Download Rosenhan`s Experiment Being Sane in Insane Places

Rosenhan's Experiment
Being Sane in Insane Places
Program Support Notes by:
Irene Matthews BSc (Hons)
Psychology, PGCE, Advanced
Certificate in Counselling, Dip Ed
(Education Management)
Produced by:
VEA Pty Ltd
Commissioning Editor:
Simon Garner B.Ed, Dip
Management
Executive Producer:
Simon Garner B.Ed, Dip
Management
© Video Education Australasia Pty Ltd 2011
Reproducing these support notes
You may download and print one copy of these
support notes from our website for your reference.
Further copying or printing must be reported to
CAL as per the Copyright Act 1968.
Rosenhan's Experiment
Being Sane in Insane Places
For Teachers
Introduction
This video is excellent for:
 Mental Health Practitioners – doctors, clinical psychologists, nurses.
 Mental Health Professionals – social workers, those working for charitable trusts such as MIND for
example.
 Psychology students.
 Sociology students.
 Social and Health care training.
 It is recommended that before playing the video you identify the different classification systems –
DSM and ICD.
 Highlight the use of these classification systems as a diagnostic tool.
 Emphasise the issue of reliability (between practitioners) of these classification systems.
 Emphasise the validity of these classification systems as Rosenhan’s study was aimed at
discovering if the classification system at the time, was a valid measure of mental health.
Please note: The DSM-IV is the fourth edition of the American Psychiatric Association’s Diagnostic
and Statistical Manual for Mental Disorders. It contains all known mental health disorders and offers a
new method of classification – multiaxial classification:
1. Individuals can be rated on multiple axis/dimensions. Diagnostic categories are used, for example
organic mental disorders, personality disorders etc.
2. DSM-IV makes diagnosis more concrete and descriptive than previously.
3. Classifications are useful to acquire new information about a disorder. This can help in the
development of new treatments and medication.
4. This type of classification has been criticised for stigmatising people and ignoring their
‘uniqueness’ by putting them in artificial groups.
Timeline
00:00:00
00:01:22
00:04:27
00:07:14
00:15:00
00:18:47
00:19:11
Introduction
Context
Methodology
Findings and explanation
Relevance today?
Credits
End program
2
© Video Education Australasia Pty Ltd 2011
Reproducing these support notes
You may download and print one copy of these support notes from our website for your reference.
Further copying or printing must be reported to CAL as per the Copyright Act 1968.
Rosenhan's Experiment
Being Sane in Insane Places
Student Notes
Rosenhan in 1973 concluded that the diagnosis of mental health patients was flawed because the
DSM 111 classification system used at that time was not valid. In other words, it could not tell those
who did have mental disorders from those who did not.
Rosenhan’s classic study: On Being Sane in Insane Places (1973).
All of the pseudo patients were admitted to hospitals and diagnosed as schizophrenic. Once
admitted, they behaved normally. However, their diagnosis seemed to bias the staff’s
interpretation of their behaviours. For example, pacing a corridor out of boredom was
interpreted as ‘anxiety’ by staff. When one pseudopatient began to make notes, it was
recorded as ‘patient engages on writing behaviour’.
Shortly after admission, the pseudopatients stopped claiming to hear voices, and all were
eventually discharged with the diagnosis of ‘schizophrenia in remission’ (a lessening of the
symptoms of schizophrenia). The only people who were apparently suspicious of them were
their ‘fellow’ patients, one of whom commented, ‘You’re not crazy, you’re a journalist or a
professor. You’re checking up on the hospital’. It took between 7 and 52 days (the average
being 19) for staff to be convinced that the pseudopatients were ‘well enough’ to be
discharged. In the time they had been in hospital, the participants had been prescribed 2,100
tablets (an average of 15 per day). None of these however, were taken.
Weaknesses:
Evaluation:
Methodological:
 Only one experimental group was used.
 Only 8 participants took part, therefore the results cannot be generalised
to other people.
Data analysis:
 Data was mostly qualitative which is open to interpretation and therefore,
subjective.
Strengths:
Ethics:
 The study involved deception. However it can be argued that its valuable
contribution outweighed its unethical means.
Methodological:
 Both quantitative and qualitative data was collected.
 The methods used were both experimental and covert participant
observation.
 Qualitative data is a rich source of information that gives us an
understanding of how people are treated in psychiatric hospitals.
 The IV and the DV were clearly operationalised.
 Hospitals across 5 States in the US were used in the study, which is a
good cross section of mental health hospitals.
 The study took place in real hospitals so it is high in ecological validity.
Ethics:
 The identity of the staff and patients were kept confidential.
Theoretical:
 Despite the fact that ‘schizophrenia in remission’ is an unusual diagnosis
according to Spitzer (1976), the study is widely held to have fulfilled its
aim of showing the deficiencies of the classification system for mental
disorder at the time (using DSM 11), and the negative consequences of
being labelled and institutionalised for mental disorder. It was studies like
this that led to pressure to revise and improve the accuracy of
classification systems.
3
© Video Education Australasia Pty Ltd 2011
Reproducing these support notes
You may download and print one copy of these support notes from our website for your reference.
Further copying or printing must be reported to CAL as per the Copyright Act 1968.
Rosenhan's Experiment
Being Sane in Insane Places
Some challenges to Rosenhan’s study
Spitzer (1975) though points out that as the clinicians in Rosenhan’s study were not required to
distinguish between normal and abnormal, the study tells us nothing about the accuracy of diagnosis
per se. Rather, the study was really assessing whether people pretending to have mental disorders
could be detected. Pretending to have and actually having a mental health condition is not the same
thing. Spitzer goes on to make the following observations:
 On the basis of the clinician’s data, diagnosis, other than those given, was justified. Each pseudo
patient ‘insisted’ on admission which itself is an important symptom of emotional disturbance. Kety
(1974) states that a person who swallowed a quart of blood and then went to hospital vomiting
blood would probably be diagnosed as having an ulcer. Just because the physician failed to notice
the deception would not imply that diagnosis was not impossible.
 The pseudopatients’ behaviour after admission was not normal. Normal people would say ‘I’m not
crazy, I just pretended to be. Now I want to be released’. At least, initially, however, the pseudo
patients remained impassive.
 The label ‘in remission’ (which the pseudopatients were released with) is very rarely used and
implies that the psychiatrist knew there was something different about the pseudopatients. All the
non-psychotic people observed by the psychiatrists were, by virtue of being given the label ‘in
remission’ diagnosed as non-psychotic. This is a 100% record of accuracy (Fleischman, 1973).
 The use of the word ‘insane’ whilst catchy is inaccurate. Insane is not a psychiatric diagnostic
category, but a legal term decided in a court of law. As such, Rosenhan used the term incorrectly.
Is Rosenhan’s study relevant today?
Since Rosenhan’s study a change in social policy has meant that the large asylums have closed
down and many more patients are cared for in the community. However, since 1973 and 2000 more
than 200 additional mental illnesses have been found. The vast majority of these are treated with
medication. Indeed 40,000,000 prescriptions per year for depression alone are issued in the UK. It
must be emphasised that if the diagnosis is incorrect then the drugs used to treat the illness may also
be incorrect.
4
© Video Education Australasia Pty Ltd 2011
Reproducing these support notes
You may download and print one copy of these support notes from our website for your reference.
Further copying or printing must be reported to CAL as per the Copyright Act 1968.
Rosenhan's Experiment
Being Sane in Insane Places
The continued problem of validity:
Several people have looked at the validity of DSM by comparing it with other classification systems.
The validity of one system can be checked by comparing it with another system already known to be
valid. If they both agree then the system being checked is also valid.
It seems that validity appears to depend on the disorder. There was greater agreement for disorders
such as depression for example yet for post-traumatic stress disorder there was little agreement,
(Andrews et al, 1999).
Another area of relevance is the fact that the medical profession has been accused of treating the
symptoms and not the patient and the depersonalisation that was witnessed in the Rosenhan study is
one that must be and continue to be, incorporated into patient care.
The BBC Horizon programme ‘How Mad Are You?’ indicated problems with diagnosis when 10
people, (5 diagnosed with a mental health condition and 5 without) were observed by 5 experts. The
experts correctly diagnosed two patients, misdiagnosed another with a mental health condition and
incorrectly identified 2 without a mental health condition. Better than what the psychiatrists managed
in the Rosenhan study but still a cause for concern!
One area of care that was highlighted in the data collected by the participants of Rosenhan’s study
was the lack of interaction between the doctors and nursing staff. 77% of participant’s efforts to
interact with doctors were ignored and this was even greater for nurses (88%). Even simple eye
contact was rare. However in a more recent replication of Rosenhan’s study, Lauren Slater faked one
single symptom - a voice in the head saying "thud" - and submitted herself for assessment on eight
separate occasions. Slater was treated with kindness and respect, and rather than the weeks of
incarceration Rosenhan and his colleagues endured, she was given consultations and then released.
The downside however was that after only 12 minutes of a psychiatrist's time she emerged with a
label from the Diagnostic and Statistic Manual on Mental Disorders (DSM) and prescriptions for antipsychotic and anti-depressant drugs!
5
© Video Education Australasia Pty Ltd 2011
Reproducing these support notes
You may download and print one copy of these support notes from our website for your reference.
Further copying or printing must be reported to CAL as per the Copyright Act 1968.
Rosenhan's Experiment
Being Sane in Insane Places
Extension Activities
1. Working in small groups, provide a detailed account of what Rosenhan’s study reveals about the
validity of classification systems. Note that the version of DSM used at that time would not have
included a multiaxial system as this was only published in 1985.
You will therefore need DSM III and DSM IV for this activity which can be found in most generic A
level text books.
2. Match the responses on the next page to the appropriate statements below.
Statements:
1. Two diagnostic classification systems are:
2. Rosenhan tried to find out if:
3. Rosenhan’s study was called:
4. Rosenhan found that: In relation to classification systems validity means:
5. Rosenhan found that the treatment in the hospitals led to depersonalisation. This is where:
6. Lack of interaction between the patients and the medical staff was one of the findings in
Rosenhan’s study. The results were:
7. Slater found similar results to Rosenhan in her replication. These were:
8. Slater found different results to Rosenhan in her replication. These were:
9. The BBC produced a programme called ‘How Mad Are You?’ which:
10. Spitzer is critical of Rosenhan because:
11. 400,000,000 prescriptions are written every year in Britain to treat:
12. New medical health problems are being discovered continually. Since 1973 to 2000 there have
been:
13. Fleishman says the diagnosis ‘schizophrenia in remission’ as indicating that:
14. Quantitative data refers to:
15. Qualitative data refers to:
6
© Video Education Australasia Pty Ltd 2011
Reproducing these support notes
You may download and print one copy of these support notes from our website for your reference.
Further copying or printing must be reported to CAL as per the Copyright Act 1968.
Rosenhan's Experiment
Being Sane in Insane Places
Responses:
a) Highlighted that the problems found in Rosenhan’s study were more accurate but not totally.
b) Criticisms levelled against the psychiatrists in his study.
c) Using different classification systems will result in the same diagnosis.
d) Rich information that often expresses thoughts, feelings and emotions
e) People are treated in terms of their symptoms and not as a person.
f) Being Sane in Insane Places
g) 77% of doctors ignored patients’ attempts at interaction compared to 88% for nurses.
h) Diagnosis of schizophrenia, medication and little interaction.
i) Depression.
j) 200 new disorders identified.
k) They knew something was different about the pseudopatients.
l) Data that can be easily quantified to produce statistics and graphs.
m) Non-admittance into a psychiatric hospital, kindness and respect, consultations and then
release.
n) The DSM and the ICD.
o) The diagnostic system in 1973 was valid tool to detect mental illness.
7
© Video Education Australasia Pty Ltd 2011
Reproducing these support notes
You may download and print one copy of these support notes from our website for your reference.
Further copying or printing must be reported to CAL as per the Copyright Act 1968.