WJEC AS Psychology PY2 - Rosenhan (1973)

Definitions:

• medical model of abnormality: abnormal behaviour stems from physiological causes; mental illness is diagnosed in the same way that physical symptoms are diagnosed, doctor identifies set of symptoms in the patient and uses them to identify the disorder; using DSM
• abnormality: behaviour/characteristics deviating from social norms

Importance: psychiatrists such as Michel Foucault, Ronnie Laing and Thomas Szasz launched an 'anti-psychiatry' movement as they believed that some people were wrongfully being institutionalised; abnormality could just be a social construction opposed to objective classification e.g. homosexuality

Previous Research:

• Foucault (1961) described development of mental illness similar to the 17th and 18th centuries where 'unreasonable' members of population were locked away, institutionalised and treated in inhumane ways eg freezing showers/straight-jackets; Foucault argued that concepts of sanity + insanity were social constructs ie not real but constructions made by society

Previous Research continued:

• Laing (1960) argued that schizophrenia is best understood in terms of individual's experience rather than a set of symptoms
• Szasz (1960) argued that the medical model is no more sophisticated than believing in demonology; it is suggested that mental illness is simply a way of excluding non-conformists from society

Aims:

1) aimed to investigate whether psychiatrists could distinguish between people who are genuinely mentally ill and those who are not; if someone is labelled sane, they can be distinguished from insane context; if not, suggests that it is the context rather than the individual's characteristics ie psychiatric diagnosis of insanity is less to do with patient but more to do with environment they are found in

STUDY 1 - gaining access and being in a mental hospital:

PSEUDOPATIENTS

• 5 men and 3 women including Rosenhan
• occupations: graduate student, psychology, psychiatrist, housewife, painter, paediatrician
• attempted to gain admission to 12 different hospitals in 5 different states in USA; hospitals represented range of different kinds of psychiatric institutions: modern/old, well/poorly staffed

GAINING ADMISSION TO HOSPITAL

• each pseudopatient called a hospital, asked for an appointment, on arrival, told admissions officer 3 FALSE pieces of info: name, occupation, and that they were hearing voices such as 'empty', 'hollow' and 'thud' - symptoms deliberately chosen because of similarity to existential (meaningless of life) symptoms
• besides description of auditory hallucinations, everything said about life events was TRUE, and none had an history of pathological behaviour

LIFE IN HOSPITAL

• participants: mental hospital nurses and staff
• research method: observation (covert, naturalistic)
• in hospital, patients instructed to act normally once they were admitted to psychiatric ward, other than some nervousness and tension about being found out, pseudopatients behaved normally
• spent time talking to other patients
• made notes on observations of life on wards, initially secretly but soon apparent staff didn't care
• pseudopatients secretly didn't take medication, otherwise followed routine
• reports from nurses show patients friendly, co-operative + exhibited no abnormal indicators
• pseudopatients didn't know when they would be discharged as 1 condition was to get out by own devices

STUDY 2: after results of research publicised, staff of another hospital(that hadn't received any pseudopatients) challenged Rosenhan claiming it could not happen in their hospital; Rosenhan informed that in next 3 months, 1+ pseudopatients would present themselves; staff asked to rate on a 10 point scale their confidence level that the person was genuinely ill (1 being high confidence of pseudopatient) Judgements obtained on 193 patients admitted over the 3 months

STUDY 3: Rosenhan also included mini study of way staff responded to pseudopatients; in 4 hospitals, pseudopatients approached staff member with the following question:

"Pardon me ___, could you tell me when I will be eligible for grounds privileges?"

Pseudopatients did this as normally as possible, avoiding asking any particular person more than once a day

Results from Experiment:

STUDY 1 

• all pseudopatients admitted and all but one diagnosed as schizophrenic; each eventually diagnosed with schizophrenia 'in remission': length of hospitalisation varied from 7 - 52 days, with an average of 19 days
• very limited contact between staff + patients observed in study: average amount of time attendants spent out of 'cage' was 11.3% of their total time at work, much was spent on chores rather than patients
• average daily contact with psychiatrist: 6.8 minutes a day (based on 6 patients over 129 days of hospitalisation)
• 'real' patients at hospital voiced suspicions, 35/118 patients made statements like 'you're not crazy' or 'you're a journalist'
• during research, pseudopatients given 2100 tablets, including Elavic, Stelazine + Compazine
• nursing records for 3 pseudopatients: writing seen as aspect of abnormal behaviour: "patient engages in writing behaviour"

Conclusions from Experiment:

• Rosenhan concluded cannot distinguish between sane and insane in psychiatric hospitals; hospital imposes special environment which the meaning of behaviour can be easily misunderstood; consequences of patients hospitalised in such an environment can be: powerlessness, depersonalisation, segregation, mortification and self-labelling = undoubtedly counter-therapeutic
• failure to detect sanity during course of hospitalisation may be due to doctors showing TYPE 2 error: more inclined to call a HEALTHY person = SICK; TYPE 1 error: more inclined to call a SICK person = HEALTHY
• once labelled schizophrenic, nothing the pseudopatients could do to overcome label: once person is designated abnormal, all other behaviours are coloured by label; label is so powerful that many normal behaviours overlooked completely or misinterpreted

Results from Experiment:

STUDY 2 = over 3 months, 193 patients admitted for treatment; none were actually pseudopatients:

• 41 judged to be pseudopatients by at least 1 staff member
• 23 suspected to be pseudopatients by at least 1 psychiatrist
• 19 suspected to be pseudopatients by psychiatrist and at least 1 staff member

STUDY 3 = most common response was a brief reply as member of staff continued walking past without pausing or making eye contact

• 4% of psychiatrists stopped, 0.5% of nurses
• 2% in each group stopped and chatted

Conclusions from Experiment:

• STUDY 2: resulted in avoiding Type 2 error, staff made Type 1 error, proving they cannot distinguish between sane and insane
• STUDY 3: shows how patients depersonalised through avoided contact; patients depersonalised also by: punishment, lack of privacy and use of drugs as form of treatment

STRENGTHS

• study: covert, naturalistic, participant observation study; important as it ensured doctors, nurses and patients behaved naturally, no demand characteristics
• good range of quantitative + qualitative data collected: quantitative: important numbers (how many patients etc) and qualitative: useful info on kinds of things doctors and nurses said about and to pseudopatients
• care taken to ensure hospitals were representative of range available to public, ranged in terms of budget, size, location in US; suggests representative sample of doctors of nurses = high level of population validity for USA achieved

WEAKNESSES

• ethics: no informed consent from staff (pps)and pseudopatients deliberately set out to deceive pps
• lack mundane realism: task of identifying fake patients in hospital settings is entirely different to assessing fake patients in a courtroom
• lack internal reliability as pseudopatients all different, would behave/react in different ways = inconsistent, they recorded data = could lack interobserver reliability  

1. Lauren Slater (2004) SUPPORTS

• single, unsystematic study, presented herself at 9 hospitals with a single auditory hallucination (word: thud) as Rosenhan's pseudopatients had done, also previously diagnosed with clinical depression
• wasn't admitted to any hospitals but given prescriptions for drugs and psychotic depression diagnosis

Research may not support Rosenhan's conclusions as Slater not admitted to any hospitals but does SUPPORT in a way as Slater offered treatment = drugs 2004 equivalent of hospitalisation in 1973?

2. Spitzer (1976) CONTRADICTS

• investigated individuals admitted with schizophrenia in his own and 12 other hospitals (US), found discharge dia. 'schizophrenia in remission' given rarely
• unusual diagnosis reflects unusual pseudopatient symptoms

CONTRADICTS Rosenhan as Spitzer concluded the pseudopatient's discharge diagnosis due to patients' behaviour, not setting in which diagnoses made

3. Langwieler and Linden (1993) SUPPORTS/DEVELOPS

• sent a trained pseudopatient to 4 physicians each with different professional background
• diagnosticions proposed 4 different diagnoses and 4 different treatments even though pseudopatients symptoms were the same

SUPPORTS Rosenhan's research, and DEVELOPS by suggesting today the situation symptoms are found in can be still be more important than symptoms for a diagnosis, important situational factors: occupation/class

4. Sarbin + Mancuso (1980)

• claimed that a psychiatrist using DSM III would not diagnose Rosenhan's pseudopatients with schizophrenia, since 'hallucinations' must be repeated on several occasions, whereas Rosenhan's pseudopatients only report one occurrence

Suggests Rosenhan had an impact on psychiatric movement, and changed the process of diagnosis