Rosenhan (1973) Being Sane in Insane Places

Aim:

To test the hypothesis that psychiatrists cannot reliably tell the difference between people who are sane and those who are insane.

Study I

Method:

Sample:

Eight sane people –

• One graduate student
• Three psychologists (including Rosenhan)
• A paediatrician
• A painter
• Housewives

Procedure:

Field experiment – took place in natural setting but researchers manipulated certain factors.

Participant observation by pseudo-patients.

Gain in admission in 12 different psychiatric hospitals – five different American states.

  – Complained of hearing unclear voices “empty, hollow, thud” – unfamiliar but same sex

                            –   Simulated existential crisis – “who am I?” “what’s all this for?”

Participants – gave false name and address but all other life details correctly.

             –  Once inside, told to convince that they were sane and stop showing abnormality.

              – Pseudo-patients were not detected – couldn’t leave until diagnosed as “fit”

Independent Variable: Hearing Voices

Dependent Variable: 

• If participants were admitted at the psychiatric hospital
• The diagnosis of the patient – 7 with schizophrenia and 1 with bi-polar disorder
• Reaction of staff to the fake symptoms and final diagnosis.
• Treatment of pseudo-patients.

 Results:

• Stay in hospital = 7-52 days
• Given 2100 medication tablet – all but two flashed down the toilet.
• Other patients did the same but was ignored if good behaviour.
• Nurses stayed in ward offices 90% of time
• Patient spent less than 7 minutes per day with psychiatrist staff.
• Depersonalization and powerlessness -deprived of many human rights.

 

Study II

Method

Procedure:

• Research hospital, aware of the first study, falsely informed that during next three months one or more pseudo patient would attempt to be admitted.
• Staff members asked to rate 1-10 each patient likelihood of being a pseudo.

         Manipulated independent variable

Dependent Variable:

• Number of patients which staff suspect of being a pseudo.

Results:

• Number of patients judged = 193 
• Number of patients confidently judged as pseud patients by at least one staff member = 41
• Number of patients suspected by one psychiatrist = 23
• Number of patients suspected by one psychiatrist and one other staff member = 19

Conclusion:

1. Demonstration that psychiatrists cannot reliably tell the difference between people who are sane and those who are insane.
2. First study – failure to detect sanity.
3. Second study – failure to detect insanity.
4. Psychiatric labels tend to stick in a way medical labels do not – everything done by a patient is seen in accordance to label.
5. Should focus on specific problems and behaviour of person rather than label.

Strengths:

• Use of participant observation: Since the pseudo-patients carried the observations, they could remain objective but at the same time experience incidents from a patient’s perspective. This makes their feelings, behaviours and reactions a bit more realistic because they can sympathise without losing all objectivity.
• Ecological validity: The study was a field experiment; therefore, it took place in a natural setting. This makes the results a lot truer to real life rather than being a result of an artificial situation.
• Quite generalizable: The study was conducted in 12 different hospitals over five different American states, which makes the finals results generalizable to American hospitals.

Weaknesses:

• Some lack of ecological validity in participants: The pseudo-patients went through an unpleasant experience; however, their emotions cannot be exactly like the real patients because they didn’t have the comfort of knowing that their diagnosis was fake and their stay was temporary.
• Validity: The validity is questionable because the pseudo-patients reported hallucinations which are very common symptoms in schizophrenics. Therefore, in a way the diagnosis was correct because the psychiatrists based it on the information they were given.
• Ethics: Rosenhan did not get consent from the hospital staff, so they didn’t give permission for their hospitals to be used in an experiment. This lead to a lot of deception, since the pseudo-patients lied about their identity and purpose of admission. There was a lack of withdrawal because the pseudo-patients were left on their own to convince the staff they were fit enough to be released.