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Rosenhan - Coggle Diagram
Rosenhan
Ethics
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-the doctors and nurses in the hospital to not give consent neither were they given the right to withdraw
-He did protect confidentiality, no staff were named
-Rosenhan can also be criticized for not protecting his own researchers. they were put in a stressful and harmful environment. None of the observers were harmed physically but they could have been harmed psychologically as they witnessed physical abuse going on
-However, Rosenhan took a few precautions. In his own case, he notified the hospital manager and chief psychologist of what he was doing. For all the pseudopatients, he prepared lawyers who would intervene to get the pseudopatients out of hospitals if they requested it.
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Reliability
-Rosenhan's study is reliable because he followed a standardised procedure. His 8 pseudopatients were trained to behave the same way. They reported the same symptoms (hearing a voice that said 'hollow', 'empty' and 'thud') and concealed that they had any background in psychology or psychiatry. In the hospital, they stopped claiming to hear voices and took secret notes on what they observed.
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-the graduate student asked his wife to bring is homework indicating that he was a psychology student
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-another one stated that he was going to be a psychologist and one of the visitors was a psychology professor
-However, the follow up study provides evidence to back up the conclusions of the first.
Results
All 12 hospitals diagnosed the pseudopatients as mentally ill. 11 hospitals diagnosed schizophrenia, 1 hospital (the private hospital) diagnosed manic-depression (bipolar disorder). The pseudopatients went to hospitals that had diagnosed them with schizophrenia.
None of the staff recognised that the pseudopatients were healthy. It took between 7 and 52 days for the pseudopatients to be discharged; the mean length of stay was 19 days.
The pseudopatients were discharged with a diagnoses of "schizophrenia - in remission" (meaning the person has schizophrenia but the symptoms appear to have stopped) in 7 cases; 1 pseudopatient was discharged with a diagnosis of "schizophrenia" on their medical record.
Staff Abusing Patients:The pseudopatients were well-behaved and none of them were harmed in any way, but they observed other patients being verbally or physically abused by staff. Rosenhan reports that patients were awakened in the morning by an attendant shouting "Come on you m---- f----s, out of bed!" and one patient was beaten for saying to an attendant "I like you".
Patients refusing medication: The pseudopatients disposed of their pills but when they went to flush them down the toilet, they often observed that other patients had done the same thing
Depersonalisation & powerlessness: The patients weren't treated as persons. There were no doors on toilet cubicles and staff would inspect their medical records and personal belongings without asking permission. Staff would not make eye contact with patients. Staff would discuss patients within earshot, as if the patients could not hear them. Attendants would abuse patients while other patients were watching, but not when doctors were present.
Validity
-Seymour Ketty (1974) criticized Rosenhan, saying that, because the pseudopatients were faking an unreal mental condition, it doesn't tell us anything about how people with genuine mental conditions are diagnosed.
-Kety's point is that psychiatrist don't expect someone to carry out deception in order to be admitted to a psychiatric hospital. In other words, the study lacked ecological validity.
-Pseudopatients observed and recorded their experiences - rich and in-depth - could have been bias to their own opinions and emotions
Pseudopatients had to lie about hearing voices - deception could have guided the results - not natural
Generalisability
-Used a range of hospitals in the United states: private and state hospitals, old and new, well funded and under funded
-12 is a small sample size, compared to all of the USA, so anomalies could have skewed results
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-There has been a lot of improvement in mental health since the 1970s so it could be argued that the results are time-locked and cannot be generalised to diagnosis and psychiatry today.
Applications
-In the 40 years since to study took place, institutions have changed their working practices considerably e.g. reviewing their admission procedures and training the way staff interact with patients.
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-Had a major influence in reforming the DSM. DSM-III (1980) defined mental illnesses much more carefully, with clear guidelines for including or excluding people from each classification. For example, in DSM-III, a hallucination needed to be repeated several times; in DSM-IV (1994) hearing voices needed to be experienced for over a month before a diagnosis of schizophrenia can be made and DSM-5 makes this 6 months.
Aim
Wanted to test the reliability of mental health diagnosis, to see if medical professionals could tell the sane from the insane in a clinical setting.
Wanted to investigate the effect of labeling on medical diagnosis.
Investigated whether healthy pseudopatients would be given a diagnosis of mental illness and whether their imposture would be recognised by medical staff and other patients. Later, he investigated whether genuine patients would be identified as pseudopatients by suspicious staff.
Procedure
Rosenhan approached the head of the hospital he went to and informed him of the deception, but the other pseudopatients weren't known to anyone on the staff. Rosenhan also briefed lawyers to get the pseudopatients out if anything went wrong.
When they were admitted to a hospital, they started behaving normally and stopped reporting hearing voices. They took a notepad and pen along with them to record what they heard and saw (unstructured observation). They tried to do this covertly, but if the staff detected them they carried on recording things overtly.
As soon as they were admitted, the pseudopatients requested to be discharged. They secretly disposed of any medication they were given (eg they flushed pills down the toilet) but otherwise they were friendly and polite and did everything that was asked of them - Rosenhan instructed them to be "paragons of cooperation".
In 3 hospitals, a record was kept of how many patients voiced suspicions about the pseudopatients and how much time the staff spent on the ward, interacting with the patients
In 4 hospitals, the pseudopatient approached staff with a scripted question: "Pardon me, Mr [or Dr or Mrs] X, could you tell me when I will be eligible for grounds privileges?” (or “ . . . when I will be presented at the staff meeting?” or “. . . when I am likely to be discharged?”). The member of staff's answer and body language were recorded.
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Conclusions
Rosenhan draws attention to the private hospital that diagnosed a pseudopatient with manic-depression. This is a more treatable disorder than schizophrenia. Rosenhan notes that wealthier people are more likely to get diagnosed with milder problems that have better therapeutic outcomes, which shows that your class background affects the way you are diagnosed.
In particular, Rosenhan identifies a tendency toward false positives (Type I errors) in normal diagnoses, but Type II errors (false negatives) when "the stakes are high" (ie. when the hospital knows its diagnoses are being assessed).
Sample
The participants were the staff and patients in 12 psychiatric hospitals (mental asylums) in the United States.
The hospitals were in 5 different states, on the East and West coasts of the country.