Rosenhan, 1973 (Insanity) Flashcards Preview

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Flashcards in Rosenhan, 1973 (Insanity) Deck (28):

What is schizophrenia?

A mental disorder where a person finds it difficult to know if something is real or not (hearing voices).


What are the symptoms of schizophrenia?

-delusions (+)
-hallucinations (+)
-thought disorders (+)
-unusual emotional responses (-)
-lack of motivation (-)


How is schizophrenia treated?

-medicine: anti-psychotic medication.


What is the method of the study 1?

Covert participant observation.


What is the aim of study 1?

To see if sane individuals who presented themselves to a psychiatric hospital would be diagnosed as insane.


Describe the pseudopatients in study 1?

-5 men
-3 women
-Various ages and occupations (graduated student, psychologist, pediatrician, painter and housewife)
-Rosenhan was a pseudo patient himself


Who were the participants in study 1?

-Hospital staff and patients in 12 hospitals across the USA from 5 states.
-Different kinds of psychiatric hospitals (old, modern, poorly staffed etc.)
-Only one hospital was private.


Describe the procedure in study 1.

-Each pseudopatient asked for an appointment.
-On arrival he/she had been hearing voices (empty, dull, thud and hollow) and spoken in an unknown voice. These symptoms were chosen as it has not been reported for schizophrenia before.
-Gave personal information (non of their life histories were abnormal).
-Once in the hospital, they acted normal (other than being nervous because of how easy they got into the hospital, afraid of being detected as fraud).
-They did not take any of their medications and instead hid it.
-They spent lots of time writing notes about their environment and were friendly to the staff.
-The staff thought that their writing (making notes) was an aspect of their illness, "Patient engages in writing."
-When the patients were mistreated and got angry, it was said that their anger was because of their condition.
-However other patients became suspicious of their note taking and many of the real patients (35/118) accused them as being fake and said things like, "You're not crazy!" or, "You're a journalist."


What were the results in study 1?

-None of the pseudopatients were detected as fake: diagnostic system failed.
-8 pseudopatients were admitted with schizophrenia.
-On discharge, they were said to have, "schizophrenia in remission."
-Once diagnosed it shows that you have a "sticky label" and that you can't overcome the tag.
-7 days was shortest stay.
-52 days was longest stay.
-19 days was the average stay.


What type of error was study 1 and define it?

False positive: saying somebody who isn't ill is.


Why did the participants fail to detect sanity from insanity?

It is more dangerous to misdiagnose illness than health. Therefore they feel as though it's "safer" so they leave it even though they suspect that they aren't actually ill.


What is the aim in study 2?

To see if the tendency towards diagnosing the sane as insane (study 1) could be reversed.


Who were the participants in study 2?

The staff in one psychiatric hospital.


What was the method in study 2?

Self report.


Describe the procedure in study 2.

When the staff in one psychiatric hospital was informed about the first study, they doubted their hospital would have made similar mistakes. Rosenhan then told them that at some point during the next three months, one or more pseudopatients would try to be admitted to their hospital. This was also a controlled participant observation. Each member of staff was asked to rate all patients who tried of gain admission within the next three months. There were asked to rate all patients using a 10-point scale.


What were the results from study 2?

-193 patients were admitted for treatment.
-41 were judged to be pseudopatients by at least one staff member.
-23 were suspected by at least one psychiatrist.
-19 were suspected by a psychiatrist and another staff member.


Did Rosenhan actually send any pseudopatients (study 2)?



What was the explanation for study 2?

The hospitals were now making more type 1 errors (calling a sick person healthy) because they were trying to avoid type 2 errors. This indicates that the process of diagnosis is open to many errors and can not be seen as reliable.


What was the aim of study 3?

To investigate the patient-staff contact.


Who were the participants in study 3?

Doctors, nurses and other staff of the hospital.


Describe the procedure of study 3.

In four of the hospitals, pseudopatients approached a staff member with the following question, "Pardon me, could you tell me when I will be presented at the staff meeting?" The pseudopatients did this as normally as possible and avoided asking any particular person more than once a day.


What were the results of study 3?

They usually made brief replies and kept moving or no response at all. A typical answer would be, "Good morning, Dave. How are you today?" and then the staff member would move off without waiting for an answer. In contrast a young lady asked staff members from a university questions and they responded 100% of the time and made eye contact. This avoidance between staff and patients serves to depersonalise the patients.

-4% of psychiatrists and 0.5% of nurses stopped.
-2% in each group paused and chatted.


What does the study show?

-Diagnosis is unreliable as even psychiatrists makes mistakes.
-Diagnostic labels stick.
-Contact with staff and patient was minimal.
-Lack of eye contact or verbal contact from staff depersonalised patients.


What are the strengths of the study?

-Used study 1&2 to test reliability of diagnosis of both sanity and insanity.
-Use of participant observation allows accurate account of experiences in hospitals.
-Quite high in EV as it's in the Ps real environment.


What were the weaknesses of the study?

-Broke deception as they were actual patients.
-Symptoms weren't exactly like schizophrenia symptoms.
-In study 2, it involved real patients being treated with suspicion and not receiving the care they needed.
-Consent was broken.
-Could not be debriefed but to counteract staff and hospitals were kept anonymous.


How representative was the sample?

A wide variety of hospitals was used across the USA. It can therefore be generalised to other USA hospitals but cannot be generalised to other countries.


What type of data was collected?

-Qualitative: descriptions of experiences and events that happened (e.g. Depersonalisation)
-Quantitative: numbers admitted and discharged in study 1. Number of patients said to be pseudopatients from study 2.


What would you change?

-Sample (only from america): Use samples from other countries. Can be generalised to more countries but it'd take a lot of effort and it could be expensive.
-Method: do interviews so you have data from real patients, it'd be more accurate but some may not be willing to take part.