Rosenhan (1973)

Rosenhan (1973)

ABOUT
1. AIM
  1. 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.
2. IV & DV
  1. This is an observation, not an experiment, so there is no IV or DV.
3. SAMPLE
  1. The participants were the staff and patients in 12 psychiatric hospitals (mental asylums) in the United States.
4. METHOD
  1. Covert participant observation in a naturalistic setting
PROCEDURE
1. The pseudopatients went to clinical interviews and reported their symptoms.
2. When they were admitted to a hospital, they started behaving normally and stopped reporting hearing voices.
  1. 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.
3. They secretly disposed of any medication they were given (eg they flushed pills down the toilet)
4. STRUCTURED OBSERVATION
  1. Rosenhan carried out two structured observations during the study:
    1. 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
    2. In 4 hospitals, the pseudopatient approached staff with a scripted questions and their replies and body language were recorded
5. FOLLOW-ON STUDY
  1. 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.
  2. 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
1. All 12 hospitals diagnosed the pseudopatients as mentally ill.
  1. 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.
2. What did the pseudo patients observe?
  1. They observed other patients being verbally or physically abused by staff.
  2. Patients refusing or disposing of medication
  3. Staff would not make eye contact with patients. Staff would discuss patients within earshot, as if the patients could not hear them.
3. Structures Observations
  1. Although staff were not suspicious of the pseudopatients, other patients were. 35 out of 118 patients accused the pseudopatients of not being genuinely ill.
  2. Rosenhan observes that the staff behaved as if mental illness were "catching" (contagious).
    1. The staff spent most of their time in a secure area with glass windows ("the cage") and little time on the ward.
4. Follow-on study
  1. Rosenhan sent NO pseudopatients in the follow-on study, so ALL the patients seeking admission were genuine.
    1. 41 were rated as pseudopatients by at least one member of staff
EVALUATION
1. GENERALISAILITY
  1. 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.
  2. Nevertheless, 12 is a small sample for a country as big as the USA
2. RELIABILITY
  1. Rosenhan trained his pseudopatients beforehand, but they didn't all follow the same standardised procedures.
3. APPLICATION
  1. It caused psychiatric hospitals to review their admission procedures and how they trained their staff to interact with patients.
4. VALIDITY
  1. 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.
5. ETHICS
  1. 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
1. It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals - David Rosenhan
2. 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.

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	Created by Molly Burns over 6 years ago