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Rosenhan (1973) (Evaluation (Generalisability (Hospitals varied so…
Rosenhan (1973)
Aim
To see if eight sane people who gained admission into 12 different hospitals would be 'found out' as sane.
Find out the experience of being in such an institution was like, and what it feels like to be viewed as 'insane'.
Participants
Study 1
8 pseudo-patients (3 women & 5 men)
- Rosenhan one of the pseudo-patients
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Procedure
Study 1
- Settings varied so findings could be generalized
- 12 hospitals in 5 states varied in character (e.g old/new, good ratio of staff to patients or not, private or not)
- Hospital admissions
- Pseudo-patients arrived saying they had been hearing unclear voices that said "empty", "hollow" or "thud"
- These words placed an emphasis on the person's life (e.g life being hollow)
- On being admitted the pseudo-patients stopped simulating symptoms of abnormality
- Given medication (did not swallow), followed instructions from staff and talked to other patients
Study 2
- Rosenhan wondered whether the diagnosis of 'insane' for 'sane' people could be reversed
- Staff at a teaching hospital doubted the findings of the first study, so Rosenhan told them in the next 3 months one or more pseudo-patients would attempt to be admitted
- Each staff asked to rate patients presenting themselves on a scale of 1-10 to reflect likelihood of them being the pseudo-patient
Results
Study 1
- Pseudo-patients not detected
- All except one admitted with a diagnosis of schizophrenia in remission
- No records or behaviour by staff showed there were doubts about the authenticity of the patients
- Patients spent average of 19 days in hospital
Study 2
- Judgments given on 193 patients admitted for psychiatric treatment, of which 41 judged by one staff member to be pseudo-patients
- 23 considered suspect by at least one psychiatrist and 19 thought to be pseudo-patients by one psychiatrist and one staff member
- There were no pseudo-patients
- An explanation for the failure to detect sanity is that 'insanity' is a powerful central trait, therefore all behaviours are coloured by the label 'insane' and normal behaviour is overlooked
Evaluation
Generalisability
- Hospitals varied so findings could be generalized
- 12 hospitals, strengthening the findings
- If one had been involved it might have been that hospital alone that 'labelled' mental illness
- Progress in mental health care since 70's so results may be 'time-locked', can't be generalized to psychiatric diagnosis today
- Patients diagnosed using DSM-II, today's DSM-5 requires two symptoms (not one) and symptoms for 6 months
Reliability
- Using 8 people in 12 hospitals
- Study was able to be replicated and the same results found
Applications
Findings are strong as the idea of people perceived through the use of labels was clear and is still likely to be the case, although the study was 40 years ago
Validity
- Pseudo-patients said they heard voices, standard symptom of schizophrenia
- Perhaps not surprising they were considered to have it but doesn't explain why the patients weren't realized to be sane
- Equally unsurprising that pseudo-patients were wrongly identified in Study 2 as staff were (wrongly) informed some would be presenting themselves for treatment
- 'lies' may have guided the results, means the studies weren't natural and to the extent, not valid
Ethics
- Hospital staff deceived about pseudo-patients symptoms being real
- Might be criticized for failing to care for his own pseudo-patients
- Putting them in a harmful environment, experienced tension and witnessed abuse
Conclusion
- Sane cannot be distinguished from the insane in psychiatric hospitals
- Special meanings are given to behaviour
- Patients in such an environment experience powerlessness, depersonalization and segregation
- Rosenhan felt the perceptions of mentally ill patients were distorted in a psychiatric hospital
- Staff can be helped by reading his study to understand how patients experience such hospitals