ROSENHAN

• history of mental health:

  • symptoms have always been seen as abnormal or unusual
  • Madness seen as punishment from God
  • seen as a result of supernatural forces- often blamed witches
• 3 definitions of abnormality:

  • Abnormality as a behaviour which deviates from the statistical norm
  • Abnormality as behaviour which deviates from the social norm
  • Abnormality as failure to function adequately in society (maladaptiveness)
• Categorising mental disorders:

  • DSM contains revised diagnoses
  • reliability of categories was inc. by using precise definitions of each disorder
  • based on a multi-axial system- individual judged on 5 scales or axes
• Definition of powerlessness


  loss of authority or control an individual has to make their own legal or personal decisions.
• Definition of depersonalisation


  a loss of their sense of personhood
• Aim of exp 1:


  To investigate whether the sane can be reliably & accurately distinguished from the insane
• Sample of exp 1:

  • 8 pseudopatients over the age of 20
  • 3 female, 5 male
• Method of exp 1 pt1:

  • psuedopatient would arrive at a mental health hospital claiming they heard voices
  • patients had to be released by their own means
  • convincing staff they were sane
• Method of exp 1 pt2:

  • indicated to staff they were no longer experiencing symptoms
  • obeyed the rules & routines of the ward
  • pretended to take medication prescribed to them
  • participants would make notes of what happened
• IV: the 12 different hospitals used
• DV: admission of participants to hospital, diagnoses receieved and recording their experiences on the ward
• Results pt1:

  • successfully admitted
  • psuedopatients not detected by staff
  • all except 1 received a diagnosis of schizophrenia
  • length of stay ranged from 7 - 52 days
  • avg stay = 19 days
• Results pt2:

  • patients at hospitals raised suspicions about participants
  • hospital staff did not raise concerns about the participants
  • found a strong tendency to type 1 errors in diagnosis
• Stickiness of labels


  found behaviour of psuedopatients were always interpreted as part of their diagnosis.

  • pacing corridors from boredom - nurse asked if they were nervous
  • recording notes - described as 'engaging in writing behaviour' by nurses
  • waiting outside cafeteria before lunch - described as demonstrating the 'oral-acquisitive' nature of their condition
• Hospitalisation experience:


  overwhelmingly negative and unpleasant

  • staff avoided interactions with patients
  • 11.3% of attendants time was spent seeking attention from staff
  • experienced depersonalisation mostly from psychiatrists
  • better cooperation from less powerful staff & interns
• Powerlessness


  evident in each institution

  • inadequate personal privacy
  • lack of confidentiality = patients' case notes openly read by staff
  • personal hygiene and waste evacuation was monitored
  • toilets had no doors
• depersonalisation

  • staff engaged in physical abuse of patients
  • ceased in presence of other staff = credible witnesses
  • 2100 pills administered to psuedopatinets
  • patients disposed of their medication - not challenged by staff
• causes of depersonalisation

  • staff's attitude towards patients affected their treatment
  • formal hierarchical structure of hospitals
• Aim of exp 2: To investigate whether the sane can be accurately distinguished from the insane
• Sample:

  • psychiatric staff - briefed on findings of the main study
  • judgements made on 193 patients who were admitted for psychiatric treatment
• Design of exp 2:

  • staff informed that at some point of the 3 month period some psuedopatients would attempt to gain admission
  • staff asked to rate each patient on a 10 point scale
  • likelihood of them being a psuedopatinet
• Results of exp 2:

  • 41 patients were rated with high confidence of being a psuedopatient
  • no psuedopatients presented themselves to the hospital for admission during the study
  • gives evidence for the argument of lack of reliability in diagnosis
  • staff committed a type 2 error
• Conclusions:

  • psychiatrics are unable to reliably identify sane psuedopatients
  • psychiatrics fail to reliably detect insanity
  • within the 'insane' environment of the psychiatric hospital an individual's behaviour is perceived in a distorted manner, which can maintain a diagnostic label