Rosenhan

Question 1

background

Answer 1

• inspired by anti-psychiatry movement
• wanted to challenge diagnostic system for mental health
• as it puts emphasis on the individual as the source of the symptoms not the environmental context of where symptoms arose

Question 2

aims - study 1

Answer 2

• test that psychiatrists cannot reliably tell the difference between people who are sane vs insane
• investigate whether diagnosis of mental illness is invalid and affected by observer bias causing clinicians to see behaviour as symptomatic of an underlying disorder instead of something that appears in a certain context
• highlight negative effects of being diagnosed as abnormal and institutionalised

Question 3

sample - study 1

Answer 3

• 12 different hospitals
• across 5 states in USA
• hospitals had varying funds, resources, staff : patient ratio, private/state control

Question 4

method - study 1

Answer 4

• experimental
• using covert participant observation techniques

Question 5

independent variable - study 1

Answer 5

• symptoms displayed to psychiatrist

Question 6

dependent variable -study 1

Answer 6

• admission to hospital

Question 7

procedure - study 1

Answer 7

• pseudo patients of varying background
• each pseudo patient adopted a fake identity and dispatched to different hospitals
• each pseudo patient telephoned hospital for an appointment
• arrived of hearing voices
• apart from fake names/occupations they were told to tell the truth
• no life stories were pathological
• once admitted to ward the pseudo patients ceased simulating and symptoms of abnormality
• patients now had to get themselves discharged

Question 8

pseudo patients - study 1

Answer 8

• 5 were men (including Rosenhan)
• 3 women
• none had recorded mental health issues
• each adopted a fake name and profession

Question 9

what voices did the pseudo patients claim to hear - study 1

Answer 9

• same sex
• said things such as ‘empty, hollow and thud’
• words associated with how meaningless life is

Question 10

what did the pseudo patients do once on the ward - study 1

Answer 10

• recorded notes on things they observed
• these were initially done in secret
• once they found out no one cared, they were made publically

Question 11

results - aim 1 - study 1

Answer 11

• all pseudo patients were admitted
• 7 with SZ, 1 with manic psychosis
• discharged as SZ in remission
• remained in hospital for 7-52 days

Question 12

what normal things did the pseudo patients do which were seen as a characteristic as acquisitive syndrome

Answer 12

• waiting outside cafeteria for lunch 30 minutes before lunchtime

Question 13

what normal things did the pseudo patients do which was seen as pathological

Answer 13

• writing behaviour

Question 14

Rosenhan - study 1 - notes

Answer 14

• there is an overlap between sane and insane behaviours
• given the environment where the behaviour is conducted has an impact of how behaviour is interpreted by others

Question 15

real patients on the ward - notes - study 1

Answer 15

• knew the pseudo patients were normal
• 35/118 patients voiced their suspicions to staff
• some shouted ‘you’re not crazy, you’re a journalist, you’re checking up on the hospital

Question 16

Aim 2 - quantitative data - study 1

Answer 16

• when patient asked staff a question, the pseudo patients noted:
• walks on with head averted
• makes eye contact
• pauses and chats
• stops and talks

Question 17

walks on with head averted

Answer 17

• psychiatrist = 71%
• nurse = 88%

Question 18

makes eye contact

Answer 18

• psychiatrist = 23%
• nurse = 10%

Question 19

pauses and chats

Answer 19

• psychiatrist = 2%
• nurse = 4%

Question 20

stops and talks

Answer 20

• psychiatrist = 4%
• nurse = 0.5%

Question 21

aim 2 - qualitative data - study 1

Answer 21

• pseudo patients treated like they were invisible
• reports show inhumane treatment
• including genuine patients being physically beaten for initiating verbal contact
• Rosenhan witnessed patient being beaten for telling attendant he liked him
• patients frequently woken up by ‘ come on you mfs out of bed’

Question 22

conclusion - study 1

Answer 22

• based on 1 symptom all pseudo patients were admitted to hospital
• Rosenhan said this was because 2 types of error were made

Question 23

type 1 error -

Answer 23

• professional diagnoses a sick person as healthy

Question 24

type 2 error -

Answer 24

• professional diagnoses a healthy person as sick

Question 25

study 1 conclusion - expanded

Answer 25

- when diagnosing professionals use medical model to make their judgement - they base it as any sign of ill well being should be treating - but this is problematic - once diagnosed, hard to get rid of label - having been labelled as SZ once, there was nothing the pseudo patient could do to get rid of this - once tagged as abnormal, their behaviour was interpreted according to this label - label was so powerful, normal behaviours were completely re-evaluated to mean something else

Question 26

study 2 - aim

Answer 26

- to further test reliability and validity of diagnosis - to test the type 1 and type 2 error

Question 27

sample - study 2

Answer 27

- staff in a research and teaching hospital - at Stanford University

Question 28

method - study 2

Answer 28

- field experiment

Question 29

independent variable - study 2

Answer 29

- expectations of staff

Question 30

dependent variable - study 2

Answer 30

- diagnosis of patients

Question 31

procedure - study 2

Answer 31

- staff at hospital were given results for first part of study - they discussed ideas of a type 1 and 2 error - concluded this would not be possible in their hospital - the staff were then informed that at some point in 3 months 1 or more pseudo patients would attempt to be admitted - no actual pseudo patients were sent - each member of staff was asked to rate each new patient on likelihood that they were a pseudo patient

Question 32

results - study 2

Answer 32

- judgements were obtained on 193 patients who were admitted for treatment - 41 patients were alleged with high confidence to be pseudo patients by 1 staff member - 23 were considered suspect by a staff member - 19 were suspected by 1 psychiatrist and some member of staff

Question 33

conclusion - study 2

Answer 33

- shows how sane people can be diagnoses as insane - but when consequences are being measured, diagnosis is reversed - more type 1 errors made

Question 34

how was being a hospitalised pseudo patient overwhelming, powerless and caused depersonalisation

Answer 34

- once admitted and deemed abnormal - patients stripped of their humanity - given now power/choice

Question 35

what does Rosenhan mean by 'stickieness of labelling' and the consequences of this

Answer 35

- once diagnosed as abnormal it is hard to ever be classed as normal again - this has a permanent restricting affect on life

Question 36

explain why psychiatrists diagnosis was not valid

Answer 36

- pseudo patients were intentionally faking symptoms to gain an entry - however acted normally afterwards - despite this, psychiatrists continued to categorise pseudo patients behaviour as abnormal

Question 37

was the psychiatrists diagnosis reliable

Answer 37

- no - 8 patients misdiagnosed as showing abnormal behaviour and suffering from a mental health disorder - psychiatrist is therefore inconsistent with correctly diagnosing = unreliable

Question 38

how has this study influenced by society and how it approaches mental health

Answer 38

- by exposing potential for diagnostic errors - and dehumanising conditions within mental institutions - demonstrated the few rights patients had and mistreatment by staff

Question 39

ethics - consent

Answer 39

- observation was covert - no hospital staff aware of study except for hospital administrators + chief psychologist - did not give permission to participate - no informed consent for staff

Question 40

ethics - confidentiality

Answer 40

- psychiatric hospitals privacy was violated - protected pseudo patients identity by giving them a fake identity to ensure their Sz label did not affect them after the study

Question 41

ethics - right to withdraw

Answer 41

- covert = staff unaware of experiment so did not get to opt out, even though their emotional state may have been affected - patients were anxious and all but 1 wanted to leave due to highly distressing environment = could not withdraw - Rosenhan ensured pseudo patient was known by chief administrator/psychologist so they could be discharged

Question 42

ethics protection from harm

Answer 42

- pseuds experienced psychological distress when witnessing events which occurred / highly distressing environment - however this exposed the systematic issues in care which helped to improve treatment of actual patients and in future protect them from harm - actual patients who needed attention were deprived of treatment given to pseuds - prolonging abnormal behaviour of real patients - Rosenhan put in procedures to eliminate distress faced by pseuds in hospital environment

Question 43

ethics - deception

Answer 43

- pseudo patients said they were hearing voices - faked their name and profession = lies!

Question 44

generalisability - good

Answer 44

- 8 pseudo patients sent to 12 hospitals across 5 different states with - hospitals had different backgrounds of over/understaffed, old/new, public/private - sample of hospitals varied and large - representative of hospital facilities and wider populations - ideas of diagnosis = applicable

Question 45

generalisability - bad

Answer 45

- ethnocentric sample as all 12 hospitals were in America - findings cannot be applied to other countries - as diagnosis patterns may not have been the same - cultural differences impacts diagnosis - e.g USA uses DSM, UK uses ICD

Question 46

ecological validity - good

Answer 46

- field experiment - covert = staff were unaware of pseudo patients studying their behaviour - increasing realism, and decreasing socially desirable behaviour - realistic reflection as staff thought it was a normal day at work - increasing mundane realism - we can apply to similar situations in other hospitals

Question 47

reliability - good

Answer 47

- procedure was standardised in terms of the script each pseud said - same method used for each pseud - they followed the same symptoms - allowing the study to be retestable in other hospitals around the world / modern society - to see if diagnostic process has improved

Question 48

Applications - good

Answer 48

- exposes care system as facilitating depersonalisation of patients - this can further damage their illness - helping to improve treatment and hospital environment - shows environment influences behaviour, e.g queuing for lunch 30 mins outside cafe - 35/118 patients recognised pseudo patients highlighting the issues of diagnosis

Question 49

Applications - bad

Answer 49

- findings may be history specific as study took place in 1970s - findings may not apply to modern society - diagnostic systems are likely to have improved - so mental hospitals are now completely different in 21st C due to psychology advances - so can't apply results as much