Zusammenfassung der Ressource
Rosenhan (1973)
- ABOUT
- AIM
- Rosenhan wanted to test the reliability of mental health
diagnosis, to see if medical professionals could tell the
sane from the insane in a clinical setting.
- IV & DV
- This is an observation, not an
experiment, so there is no IV or DV.
- SAMPLE
- The participants were the staff and patients
in 12 psychiatric hospitals (mental asylums)
in the United States.
- METHOD
- Covert participant observation in a naturalistic setting
- PROCEDURE
- The pseudopatients went to clinical
interviews and reported their
symptoms.
- When they were admitted to a hospital,
they started behaving normally and
stopped reporting hearing voices.
- They took a notepad and pen along with them
to record what they heard and saw
(unstructured observation). They tried to do
this covertly, but if the staff detected them
they carried on recording things overtly.
- They secretly disposed of any
medication they were given (eg
they flushed pills down the
toilet)
- STRUCTURED OBSERVATION
- Rosenhan carried out two structured observations during the study:
- In 3 hospitals, a record was kept of how many
patients voiced suspicions about the
pseudopatients and how much time the staff
spent on the ward, interacting with the
patients
- In 4 hospitals, the
pseudopatient approached
staff with a scripted
questions and their replies
and body language were
recorded
- FOLLOW-ON STUDY
- After the main study ended, Rosenhan contacted his
own hospital and revealed the results. The hospital
agreed to a second study, but this time they would be
aware that new pseudopatients would be seeking
admission over the next 3 months.
- Staff were issued with a questionnaire
to rate each new patient on a 10-point
scale: 9-10 meant high confidence that
the patient was really ill but 1-2 meant
a strong suspicion that this was a
pseudopatient.
- RESULTS
- All 12 hospitals diagnosed the
pseudopatients as mentally ill.
- None of the staff recognised that the
pseudopatients were healthy. It took
between 7 and 52 days for the
pseudopatients to be discharged; the
mean length of stay was 19 days.
- What did the pseudo patients observe?
- They observed other patients being verbally or physically abused by staff.
- Patients refusing or disposing of medication
- Staff would not make eye contact with patients. Staff would discuss patients
within earshot, as if the patients could not hear them.
- Structures Observations
- Although staff were not suspicious of the pseudopatients,
other patients were. 35 out of 118 patients accused the
pseudopatients of not being genuinely ill.
- Rosenhan observes that the staff behaved as if mental illness
were "catching" (contagious).
- The staff spent most
of their time in a
secure area with
glass windows ("the
cage") and little
time on the ward.
- Follow-on study
- Rosenhan sent NO pseudopatients in the follow-on study,
so ALL the patients seeking admission were genuine.
- 41 were rated as pseudopatients by at least one member of staff
- EVALUATION
- GENERALISAILITY
- Rosenhan made a point of using a range of psychiatric
hospitals - private and state-run, old and new, well-funded and
under-funded - from across the United States.
- Nevertheless, 12 is a small sample
for a country as big as the USA
- RELIABILITY
- Rosenhan trained his pseudopatients beforehand, but they
didn't all follow the same standardised procedures.
- APPLICATION
- It caused psychiatric hospitals to review their admission procedures and
how they trained their staff to interact with patients.
- VALIDITY
- The fact that 11 of the 12 diagnoses were consistent -
schizophrenia - may prove diagnoses is reliable after all. If
patients present the same symptoms, they receive the
same diagnosis. This goes against Rosenhan's view that
diagnosis is unreliable.
- ETHICS
- The hospital staff were deceived about the
pseudopatients’ symptoms being real. The
doctors and nurses in the hospitals could not
consent to take part or exercise their right to
withdraw from the study.
- CONCLUSION
- It is clear that we cannot distinguish the sane from the insane in
psychiatric hospitals - David Rosenhan
- Rosenhan notes that
wealthier people are more
likely to get diagnosed with
milder problems that have
better therapeutic outcomes,
which shows that your class
background affects the way
you are diagnosed.