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.
- 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.
- 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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