Rosenhan (1973), (Clin) Flashcards
(10 cards)
Aim
Rosenhan wanted to test reliability of mental health diagnosis, to see if medical professionals could tell the mentally ill from the healthy in a clinical setting.
Procedure
- a field experiment crossed with naturalistic observations.
- conducted in the “real world” + mainly consisted of notes + observations of the pseudopatients (participant observation). Rosenhan had 8 pseudopatients obtained through opportunity sampling, 3 women + 5 men from various professions e.g. a painter, a housewife, a paediatrician and psychologists (inc. Rosenhan himself)
- all people who were not mentally ill that would pretend to experience schizophrenic symptoms. Saying that they hear “hollow” “thud” and “empty” – auditory hallucinations.
- pseudopatients communicated with 12 psychiatric hospitals in the USA, situated on both the East and West Coast. These hospitals also varied in funding and staffing. There was even a private hospital.
- 8 pseudopatients visited the 12 hospitals and were admitted after their evaluation.
- When pseudopatients admitted into hospitals, were instructed to act as they would normally, not displaying any symptoms of mental illness.
- Taking notes regarding their experiences + following instructions of hospital staff (other than taking medication)
- The pseudopatients had to behave in a way to convince hospital staff that they were not mentally ill before being discharged
Follow up study
- Rosenhan agreed with 1 leading hospital to do follow up study.
- Every staff patient who dealt with admissions had to rate all patients in terms of probability that they were pseudopatients on a scale of 1-10.
- In 3 months, 193 patients admitted to hospital.
- 41 of those considered to be fake patients by one staff member
- 23 suspected as being fake by one psychiatrist.
- 19 considered to be fake by two staff members: one psychiatrist and one other member of staff.
- In reality, Rosenhan not sent single pseudopatient to hospital. Confirming his initial results about diagnoses being invalid to be correct.
Findings
Quantitative findings:
- found 11/12 hospitals admitted pseudopatients with a diagnosis of schizophrenia
- Every single hospital diagnosed the pseudopatients with a mental disorder.
- Length of hospitalization ranged from 7 to 52 days with an average of 19 days
- None of staff were able to identify that pseudopatients faking symptoms. However, many legitimate patients were easily able to identify this (believing they were journalists)
- 4/12 hospitals, no staff answered the pseudopatients when they asked them questions. It was found that 71% of doctors and 88% of nurses and other staff ignored the pseudopatient when questioned.
Qualitative findings
- 3 ‘normal’ behaviours were misinterpreted as ‘abnormal’, including note writing being interpreted by a nurse as ‘engaging in writing behaviour’ as though it was something only a person with a mental illness would do.
- Another interpreted pacing up and down as a sign of nervousness, when the pseudopatient was just bored.
Conclusion
- results demonstrate, medical professionals cannot reliably differentiate those who were mentally ill and those who were not.
- Furthermore, suggests that label of “mental illness” once applied to a person, all behaviours observed in context of label. Creating self-fulfilling prophecy if person is treated in accordance with their “mental illness”
- ‘Normal’ behaviour misinterpreted as ‘abnormal’ to support idea that pseudopatients had a mental illness. suggests validity of psychiatric diagnoses was low.
- Ironically, due to the consistency of diagnoses they are reliable but incorrect.
Evaluate one strength of the study
I - A strength of Rosenhan’s study was that it had high internal validity.
J - The doctors + nurses in 12 hospitals were unaware were being observed by pseudopatients + therefore likely that treated them in exactly the same way as they would have treated any of their real patients.
E - This lack of demand characteristics means that study is very useful in highlighting issues surrounding the difficulty of diagnosing mental disorders accurately.
Evaluate a second strength of the study
I - A strength of Rosenhan’s study was that it had high ecological validity
J - For example, the study was field experiment based on observations in real psychiatric settings. The study used 12 real hospitals that varied in size and location as well as involving observing the interactions between real medical staff + real patients.
E - This is a strength because means that we can be confident that invalid nature of diagnoses apply to real hospitals, locations and medical teams.
However, the hospitals were all in the USA. The doctors and patients were all from the same culture, therefore the findings may only tell us about the diagnosis and the treatments provided in the USA in the early 70s
Evaluate a third strength of the study
I - A strength of Rosenhan’s study was that it was applied + paved way for critical reforms in diagnostic process.
J - The DSM-3 had new diagnostic criteria added to many of mental health disorders included within. definitions + boundaries of mental + medical disorders were changed from loose interpretations of disorders from paragraphs to a checklist of symptoms, several of which were required for a diagnosis to meet the book’s standards
E - This is a strength because study led to beneficial changes in diagnostic manuals, which made diagnostic process of mental health disorders more reliable.
Evaluate one weakness of the study
I - A weakness of Rosenhan’s study was that it was ethnocentric.
J - study was conducted across 12 hospitals in 5 states of America + focused on the use of DSM-2 manual for diagnosing mental disorders.
E - This is a weakness because other cultures may not use the DSM-2 manual + also may not share westernised view of some symptoms, particularly hallucinations, so cannot assume that process of diagnosing mental disorders will show similar problems in other cultures + countries.
Judgement
Overall, Rosenhan was very useful at highlighting issues in mental health dignosis + helped with changing resources + processes to be more reliable. However, as only used hospitals in USA , findings may need to be assessed for reliability in other cultures. So, study should be replicated in a variety of different countries.
