Rosenhan - Classic study Flashcards
aim - P1, A01
To investigate whether psychiatrists were able to distinguish the sane from the insane.
He also wanted to be able to provide evidence to support the idea that mental disorders lie not with the individual but with the person making the diagnosis.
sample - P1, A01
- 8 Pseudopatients – one psychology graduate in his 20s, 3 psychologists, one paediatrician, one psychologists, a painter and a housewife. 3 women and 5 men.
- 12 different hospitals which were located in 5 different states on the east and west coast of America.
strength of sample - P1, A01
one strength of Rosenhan’s study was that it was able to be generalised to the wider population due to the sample which was used
Rosenhan used a sample of 12 hospitals of varying staff-patient ratios and funding across the USA which makes the findings generalisable to the wider population
therefore this means that the findings that misdiagnosis occurs in the USA and how patients were treated in other American hospitals can be generalised to the wider population
COUNTER ARGUMENT TO strength of sample - P1, A01
however, the study was only carried out in America in American hospitals
this reduces the generalisability of the findings because this type and level of misdiagnosis and mistreatment of patients may only occur in America
therefore, this means that we cannot be sure that this level of misdiagnosis and mistreatment of patients would happen in the rest of the world, outside America
type of study - P2, A01
Naturalistic, covert, participant observation
method - P2, A01
- Each pseudopatient presented themselves at a psychiatric hospital complaining they had been hearing unfamiliar, hollow voices of the same sex. Each patient gave false information about their professions in order to avoid suspicion, all other information provided to the clinicians was true
- The pseudopatient approached a total of 12 hospitals in 5 states on both the East and West coast of America. Some were old and shabby, some were modern. One was a private hospital and the 7 others were state funded. Some well-staffed and some understaffed.
- Once the pseudopatient were admitted they started to behave normally following an initial period of unsurprising nervousness. As soon as they were admitted they requested to be discharged and secretly disposed any medication they were given down the toilets. The pseudopatient kept records of their observations covertly.
- (follow-up study) Following the initial study, some hospitals wanted to show this couldn’t happen in their workplace. Rosenhan agrees to send more pseudopatients to the wards to see if they would be identified as healthy imposters – no pseudopatients were actually sent. Staff had to rate every patient on a scale of 1-10 – 1 represented a high confidence that the patient was fake.
- (Mini experiment) During the study, the pseudopatients approached a staff member within the hospital grounds and asked a courteous question about when they would be discharged. Responses were compared with a similar encounter between people on the Stanford University Campus
strength of procedure - P2, A03
one strength of Rosenhan’s study is the use of a covert participant observation and the collection of both qualitative and quantitative data
as the staff were unaware that the pseudopatients were researchers, their behaviour would have been more natural
for example, Rosenhan reports instances of physical abuse that were observed by the pseudopatients but stopped when other staff appeared
therefore, this means that the data collected has high ecological validity, enhanced by the wealth of data collected in naturalistic observations
COUNTER ARGUMENT TO strength of procedure - P2, A03
however, it could be argued that the validity of the study is poor
the pseudopatients may have only recorded instances of negative interactions between staff and patients as they were all supporters of Rosenhan
also, there was only one pseudopatient per hospital and therefore there was no way of establishing whether the data each person collected was reliable
therefore, this means that the validity of the study may have been poor and the data may not be reliable as is thought
results / findings - P3, A01
- All of the pseudopatients were admitted in the initial experiment, 7 were diagnosed with schizophrenia and one with bipolar. When released they were said to have ‘schizophrenia in remission. The length of hospitalisation ranged from 7-52 days with the average being 19. About 30% of other patients on the ward voiced a suspicion about the pseudopatients – saying they thought they were sane and potentially journalists.
- In the follow up study, at least 1 member of staff at the hospital reported incorrectly, with high confidence that 41/193 patients were fake, 23/193 were reported by at least one psychiatrist and a further 19 were thought to be fakers by at least 1 psychiatrist and other member of staff.
strength of the findings, application - P3, A03
one strength of Rosenhans study is that the findings have led to changes being made to the DSM-III
the failiure of psychiatrists to make accurate diagnoses led to a call for changes
Robert Spitzer saw the DSM revision as an oppourtunity to address the issues rasied by Rosenhan’s study ‘Whether we like it or not, the issue of defending the boundaries of mental and medical disorder cannot be ignored. increasingly there is pressure for the medical profession and psychiatry in particular to define its area of prime responsibility’ (Healy 1997)
Therefore, this study has agruably paved the way for critical reforms to the dianostic process - though this was not Rosenhan’s inention
conclusions - P4, A01
- it was concluded that the sane cannot be distinguished from the insane in psychiatric hospitals.
- Rosenhan explains that the overdiagnosis of psychiatric illness - clinicians avoided calling a sick person healthy because this was potentially dangerous also identified that the hospitals had a tendency to make type 1 and type 2 errors when they knew they were being assessed in the follow up study.
strength of conclusions - P4, A01
one strength of Rosenhan’s study was the major influence on attitudes towards the medical approach to mental illness
in the 1960s, there was growing discontent with the medical psychiatric approach to diagnosis
psychiatrist Thomas Szasz (1960) argued that mental illnesses are problems in living not dieseases, and therefore it is inappropriate to use a medical model
Rosenhan’s study supported this because it demonstrated that diagnosis of mental states was invalid
he also argued that labels once given were sticky and therefore, when patients were released it was with a diagnosis of ‘schizophrenia in remission’, so they would forever be labelled ‘schizophrenia’
therefore, this study drew attention to the need for considerable reform in psychiatry, to avoid the misues of diagnostic labels
Rosenhan’s suggestion was that the system should be replaced by a more behavioural approach which avoids labels and their self-fulfilling consequences
weakness of rosenhans study, ethics - P5, A03
one weakness of Rosenhan’s study is that it has ethical issues
although the study led tot long-term benefits to society there were risks to the pseudopatients, clinicians and real patients
clinicians were made to feel incompetent (psychologial harm), real patients may have been discriminated against due to clinicians believing that they were fake (also psychological harm) and the reputation of psychiatry was irreparably damaged, potentially leading to vulnerable people failing to seek support
therefore, these are important considerations as the benefits of scientific research should always be weighed carefully against potential harm to the participants and society at large
