classic study: being sane in insane places (Rosenhan, 1973)

Question 1

background

Answer 1

• tested if hospital staff could tell the difference between sane and insane people
• pseudo-patients had no prior mental illness diagnosis
• purpose was to see if they could be detected as “sane” in a mental health context
• aimed to critique the reliability and val of DSM II
• questioned how ‘abnormality’ is defined

Question 2

what was the aim of rosenhan’s study with 8 pseudo-patients in 12 hospitals?

Answer 2

• investigate if 8 people posing as patients would be detected as sane by hospital staff
• use DSM classification to see if they were identified correctly
• explore the experience of being viewed as ‘insane’
• understand what it’s like to be treated as mentally ill

Question 3

what does pseudo mean?

Answer 3

• fake, false, fraudulent

Question 4

sample

Answer 4

• 8 pseudo patients = 3 women and 5 men
• included 3 psychologists, a paediatrician, a psychiatrist, a painter, a housewife, and rosenhan himself
• hospital administrator and chief psychologist knew about the study, but no one else did
• employed different occupations to avoid being treated differently by mental health staff (those in mental health jobs)

Question 5

how did rosenhan increase the generalisability of his study?

Answer 5

• used 12 different hospitals
• hospitals located in 5 different USA states
• variety of hospitals to ensure broader applicability of results

Question 6

how did the pseudo-patients gain admission to the hospitals in rosenhan’s study?

Answer 6

• called for an appointment and arrived at the administration office
• claimed to be hearing unclear voices saying “empty,” “hollow,” and “thud”
• used these symptoms to gain admission to the hospitals

Question 7

what did the pseudo-patients do upon admission to the hospitals in rosenhan’s study?

Answer 7

• gave a different name
• provided some personal history, including details of their own life
• used false identities to avoid detection

Question 8

what did the pseudo-patients do after being admitted in rosenhan’s study?

Answer 8

• stopped simulating symptoms of abnormality and behaved “normally”
• did not swallow the medication given to them
• followed staff instructions and chatted with other patients
• each pseudo-patient had to convince staff they were sane to get out

Question 9

what were the tasks of the pseudo-patients in rosenhan’s study?

Answer 9

• seek release by convincing staff they were sane
• observe and record the experiences of institutionalised mentally disordered patients
  
  • initially done covertly, though later found unnecessary

Question 10

what were the results of rosenhan’s study regarding the detection of pseudo-patients?

Answer 10

• 7/8 were diagnosed with schizophrenia, 1 with manic depression
• none of the hospital staff suspected the pseudo-patients were faking
• stay ranged from 7 to 52 days, average was 19 days
• at discharge, all were given a diagnosis of ‘schizophrenia in remission’

Question 11

what did rosenhan’s study suggest about the impact of being labelled as schizophrenic?

Answer 11

• once labelled as schizophrenic, the pseudo-patient was “stuck” with that label
• evidence showed that the label influenced how the patients were treated by staff
• highlights the lasting impact of psychiatric diagnoses

Question 12

what did rosenhan’s study reveal about the failure to recognise the sanity of pseudo-patients?

Answer 12

• hospitals were considered good or excellent, not to blame for failing to recognise sanity
• 35/118 patients in the first 3 hospitals suspected the pseudo-patients were sane, calling them journalists or professors
• pseudo-patients took notes on staff and patients, which might have triggered suspicion
• the fact that patients recognised normality when staff did not raises important questions
• doctors tend to err on the side of caution, labelling healthy people as sick rather than the other way around

Question 13

what did rosenhan do after staff at a teaching hospital doubted the findings of his first study? (procedure 2)

Answer 13

• told staff that 1 or more pseudo-patients would attempt to be admitted over the next 3 months
• hospital staff were asked to rate patients on a scale of 1-10 to reflect the likelihood of them being a pseudo-patient
• this was done to test if staff could detect pseudo-patients based on their behaviour

Question 14

what were the results of rosenhan’s second study with hospital staff judging patients?

Answer 14

• judgements were made on 193 patients admitted for psychiatric treatment
• 41/193 were judged by at least 1 staff member to be pseudo-patients with high confidence
• 23/193 were considered suspicious by at least 1 psychiatrist
• 19/193 were judged as pseudo-patients by 1 psychiatrist and another staff member
• no pseudo-patients were actually sent by rosenhan

Question 15

what distortions of behaviour were observed in rosenhan’s study?

Answer 15

• normal behaviour was interpreted through the ‘label’ of schizophrenia
  
  • case history: normal history distorted to highlight ambivalence and emotional instability
  • note-taking: recorded as ‘patient engaging in writing behaviour’, seen as a symptom of the disorder
  • pacing: viewed as nervousness, interpreted as a symptom of the disorder
  • waiting outside cafeteria: seen as showing the ‘oral-acquisitive nature of the syndrome’ by a psychiatrist

Question 16

what did rosenhan’s study reveal about the lack of monitoring in psychiatric hospitals?

Answer 16

• very little contact with doctors, strong segregation between staff and patients
• nurses came out of ‘the cage’ (glassed area) an average of **11.5 times per shift*
• doctors were even less available and rarely seen on wards
• those with the most power (doctors) had the least interaction with patients

Question 17

what did rosenhan’s study reveal about the lack of normal interaction in psychiatric hospitals?

Answer 17

• pseudo-patients asked staff courteously for information, e.g., about staff meetings or discharge
• responses were brief, often irrelevant, and given on the move
• staff rarely made eye contact or engaged in normal conversation

Question 18

what did rosenhan’s study reveal about powerlessness and depersonalisation in psychiatric hospitals?

Answer 18

• powerlessness and depersonalisation caused by lack of rights, constructive activities, choice, or privacy
• patients were denied control over their lives and treated as objects rather than individuals

Question 19

what did rosenhan conclude from his study regarding psychiatric staff and the DSM?

Answer 19

• staff in psychiatric hospitals were unable to distinguish the sane from the insane
• the DSM was not a valid measurement of mental illness at that time

Question 20

strength - gen

Answer 20

• used a range of psychiatric hospitals
• included private and state-run, old and new, well-funded and under-funded hospitals
• selected hospitals from across the United States

Question 21

weakness - gen

Answer 21

• hospitals all based in USA
• ethnocentric

Question 22

application

Answer 22

• changed DSM due to findings
• caused there to be a review

Question 23

weakness - reliability

Answer 23

• reliable at the time as 7/8 pseudo-patients presented the same symptoms and received the same diagnoses
• results would likely differ now as the DSM has been refined and improved since the study

Question 24

weakness - validity (Kety)

Answer 24

• criticised that the pseudo-patients were faking an unreal mental condition
• argued it doesn’t reveal how people with genuine mental conditions are diagnosed
• pointed out that psychiatrists don’t expect deception for hospital admission
• claimed the study lacked eco val

Question 25

strength - ethics

Answer 25

- **notified** the management of the hospital he went to - ensured **no staff or hospitals** were **named** to protect **confidentiality**

Question 26

weakness - ethics

Answer 26

- hospital staff were **deceived** about the pseudo-patients' symptoms being real - doctors and nurses couldn’t **consent or withdraw** from the study - other patients in the study **couldn’t consent or withdraw** either - patients didn't enter hospitals for psychology research, raising **ethical concerns** about informed consent