study

• aim


  to test the reliability of mental health diagnosis
• method


  participant observation

  internal validity but researcher bias
• sample


  12 psychiatric hospitals across 5 hospitals in america

  8 pseudopatients pretended to be suffering from mental illness

  ethnocentric
• getting admitted


  phone hospital ad asked for an appointment complaining of hearing voices saying 'empty, hollow and thud'
• behaviour at the hospital


  once admitted they behaved normally saying they no longer experienced symptoms

  had to convince the nurses they were sane to be released

  showed exemplary behaviour obeying orders and following instruction
• diagnosis


  stayed from 7 - 52 days with mean stay 19 days

  7 diagnosed with schizophrenia
• abuse by staff


  distrusted and feared patients while also wanting to help

  this conflict lead to a lack of interaction

  average daily contact was 6 - 8 minutes
• comments


  38/118 patients suspected the pseudo patients

  'youre not crazy youre a journalist or a professor'
• powerlessness


  depersonalisation

  patients felt they had no control over their day

  patients cannot initiate contact with staff

  denied freedom of movement
• effect of labelling 


  normal behaviour as interpreted as symptoms of their behaviour

  queuing early for lunch was seen as pathological behaviour

  written observation was seen as compulsive note taking

  one patient had a difficult relationship with his father in the teen years and this was seen as a schizophrenic reaction
• lack of privacy


  personal hygiene was monitored

  many toilets didn't have doors

  medical records could be accessed by nurses at any time

  had strict routines and couldn't be left unattended
• conclusions


  diagnosis depends on the situation you are in

  labels lead to misinterpretation

  type one error on study one (healthy labelled sick)

  type two error on study two (sick were labelled healthy and turned away)

  diagnosis is consistently inaccurate
• individual / nature / biological

  Somatogenic - brain structure, genes, neurotranmitters

  Greek - imbalances in the humours

  Ideal mental health - attitudes and personality, cognitions
• situational / nurture / environment

  deviation from social norm - fits social expectations

  rosenhan - social interactions affected by hospitals or unis

  stickiness of labels affect normal behaviour

  interpreted in contact with a label
• psychic determinism


  psychogenic - unconscious mind
• free will


  failure to function adequately, choosing not to act this way
• socially sensitive 


  IS - diagnosis of mental illness is distressing and stigmatised

  IS NOT - can get treatment and answers for a patients experience

  IS - rosenhan = nurses and doctors argue it caused a negative view of psychiatry - patients lost trust so less likely to seek treatment

  IS NOT - rosenhan = improvement to diagnosis DSM2 and DSM3

  IS - doesnt account for those who are eccentric and positive behaviours
• reuctionist 


  statistical infrequency - abnormal is uncommon but doesnt account for rare positive behaviours

  social norms - focus on particular cultural norms
• holism


  somatogenic - brain structure, genes, neurotransmitters

  DSM5 - multiple criteria to be diagnosed

  also considers personal background and experience
• usefulness


  somatogenic - treatments such as drug treatments and psychosurgery

  psychogenic - treatments such as psychoanalysis developed into CBT

  rosenhan - developed DSM

  social norms are culturally bound

  ideal mental health is too unrealistic
• ethics


  study 2 - psychological/physical harm as 193 patients were turned away

  deception - patients were unaware about pseudopatients, told and then didnt act

  informed consent as they were told about the study

  psychological harm to hospital staff so they may not trust themselves
• scientific 


  participant observation so low control over EVS

  study one - standardised procedures using same verbs

  statistical infrequency - quantitative

  prehistoric/greek - sujective

  somatogenic - measurable brain scans
• reliability


  no evidence of inter rater reliability although all pseudo patients reported similar experiences

  Brown - researched the reliability of diagnosis and found inter rater reliability of 0.67 for repeat depression diagnosis using DSM4

  standardised procedures as they all say the same symptom
• validity


  rosenhan - real hospitals with real staff and patients who were unaware - representative behaviour

  control over variables and standardised procedures eg. admission in study one

  low population validity as american
• ethnocentric


  american

  DSM - cultural norms of western cultures

  rosenhan - normality and abnormality are not universal as it varies across cultures

  DSM5 - attempts to reduce bias = section 3 on cultural relativity and awareness, culturally bound syndrome
• sampling bias


  rosenhan used hospitals from 5 states

  varying sizes, ages and funding of hospitals

  DSM - based on white middle class families

  psychogenic - primarily based on patient in vienna during the late 19th century