Mental Health: Rosenhan (1973) Flashcards
What is Rosenhan (1973) on?
Being sane in insane places.
What does Rosenhan’s 1973 study look at?
The reliability of psychiatric diagnoses & the experiences of psychiatric patients in the hospital.
Rosenhan 1973: Study 1
Who were the researchers / observers?
3 women, 4 men + Rosenhan.
(8 pseudo-patients)
All deemed to have no present or past symptoms of psychiatric / mental disorders.
Rosenhan 1973: Study 1
What was the procedure?
1- Ps had appointment with hospital. (False name, occupation & employment).
2- Ps complained of hearing a voice - same gender, saying “empty”, “hollow”, and “thud”.
-> Provided truthful information on all matters other than their name, occupation, and employment, with those things changed to fit with their ‘fake’ information.
3- Admittance: Ps stopped showing symptoms.
4- In psychiatric wards: Ps engaged with patients and staff (as they would normally with colleagues in everyday life).
-> Told staff they were fine / no symptoms.
-> Received prescribed medication (didn’t ingest).
-> Recorded their observations (ward, staff & patients).
5- Ps discharged when hospital’s staff saw fit.
6- Between 1 and 4 Ps repeated this process at 4 other hospitals.
Rosenhan 1973: Study 1
Who were the participants?
The doctors and nurses who were working in the 12 hospitals chosen for the study in 5 states across America in the 1960s.
They did not know they were taking part in the study.
(Some were old / new & some well / short staffed).
Rosenhan 1973: Study 1
Results
(Diagnosis, hospitalisation time, detected?)
There were 12 attempts at admission.
All were successful (12 admitted & diagnosed).
-> 11 (91.7%) = schizophrenic
-> 1 (8.4%) = manic depressive
Average hospitalisation time was 19 days.
(Range: 7 - 52).
Detected? (e.g., from note taking)
Hospital staff didn’t notice. Patients did:
During first 3 admissions to hospitals:
35 / 118 patients = concern whether they were actually mentally ill.
Rosenhan 1973: Study 1
Conclusions
1 - Psychiatric diagnosis is inaccurate.
Rosenhan’s claim is supported - “we cannot distinguish the sane from the insane in psychiatric hospitals”
2- Hospitals seem to be special environments where behaviour becomes distorted easily and patients are treated in such a way as to perpetuate any problems they may have rather than being provided with the environment that would help and support them.
3- Patients in psychiatric hospitals experience powerlessness and depersonalisation.
4- Once a patient has been labelled ‘insane’, all subsequent behaviour is seen in the light of the label given - self fulfilling prophecy.
Rosenhan 1973: Study 1
Research method(s)
Field experiment
Participant observation
Self-report
Give examples of how staff behaved & how they treated the patients.
1- Labelling:
The pseudo-patients’ normal behaviour were often interpreted as symptoms of their diagnosed disorder by the staff E.g., queuing early for lunch = pathological behaviour.
2- De-personalisation & powerlessness:
The patients lacked privacy e.g.:
-> many of the toilets did not have doors
-> their personal hygiene was monitored
-> medical records could be accessed by any staff members regardless of their role (makes patients feel powerless).
Patients were also unable to initiate contact with staff (staff averted their heads / avoided eye contact) and they were denied freedom of movement.
Explain the term ‘depersonalisation’ in relation to the patients.
DEFINITION: Patients weren’t seen as people - only identified as their label - seen as their disorder rather than a person.
Examples:
1- Patients lacked privacy - toilets did not have doors.
2- Their personal hygiene was monitored.
3- Medical records could be accessed by any members of staff regardless of their role.
Explain the term ‘powerlessness’ in relation to the patients.
As a result of de-personalisation, the patients felt an overwhelming feeling of powerlessness.
This was evident in many parts of the experience - patients were unable to initiate contact with staff and they were denied freedom of movement and privacy.
Rosenhan 1973 - evaluation issues & debates.
Reliability
Reliability = consistency of measure.
Low:
No direct comparison of the observations between the pseudo-patients in different hospitals.
This could lead to questions about inter-observer reliability.
High:
However, observations seemed to be consistent with each other, with all pseudo-patients reporting similar experiences.
Low external reliability -> can’t be replicated nowadays -> no asylums.
Rosenhan 1973 - evaluation issues & debates.
Ethics
- Deception
- Informed consent
- Right to withdraw
- Protection from harm
- Confidentiality
- Debrief
Unethical:
1- Deception:
-> Deceived staff - false symptoms (voice saying “empty”, “hollow”, “thud”).
-> Pseudo-patients: false patients.
2- Covert observation - observation guideline.
-> Pseudo-patients wrote notes - recorded observations of behaviour of staff & patients who were not aware they were being watched.
-> Recorded within private space - breach of observation guideline).
3- 2nd part: Deception
-> Told hospital were going to send in false patients but didn’t.
4- Informed consent:
-> Ps (hospitals) not given informed consent as they were not aware of the study.
-> JUSTIFICATION: If they gave informed consent = could lead to demand characteristics - not covert - wouldn’t have valid results so study not useful.
5- Right to withdraw:
-> Didn’t know they were taking part.
-> Not kept after study finished because they may have felt obliged.
6- Protection from harm:
-> Could affect mental health of already vulnerable patients (who thought something was going on).
-> Could affect mental health of staff when told the results - got it wrong etc. - mental harm / stressful.
Ethical:
1- Not deceptive:
-> Once inside answered questions truthfully - based on their real life experience (except name, occupation etc.) BUT deception had already happened.
2- Confidentiality:
-> Know the hospitals and the time it took place, but their names weren’t disclosed.
3- Debrief:
-> Debriefed first part (to be able to conduct 2nd part).
-> Debriefed 2nd part - told hospitals they did not send any fake patients.
Rosenhan 1973 - evaluation issues & debates.
Socially sensitive research
1- The diagnosis of the disorders can have a profound consequences on the individuals, their family & wider community.
2- Many nurses complained the study made their profession look bad. (However, there was an overall benefit to society).
3- Study raised awareness of the flaws in psychiatry diagnosis and treatment - as a result diagnostic systems have become more stringent.
Rosenhan 1973 - evaluation issues & debates.
Reductionism
Reducing the doctor / nurse responses to the pseudo-patients down to the label given to them = reductionist.
(Could be other factors involved in their behaviour towards patients).
