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Clinical Classic Study: Rosenhan (1973): Being sane in insane places

Rosenhahn Video Notes:

Rosenhan’s study can be considered a field experiment crossed with naturalistic observations.
It was conducted in the “real world” and mainly consisted of notes and observations of the pseudopatients

Aim: Rosenhan wanted to test the reliability of mental health diagnosis, to see if medical professionals
could tell the mentally ill from the healthy in a clinical setting.

Procedure:
 -Rosenhan had 8 pseudopatients, 3 women and 5 men from various professions,
including psychologists, a housewife and a pediatrician

-They were people who were not mentally ill that would pretend to experience
schizophrenic symptoms. Saying that they hear hollow “thuds” and “voices”.

-The pseudopatients communicated with 12 psychiatric hospitals in the USA, situated

on both the East and West Coast. These hospitals also varied in funding and staffing.
There was even a private hospital.

-When the pseudopatients were admitted into the hospitals, they were
instructed to act as they would normally. Taking notes regarding their
experiences and following instructions of the hospital staff (other than
taking medication)

-The pseudopatients had to behave in a way to convince the hospital

staff that they were not mentally ill before being discharged

Findings:
-Every single hospital diagnosed the pseudopatients with a mental disorder. 11 were diagnosed with
schizophrenia.

-The Length of hospitalization ranged from 7 to 52 days with an average of 19 days

-None of the staff were able to identify that the pseudopatients were faking their symptoms. However,
many legitimate patients were easily able to identify this.

-In 4 of the 12 hospitals, no staff answered the pseudopatients when they asked them questions. It was
found that 71% of doctors and 88% of nurses and other staff ignored the pseudopatient when questioned.

-The qualitative findings were that three ‘normal’ behaviours were misinterpreted as ‘abnormal’, including
note writing being interpreted by a nurse as ‘engaging in writing behaviour’ as though it was something
only a person with a mental illness would do. Another interpreted pacing up and down as a sign of
nervousness, when the pseudopatient was just bored.
 The follow-up study:
-Rosenhan agreed with one leading hospital to do a follow up study.

-Every staff member who dealt with admissions had to rate all the patients in terms of the probability that
the were pseudopatients.

-In 3 months, 193 patients were admitted to the hospital. The staff had to rate each incoming patient from
a scale of 1-10 how likely they thought the patient was a fake

-41 of those were considered to be fake patients by -19 were considered to be fake by two staff
one staff member members.

Findings:
In reality, Rosenhan had not sent a single pseudo patient to this hospital.

Confirming that his initial results about diagnoses being invalid to be correct.

Conclusion:
The results demonstrate that medical professionals cannot reliably differentiate those who were mentally
ill and those who were not.

Furthermore, he suggests that the label of “mental illness” once applied to a person, all their behaviours
will be observed in the context of that label. Creating a self fulfilling prophecy if the person is treated in
accordance to their “mental illness”

‘Normal’ behaviour was misinterpreted as ‘abnormal’ to support their idea that the pseudopatients had a
mental illness. This suggests the validity of psychiatric diagnoses was low. Ironically, due to the
consistency of diagnoses they are reliable but incorrect.

Evaluation of Rosenhahn
 1.Identification 2.Justification 3.Elaboration

A strength of Rosenhan’s What about the setting the study took

study was that it had high place in makes it high in ecological
ecological validity… validity?

Counterpoint: However, the hospitals were all in the USA. The doctors and patients were all from the
same culture, therefore the findings may only tell us about the diagnosis and the treatments provided in
the USA in the early 70s.

This is a weakness because other cultures may not use the DSM-II manual and also may not share the
westernised view of some symptoms, particularly hallucinations, so we cannot assume that the process of
diagnosing mental disorders will show similar problems in other cultures and countries.

A strength of Rosenhan’s
study was that it was applied
and paved the way for critical
reforms in the diagnostic
process.
Application
The DSM-III had new diagnostic criteria
added to many of the mental health
disorders included within.
The definitions and the boundaries of
mental and medical disorders were
changed from loose interpretations of
disorders from paragraphs to a checklist
of symptoms, several of which were
required for a diagnosis to meet the
book’s standards
This is a strength because
the study lead to beneficial
changes in diagnostic
manuals, which has made
the diagnostic process of
mental health disorders more
reliable.

A weakness of Rosenhan’s What about the procedure of the study

study was that it had a number made it unethical?
of ethical issues…