Rosenhan study Flashcards
What was the aim of the study?
To investigate the diagnosis of mental health illnesses and see if imposters could be recognised in a mental health institution
Who were the Pseudopatients?
8 Pseudopatients - There were 3 women and 5 men: a psychology graduate student in his 20s, three psychologists (including Rosenhan himself), a paediatrician, a psychiatrist, a painter, and a ‘housewife’.
Who were the sample?
Hospital doctors and staff at 12 hospitals
What words did the pseudopatients say they had heard?
Empty, thud and hollow
What did the psuedopatients do when they had been admitted?
Acted normal, kept notes covertly, threw the drugs they were given away
What were the results of the study?
All 12 hospitals diagnosed the pseudopatients as mentally ill. 11 hospitals diagnosed schizophrenia, 1 hospital (the private hospital) diagnosed manic-depression (bipolar disorder). The pseudopatients went to hospitals that had diagnosed them with schizophrenia.
None of the staff recognised that the pseudopatients were healthy. It took between 7 and 52 days for the pseudopatients to be discharged; the mean length of stay was 19 days.
What conclusions can be made?
It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals - David Rosenhan
Multiple false positives - it’s clear that diagnosis of schizophrenia was not reliable at the time
Comment on the study in terms of generalisability
Rosenhan made a point of using a range of psychiatric hospitals - private and state-run, old and new, well-funded and under-funded - from across the United States. Nevertheless, 12 is a small sample for a country as big as the USA and a few “bad apples” could have skewed the results of Rosenhan’s observations.
Comment on the study in terms of reliability
Rosenhan trained his pseudopatients beforehand, but they didn’t all follow the same standardised procedures.
Data from a 9th pseudopatient was not included in Rosenhan’s report because, among other things, he did not follow procedures.
The graduate student asked his wife to bring in his college homework to do, revealing he was a psychologist.
Another pseudopatient revealed that he was going to become a psychologist and one of his visitors was a college Psychology professor
One pseudopatient struck up a romantic relationship with a nurse.
Rosenhan explains this as the pseudopatients resisting the effects of depersonalisation and powerlessness. However, it also suggests they failed to follow instructions and act consistently.
Cannot be replicated exctaly
Comment on the study in terms of applicability
This study had a huge impact on mental health care, not just in America but worldwide. It caused psychiatric hospitals to review their admission procedures and how they trained their staff to interact with patients. It started the move away from dependency on the “chemical straitjacket” of drugs to treat mental health. Today, the study is a compulsory part of training in psychiatric medicine and nursing.
Along with Robert Spitzer’s criticisms, this study was a major influence on reforming the DSM. DSM-III (1980) defined mental illnesses much more carefully, with clear guidelines for including or excluding people from each classification. For example, in DSM-III, a hallucination needed to be repeated several times; in DSM-IV (1994) hearing voices needed to be experienced for over a month before a diagnosis of schizophrenia can be made and DSM-5 makes this 6 months.
Comment on the study in terms of validity
Field study - real hospitals / real doctors and nurses / real environment - therefore high ecological validity
Comment on the study in terms of ethics
The hospital staff were deceived about the pseudopatients’ symptoms being real. The doctors and nurses in the hospitals could not consent to take part or exercise their right to withdraw from the study. The other patients in the study had no possibility of consenting or withdrawing and didn’t enter psychiatric hospitals in order to be in psychology research
However, Rosenhan notified the management of the hospital he went to.
If Rosenhan thought that the management of the hospital he went to could be trusted, why didn’t he inform the hospitals the other pseudopatients went to?
Rosenhan did protect confidentiality - no staff or hospitals were named.
A different ethical issue with Rosenhan’s study is that it contributed to a crisis of public confidence in the American mental health system - which may have prevented people who genuinely needed help from seeking it.
However, Rosenhan wasn’t the only critic of psychiatry at the time. Two years after Rosenhan, “One Flew Over The Cuckoo’s Nest” (1975) dramatised many of the same problems in mental health care. It won the Best Film Oscar.
Rosenhan may be criticised for failing in a duty of care towards his own researchers - the pseudopatients. He put them in a harmful environment where they experienced tension and stress. None of them were physically abused but they witnessed physical abuse going on. They were instructed in how to avoid taking medication, but if they had been forced to take medication, it could have produced side-effects on them.
However, Rosenhan took a few precautions. In his own case, he notified the hospital manager and chief psychologist of what he was doing. For all the pseudopatients, he prepared lawyers who would intervene to get the pseudopatients out of hospitals if they requested it.
