Classic Study: Rosenhan (1973)

Being Sane in Insane Places

Aim: Rosenhan wanted to test the reliability of mental health diagnosis, to see if medical professionals could tell the sane from the insane in a clinical setting. He also wanted to investigate the effect of labeling on medical diagnosis.

Participants/Sample: The sample included 8 pseudopatients, including Rosenhan himself. There were 3 wonem and 5 men. They included a mixture of graduates, housewives and other professionals such as a paediatrician. They were all assessed for a history of mental illness and all had no previous psychological problems. The participants were hospital staff/patients. The pseudopatients were the researchers.

There were 3 stages to this study.

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Procedure

1. Entrance to the Institution:

Pseudopatients had to phone the admissions office of one of 12 hospitals and make an appointment because they could hear voices. The voices said: empty, thud and hollow.

The biographies of the pseudopatients were true including life events and family relationships. All 8 were admitted with schizophrenia, apart from one who was diagnosed with manic depression with psychosis.

(DSM-2 was used at the time)

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Procedure

2. Life in the Institution:

When they arrived onto the wards, the pseudopatients began to act normally. They then observed life on the ward and co-operated with the staff. They recorded their experiences by taking notes. They also had to convince staff they were in fact normal and had visitors to indicate they were behaving normally.

3. Rosenhan Later Conducted a Follow Up Study:

The hospital was aware this time that new pseudopatients would be seeking admission over the next 3 months. Staff were issued with a questionnaire to rate each new patient on a 10-point scale on how confident they were that the patient was mentally ill. 

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Results

  • All 12 hospitals diagnosed the pseudopatients as mentally ill
  • It took 7-52 days for the pseudopatients to be discharged (mean = 19 days)
  • Patients did suspect that the pseudopatients were sane
  • The staff treated the researchers in a way that wasconsistent with their diagnosis and frequently pathologised normal behaviour e.g note taking was referred to as 'writing behaviour', pacing the corridors out of boredom was interpereted as nervousness.
  • When contact was initiated towards nurses by the pseudopatients, 71% of the time they were ignored, eye-contact was only made 23% of the time, with verbal responses in only 2% of the cases.
  • Average daily contact between patients and psychiatrists was 6.8 minutes.
  • Staff spent 90% of their time in their office
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Follow Up Study

  • While the hospital were expecting pseudopatients, Rosenhan sent no pseudopatients to the hospital.
  • 193 patients arrived at the hospital over the 3 month period.
  • 41 were rated as pseudopatients by at least one member of staff
  • 23 were rated pseudopatients by at least one psychiatrist
  • 19 were rated as psuedopatients by a member of staff and a psychiatrist
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Conclusions

  • Rosenhan concluded that the diagnostic label changed the perception of the person so that all of their behaviour was interpreted within the context of their label.
  • He then argue that this could lead to a self-fulfiling prophecy as the person is then treated in a way that is consistent with the label and their behaviour in response to this is interpreted as being consistent with the label, thus confirming the validity of the label.
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Generalisability

  • Generalisability: On one hand, generalisability was good because Rosenhan used a range of psychiatric hospitals - private and state-run, old and new, well-funded and under-funded. However, 12 is a small sample for a country as big as the US. Also, lots of progress has been made in mental health since the 1970s so findings can't be generalised to psychiatric diagnosis/care today. In conclusion, more research needs to be done today in a wider range of hospitals and perhaps more countries/cultures.
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Reliability/Validity

  • Reliability: Rosenhan trained his pseudopatients beforehand, but they didn't all follow the same standardised procedure e.g one revealed he was going to become a psychology professor and one of his visitors was a college Psychology professor. This gives the study poor internal reliability. On the other hand, the study has good external reliability as Slater's research supports Rosenhan's findings. However, different diagnostic criteria are used in different countries.
  • Validity: Good ecological validity as it was a natural setting. Particiapants didn't know they were taking part in research so no demand characteristics. On the other hand, pseudopatients were faking a mental illness so it doesn't really tell us anything about how people with real mental illnesses are diagnosed. The fact that 11/12 of the diagnoses were consistent may prove diagnosis is reliable. If patients present the same symptoms, they get the same diagnosis. This goes against Rosenhan's view that diagnosis is unreliable.
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Applications/Ethics

  • Applications: The stugy caused psychiatric hospitals world-wide to review their admission procedure and how they trained staff to interact with patients. It was also influential in the subsequent update of DSM.
  • Ethics: Hospital staff were decieved about the psuedopatients' symptoms being real. The doctors/nurses couldn't consent to take part or exercise their right to withdraw. Hpwever, Rosenhan notified the management of the hospital he went to and confidentiality was protected - none of the staff or hospitals were named. As well as this, the time the doctors/psychiatrists spent with the pseudopatients was time taken away from people with a real mental illness. There are also problems with privacy as pseudopatients were recording their observations of the hospital staff and patients.
  • In conclusion, the applications of the study to society outweigh the ethical costs.
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