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28 Cards in this Set

  • Front
  • Back

Background

- A particularly interesting and troubling insane illness is Schizophrenia, the name means 'shattered mind' and the symptoms include:


- Delusions


- Hallucinations


- Disordered thinking (confusion, panic etc.)


- Emotional problems (inappropriate emotions or lack of emotion)


- Motor problems (tics, twitches etc.)

Background

A person must suffer from more that one of these symptoms to be considered schizophrenic, because all sorts of perfectly sane people have odd ideas, strange moods, vivid imaginations etc.

Background: Anti psychiatric movement

- Led by thinkers like R.D. Laing


- Claimed that psychiatry was a non-science and that psychiatric diagnosis was an excuse to lock away troublesome people.


- Rosenhan was inspired by one of Laings lectures

Aim

The overall aim was to test the accuracy of psychiatric diagnosis


Study 1 - Test the hypothesis that psychiatrists cannot reliably tell the difference between people who are sane and insane

Study 1

Rosenhan wanted to see if people who presented themselves to psychiatric hospitals would be diagnosed as insane - so the aim was to investigate the reliability of psychiatric diagnosis

Method 1

- Covert Observation


- Opportunity Sample off hospital staff


- Field Experiment

Sample

- 8 people including Rosenhan


- 5 men, 3 women (inc. a student, doctor, painter, housewife, psychiatrist, a psychologist)


- He called them pseudo patients


Pseudopatients

- Psudopastients applied to be let into 12 different hospitals across America (represented a broad range, old, modern, well staffed, poorly funded, private)


- They phoned the hospital for an appointment and went to admission interviews


- Told the truth about their life stories but changed their name an job detail (to protect them)

Pseudopatients

- Al claimed to hearing voices , an important control was that each pseudopatient claimed to hear unknown voices repeating words like HOLLOW, EMPTY and THUD - which suggest an existential crisis

Inside the hospital - Instructions

- Stop claiming to hear voices and act noramal


- Don't take any medication


- Take written notes of what happens, do secretly but if found out continue openly


- Approach member of staff with the question: 'Pardon me, could you tell me when I am likely to be discharged?'


- Get themselves out by thier own admission

Inside the hospitals

- Pseudopatients took part in ward activities, speaking to patients and staff as normal


- They said they were fine and no longer experiencing symptoms when asked how they were feeling

Pseudo patient observation on staff

- In 4 of the hospitals pseudopatients carried out an observation of behaviour of staff towards patients that illustrate the experience of being hospitalised on a psychiatric ward.


- They approached staff with a request such as 'when am I likely to be discharged?'


- Rosenhan carried out a similar study at Stanford University with students asking university hospital staff a simple question


- This was a field experiment where the IV was a comparison with the uni hospital staff


- Responses were compared with treatment of the pseudopatients got

Results: Quantitative

- All pseudopatient admitted, 7 diagnosed with schizophrenia, 1 with manic depression


- Kept in hospital between 7 - 52 days - average of 19 days


- Only discharged when stopped claiming to be sane and admitted to being ill


- All discharged with schizophrenia in remission


- Ignored when asked staff questions, they did pause or make eye contact, only 2% stopped, not a result of being busy as every member of staff stopped at the university which is also busy


- 35 out of 118 other patients suspected their sanity

Results: Qualitative

- Normal behaviour of pseudo patients was often seen as aspects of their insanity (e.e. the patients writing was seen as an aspect of their pathological behaviour)


- Rosenhan notes that there is an enormous overlap in the behaviours of the same and the insane


- We all feel depressed, angry, have mood swings but in the context of psychiatric hospitals these were interpreted as pathological


- Behaviour was misinterpreted by the staff (e.g. patients waiting outside cafeteria for lunch out of boredom was seen as a sign of 'oral-acquisitive syndrome'

Method 2

- Field experiment using observations


- Opportunity sample

Procedure 2

- Observation carried out of the staff of 4 of the hospitals, the pseudopatients looked at the behaviour of staff towards patients to illustrate the experience of being hospitalized on a psychiatric ward.


- In the university nearly all requests were acknowledge and respinded to unlike the psychiatric hospital where they were treated like they were invisible

Results 2

Results 2

- Rosenhan noted that experience of hospitalisation for the pseudopatients was on of depersonalisation and powerlessness


- Patients were deprived of basic human rights such as freedom of movement and privacy


- Medical record were open for all staff to see


- Personal hygiene was monitored and many of the toilets did not have doors


- Some of the ward orderlies were brutal to patients in view of other patients but stopped as soon as a another member of staff approach, suggesting staff are credible witnesses but not patients


- A total of 2,100 medication tablets were given to the pseudopatients (one 2 swallowed). Often pseudopatients found other tablets of actual patients disposed in the toilet,as long as the patients cooperated then their behaviour went unnoticed


- Nurses stayed in the wards office 90% of the time, the number of times medical staff came onto the ward and the amount of time spent with psychiatrists, registrars etc. was on average 7 mins per day

Conclusions

- Rosenhan argues that psychiatric diagnoses are 'sticky labels'. It is really hard to convince people you are sane once diagnosed with mental illness. Everything you do is yet another example of your madness.


- E.g. patients walking the halls because they were bored were diagnosed with anxiety

Study 2

Rosenhan wanted to see if hospitals would consider people with genuine health problems to be fakes

Method

When hospitals found out abut the pseudopatients they were outraged at being deceived in his way. One of them challenged Rosenhan to send more pseudopatients confident that forewarning the doctors and nurses would spot them.


Rosenhan informed them that during the next 3 months at least 1 pseudopatient would try to be admitted. Each member of staff was asked to rate all new admissions on a 10 point scale (10= definitely a pseudo patient and 10= certainly a genuine patient)

Results

Over the 3 month period 193 patients were admitted for treatment


- 41 were judged to be pseudopatients by at least 1 member of staff


- 23 were judged to be pseudopatients by at least 1 trained psychiatrist


- 19 were judged to be pseudopatients by one psychiatrist and one other member of staff


Rosenhan didn't send any pseudopatients

Conclusion

Rosenhan claims he had shown that the diagnostic procedure in psychiatric hospitals is unreliable, suggesting that diagnoses are invalid too and that we cannot tell the sane from the insane.


- Hospitalising the mentally ill seems to create powerlessness and depersonalisation.


- The power of sticky labels makes it hard for staff to view patients behaviour clearly and objectively.


- Often patients act up to the way they have been labelled(Self Fulling Prophecy)

Rosenhan has 2 soluations:

1.Treat mental illness in new ways, in particular caring for the mentally ill in community setting rather then in impersonal situations and using behavioural therapies that don't 'label' patient.


2. Train mental health workers to be more sensitive to their patients as people, and to recognise how much of patients behaviour is produced by the situation they are in


Rosenhan's recommendations were followed and it provoked change



Evaluation: Strengths

- Participant observation - pseudopatients could experience from the patients perspective


- Over/field experiment - so fairly ecologically valid but still able to manage variables such as pseudopatients behaviour


- Wide range of hospitals - on different states, old, new etc. can be generalised


- Using 8 people in 12 hospitals means the study was replicated and the same results were found so gives the study reliability


Evaluation: Weaknesses

- Deception of hospital staff, although he did conceal the names of hospitals and staff


- Pseudopatients experience could have been different as they had the comfort of knowing they weren't actually insane. Did show symptoms inside so may have been treated differently


- Doctors more likely to make a type 2 error (call as healthy person sick, than a type one error (Call a sick person healthy)


- Ethics: Pseudopatients despite agreeing to take part may have experienced mental harm, it could also impact on genuine patients who were not believed


Changes and Implications

Instead of using the participant observers posing as patients, they could pose as hospital staff


- Find out more detail and understanding why the nurses etc. behave the way they do. Which may be more insightful and relevant and give reasons for findings.


Changes and Implications

Instead of using live pseudopatients, psychiatrists could be shown a video of someone while having a clinical interview with another psychiatrist. The video recorded pseudopatient could report the same symptoms as in the original study.


- Simpler procedure and less time consuming


- Many more participants can be enlisted and therefore use a larger sample meaning the results should more likely be meaningful and statistically analysable


- But psychiatrists would now they are taking part in a study and act up to social desirability and take more care in making their diagnosis that they might do normally