Rosenhan Aims and Context
Individual differences- aims of research to establish the level of variability between individuals.
- since the 1800s the USA encountered Drapetomania sleaves striving for freedom but their slavers refered to this as a mental illness.
- since the 30s, medical practices such as ECT, cutting parts of the brain, the introduction to drugs etc- Bedlam(chaos) is a term derivered from bethlehem hospital. Trepanning to release demons if schiz symtoms displayed hallucinations delusions paranoia.
- Statistics manual such as ICD(international classification of diseases) and DSM(diagnostic statistics manual-US) have been developed to diagnose mental illness but they suffer from reliability(not all psychiatrists diagnose the same) and validity(psychiatrists can be misled by symptoms) issues.
- this led to the anti-psychiatry movement. Szasz argues that mental illness is a incoherent combination of medical and psychological concept- "myth"
- Foucault argued that sanity and insanity were social constructs highlighting the power of the sane.
- Rosenhan thus claimed that catorgorisation of mental illness is useless at best and harmful and misleading.
- Rosenhan aimed to investigate if psychiatrists could distinguish the sane from the insane. He aimed to find out if the characteristics reside in the patients or the environment.
- Aim to investigate the question of whether the sane can be distinguished from the insane using observation.
- 8 sane pseudo(fake) patients - 5 men and 3 women
- Gained admission to 12 different hospitals(participants) in 5 different states in the US and employed pseudonyms.
- following admission to hospital, no further symptoms were acted out and they acted as normal.
- Each was told that they would have to get out by convincing the staff that were sane.
- The pseudo patients called the hospital for an appointment, saying that they heard voices of the same sex saying things such as empty, hollow and thud. (common features)
- The pseudo patients talked to other patients and made notes on (naturalistic) observation of staff discreetly and then openly obtaining both qualitative and quantative data.
- The patients behaved as normal as possible so the conclusion must be the diagnosis results from the environment.
- A follow up study was conducted where Rosenhan was asked to send more patients to another institution.
Rosenhan Findings and Conclusions
- Quantative - pseudo patients exhibited signs of nerves, anxiety and stress with 7 patients desiring discharge immediately.
- Quantitative - the pseudo patients were never detected. Admited, except in one case, with a diagnosis of schizophrenia.
- Quantative- Each discharged with a diagnosis of schizophrenia in remission. Length of stay ranged from 7-52 days an average of 19 days with 6.8 minutes of contact of psychiatrist.
- Qualitative- daily visitors could detect no behavioural consequences nor could real patients who regularly voiced suspicions such as youre not crazy and youre a journalist.
- 2100 tablets given including clompazine.
- Rosenhan concluded that a type 2 error was being made (calling a healthy person sick)
- label of schiz led to classification of behaviour being as such so every behaviour was seen as a schizophrenic thereafter.
- Follow up study found 41/193 to be classified as fake - Rosenhan didn't send any imposters- type 1 error- calling sick people healthy.
- Rosenhan clearly suggested that we can't distinguish the sane from the insane in psychiatric hospitals.
- The study was valid in that it measured what it was supposed to and nurses behaved naturally and real institutions used.
- The study was a naturalistic observation = eco validity, first hand report
- Ethical problems of deception(hospital unaware), consent, stress and discomfort(stressful for confederates)
- There are problems with generalising from 8 pseudo patients to genuine patients. Spitzer argues that they are completely different.
- reliability and validity(of the psychiatrists) issues are repeat experiment conducted where 193 patients were admited but 41 were claimed to be imposters- they were imposters.
M+ Naturalistic observation, high eco validity, first hand research. - observer bias -extraneous variables -doctors were under pressure to diagnose what is infront of them
R+ second study shows that the research is reliable as both found errors being made.
V+ it does show that clinicians do diagnose accurately with the symptoms given to them. why would they assume someone was lying? - However it illustrates how easily clinicians can get it wrong.
S- small number of hospitals however was done in different states, also realife institutions used.
Rosenhan Alternative Research
- Slater 2004- Attempted to replicate rosenhans study. She visited different hospitals where she explained typical symtoms of a mental patient, most institutions diagnosed her with an illness. Its more valid as its a recent study and psychiatrists are more aware of pseudos however it also lacks validity as she was previously diasnosed with a mental illness in the past. Both clearly show that Psychiatrists diagnose simply on verbal symtoms.
- Spitzer- He gave 74 psychiatrists a case description and then they had to answer questions regarding diagnosis and treatment. He only used case histories so this lacks ecological validity as in real life the patients are seen to. Only 3 offered a diagnosis of psychotic depression and only one third offered medication. Doesn't add reliability as the doctors were willing to refuse.
- Sabin and Mancuso- notes that DSM is updated now and claims that people wouldn't be diagnosed as easily now as they would have been then, this shows ecological validity as its carried out in usualo practices. No ethical issues etc as its only a review.
- CONCLUDES- It can be seen that diagnosis of particular symptoms is accurate i.e. confederates went in with schiz symptoms and got diagnosed BUT it does show them and the system can be easily manipulated HOWEVER a psychiatrist wouldn't expect a patient to lie about having an illness.