Rosenhan 1973 - on being sane in insane places

Background
1. This study was done in the time of the anti-psychiatry movement which was launched in the 1960's by Foucalt, Szasz and Laing.
2. An attempt to show how bad diagnosis of mental health was
3. Cooper had found that psychiatrists in NY were 2x more likely to diagnose SZ than psychiatrists in London
4. The anti-psychiatrist movement questioned the validity of psychiatric diagnosis
Aim
1. Investigate whether it was the characteristics of the individual which lead to a diagnosis of mental illness or whether the context (psychiatric hospital) would have greater influence
Procedures
1. 8 confederates = pseudopatients. Took place in 5 different states, covering 12 psychiatric hospitals.
  1. Call for appointment --> Arrived and complained of hearing voices saying empty hollow and thud --> real life histories given but false names and occupations --> stopped pretending symptoms once on ward and recorded observations --> discharged when they convinced staff they were sane
2. to see whether tendency towards diagnosing sane as insane could be reversed
  1. Staff told every hospital would admit one or more pseudopatient in the next 3 months --> each new patient assessed on how likely they were a pseudopatient on a scale of 1-10 --> there were no psuedopatients
Findings
1. 100% wrongly admitted to ward
2. Average length of stay ranged from 7-52 days, averaging 19 days
3. 11 diagnosed with SZ and 1 with manic depression
4. No professional questioned their genuineness but patients did (are you a journalist)
5. Experience of hospitals unpleasant due to abuse, minimal privacy, depersonalisation and loss of power
6. Staff misinterpret normal behaviour
7. Ppts given 1200 meds - flushed down toilet and found other tablets there too
8. Professionals tended to keep away from patients, rarely made eye contact or conversation
9. Part 2 - Out of 193, 41 judged as pseudo. Of those 41, 19 suspected by 2 members of staff
Conclusions
1. There are many problems in the psychiatric diagnosis department
  1. Misdiagnoses are common
  2. Inadequate efforts to communicate with patients
  3. Rely on drugs
  4. Physical and verbal abuse
2. Psychiatric hospitals had very bad conditions
  1. Lacks privacy
  2. Leads to feelings of depersonalisation
3. DSM (pub. 1952) not working too well - many misunderstandings?
4. Type 2 errors are just as likely as type 1 errors (both found)
Evaluation
1. Generalisability
  1. Used range of hospitals from 5 states
  2. but this is only 10% of states in USA!
  3. Only 8 confederates - not many people to report back
2. Reliability
  1. Low inter-rater reliability - only one experimenter
  2. High consistency between 12 hospitals - not just a one-off
3. Application
  1. Nelly Bly found the same in the 1980s
  2. Shows what needs to be imroved
4. Validity
  1. Used DSM but now we have DSM V (outdated)
  2. Population validity high - tested USA which was aim
  3. Trauma = remembered wrong, exaggerated, observations depend on expectations
  4. Demand characteristics in part 2
  5. Historical validity (Nelly Bly)
  6. Ecological validity - real life institutes
  7. Not mundane realism - normally you wouldn't go into mental hospital
  8. Part 2 = overthinking - impact on judgement
5. Ethics
  1. Part 2 all ppts had no informed consent or right to withdraw, and deception was used
  2. Unethical for pseudopatients - could get PTSD etc

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Rosenhan 1973 - on being sane in insane places

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