Rosenhan (1973) - Being Sane In Insane Places - Revision Cards in A Level and IB Psychology

Rosenhan (1973) - Aims & Context

Mental illness is diagnoed the same way as physical illness. In America, they use DSM. In Europe, they use ICD.

Szasz argues that mental illness is a comination of medical and psychological concepts. This idea legitimises the use of psychiatric force to control deviance from societal norms.

Foucault argues that sanity and insanity are social ideas; it is convenient for society to judge who is sane and insane.

Holocaust documentaries argued that the medicalisation of social problems provided the origins of the 1940s mass murders.

Rosenhan questioned the validity of diagnostic methods;
- "If sanity and insanity exist, how shall we know them?"

The aim of Rosenhan's study was:
- To investigate whether psychiatrists can distinguish between mentally ill people and healthy people.
- To investigate if the environment determines the diagnosis.
- To investigate if psychiatrists can identify pseudo-patients.

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Study 1 - Controlled Observation:
- 8 sane people tried to gain admission to 12 hospitals in USA
- 3 women and 5 men, with false names and false occupations. They had to get out by convincing the hospital that they were sane.
- The pseudopatients told the hospital that they were hearing voices saying "empty", "hollow", and "thud".
- They were admitted with schizophrenia, but acted normally as soon as they were admitted - they took notes on other patients and accepted medication (but did not take it).
- Opportunity Sample: Range of hospitals; old and new, well staffed and poorly staffed, and one private hospital.
Study 2 - Additional Research:
- A different hospital claimed that they could spot the pseudopatients.
- The staff were asked to rate on a 10 point scale.
- Data was taken on 193 patients, however no pseudopatients were actually sent to the hospital.
Study 3 - Field Experiment:
- In 4 hospitals, the pseudopatients tried to ask questions.
- They asked their questions no more than once a day.
- For example; "Pardon me, Mr/Mrs/Dr, could you tell me when I am likely to be discharged?". They were ignored.

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Study 1 Findings:
- The pseudopatients exhibited signs of nervousness and anxiety as they were nervous of being found out.
- All but one pseudopatient were admitted in with a diagnosis of schizophrenia.
- The length of hospitalisation ranged from 7-52 days, with an average of 19 days.
- The average daily contact with the psychiatrists was an average of 6.8 minutes per day.
- While at the hospital, the 'real' patients regularly voiced their suspicions; 35 out of 118 real patients made statements such as "you're not crazy".
- Nursing records for 3 pseudopatients indicate that their writing was seen as an "aspect of their pathological behaviour"
Study 1 Conclusions:
- Rosenhan concluded that "It is clear that we cannot distinguish the sane from the insane".
- Also that the failure to detect sanity may be due to the fact that the doctors were showing a strong type 2 error (the inclination to call a healthy person sick).
- Having once been labelled schizophrenic, there is nothing the pseudopatients could do to overcome the label. This means that many of the normal behaviours were overlooked or misinterpreted.
- Once in the mental health system, patients' normal behaviour was interpreted as symptoms of their disorder; shows the validity of the diagnosis was poor.

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Study 2 Findings:
- Out of 193 admitted patients, 23 were thought to be a pseudopatient.
- 41 were judged to be pseudopatients by at least 1 staff member.
- 19 were judged to be pseudopatients by a psychiatrist and a staff member.
Study 2 Conclusions:
- Were the 23 patients really sane? Or had the staff made a type 2 error in order to avoid making a type 1 error (calling sick people healthy)?
- "Any diagnostic process that lends itself so readily to massive errors of this sort cannot be a very reliable one".
Study 3 Findings:
- The common response was brief, with no eye contact.
- 4% of psychiatrists and 0.5% of nurses stopped and talked.
- 2% of staff in a group stopped and chatted.
As a control, students at Stanford University asked 6 questions.
All of the staff members stopped and talked, and also maintained eye contact.

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Field Study:
- High ecological validity because the behaviour will be normal
- Variables can't be controlled.
Reliability:
- Other studies had similar results, which demonstrates conistency and therefore reliability.
- A range of hospitals were used, so the findings can be generalised.
- However, Andrews et al (1999) assessed 1500 people using ICD and DSM IV, and found only 35% agreement.
- The study is ethnocentric - it was carried out in America, so the findings can't be generalised to other countries due to cultural differences.
Validity:
- The pseudopatients were nervous. The staff could have noticed this unusual behaviour and kept them in for observation.
- The participants were instructed to act "normally"; their ideas of "normal" could be subjective, leading to different behaviour.
- High internal validity due to them being unaware of being in a study.
Ethical Issues:
- Protection From Harm: The findings may have discouraged other people from actually seeking help.

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Slater (2004) - Supports:
- All 9 psychiatric emergency rooms diagnosed her with psychotic depression.
- She claimed that diagnoses are subjective and driven by the zeal to prescribe.
- However, she had already been diagnosed with depression before the study.

Sarbin & Manusco (1980) - Contradicts:
- DSM is more valid nowadays - it has been developed since 1973.
- This means that Rosenhan's study is no longer valid.

Loring & Powell (1988) - Develops:
- Patients are being diagnosed based on appearance rather than just their symptoms.
- Gave 290 psychiatrists a transcript of a patient interview; half of the psychiatrists were told that the patient was black, the other half were told white.
- Black patients were more likely to be seen as violent and dangerous.

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