Aim: To investigate whether psychiatrists can reliably tell the difference between people who have a mental disorder and those that do not.
Method Study 1: The main study was a field experiment involving participant observation. The participants were hospital staff in 12 different hospitals. The first part of the study involved eight sane people (pseudo-patients) attempting to gain admission to 12 different hospitals by telephoning the hospital for an appointment, and arriving at the admissions office complaining that they had been hearing voices. After they had been admitted to the psychiatric ward, the pseudo patients stopped simulating any symptoms of abnormality.
Results: None of the pseudo patients was detected and all but one were admitted with a diagnosis of schizophrenia and were eventually discharged with a diagnosis of ‘schizophrenia in remission’. The pseudo-patients remained in hospital for 7 to 52 days (average 19 days).
Method Study 2: In the secondary study, staff of a teaching and research hospital, were falsely informed that during the next three months one or more pseudo patients would attempt to be admitted into their hospital. Staff members were asked to rate on a 10-point scale each new patient as to the likelihood of them being a pseudo patient.
Results: Many patients of the hospitals regular intake were judged to be pseudo patients. For example, around ten per cent of their regular intake was judged by one psychiatrist and another staff member to be pseudo patients. Conclusion: Rosenhan claims that the study demonstrates that psychiatrists cannot reliably tell the difference between people who are sane and those who are insane.
More in-depth version:
Background: The most commonly accepted approach to understanding and classifying abnormal behaviour is known as the medical model (in line with the Biological Approach). In the 1960’s a number of psychiatrists and psychotherapists, known as the anti-psychiatry movement, started to fiercely criticise the medical approach to abnormality. David Rosenhan was a critic of the medical model and this study can be seen as an attempt to demonstrate that psychiatric classification is unreliable.
Aim: The aim of this study was to study how well psychiatrists could distinguish real patients with schizophrenia from pseudo-patients, who faked a single symptom. This provided a measure of the validity of the DSM-II system for diagnosis.
Method Study 1: The independent variable of the field experiment was the fake symptoms of the pseudo patients, and the dependent variable was the psychiatrists’ admission and diagnostic label of the pseudo patient. The study also involved participant observation. The pseudo-patients kept written records of how the ward as a whole operated, as well as how they personally were treated. The eight sane people who volunteered to conduct the procedure attempted to gain admission to 12 different hospitals, in five different states in the USA. These pseudo-patients, on arrival at admissions at the hospital, complained that they had been hearing voices. They said the voice, which was unfamiliar and the same sex as themselves, was often unclear but it said ’empty’, ‘hollow’, ‘thud’. The pseudo patients gave a false name and job (to protect their future health and employment records), but all other details they gave were true including general ups and downs of life, relationships, etc. After they had been admitted to the psychiatric ward, the pseudo patients stopped simulating any symptoms of abnormality. The pseudo patients took part in ward activities, speaking to patients and staff as they might ordinarily. When asked how they were feeling by staff they were fine and no longer experienced symptoms. Each pseudo patient had been told they would have to get out by their own devices by convincing staff they were sane. The pseudo patients spent time writing notes about their observations.
In four of the hospitals the pseudo patients carried out an observation of behaviour of staff towards patients that illustrate the experience of being hospitalised on a psychiatric ward.
Results: None of the pseudo patients was detected and all but one was admitted with a diagnosis of schizophrenia and was eventually discharged with a diagnosis of ‘schizophrenia in remission’. This diagnosis was made without one clear symptom of this disorder. They remained in hospital for 7 to 52 days (average 19 days). Although they were not detected by the staff, many of the other patients suspected their sanity (35 out of the 118 patients voiced their suspicions). Some patients voiced their suspicions very vigorously for example ‘You’re not crazy. You’re a journalist, or a professor. You’re checking up on the hospital’.
The pseudo patients’ normal behaviours were often seen as aspects of their supposed illness. For example, nursing records for three of the pseudo patients showed that their writing was seen as an aspect of their pathological behaviour. ‘Patient engages in writing behaviour’. The observation of staff treatment of patients revealed that the pseudo patients were treated as if they were invisible.
Rosenhan noted that experience of hospitalisation for the pseudo patients was one of depersonalisation and powerlessness. It was estimated that staff administered 2,100 medication tablets to the pseudo-patients. The number of times medical staff came onto the ward, and the amount of time spent with psychiatrists, psychologists, registrars and so forth was, on average, under seven minutes per day.
Method Study 2: The staff of a teaching and research hospital, which was aware of the first study, was falsely informed that during the next three months one or more pseudo patients would attempt to be admitted into their hospital. Staff members were asked to rate on a 10-point scale each new patient as to the likelihood of them being a pseudo patient. This false information was the manipulated independent variable, and the dependent variable was the number of patients which staff subsequently suspected of being pseudo patients.
Results: Judgement of all admissions patients as to the likelihood that they are pseudo patients.
Conclusion: The study demonstrates that psychiatrists cannot reliably tell the difference between people who mentally disordered and those that are mentally healthy. It also indicates that DSM-II was not a valid measurement of mental illness and once labelled with a condition like schizophrenia, patients find it difficult to escape the label and be judged as ‘normal’.
Evaluation:
| Strengths | Weaknesses |
| + Rosenhan used a range of hospitals. They were in different States, on both coasts, both old/shabby and new, research-orientated and not, well-staffed and poorly staffed, one private, federal or university funded. This allows the results to be generalised. + The study had some control over variables and certain procedures were standardised allowing for replication. As the study was conducted/ repeated in several hospitals where similar results were found this enhances the reliability of the findings. + Confidentiality was maintained, Rosenhan did not reveal the names of hospitals or staff and he attempted to eliminate any clues which might lead to their identification. +/- Rosenhan’s study highlighted the need for revisions and improvements of DSM as a diagnostic tool and thus had useful application. When Rosenhan did his study the psychiatric classification in use was DSM-II. However, since then a new classification has been introduced which was to address itself largely to the whole problem of unreliability – especially unclear criteria. It is argued that with the newer classifications, psychiatrists would be less likely to make the errors they did. Studies now would be unlikely to replicate the findings. |
– However, whilst the pseudo-patients’ observations would try to be objective, some subjectivity and the emotions of the pseudo-patients could have influenced these observations. – The staff at the hospital (the participants) were deceived and they were naive to being participants in a study which is unethical. |