Rosenhan Being Sane in Insane Places

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  • Created by: Kathryn
  • Created on: 15-04-14 16:10

Context and Aims

Abnormal Behavior - behavior that's considered to go against social norms

The medical model - Believes mental disorders are a result of physiological factors, are a physical disease. 

Foucalt - Argued that sanity and insanity are social consturcts, are not real but made up by society. 

Szasz - Suggested that medical model is no more useful than believe in demonology. Unhelpful, way of excluding the non-conformists 

Laing - Believed schizophrenia cant be determined by set of symptoms but rather by individual experience

 

Aim - To investigate whether psychologists could distinguish between those who are mentally ill and those who arent.

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Procedure Study 1

Psuedo patients 

5 men and 3 women including Rosenhan himself. They attempted to get admission to 12 different hospitals in 5 different states in USA. 

Admission

Each P called the hospital, telling them they had been hearing voices saying the words 'empty','hollow' and 'thud'. Beyond this, P's described life events as accurately as possible. None had history of pathological behavior. 

In Hospital

psuedopatients behaved normally, allowed some nervous tention about being found out. Made notes on observations. Apart from secretely not taking medicine, psuedopatients folloed the wards routine. 

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Procedure Study 2+3

Study 2

A hospital that had not received pseudo patients first time round challenged Rosenhan that it would not happen to their hospital. He informed the hospital over the next 3 months he would send one or more pseudo patients to try and gain access to the hospital. 

Staff were asked to rate patients depending on how confident they were actually ill (1 low confidence 10 high). 193 patients were judged during study. 

Study 3

Approac staff members and ask following questions -'Pardon me Mr/Mrs/Dr x, could you tell me wen i'm elligible for my ground privledges?' or 'when will i be presented at staff meeting?' or 'when am i likely to be discharged. 

This was a mini study to see how staff responded to the psuedo patients. 

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Findings Study 1

Study 1 

All psuedo patients were admitted to hospital, 1 diagnosed as schizophrenic. All discharged with diagnosis of scizophrenia 'in remission'

Length of hospitalisation varied from 7 -52 days, with an average of 19 days 

Staff spent 11.3% of time at work outside office. Most of this was spent doing chores.     They emerged from offices 11.5 times per shift.                                                           Psychiatrists and physicians were seen on the ward on average 6.7 times a day. They had an average of 6.8 minutes contact between patients. 

35 of 118 real patients made statements such as 'you're not crazy' or 'you're a journalist'.

During the reserch psuedopatients were given a total of 2,100 tablets. 

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Findings Studies 2 + 3

Study 2

Over 3 Months - 193 patients were admitted for treatment at hospital, none of which were psuedo patients. 

- 45 were judged to be psuedopatients by at least 1 staff member.                                 - 23 were suspected of being psuedopatients by at least 1 of the psychiatrists                -19 were suspected of being psuedo patient by psychiatrist and one other staff member

Study 3 

Common response was a brief answer, staff walked past without stopping.                      - 4% of psychiatrists and 0.5% of nurses stopped, 2% in each group paused and chatted  - As a control a young women asked staff members and Stanford Univesity six questions, all staff members stopped and gave answers and eye contact. 

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Conclusions

Type 1 and Type 2 Errors - physicians were more inclined to call healthy people sick (type 1 false positive) that sick people healthy (false negative type 2). Is much more dangerous to misdiagnose or even false diagnoserather than sit on the line between side of causion. 

Labels - Label sticks even though it doesnt fully describe the person. E.g patients were released as 'schizophrenia in remission', explaining that they are schizophrenic but still sane

Powerless and Depersonalising - Felt depersonalised as contact was avoided. Staff treated patients with little respect; incidents of pushing and beating patients.                    Personal privacy was reduced (no doors on toilets) and anyone could read patients files. Use of psychotic drugs gave staff a false belief patients were getting better so no need for contact. 

Rosenhan believes we prefer to invent knowledge rather than admitting 'we dont know'

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Evaluation (Method, Ethics and Reliability)

Method                                                                                                                                 NATURALISTIC OBSERVATION                                                                                          + Covert observations allowed for other patients to behave normally. Staff could not find out true aims                                                                                                                         - Psudopatients may not have been able to observe everything 

Ethics                                                                                                                                   - Did not know they were being observed as staff didnt give consent                                     - Hospital had to spend money and time on psuedopatients treatment, waste of money and taking it away from those who need it 

Reliablity                                                                                                                              - Psuedopatients in charge of own observations, could lead to observer bias, may not write down eveything experienced to support Rosenhans hypothesis                                             + Reliability could be increased by sending another load of psuedopatients and getting them to note down their experience to compare and contrast with observations from first group

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Evaluation (Validity and Sample)

Validity                                                                                                                                 + In 5 different states and had other differences so data is not restricted to one source       - Not that realistic as psychiatrists aren't normally faced with healthy people                        - Cant be generalised to whole population as it was only done in America 

Sample                                                                                                                                 + Reasonably representative sample as variety of different hospitals                                    - Culture bias, psychiatrists that diagnose them only from america 

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Alternative Evidence

Spitzer (76)                                                                                                                           Suggested Rosenhans findings are not valid; psychiatrists are not usually going to be diagnosisng people who have lied about symptoms. Said that it is the same with physical illness, hospital would diagnose them even if symptoms are a lie.                                      Kety supports Spitzer by giving example if he were to drink blood then went to hopsital puking blood he would be diagnosed of having peptic ulcer.                                               This CONTRADICTS as doctors will have diagnosed correctly even if they were a lie. 

Spitzer et al (75)                                                                                                                  Asked 74 emergency room psychiatrists what diagnosis and treatment they would give to the case description (hearing thud).                                                                                     Found only 3 psychiatrists gave diagnosis of psychotic depression and only a third suggested medication.                                                                                                         CONTRADICTS as shows psychiatrists dont over subscribe medication. Suggests Rosenhans study may bey un representatitve of all hospitals of USA

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Alternative Evidence

Sarbin and Mancuso                                                                                                           Notes that psychiatrists using DSM III (3) (published in 1980) would not diagnose Rosenhans psuedo patients with SZ since hullucinations must occur on more than one occasion where as Rosenhans patients only reported one occurance. 

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