{"id":1118,"date":"2019-04-02T05:21:20","date_gmt":"2019-04-01T20:21:20","guid":{"rendered":"http:\/\/101psych.com\/?p=1118"},"modified":"2019-04-02T05:21:20","modified_gmt":"2019-04-01T20:21:20","slug":"rosenhans-observation","status":"publish","type":"post","link":"https:\/\/www.themantic-education.com\/ibpsych\/2019\/04\/02\/rosenhans-observation\/","title":{"rendered":"Key study: “On being sane in insane place” (Rosenhan, 1973)"},"content":{"rendered":"

Rosenhan’s famous study attempted to demonstrate the unreliable nature of psychiatric diagnosis in the 1970s and how poorly patients were treated in psychiatric hospitals. While his methods were a little suspect, the study seemed to make the point Rosenhan was hoping for.\u00a0<\/strong><\/p>\n

Background Information<\/b><\/h2>\n

One of the most influential studies conducted investigating the difficulties in defining normality and abnormality, and the inherent repercussions for valid and reliable diagnoses of psychological disorders, was conducted by David Rosenhan.<\/span> This research was published in 1973, a time when psychiatric hospitals were quite different to the way they are today.<\/span><\/p>\n

Aims<\/strong><\/h2>\n

Prior to this study, some researchers had conducted participant observations of psychiatric hospitals, but this was often for a short time and the hospital staff knew of their presence. Rosenhan wanted to take this research one step further and so he conducted a participant, naturalistic, covert observation.<\/span> He was interested in investigating whether the 8 <\/span>pseudopatients(people pretending to be patients)\u00a0would be diagnosed based on their objective symptoms and behaviours, or if the nature of the environment would influence the interpretation of their behaviours by the professionals who were diagnosing them. Perhaps his aim can be best summarised by the question he poses in the opening to his article:<\/span><\/p>\n

\"evil

Psychiatric hospitals were once called “insane asylums,” “mental hospitals,” or more informally “nut houses” or “loony bins.” The classic image of an “insane” person is them wearing a straightjacket.<\/p><\/div>\n

\u201cIf sanity and insanity exist, how shall we know them?\u201d<\/span><\/p>\n

Methodology and Results<\/b><\/h2>\n

Rosenhan was one of the pseudopatients, along with 7 others. They were an eclectic mix of people who used false names and occupations. There was a graduate student of psychology, three psychologists, a pediatrician, a psychiatrist, a painter and a housewife. <\/span><\/p>\n

They sought admission into 12 different hospitals on the East and West coasts of the United States. The only symptom they were told to give the hospitals was that they had been hearing voices from a stranger\u2019s voice that was the same gender as them, and the voices were unclear but they thought they said \u201cthud\u201d, \u201cempty\u201d and \u201chollow\u201d. One reason why these words were chosen was because there is a suggestion that they are signaling some sort of crisis in the individual\u2019s life, such as their life \u201cis empty and hollow\u201d. Once they were granted admission into the hospital, all the other details about their lives and their personal histories that they told the hospital staff were true.<\/span><\/p>\n

Results<\/strong><\/h2>\n

Of the 12 admissions to the hospitals, 11 were diagnosed with schizophrenia and one was diagnosed with manic-depressive psychosis. They remained in the hospitals for a range of 7 to 52 days, with an average of 19 days.<\/span><\/p>\n

\"Scared

Schizophrenia is a mental disorder that has many varieties. It is mainly characterized by an inability to understand reality (e.g. not being able to determine what is real and what is not).<\/p><\/div>\n

Once the pseudopatients were admitted to the hospital, they carried on behaving normally and told the staff their symptoms had stopped. They took notes and made other observations, at first hiding this in case the staff found out, but after they realized the staff weren\u2019t paying attention to them, they took notes freely. This resulted in other patients in the hospital raising questions about the authenticity of the pseudopatients\u2019 illnesses. In fact, during the first 3 admissions to hospitals, 35 of 118 patients expressed some concern regarding whether or not the pseudopatients were really ill. This raises an interesting question, like why can the diagnosed \u201cmentally insane\u201d recognize sanity, while the trained professionals cannot?<\/span><\/p>\n

Follow-up study<\/strong><\/h2>\n

After this original study was conducted, one hospital heard of the findings and challenged Rosenhan to send pseudopatients to their hospital with the belief that they would be able to spot the fakes from the genuine patients. Over a three month period, 193 patients were admitted for treatment and received a judgement<\/span> based on the staffs\u2019 beliefs if they were an actual patient or not. Of these 193, 41 were judged with high confidence by at last one member of the staff to be a pseudopatient, while 19 were suspected as being a pseudopatient by a psychiatrist and at least one other member of the staff. In fact, Rosenhan had not sent any pseudopatients during this time.<\/span><\/p>\n

Conclusions<\/strong><\/h2>\n

While they were on the hospital wards, the pseudopatients made notes about their experiences and in his article Rosenhan details the dehumanization that was experienced by the pseudopatients while they were in the care of the hospital staff. He believes that it is the power of the label (in this case schizophrenia) that influences the way the clinicians interpret their behaviour: \u201cOnce a person is diagnosed abnormal, all of his other behaviours are colored by that label\u201d. For example, a perfectly normal description of one of the pseudopatient\u2019s relationships with family members was interpreted by the clinician in a way that was consistent with his diagnosis of schizophrenia. Rosenhan\u2019s study highlights ethical considerations regarding diagnosis, primarily those concerned with the power of labels and stigmatisation. <\/span><\/p>\n

Critical thinking considerations<\/b><\/h2>\n
    \n
  1. How does this study demonstrate difficulties in defining normality and abnormality?<\/span><\/li>\n
  2. How does this study demonstrate validity and reliability issues related to the diagnosis of psychological disorders?<\/span><\/li>\n
  3. How does this study demonstrate ethical considerations in diagnosis, such as the effects of labels and the potential for stigmatisation?<\/span><\/li>\n
  4. Are there limitations to this study? For example, why might we be limited in applying these findings to today’s psychiatric hospitals?<\/li>\n<\/ol>\n

    Interview with David Rosenhan…<\/p>\n