital this time Rosenhan claimed that he was going to send pseudo-patients to a hospital over the next three months and the hospital staff would have to rate from1-10 how likely they thought each new admission were pseudopatients. Rosenhan sent none and was testing how many they would falsely judge as a pseudopatient.
A third study was conducted on the university campus asking mental health staff
Findings and Conclusions of Rosenhan
11/12 pseudo-patients were diagnosed with ‘schizophrenia’ and one with ‘manic depression’
Pseudo-patients remained in hospital for 7-52 days with an average of 19.
When the pseudo-patients were discharged they were given the label ‘schizophrenia in remission’
The nurses notes showed that each normal thing that the pseudo-patients had done was interpreted as a symptom of their madness.
Note taking, was noted as “excessive writing behaviour” and bored pacing was interpreted as a sign of ‘nervousness’.
Pseudo-patients observed the staff interaction with patients and found that, they often stayed in their ‘glass cage’ at the end of the ward, the nurses only emerged from the glass cage on average 11.5 times a day, psychiatrists were seen at about 6.7 times a day and spent about 6.8 minutes a day with patients.
Pseudo-patients recorded how the staff treated patients, it was found that they used beatings as punishments, with little respect and no privacy.
Study 2, 193 genuine patients in the follow up stidy were admitted and 41 were judged as pseudopatients by at least one member of staff
23 were judged as pseudo-patients by a psychiatrist
19 were judged by a member of staff and a psychiatrist
In study 3. When pseudo-patients attempted to ask questions the majority of staff ignored the pseudo-patients and gave them no eye contact.
0.5% of nurses stopped and answered questions
4% of psychiatrists stopped and answered questions
2% of staff paused and chatted
Whereas, In the controlled condition on a university campus the pseudo-patients questions were answered by 100% of the staff that they asked, and they were given full eye contact.
Rosenhan concluded that mental health professionals did not have a reliable diagnosis between real and fake patients.
The system of diagnosis was not valid, on a single occasion pseudo-patients could report having symptoms of mental health and received a diagnosis based on that, also that their normal behaviour was interpreted as a sign of mental illness.
Evaluation of the methodology of Rosenhan
The study conducted by Rosenhan was a field study, Rosenhan and his 7 pseudo-patients had went to 12 hospitals and pretended to be real mental health patients in order to test the validity of diagnosis.
The fact that Rosenhan used real participants in real life environments gives the study good ecological validity as the participants had no idea that they were being studied their behaviours were true to life and had no demand characteristics.
Rosenhan used a variety of hospitals for his sample, this gave his study representativeness although it was a small sample.
Ethics, the pseudo-patients had deceived the hospital staff by pretending to be real patients, this caused distress to the real patients who could tell that the pseudo-patients had no visible symptoms of mental illness and caused harm to both the pseudo-patients and patients who felt anxious, so this breaches the protection from harm guideline.
Also the nurses, doctors and patients all included in the study had not given informed consent, to validate their use in a study, this means that they had their privacy breached as their interactions were all observed and recorded for psychological use.
There was good internal validity of the study, this was proven as each of the pseudo-patients but one were diagnosed with schizophrenia, meaning that their symptoms were true of the diagnosis.
The study lacked mundane realism as usually mental health staff do not have to distinguish between fake patients and were not then looking for signs of ill truth, but instead interpreted ‘note taking’ as paranoid writing behaviour.
The study could be replicated and has been but it may not receive the same results as mental health staff have more precautions before admitting patients into the hospital because of this study, ICD and DSM IV are used thoroughly.
Alternative evidence of Rosenhan
Slater (2004) Had replicated the study by going to 9 hospitals for an appointment she reported that she had heard a voice saying ‘thud’, and that she was diagnosed with psychotic depression. Her study supports Rosenhan’s as she had been diagnosed upon giving the symptom of hearing a voice showing reliability to Rosenhan’s method, however there are weaknesses of the fact that Slater had a previous history of depression and her symptoms had been linked to that, also there was a lack of ethics to the study as slater deceived the hospitals by pretending to have symptoms.
Spitzer (1975) found evidence to contradict Rosenhan’s findings stating that Mental Health professionals rely on patients accounts of their mental state and therefore it would not be valid to deceive them into thinking that your fake symptoms are real for psychological research.
Sabin and Mancusol (1980) stated that Rosenhan’s study could not be replicated not as the mental health system has more guidelines to follow, such as the ICD and DSM, it was a “snapshot in time”
