Rosenhan's Study

to see if psychiatric diagnosis is accurate, reliable and affected by bias. also to investigate what life is like inside a psychiatric hospital.

DOCTORS AND NURSES who worked in 12 hospitals across 5 states. A range of hospitals were used: old, new, understaffed, lots of staff. 

the sample is not the pseudo patients.

• 8 pseudo patients (confederates) - 3 women and 5 men with no history of mental health
• ppts telephoned one of the 12 hospitals for an appointment and arrived at the admissions office complaining they had been hearing voices say "empty" "hollow" "thud".
• they gave a false name and job but all other details were true
• all were admitted with a diagnosis of schizophrenia except one who received manic depression
• once admitted, they stopped producing symptoms and behaved how they normally would
• they spent their time making notes about life inside the hospital and trying to convince staff of their sanity

• none of the patients were detected and were discharged with a diagnosis of being in remission. on average remained in hospital for 19 days 
• many real patients suspected the pseudo patients sanity
• patients were treated by staff in a way that was consistent with their diagnosis
• depersonalisation by staff was an issue as patients were ignored 71% of the time, eye contact was made only 23% of the time with a verbal response in 2% of cases.
• 0/185 questions were answered by staff
• 2/2000 tablets administered were taken showing lack of supervision

• a leading institution agreed to do a similar study as they thought it would be unlikely that they could be fooled.
• staff were asked to rate on a 10 point scale the probability that each patient could be a pseudo patient.
• over a 3-month period, 193 patients were assessed and 41 were judged to be false by at least 1 member of staff and 19 by at least 2.
• no pseudo patients were sent to hospital.

• Rosenhan concluded that diagnostic processes like DSM lead to inaccurate outcomes making the system less valid as they demonstrate a failure to detect sane patients.
• behaviour displayed after a patient has been labelled with a mental disorder is then interpreted in a way that is consistent with their diagnosis as the perception of the person has altered.
• this could lead to a self-fulfilling prophecy in that people respond to how they are treated and so the diagnosis becomes confirmed as they display behaviour that fits the label.
• hospitals are more likely to make type 2 errors saying that there is no disorder when there is when they are being watched as they are more cautious with their diagnosis but make more type 1 errors in everyday diagnoses as it easier to admit a patient than to send them away.