Classic Study: Rosenhan (1973) Flashcards
(21 cards)
What were the aims of Rosenhan’s first study?
- To investigate whether psychiatrists can reliably tell the difference between people who are sane and those that are insane
- To highlight the negative effects of being diagnosed as abnormal and institutionalised
Who were used in the sample of the first study?
- 8 pseudo patients including Rosenhan (not the sample), but included 5 males, 3 females and of varying professions, such as a psych graduate, three psychologists, a paediatrician, a psychiatrist, painter, and a housewife.
- Dispatched to 12 different psychiatric hospitals across the USA with varying funds and staff/patient ratios
- Hospitals were on both the east and west coast of America.
- None had any recorded mental health issues
What type of method was used in the first study?
Covert participant observation.
Briefly describe the procedure of the first part of this classic study.
- The hospital managers were aware of the study taking place
- Each patient on arriving at admissions complained about hearing unfamiliar voices of the same sex saying “empty, hollow, thud”
- Psychiatrists used the DSM-II to diagnose
- All background information pseudo patients gave were the truth, on name was changed
- All ppts were taught how to avoid swallowing medication
- Pseudo patients ceased simulating symptoms of abnormality upon entering ward
- Ppts had to get themselves discharged, feeling powerless
- Once there, ppts recorded notes of things such as: how many times nurses interacted with patients
- Lawyers were briefed if anything were to go wrong, ensuring patients were never on the ward
What was the IV and DV of the first study?
IV = Symptoms displayed to the psychiatrist DV = Admission to the hospital
What were the qualitative results of Rosenhan’s first study?
- All pseudo patients were admitted (11/12 were diagnosed with schizophrenia in remission, 1 with manic depression)
- Discharged as schizophrenia in remission.
- Normal behaviours were often seen as aspects of their illness (e.g. writing notes was seen as abnormal)
- once under the abnormal label, all behaviours were interpreted within that label- e.g. queueing for food was seen as ‘oral acquisitive syndrome’.
- Real patients on the ward noticed the pseudo patients were normal- one said ‘you’re not crazy, you’re a journalist or a professor checking up on the hospital’.
- Hospital conditions were terrible, e.g. lack of privacy, medical records on display and patients experienced depersonalisation
- Real patients would flush medication down the toilet
What were the quantitative results of Rosenhan’s first study?
- Only 4% of psychiatrists stop and talk to patients
- Only 10% of nurses make eye contact when asked questions by patients
- 71% of psychiatrists and 88% of nurses walk on with their head averted when asked questions by patients
- 35/118 real patients noticed that the pseudo patients were fake.
- all pseudo patients were administered 2100 pills, only two were swallowed.
- nurses emerged from the cage 11.5 x during the day shift.
Describe the conclusion of Rosenhan’s first study.
- All pseudo patients were admitted based on one symptom
- Type One error - when the professional diagnoses a sick person as healthy
- Type Two error - when a professional diagnoses as healthy person as sick
- Once diagnosed, it is hard to get rid of the label associated with the mental illness and so became depersonalised
- Once tagged as abnormal, all behaviours were interpreted according to their institutional label
What were the aims of Rosenhan’s second study?
- To further test the reliability and validity of diagnosis
- To test the type one and type two error
Who were used in the sample of the second study?
Staff in a research and teaching hospital with the ground of Stamford University.
What type of method was used in the second study?
Field experiment
Briefly describe the procedure of the second part of this classic study.
- The hospital asked Rosenhan to send more pseudo patients due to not believing type one and two errors would occur in their institution
- The staff were then informed that at some point in the next 3 months, one or more pseudo patients would attempt to be admitted
- Each member of staff were asked to rate each new patient on the likelihood of being fake
What was the IV and DV of the second study?
IV = Expectations of the staff DV = Diagnosis of patient
What were the results of Rosenhan’s second study?
- 193 were admitted for treatment
- 41 were alleged wuth high confidence to be pseudo patients by one member of staff
- 23 were considered suspect by a member of staff
19 were suspected by one psychiatrist and some member of staff.
(Despite none being sent).
Describe the conclusion of Rosenhan’s second study.
- Sane people can be diagnosed as being insane but when consequences are being measured, the diagnosis is reversed
- Instead of making more type two errors, they tend to lean towards type one
How has Rosenhan’s study influenced society and it’s approaches to mental health?
- It has changed the ways in which a psychiatrist or psychologist diagnoses a patient with a mental disorder
- Hospital conditions have improved
- The DSM has improved by using axes to give a more detailed structure to follow to make sure diagnosis is accurate
Evaluate the generalisablity using a high and low point.
A strength is that there is high levels of generalisability. This is because a range of ppt sample was used, with 12 different hospitals with different characteristics and locations. Therefore it is representative of psychiatric hospitals do in different parts of America, so can be generalised to the wider American society. However, it is ethnocentric as it is not representative of diagnosis and psychiatric hospitals in different cultures and countries, so this reduces the findings usefulness.
Evaluate the reliability using a high and low point.
A strength is the standardised procedure… the standardised procedure of symptoms and behaviour upon admission can easily be replicated to check for consistency within results.
A strength of study 2 is that it has high levels of reliability. It collected quantitative data….. due to it being rated on a scale it can easily be replicated and results are without misinterpretation as they are objective and numerical.
A strength is that the DSM was found to be reliable. 11/12 pseudopatients were diagnosed with sz in remission, so therefore the DSM is reliable, but not valid.
However, a weakness is that there is a lack of a standardised procedure. This is because of the individual behaviours of the pseudopatients was not entirely what rosenhan had instructed. The psychology graduate requested his psychology homework and textbooks, and one even tried to start a romantic relationship with the nurse. This means that it is not entirely replicable.
Are there any applications?
A strength is the positive applications to society. This is because it has had a profound impact on mental health care- it has led to reviewing patient admission procedures, training staff on patient interactions to avoid depersonalisation, as well as updating the DSM-II to the DSM-III. This makes diagnosis more reliable and prevents false admissions and misdiagnoses.
Evaluate validity using a high and low point.
A strength of the study is that there is high levels of ecological validity. Staff were unaware that the study was taking place and they were observed in their natural work environment of their own hospital, so this would reflect staff treatment oof normal patients in psychiatric hospitals.
A weakness is that there is low internal validity. This is because the pseudopatients were faking mental illness…… and this doesn’t represent how genuine mental conditions are diagnosed.
Additionally, there is low internal validity as the 9th pseudopatients had a positive experience and reportedly ‘enjoyed it’, but this experience wasn’t included in the report. Therefore, there has been publication bias which reduces the internal validity of the findings.
Using the acronym ‘PEEJ’, evaluate 2 ethics points.
An ethical weakness of this study is that the pseudopatients were given false labels of schizophrenia and manic depression (bipolar). This could lead to a self-fulfilling prophecy in which they develop these symptoms. The pseudopatients were medicated and depersonalised which may have caused them lasting psychological harm and distress. However, a fake name was given to the pseudopatients to protect their identity and all were taught before the study how to avoid swallowing medication, so therefore the institutional label given to them won’t affect their everyday life and they wouldn’t have taken any unnecessary medication.
