Rosenhan (1973) - Being Sane In Insane Places

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  • Created by: ernily
  • Created on: 19-04-15 20:44

Rosenhan (1973) - Aims & Context

  • Mental illness is diagnoed the same way as physical illness. In America, they use DSM. In Europe, they use ICD.
  • Szasz argues that mental illness is a comination of medical and psychological concepts. This idea legitimises the use of psychiatric force to control deviance from societal norms.
  • Foucault argues that sanity and insanity are social ideas; it is convenient for society to judge who is sane and insane.
  • Holocaust documentaries argued that the medicalisation of social problems provided the origins of the 1940s mass murders.
  • Rosenhan questioned the validity of diagnostic methods;
    • "If sanity and insanity exist, how shall we know them?"
  • The aim of Rosenhan's study was:
    • To investigate whether psychiatrists can distinguish between mentally ill people and healthy people.
    • To investigate if the environment determines the diagnosis.
    • To investigate if psychiatrists can identify pseudo-patients.
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Rosenhan (1973) - Procedures

  • Study 1 - Controlled Observation:
    • 8 sane people tried to gain admission to 12 hospitals in USA
    • 3 women and 5 men, with false names and false occupations. They had to get out by convincing the hospital that they were sane.
    • The pseudopatients told the hospital that they were hearing voices saying "empty", "hollow", and "thud". 
    • They were admitted with schizophrenia, but acted normally as soon as they were admitted - they took notes on other patients and accepted medication (but did not take it).
    • Opportunity Sample: Range of hospitals; old and new, well staffed and poorly staffed, and one private hospital.
  • Study 2 - Additional Research:
    • A different hospital claimed that they could spot the pseudopatients.
    • The staff were asked to rate on a 10 point scale.
    • Data was taken on 193 patients, however no pseudopatients were actually sent to the hospital.
  • Study 3 - Field Experiment:
    • In 4 hospitals, the pseudopatients tried to ask questions.
    • They asked their questions no more than once a day.
    • For example; "Pardon me, Mr/Mrs/Dr, could you tell me when I am likely to be discharged?". They were ignored.
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Rosenhan (1973) - Findings & Conclusions

  • Study 1 Findings:
    • The pseudopatients exhibited signs of nervousness and anxiety as they were nervous of being found out.
    • All but one pseudopatient were admitted in with a diagnosis of schizophrenia.
    • The length of hospitalisation ranged from 7-52 days, with an average of 19 days.
    • The average daily contact with the psychiatrists was an average of 6.8 minutes per day.
    • While at the hospital, the 'real' patients regularly voiced their suspicions; 35 out of 118 real patients made statements such as "you're not crazy".
    • Nursing records for 3 pseudopatients indicate that their writing was seen as an "aspect of their pathological behaviour"
  • Study 1 Conclusions:
    • Rosenhan concluded that "It is clear that we cannot distinguish the sane from the insane".
    • Also that the failure to detect sanity may be due to the fact that the doctors were showing a strong type 2 error (the inclination to call a healthy person sick).
    • Having once been labelled schizophrenic, there is nothing the pseudopatients could do to overcome the label. This means that many of the normal behaviours were overlooked or misinterpreted.
    • Once in the mental health system, patients' normal behaviour was interpreted as symptoms of their disorder; shows the validity of the diagnosis was poor.
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Rosenhan (1973) - Findings & Conclusions

  • Study 2 Findings:
    • Out of 193 admitted patients, 23 were thought to be a pseudopatient.
    • 41 were judged to be pseudopatients by at least 1 staff member.
    • 19 were judged to be pseudopatients by a psychiatrist and a staff member.
  • Study 2 Conclusions:
    • Were the 23 patients really sane? Or had the staff made a type 2 error in order to avoid making a type 1 error (calling sick people healthy)?
    • "Any diagnostic process that lends itself so readily to massive errors of this sort cannot be a very reliable one".
  • Study 3 Findings:
    • The common response was brief, with no eye contact.
    • 4% of psychiatrists and 0.5% of nurses stopped and talked.
    • 2% of staff in a group stopped and chatted.
  • As a control, students at Stanford University asked 6 questions
  • All of the staff members stopped and talked, and also maintained eye contact.
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Rosenhan (1973) - Evaluating The Methodology

  • Field Study:
    • High ecological validity because the behaviour will be normal
    • Variables can't be controlled.
  • Reliability:
    • Other studies had similar results, which demonstrates conistency and therefore reliability.
    • A range of hospitals were used, so the findings can be generalised.
    • However, Andrews et al (1999) assessed 1500 people using ICD and DSM IV, and found only 35% agreement.
    • The study is ethnocentric - it was carried out in America, so the findings can't be generalised to other countries due to cultural differences.
  • Validity:
    • The pseudopatients were nervous. The staff could have noticed this unusual behaviour and kept them in for observation.
    • The participants were instructed to act "normally"; their ideas of "normal" could be subjective, leading to different behaviour.
    • High internal validity due to them being unaware of being in a study.
  • Ethical Issues:
    • Protection From Harm: The findings may have discouraged other people from actually seeking help.
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Rosenhan (1973) - Alternative Evidence

  • Slater (2004) - Supports:
    • All 9 psychiatric emergency rooms diagnosed her with psychotic depression.
    • She claimed that diagnoses are subjective and driven by the zeal to prescribe.
    • However, she had already been diagnosed with depression before the study.
  • Sarbin & Manusco (1980) - Contradicts:
    • DSM is more valid nowadays - it has been developed since 1973.
    • This means that Rosenhan's study is no longer valid.
  • Loring & Powell (1988) - Develops:
    • Patients are being diagnosed based on appearance rather than just their symptoms.
    • Gave 290 psychiatrists a transcript of a patient interview; half of the psychiatrists were told that the patient was black, the other half were told white.
    • Black patients were more likely to be seen as violent and dangerous.
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