Rosenhan (1973) 'On being sane in insane places'

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  • Rosenhan (1973) 'On being sane in insane places'
    • Aim
      • To tell how psychiatrists could distinguish real patients with schizophrenia from pseudo patients, who faked a single symptom.
    • Procedure
      • Rosenhan himself and 7 volunteers, 5 of whom were doctors or psychologists arrived at a range of mental hospitals (12) reporting a single symptom
        • Hearing voices saying 'empty' 'hollow' and 'thud'
          • Once admitted, they then acted normally, co-operating with staff and seeking to be released ASAP.
            • When asked, they reported no further symptoms. The pseudo patients recorded the responses of doctors and nurses when they spoke to them
            • In a follow-up procedure staff at another hospital were informed that 1 or more pseudo patients would present  over the next few months
              • Staff at this hospital were asked to rate all new patients on a 1-10 scale for how likely each new admission was to be a pseudo patient
                • No pseudo patients approached them; the fact was to see how many real patients were misidentified
    • Results
      • All 8 pseudo patients were admitted to hospitals
      • The average stay was 19 days (range 7-52 days)
      • in 30% of the cases, real patients made comments to the effect that the pseudo patients had nothing wrong with them
      • 71% of doctors and 88% of nurses completely ignored the pseudo patients when they tried to speak to them
    • Conclusion
      • The study revealed 2 major weaknesses in the psychiatric system of the time
        • The environment has a major impact on the process of diagnosis and in the hospital environment staff could not tell the mentally disordered from the mentally healthy
        • Once labelled with a condition like schizophrenia,patients find it difficult to escape the label and be judged as 'normal'
    • Evaluation
      • Rosenhan used a range of hospitals in different states on both coasts so allows results to be generalised
        • The study demonstrates both the limitations of classification and importantly the appalling conditions in many psychiatric hospitals.
          • This has stimulated much further research and has lead to many institutions improving their philosophy of care.
            • The hospital staff were deceived - unethical. Although Rosenhan did conceal the names of hospitals or staff and attempted to eliminate any clues which might lead to their identification
              • Ethics- medication would have been harmful to pseudo patients if swallowed
                • Although the pseudo patients went into the study understanding what they had to do it would have been distressing being unable to get discharged
                • No mention of a debrief so nurses and doctors may have felt shame and embarrassment and would have not been able to express it
      • Field experiment so fairly ecologically valid whilst still managing to control variables such as the pseudo patients behaviour
      • Participant observation meant that the pseudo patients could experience the ward from the patients perspective while also maintaining some degree of objectivity


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