ROSENHAN OVERVIEW

AIMS

aimed to investigate whether psychiatrists could distinguish between people who are generally  mentally ill and those who are not, he also aimed to see whether situation or personaility determines a diagnosis.
he argues is pseudopatients were diagnosed as sane this would show that the sane individual can be distinguished from the insane context- but if the pseudopatients were diagnosed as insane then it is the context rather than the individuals characteristics 

CONTEXT

• anti-psychiatric movement became popular in the 1960s
• Foucalt(1961) argued that the concepts of sanity were social constructs (not real)
• Laing(1960) argued schizophrenia was best understood in someones experience not symptons
• Szasz(1960) medical model is more sophisticated-mental illness excluded no conformists
• what is seen as normal in one culture is not normal in another
• diagnosis can be over someones opinion, people have opposing views
• rosenahn was interested in the legal implications of understanding sanity (in court)

STUDY 1

• pseudopatients- 5 men and 3 women with various occupations
• psychiatric hospitals- 12 different hospitals in 5 states of usa
• said they had been hearing voices (empty hollow thud) non had had any history of abnormality
• the pseudopatients were intructed to behave normal once admitted, spent time talking to patients and making notes. secretly didnt take mediation

STUDY 2

• one hospital was suprosed and refused to believe it happened in their hospital
• Rosenhan informed them some pseudopatients would arrive in the next 3 months
• staff asked to rate out of 10 how confident they were on diagnosing patient
• 193 genuine patients and 0 pseudopatients were admitted

STUDY 3

• rosenhan tested how staff responded to pseudopatients, pseudopatients approached staff and asked a question 

• 1  all pseudopatients were admitted, one was diagnosed with schizophenia
• hospitalisation lasted 7-52 days with an average of 19 days
• staff only spent 11% of time out of their quaters and that was for chores
• on average, psychiatrists appeared on ward 6.7 times a day and daily contact 6.8 mins per day
• real patients regularly voiced their suspicions about the pseudopatients
• nurses judged normal behaviour lie walking or writing as abnormal
• pseudopatoints were given 2100 tablets

• 2  over the 3 months 193 pateints were admitted but non were pseudopatients.
• at least one staff member judged 41 (21%) to be pseudo
• at least one psychaitrist judged 23 (12%) to be pseudo

• 3  staff mainly gave a breif reply and continued walking without making eye contact
• 4% of psychiatrists and 0.5% nurses actually stopped
• 2% in each group paused and chatted
• as a control a young lady approached staff members and all stopped and answered questions keeping eye contact.

• TYPE 1 AND 2 ERRORS
  • TYPE 1 -person is sick but diagnosed as healthy
  • TYPE 2 -person is healthy but diagnosed as sick
  • in study 1, psychiatrists were biased towards TYPE 2 - more dangerous to misdiagnose
  • in study 3 the hopsital made more TYPE 1 errors, avoiding making type 2 errors like study1
• PSYCHODIAGNOSTIC LABELS
  • ASCH(1964) found personality trauts 'warm and cold' affected perception of person
  • once someones labelled as abnormal all data interpreted in that light 'schizophrenia in remisson' still ill but temporarily sane
• POWELESS AND DEPERSONALISATION
  • behaviour of staff in study 3 showed  patients were depersonalised because contact was avoided, lack of personal privacy, lack of respect from staff, use of psychotropic drugs
  • Rosenhan- we prefer to invent knowledge rather than admit we dont know. 
• REAL LIFE APPLICATION
  • we cannot distinguish the sane from the insane, we could;
    • use community health facilities to avois effects of institutional setting
    • use behavior therapies which avoid psychiatric labels
    • increase sensitivity of mental health workers

• DESIGN- naturalistic observation
  • means there was no demand characteristics by any of the particpants
  • ethical issues
  • ecological valid
• ETHICS- deception
  • didnt inform the staff they were being observed
  • soctors proffession questioned more likely to make type 1 errors
  • informed consent
• RELIABILTY- support
  • two studys conducted in two different ways- cant be compared
  • study 1; 12 hospitals  study 2; 1 hospital
• VALIDITY- low
  • doctors werent used too the situation - not real
  • different hopsital increase validity as it gives a range 
  • slater found psychiatrists diagnosed mental illness based on one sympton of hallucination - confirming rosnhans findings (external validity)
• SAMPLE- nurses and doctors
  • deception, uninformed consent, confedentiallity

SLATER (2004) presented herself to 9 psyciatric emergency rooms with auditory hallucinations 'thud' in most cases she was diagnosed with psychotic depression and was prescribed with antipsychotics or antidepressants.

SPITZER (2005) gave 74 emergency room psychiatrists a detailed case description of Slater's clinical depression- only 3 psychiatrists offered diagnosis of depression, only 1/3 gave medication

KETY (1974) same thing could happen with physical illness, if you vomited blood (which you had just drunk) you would be diagnosed with having a peptic ulser

SPITZER (1976) discharge diagnosis of schiz in remission is hardly used

DSM strictor criteria now after a lot of research into reliability, now have to agree on diagnosis

WHALEY (2001) lower inter-rater reliability

LANGWEILER AND LINDEN (1993) 4 pateints went with same symptons and came back with different diagnosis and treatments

STRENGHTS

• experimentl design- natural setting
• high ecological validity
• reliable - supporting studies
• no demand charcteristics
• range of hospitals

WEAKNESSES

• small sample
• unethical
• only american hospitals
• internal validity- bad acting