Context/Background
In 1934, Benedict said that normality and abnormality is not a universal concept, it differs in each culture
Deviation from social normals, statistical infrequency and maladaptiveness - Gross, 2010
Research showed reliability of DSM was poor because of the vague criteria and inconsistency of data gathering techniques
Rosenhan decided that the best way to test is disposition or situation caused insanity was to put sane people into psychiatric hospitals to see if they'd be inaccurately found as insane
Aims
1- to extend research of previous doctors submitting themselves into hospitals, because in their cases the staff was aware of their roles
2- To test the DSM for validity and reliability by admitting himself and others into hospitals
3- To observe and report on experiences inside hospitals as a pseudo patient
Method
Field study, it was an experiment. participant observation and also self report
Iv= 12 hospitals and their staff
Dv= treatment and experience of the pesudopatients
Procedure
Part A-
8 pseudo patients with fake names and jobs but everything else real used their past experiences and had no psychopathic pasts or behaviours used
Only Rosenhan's presence was known by his hospital, and even then only 2 staff members, everyone else was blind to the participants
They all sought admission to the 12 hospitals across 5 states, they called and said they were hearing unfamiliar voices of the opposite sex saying the 3 words, "empty", "hollow" and "thud"
Once admitted, they all behaved normally and interacted/talked with the other patients
They said they were fine and responded to instructions when spoken to by members of staff
They observed staff's behaviour and recorded it in a notebook, but no one really cared about their note taking so they didn't bother keeping it a secret for long
They had to persuade staff that they were in fact sane before getting discharged
Part B-
In 4 hospitals, the p's approached staff and asked "pardon me, when will I be eligible for grounds privileges/present at a staff meeting/be discharged?" and they only approached once to avoid suspicion or irritation
Part C-
A lady approached staff individually at Stanford Uni who looked busy, and asked them 6 questions
1- could you direct me to the Encina Hall?
2- do you know where the fish annex is (didn't exist)
3- do you teach here?
4- how do you apply for admission??
5- is it difficult to get in?
6- is there financial aid?
Part D-
Staff at a teaching and research section of hospitals could not believe the findings of the 1st study, they were warned more pseudo patients would come over the next 3 months (None actually came)
Each member of staff was asked to rate each of the new patients on whether they were fake or not using a 1-10 rating scale, 1 was high confidence that they were fake
Findings
Part A-
All pseudo patients stayed for 7-52 days, on average 19, 7/8 were diagnosed as schizophrenic and left with a diagnosis of "schiz with remission" when they went home.
The other p was diagnosed with manic depression
None of the staff asked about the notes they just reported it as "patient engages in writing behaviour"
Misinterpreted behaviour, e.g. pacing the halls was seen as anxiety
If patients got upset, the response was seen as a symptom of illness not due to situation, and there was no change in behaviour inside the hospital by the p's
35/118 genuine patients recognised the fakes, maybe because of the note writing
2.100 pills handed to the patients, all but 2 flushed down the toilet and no staff members noticed this, the staff actually generally avoided the patients, on average spending 11.3% of the time with patients
The doctors were even more remote,, except on admission and discharge, on average physicians came to the ward 6.7 times a day
Lack of power for p's because all their movements were watched and restricted yet they had virtually no contact with the staff and their privacy was minimal, e.g. no toilet doors and physical abuse to patients, as well as depersonalisation
Parts B and C
Responses when asking simple questions to staff =
Psychiatrist in hospitals
71% walked past
23% eye contact
2% paused to chat
4% stopped to talk
13 respondents
185 attempts
Nurses in the hospitals
88% walked past
10% eye contact
2% paused to chat
0.5% stopped to talk
47 respondents
1283 attempts
Uni campus staff
0% walked past
0% eye contact
0% paused to chat
100% stopped to talk
6/6 questions answered
14/14 responded
"looking for psychiatrist" at uni medical centre
0% walked past
11% eye contact
11% paused to chat
78% stopped to talk
3.8/6 questions answered
18/18 responded
"looking for doctor at uni medical centre
0% walked past
0% eye contact
0% paused to chat
100% stopped to talk
4.8/6 questions answered
15/15 responded
Part D-
Out of the 193 genuine p's. 41 were diagnosed as pseudo patients, yet none of them were actually even from Rosenhan lol
Conclusions
Psychiatric diagnoses = inaccurate, we cannot distinguish the sane from the insane in hospitals - Rosenhan
Behaviour is easily distorted in a hospital environment and they experience powerlessness and depersonalisation, as well as being labelled as insane
Hospital staff were insensitive to feelings of patients,
The DSM-5 is not reliable and the diagnosis of mental illnesses are therefore situationally influenced
Evaluation
Method- criteria for disorders too vague, high in ecological validity, participant observation compromises validity because they may have over empathised with the other patients and had distorted reports
Ethics- labelling people as mad or insane can affect people badly, also the p's suffered physical and verbal abuse in the hospitals