ROSENHAN

• Background

  - In the 1960s the anti - psychiatry movement began where psychiatrists began to criticise the medical model

  
  

  -Beck 1962; DSM was poorly reliable and inconsistent and consistency of diagnosis was 54% in psychiatrists in 153 patients

  
  

  -The key question by Rosenhan was " Is the diagnosis of insanity based of characteristics of the patients themselves or the context in which patients are seen"

  ( kinda like the individual/ situational )
• Aim - study 1

  To investigate if sane people who present themselves at a psychiatric hospital would be diagnosed as insane
• Research method- Study 1

  -covert participant observation.

  -Rosenhan argued that it was a field experiment but cuz the study lacks a direct manipulation of the IV it is actually a covert participant observation.
• Sample - study 1

  - 12 psychiatric hospital ( private and state and new and old )

  - 8 pseudo patients ( confederate NOT participants )

  - 5 men 3 women
• Procedure study 1 - Getting admitted

  -Pseudo patients called hospitals for appointments and stated they had been hearing voices, unclear/unfamiliar, same sex and said works " empty, thud, hollow"

  - ( use of same sex leaves ambiguity as it could just be them talking to themselves in their head )

  - pseudo patient gave only false names and occupations
• Procedure study 1 - Admitted

  - they behaved normally once admitted

  - they'd only go up to staff x1 a day

  - they gathered data about experiences by writing in notebooks

  - in order to be released they had to convince them they were sane by being obedient,
• Results - Study 1

  -length of stays ranged from 7-52 days (avg of 19 days)

  -7/8 were diagnosed with schizophrenia = type one error (False positive)

  -pseudo-patients not recognized by staff, but 35/118 real patients voiced suspicions of their sanity

  - All discharged with " schizophrenia in remission"

  
  

  Stickiness of Label

  -stickiness of psycho-diagnostic label; simple behaviours misinterpreted such as e.g queuing up early for lunch due to boredom was seen as " Oral acquisitive nature of their syndrome "

  
  

  Depersonalisation and Powerlessness

  -staff avoided interaction with patients, doctoral staff even more & assumed notebooks as " excessive writing behaviour "

  -avoidance of patient's questions was high

  -powerlessness (no privacy, lack of confidentiality as anyone could walk in and read their patient history, examinations conducted in semi-public room) They were denied freedoms of movement and privacy

  -depersonalization (physical abuse, heavy reliance on psychotic drugs with no assurance that they are actually taken)
• Aim - Study 2

  To investigate whether genuine patients would be mis-identified as "sane" by various hospital staff
• Procedure - study 2

  -Staff at hospital doubted Rosenhans experiment

  -Rosenhan challenged this by sending down one or more pseudo patients in the next three months

  -Each staff was made to rate each patient on a 10 point scale on the likelihood of being a pseudo patient

  -none were actually sent down
• Results - study 2

  -staff incorrectly rated 41/193 new patients as pseudo patients

  - 23 by one psychiatrist

  - 19 by one psychiatrist + another staff member
• Conclusions

  Reliability and validity

  -psychiatrists are unable to reliably identify sane pseudo patients (type 1 error: false positive) = low validity diagnosis

  -psychiatrists fail to reliablty detect insanity (type 2 error: false negative)

  within 'insane' environment of hospital, individual's behaviour perceived in distorted manner

  
  

  Stickiness of labels

  -within that environment behaviour is perceived in a distorted manner
• Evaluation - ethics

  Ethics

  -Deception: deception occured however can be argued that hospitals had the power to not be deceived and were in fact being tested in their jobs

  -Harm: only took a few pills and they had lawyers to back up anything and help things out

  -Confidentiality: maintained
• Evaluation - usefulness

  - highlight the problems with psychiatric hospitals

  - also problems depersonalisation and powerlessness feeling with labelling

  - DSM 3 was improved become behaviour based

  - prevents misdiagnosis => could lead to discrimination

  - stickiness of labels CA: staff don't work on a basis that people are lying to them
• What are the consequences of a diagnostic procedure which lacks validity

  -stickiness of labels = lifelong situation

  -less job prospects

  -family life

  -individual rights
• Outline how mental hospitals failed to detect sanity in the research by Rosenhan

  (1973). [2]

  NB 'how' always means 'give some detail of procedure

  Plan:

  Briefly describe the procedure, ie how pseudo pts gained admission

  Note the relevant finding - all left with diagnosis remaining in place

  Explain how this shows they failed to detect sanity, eg if they realised then.....

  
  

  Example:

  -In Rosenhans study pseudo patients were admitted to mental hospitals as they called for appointments stating that they were hearing same sex voices in their heads saying words such as "empty, thud and hollow"

  -as a result of the mental hospitals failed to detect sanity as the pseudo patients were released from the hospitals with a diagnosis of schizophrenia in remission

  -this shows that the psychiatrists did not spot the patients were sane as if they realised they wouldn't have let the pseudo patients stay an average of 19 days and wouldn't have diagnosed them with schizophrenia in remission
• Explain WHY mental hospitals today would be more likely to detect such insanity [3]

  Plan:

  - In 1973 DSM 2 was in use, and only one symptom in isolation needed to diagnose

  - DSM 5 is now used: if only one symptom it needs to be very severe; clinicians also

  consider stress score and if person is failing to function adequately

  - therefore ....... [link back to Q]

  
  

  Example:

  -in the past DSM two was in use which only required one symptom in isolation to diagnose

  - however due to rise in hand study DSM-V is now used and it highlights the problem and behaviour based diagnosis has become more significant such as if only one symptom it needs to be very severe and multiple clinicians will rate the stress scores and determine if the person is failing to function adequately -therefore these factors will make it easier to detect such insanity
• Argent for Reliability in Rosenhans study

  -Rosenhan shoes consistency in the diagnosises of psychiatrist with 7 out of eight pseudo patients getting the same diagnosis of schizophrenia
• Argument for lack of reliability (from psychiatrists) in Rosenhans study

  In Rosens second study there was a lack of consistency between staff as 23 patients were considered suspect by one psychiatrist and 19 by one psychiatrist and another member of staff of staff
• The argument that Rosen hands research demonstrates the validity of diagnosis

  Referring to the Ketys "drinking a quart of blood" criticism highlights that patients do not lie to the psychiatrist. And that psychiatrist were right to admit a patient hearing voices with a diagnosis of schizophrenia because they don't work on a basis that patients try deceive/lie them