Classic Study : Rosenhan (1973)

• What was the aim of Rosenhan's study in 1973?

  To investigate clinicians' diagnosis accuracy
• What negative experiences did Rosenhan aim to gain insight into?

  Experiences of psychiatric institutions and diagnosis
• How many pseudopatients were involved in the study?

  8 pseudopatients
• What were the occupations of the pseudopatients?

  Psychologists, a paediatrician, and a painter
• How many psychiatric hospitals did the pseudopatients visit?

  12 different psychiatric hospitals
• In how many states were the hospitals located?

  5 different states
• What types of hospitals were included in the study?

  New, old, well-staffed, and understaffed
• What is a strength of the study's sample?

  Good generalisability due to varied hospitals
• What is a weakness of the study's sample?

  Ethnocentric; only conducted in America
• Why is the study's ethnocentrism a limitation?

  Diagnosis may differ across cultures
• What symptoms did the pseudopatients claim to have?

  Hearing an unfamiliar voice saying 'empty, hollow, thud'
• What did pseudopatients do immediately upon admission?

  Ceased eliciting symptoms and claimed to be 'fine'
• What was the aim of Rosenhan's study?

  To investigate the accuracy of clinicians' diagnosis and gain insight into the negative experiences of psychiatric institutions and diagnosis
• What was the sample of Rosenhan's study?

  8 pseudopatients: 5 males and 3 females with different occupations including psychologists, a paediatrician and a painter
• What was the strength of the sample in Rosenhan's study?

  Good generalisability, the sample of hospitals was varied and large which makes it representative of these facilities and the wider population
• What symptoms did the pseudopatients claim to experience?

  They claimed to hear an unfamiliar, same sex voice saying 'empty "hollow and thud"
• What did the pseudopatients do upon admission?

  They immediately ceased eliciting symptoms and responded to staff that they were 'fine' and no longer experienced symptoms
• What was a strength of the procedure in Rosenhan's study?

  Standardised procedures were followed, all participants claimed to hear the same three words and stopped all 'symptoms' immediately upon admission
• What was a strength of the field study and covert observation in Rosenhan's study?

  It reduced the chance of unnatural behaviour caused by demand characteristics, and the pseudopatients experienced levels of depersonalisation typical of real patients
• What was the average length of stay for the pseudopatients?

  19 days
• How did the hospital staff respond to the pseudopatients' normal behaviour?

  They tended to suggest that normal behaviours were a sign of their 'mental condition'
• What does Asch's statement about central personality colouring the formation of impressions suggest about the staff's diagnosis of the pseudopatients?

  Once a person is designated abnormal, other behaviours are tainted by this label, which is why the pseudopatients' normal behaviour was entirely overlooked
• What was the main diagnosis given to the pseudopatients?

  Schizophrenia in remission
• What was a strength of the results in terms of the reliability of the DSM?

  The consistent diagnosis of schizophrenia in remission across different mental health professionals in different parts of America suggests the DSM is reliable
• What were the consequences of the findings on the reform of the DSM and training for psychiatric care?

  The findings led to the reformation of the DSM and significantly improved training for professionals in order to change hospital environments and improve the validity of diagnoses
• What were the key details of the sample in Rosenhan's study?

  • 8 pseudopatients: 5 males and 3 females
  • Different occupations including psychologists, a paediatrician and a painter
  • Sent to 12 different psychiatric hospitals in 5 different states on the East and West coasts of the US
  • Hospitals varied in age, staffing levels, and included a private institution
• What were the strengths and weaknesses of the sample in Rosenhan's study?

  Strengths:

  • Good generalisability, the sample of hospitals was varied and large
  • Findings can be used to represent a range of mental institutions

  
  

  Weaknesses:

  • Study only took place in America, so findings may not apply to other cultures/countries
  • Diagnosis may differ due to cultural differences, lowering generalisability
• What were the key details of the procedure in Rosenhan's study?

  • Pseudopatients claimed to hear an unfamiliar, same sex voice saying 'empty "hollow and thud"
  • Used pseudonyms but their history remained true
  • Immediately ceased eliciting symptoms upon admission, responding that they were 'fine'
  • Made private notes about staff/patient observations, which became overt
• What were the strengths and weaknesses of the procedure in Rosenhan's study?

  Strengths:

  • Standardised procedures were followed, making the study replicable
  • Covert observation reduced unnatural behaviour from demand characteristics

  
  

  Weaknesses:

  • Lacked reliability as some pseudopatients did not follow standardised procedures
  • Ethical issues with deceiving staff and using participants' distressing experiences
• What were the key results of Rosenhan's study?

  • Average length of stay for pseudopatients was 19 days
  • Nurse reports described them as 'co-operative, friendly and exhibited no abnormal indications'
  • Despite their sanity, they were diagnosed with schizophrenia in remission (except 1 with psychotic depression)
  • Staff tended to interpret normal behaviours as signs of mental illness
• What were the implications of Rosenhan's findings for the reliability and validity of psychiatric diagnosis?

  • Suggested the DSM is reliable, as diagnoses were consistent across professionals
  • Highlighted the DSM is not valid, as pseudopatients were diagnosed with mental disorders despite being sane
  • Led to reforms of the DSM and improved training for psychiatric professionals to enhance validity of diagnoses
• What was the total number of pills administered to the pseudopatients?

  2100
• How many of the 2100 pills administered were accidentally swallowed by the pseudopatients?

  2
• What were the ethical issues with the pseudopatients' experiences in Rosenhan's study?

  They found the study distressing, and it took important resources away from real patients which could be damaging to their progress/recovery
• What percentage of the total patients on the ward correctly identified the pseudopatients as not being genuinely mentally ill?

  35/118 = 29.7%
• What did the 35 patients who correctly identified the pseudopatients say?

  'you're not crazy, you're a journalist or professor, you're checking up on the hospital'
• What does the fact that 35/118 patients correctly identified the pseudopatients suggest about clinicians' bias?

  It conveys how clinicians operate with a strong bias towards a type 1 error (false positive)