Classic study

• Aim:

  • To see if the sane can be distinguished from the insane
  • To be admitted to psychiatric wards as a patient to get more understanding of patients psychiatric experiences institutionalised 
• sample:

  • 8 pseudo patients
  • 1 graduate student in 20s, (remaining were older and more established) 3 psychologists, a paediatrician, a psychiatrist, a painter and a housewife.
  • 3 women, 5 men 
  • were nine pseudo patient
• Hospitals

  • similarly varied setting to generalise finding.
  • 12 hospitals in sample located in 5 different states in east and west coast
  • Some new some old and shabby
  • Some had good staff/ patient ratio, some understaffed
  • Only one strictly private private hospital others were supported by state or federal funds in one instance university funds
• Procedure 1

  Admission

  • after making appointment via phone pseudo patient arrived complaining about hearing voices, claimed that voices were unclear saying words like “empty” “hollow” and “thud” voices were unfamiliar and same sex as the pseudo patients. 
  • Choice of symptoms was determined by a single report of existential psychosis in literature.
• admission:

  • Beyond alleging symptoms and fake name, vocation and employment no further alterations of persons history or circumstances were made. 
  • Significant events of the pseudo patients life history were accurate of how they actually occurred. Frustrations and upsets were described as they were along with joys and satisfactions
• After admission

  • Immediately after admission pseudo patients stopped showing any symptoms of abnormality in some cases of mild anxiety due to the expectation that getting admitted would be more of a procedure 
  • They shared fear of being found out and exposed, fears of what would happen on psychiatric wards 
  • Pseudo patients spoke to staff as he would normally and attempted to engage other in conversation due to lack of activity on ward
• After admission

  • Pseudo patients responded to questioning about how they were feeling by staff as fine and no longer experiencing symptoms, responded to requests for medication and dinning hall instructions
  • Spent time writing observations of staff and patients on ward
  • encounters and request for questions from doctors and nurses were frequently ignored (mini experiment)
• Results 

  Aim 2 could pseudo patients be detected ??

  • diagnosis with 12 admissions: 11 schizophrenics, 1 manic depressive psychosis 
• Aim 2 could pseudo patients be detected ??

  • Real patients who suspected sanity 35/118
  • Time to be released 7-52 (19 days average)
  • Mini experiment: 4% of pseudo patients received answer from psychiatrist 0.5 received answers from nurse in comparison to 78% of comparison study
• Procedure 2 : follow up experiment 

  • doubted such error to occur staff were informed that at some time during 3 moths one or more pseudo patients would attempt to be admitted into hospital 
  • Each staff member was asked to rate each patient who presented themselves the likeliness of being a pseudo patient 10 point scale 1 being high confidence of pseudo patient 
• Procedure 2 Results

  There were no pseudo patients 

  • 193 patients judged
  • 41 confidently judged as pseudo patients by at least 1 staff member
  • 23 patients suspected by one psychiatrist 
  • 19 patients suspected by one psychiatrist and one member of staff
• Aim 2

  Gaining access to psychiatric wards as patients to gain insight to a patient’s psychiatric experience 
• Stickiness of psychodiagnostic label

  • normal behaviour was overlooked entirely or profoundly misinterpreted 
  • When someone is diagnosed as insane their effects in their life are misinterpreted 
• Mini experiment 

  • pseudo patients would initiate conversation with psychiatrist by asking when they would be allowed to have grounds privileges 
  • Pseudo patients claimed to be not experiencing symptoms and asked when they could be discharged 
• The cage - clinicians office

  • 11.5 times a day nurse went outside cage
  • 9.4 times the late afternoon nurses went outside
  • 6.7 times a day physicians emerged on ward
  • Those with most amount of power were least involved
• Powerlessness and depersonalisation

  • forced medication, pseudo patients were administered 2100 pills
  • Observations of nurses verbally abusing and physically abusing patients without antagonisation 
  • Staff avoided co nverstaion and eye contact
  • Watched in bathroom
  • No doors on bathroom
• Conclusion

  • Rosenhan claims study demonstrates that psychiatrists cannot reliably tell the difference between people who are sane and those who are insane 
  • Raised questions about validity of diagnostic material
• A03 generalisability :

  Representativeness of gender ratio
• A03 counter argument :

  All American sample
• A01 :

  Procedure 1) all pseudo participants called hospital to get an appointment, in interview claimed to have the symptoms of hearing an unfamiliar voice saying empty, thud, hollow

  • once admitted acted normally and answered truthfully about life events
  • Originally took covert notes but stoped as nobody seemed to care
• A03 reliability :

  All participants claimed to have the same symptoms and act in the same way making the study highly replicable 

  • consistency allows for procedure to be accurately replicated in 12 different hospitals and it suggests that if the same outcome took place in different setting is shows flaws in the diagnostic system as a whole and not the hospitals 
• A03 counter argument :

  Patients were asked to act normally once admitted but as each person has a different perception of normal and are from different backgrounds it would make the procedure less standardised due to all psudeo patients acting slightly differently 

  • rosenhans procedure therefore cannot be exactly replicated to check for consistency in the findings
• A01 : mini experiment 

  Mini experiment

  • some pseudo patients were instructed to ask when they would be released 
  • Results of mini procedure were compatred to a similar study were students approached staff on a university campus asking for directions 
• A03 mini experiment 

  Results showed that only 4% of pseudo patients received an answer from a psychiatrist and only 0.5% from a nurse whereas on the campus 78% of psychiatrists stopped to talk if they were around 
• A01 :Procedure 2

  In a follow up study Rosenhans informed hospitals that over 3. Oth period pseudo patients would entered their hospitals 

  • During time every patient that was seen clinical rated how liked it was that a patient was a pseudo patient 
• A03 result  :

  • psychiatric hotspital did like rat scale to identify and rate likelihood of of admitted patient being a pseudo patient by one psychiatrist and another staff they suspected 19 patients
  • We can learn from inaccuracy of hostpital staff identifying people who are not actual struggling from mental illness and who aren’t due to gaps in the DSM and admission procedure leading to to false diagnosis of patients
  • Implication may be to update the DSM model or accuracy of the clinical assessment as well as test retests to keep up with patients conditions and asses their levels of insanity 
• A03 counter argument :

  • however in the second procedure the 10 point rating scale may limit the internal validity of Rosenhans findings on the conditions of psychiatric  hospitals because of a social desirability bias as the clinic on may want to present themselves more positively by making diagnosis following the first procedure where pseudo patients managed to get admitted
  • Therefore clinicians may not have been rating each patient accurately because they didn’t want to misdiagnose a patient with schizophrenia  
• Procedure 2 Results

  There were no pseudo patients 

  • 193 patients judged
  • 41 confidently judged as pseudo patients by at least 1 staff member
  • 23 patients suspected by one psychiatrist 
  • 19 patients suspected by one psychiatrist and one member of staff