Sz classic study (Rosenhan) Flashcards
Aim
-to show that psychiatrists are unable to distinguish the sane from the insane.
-to provide evidence that mental disorders lie not within the individual but in the diagnostic process.
sample
sample- 12 different varied hospitals across 5 states in the east and west coast.
procedure
initial study
pseudopatients visiting the hospitals, their symptoms, behaving normally and keeping record of observations
follow-up study
told to expect pseudopatients, rating
mini-experiment
pseudopatients approaching staff, comparing responses
initial study:
-pseudopatients visited 12 psychiatric hospitals in 5 US states hearing a voice saying ‘empty’ ‘hollow’ and ‘thud’.
-all information psuedopatients gave was true (except to protect identity). If the psuedopatients were asked they said they were no longer hearing voices.
- once admitted psuedopatients behaved normally and kept record of observations.
Follow-up study:
-hospitals were told to expect psuedopatients. (but none were sent)
staff rated every patient 1-10 (1 being fake)
Mini-experiment
-psuedopatients approached a staff member in hospital ground and asked polite question about their release.
-responses were compared with a similar encounter between people on the Stanford university campus.
findings
initial study
how many pseudopatients were admitted?
length of stay?
how many real patients were suspicious?
follow-up study
how many out of 193 were wrongly reported?
mini-experiment
how many pseudopatients received answers from psychiatrist and nurse.
how many stopped to talk?
Initial study:
-all pseudopatients were admitted (seven with schizophrenia). most released with schizophrenia in remission.
-length of stay was 7 to 52 days (average of 19 days).
-about 30% of real patients were suspicious of psuedopatients.
Follow-up study:
-41/193 patients wrongly reported as fake by at least one member of staff, 23 by at least one psychiatrist and one other staff member.
Mini-experiment:
4% of psuedopatients received an answer from a psychiatrist and 0.5% from a nurse.
-100% people on campus stopped to talk.
Strengths
how was the study well designed?
observation? type of data collected?
ecological validity
what did this provide support for?
name the psychiatrist who argued that mental illnesses are problems in living, not diseases?
how does rosenhans study support this research?
Well designed:
-Rosenhan used covert participant observation and collected both qualitative and quantitative data.
-staff were unaware the psuedopatients were researchers, so their behaviour would have been more natural.
-Therefore, the data had high ecological validity, enhanced by the wealth of data collected by naturalistic observation.
Provided support for the anti-psychiatry movement:
-psychiatrist Szasz 1960 argued that mental illnesses are problems in living, not diseases, and therefore it is inappropriate to use a medical model for diagnosis of mental illness.
-Rosenhans study supported this because is showed that diagnosis of mental states was invalid. He also argued that labels for mental illness, once given, were ‘sticky’ so patients would forever be labelled ‘schizophrenic’.
-Thus the study shows a need for psychiatry reform, to avoid misuses of diagnostic labels. Rosenhan wanted to replace the system with a more behavioural approach to avoid labels.
weakness
demand characteristics
demand characteristics may explain the diagnosis:
-Psychiatrists admitted psuedopatients on flimsy evidence because they did not suspect someone would fake symptoms.
-They would assume that anyone seeking admission must have a good reason to do so.
-This may challenge the validity of some of the studies conclusions.
counter argument
Validity poor?
Recorded negative encounters
Why may this be?
Only one pseudopatient at each hospital
What does this suggest?
However, it could be argued that the validity of the study is poor. psuedopatients may have only recorded instances of negative interactions between staff and patients as they were all supporters of Rosenhan. Also, there was only one psuedopatient per hospital so no way to check the reliability of the data each person collected.
Generalisability
high
low- ethnocentric, time-locked
High:
-range of psychiatric hospitals. private and state-run, old and new, well-funded and under-funded from across the US.
therefore the findings are well representative.
-nevertheless, 12 is a small sample for a country as big as the USA, therefore potential anomalies could have skewed the results of rosenhans observations.
low:
-Only from America and doesn’t represent other cultures (ethnocentric)
-There has been a lot of improvement in mental health since the 1970s so it could be argued that the results are time-locked and cannot be generalised to diagnosis and psychiatry today.
reliability
how was a standardised procedure used?
what problem occurred with the standardised procedure?
what can back up conclusions of the initial study?
High:
-Rosenhan study is reliable because he followed a standardised procedure. His 8 psuedopatients were trained to behave the same way. They reported the same symptoms (hearing a voice that said hollow, empty and thud) and concealed that they had any background in psychology or psychiatry. In the hospital, they stopped claiming to hear voices and took secret notes on what they observed.
low:
-however they did not all follow the standardised procedure e.g. the graduate student asked his wife to bring homework, indicating that he was a psychology student.
-one of the psuedopatients started a romantic relationship with one of the nurses.
-another stated that he was going to be a psychologist and one of the visitors was a psychology professor. therefore the comparison made between hospitals would have been less accurate, decreasing inter rater reliability.
-however the conclusions of the follow-up study provides evidence that back up the conclusions of the first.
Lauren Slater (2004)
Attempted to replicate rosenhans study by presenting herself to 9 psychiatric emergancy rooms. Her symptom was isolated auditory hallucinations. Slater was given the diagnosis of ‘psychotic depression’ which she was previously diagnosed with in other hospitals.
who Attempted to replicate rosenhans study by presenting herself to 9 psychiatric emergancy rooms.
Lauren Slater 2004
Spitzer, lilienfield and Miller (2005)
Challenged Laurens finding by presenting 74 emergancy psychiatrists with her case and asking for a diagnosis and treatment.
Only 3 diagnosed her with psychotic depression and only a third recommended treatment.
who then Challenged Laurens finding by presenting 74 emergancy psychiatrists with her case and asking for a diagnosis and treatment.
Spitzer, lilienfield and Miller 2005
validity
what did Seymore Kitty 1974 challenge?
how did this show that the study lacked ecological validity?
-Seymour ketty (1974) criticised rosenhan, saying that, because the psuedopatients were faking an unreal mental condition, it doesn’t tell us anything about how people with genuine mental conditions are diagnosed.
-Ketty’s point is that psychiatrists don’t expect someone to carry out deception in order to be admitted to a psychiatric hospital. in other words, the study lacked ecological validity.
-pseudopatients observed and recorded their experiences- rich and in-depth - could have been bias to their own opinions and emotions.
-psuedopatients had to lie about hearing voices - deception could have guided the results - not natural.
Who critisised rosenhan?
Seymore Kitty 1974
