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Rosenhan - On Being Sane in Insane Places
Terms in this set (13)
Distinguishing sane from insane is domain of psychiatrists and psychiatrists are medically qualified. Two methods of classifications systems can be used to diagnose mental illness: DSM (Diagnostic and Statistical Manual) and ICD (International Standard Classification of Injuries and Causes of Death). During the 60's and 70's there was also a movement of anti-psychiatrists of which Rosenhan was a part of.
1. To show that psychiatrists cannot reliably tell the difference between sane and insane people; that psychiatric criteria for diagnosis are not valid.
2. To investigate whether 'The salient characteristics that lead to diagnosis reside in the patients themselves or in the environments and contexts in which observers find them.'
Some say there is no independent or dependent variables but others say,
IV: lack of symptoms
DV: staff's response
Twelve mental institutions (8 pseudo-patients, but some visited multiple hospitals)
participants and sampling
The 'participants' were the doctors and nurses who happened to work in the 12 hospitals chosen for the study. They did not know that they were taking part in the study.
Rosenhan was a pseudo-patient himself and had seven other people join him in the experiment but the pseudo-patients themselves were the experimenters in study 1. In study 2 it was only Rosenhan.
no apparatus was needed or used.
The description of symptoms was standardized. The entry/access procedure was also standardized.
1. The pseudo-patient telephoned a hospital and made an appointment.
2. The pseudo-patient arrived at the admissions office and complained of hearing voices: the voices were often unclear but said: 'empty,' 'hollow,' and 'thud.' The voices were unrecognizable but the same sex.
3. Other than making up a name, job, and the auditory hallucinations, every other detail was true.
Study 2: A hospital was notified that pseudo-patients were going to be sent and they were to determine who the 'fakes' were when none were sent.
1. All pseudo-patients were admitted, 11 diagnosed with schizophrenia and 1 with manic depression.
2. The earliest release took 7 days, the average 19 and the latest 52 days. One patient was not 'cured' but had 'schizophrenia' in remission.
3. Rosenhan took notes openly because once when caught writing, it was assumed to be attributed to the illness and the notes were never checked by doctors or nurses. any action that was normal was assumed to be a result of mental illness
4. Some real patients were suspicious of the pseudo-patients. Staff had little contact with the patients because they were kept in 'cages.' Some of the staff was verbally and physically abusive. There was no privacy. Powerlessness and denationalization occurred in the pseudo-patients.
1. 41 were judged with' high confidence' as fake by at least 1 staff member.
2. 23 were judged as 'suspect' by at least one psychiatrist.
3. 19 were suspected as being fake by 1 psychiatrist and 1 staff member.
4. 83 (or 43%) were judged in some way to be pseudo-patients.
Psychiatric diagnosis of mental illness is reliable because this means that all psychiatrists made the same decision to admit the patients. Psychiatric diagnosis of mental illness is not valid because people with fake symptoms were diagnosed as having mental illness and so psychiatrists cannot distinguish between who is sane and who is insane.
1. Raises questions concerning reliability and validity.
2. The label of mental illness, once applied is a difficult one to remove.
3. The experience of life on the ward is depersonalizing and creates powerlessness in a patient.
4. The situation of being on a ward affects how behavior is perceived by staff.
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