Key Research - Rosenhan

• What was the background?

  • Rosenhan observed that the prosecution and defence in murder trials each called their own psychiatrists who often disagreed on the defendants sanity
  • Led to Rosenhan wondering whether there is a way to reliably identify who is insane
  • Rosenhan was criticising the medical model
• What were the aims?

  • To see whether diagnosis is based on characteristics of patient or the context of patient

  Study 1 - To see if “sane” people presenting with a disorder would be diagnosed as insane by staff at psychiatric hospitals

  Study 2 - To see if psychiatrists and other mental health workers would be undercautious rather than overcautious because they had been told about mistaken diagnosis in study 1

  Mini exp - To see if staff behaved differently towards patients compared with a non patient who was asking similar questions
• What is the method?

  Study 1 - Covert participant observation

  Study 2 - Questionnaire

  Mini experiment - Self report
• What was the procedure of study 1?

  • Pseudo patients made an appointment at hospital admissions office
  • They complained about hearing voices that sounded like they were saying “empty” “hollow” and “thud” - schizophrenia symptom but words not linked to schizophrenia
  • Once admitted to the psychiatric ward, pseudopatients showed no symptoms and behaved as normal
  • Pseudo patients had to display exemplary behaviour to be released
  • Pseudo patients recorded their observations in a notebook - not caught as this seen as part of their psychoses
• What were the samples?

  Study 1 - Patients and staff at 12 American psychiatric hospitals across 5 states, 8 pseudo patients pretending to suffer from mental disorder - range of jobs

  Study 2 - Staff in one psychiatric hospital

  Mini experiment - Staff and pseudopatients from four of the hospitals plus a confederate
• What was the procedure of study 2?

  • Hospital staff told pseudopatients would be admitted in the next 3 months. None were actually presented
  • Hospital staff asked to rate all new patients on a 10 point scale with 1 and 2 being high confidence patient was a pseudopatient
• What was the procedure of study 3?

  • Pseudopatient asked hospital staff a question - "Excuse me, Mr/Mrs/Dr X, could you tell me when I will be presented at the staff meeting?" - always courteous - control
  • A confederate asked staff members at the Stanford University Campus a similar question ending "Do you know where ... is?"
• What were the results of study 1? - getting in

  • All but one psuedo patient were diagnosed with schizophrenia and later discharged with schizophrenia in remission - label
  • In hospital for 7-52 days
  • No pseudopatients suspected by hospital staff
  • 35 of 118 patients were suspicious about the pseudo patients "You're not crazy"
  • Normal behaviours interpreted as symptoms of their disorder - queuing early for lunch seen as pathological behaviour
  • Depersonalisation leading to overwhelming feelings of powerlessness for patients e.g. no privacy
• What were the results of study 2? - overcautious

  Number judged to be pseudopatients after 3 months:

  • 41 identified by at least one staff member
  • 23 identified by one psychiatrist
  • 19 by one psychiatrist and one other staff member - inter-rater
• What were the results of study 3? - mini exp

  • 4% of pseudopatients received an answer from a psychiatrist (185 attempts)
  • 88% of occasions nurse moved on completely ignoring patient - nurses ignorant or got lots of patients to attend to - soc. sens
  • 14 requests at university responded to although when asked if could find psychiatrist responses dropped to 78% - negative perception of mental health
• What were the conclusions?

  • Diagnosis is not valid as psychiatrists failed to distinguish the sane from the insane
  • All except one pseudo patient was diagnosed with the same disorder suggesting diagnosis is reliable
  • Rosenhan noted the stickiness of labels where once a person was labelled "insane" all behaviours were interpreted according to this label
• How does Rosenhan's research explain categorising mental health?

  • Indicates there is a lack of validity in categorising and diagnosing psychological disorders
  • Pseudo patients categorised as having psychological disorder simply by telling staff they had symptoms and this label led to their normal behaviour being interpreted according to the context so it lacked validity
  • Supports anti psychiatry movement as it criticises the idea psychological illnesses can be diagnosed in the same way as physical illnesses