Rosenhan

Question	Answer
How is the medical model of abnormality used to diagnose mental illness?	The medical model of abnormality assumes that abnormal behaviour stems from physiological causes."Mental illness" is diagnosed the same way that physical symptoms are diagnosed using the medical model of abnormality where the psychiatrist identifies a set of symptoms (which have been standardized by the DSM) and uses these to identify the disorder
Why is this approach (diagnosis of mental illness) controversial in reference to the anti-psychiatry movement?	Psychiatrists such as Michel Foucault, RD Laing and Thomas Szasz launched an 'anti-psychiatry' movement as they believed that some people were wrongfully being institutionalized; abnormality could just be a social construction opposed to objective classification e.g. homosexuality
What did Foucoult (1961) believe about mental illness?	Foucault (1961) described development of mental illness similar to the 17th and 18th centuries where 'unreasonable' members of population were locked away, institutionalized and treated in inhumane ways eg freezing showers/straight-jackets; Foucault argued that concepts of sanity + insanity were social constructs ie not real but constructions made by society
What did Laing (1960) believe?	Foucault's ideas had an influence on Laing and Szasz. Laing (1960) argued that schizophrenia is best understood in terms of individual's experience rather than a set of symptoms
What did Szasz (1960) argue?	Szasz (1960) argued that the medical model is no more sophisticated than believing in demonology; it is suggested that mental illness is simply a way of excluding nonconformists from society
What question did Rosenhan raise due to the influence of Szasz, Laing and Foucault?	Rosenhan influenced by these ideas asked “If sanity and insanity exist, how shall we know them?”.
What evidence did he provide for us not being able to tell normal from abnormal?	Much disagreement about meanings of terms such as sanity, insanity, mental illness and schizophrenia Conceptions of normal and abnormal not universal – what is seen as normal in one culture may be seen as quite aberrant in another
What did Rosehan aim to investigate?	aimed to investigate whether psychiatrists could distinguish between people who are genuinely mentally ill and those who are not
How did he propose to go about doing this?	He argued that the question of personality vs. situation can be investigated by getting "normal" people to seeking admission to a hospital and if such pseudo-patients were diagnosed as sane, this would show that sane individuals can be distinguished in an insane context. On the other hand, if the pseudopatient were diagnosed as insane, then this suggests that it's the context and not individual's characteristics that determines the diagnosis and that the psychiatric diagnosis of "insanity" has less to do with the patient and more to do with the insane environment in which they're found
Who were the pseudo patients in Study 1?	Rosenhan conducted 3 studies. In Study 1 the pseudo patients were 5 men and 3 women of various ages and occupations (e.g. psychologist, painter, pediatricians and housewife) including Rosenhan himself
How many hospitals did ppts from study 1 attempt to gain access to?	They attempted to gain admission to 12 different hospitals in 5 different states in the USA and the hospitals represented a range of different kinds of psychiatric institutions and only one was a private hospital.
How did each of the pseudo patients present symptoms to hospitals in study 1?	Each pseudo patient called a hospital and asked for an appointment and on arrival they told admissions officers that they'd been hearing voices saying words that included "empty", "hollow" and "thud" and these symptoms were deliberately chosen because they're similar to existential symptoms and their absence in psychiatric literature. Beyond the description of auditory hallucinations each pseudo patient described their life events accurately (both good and bad) and none of them had any history of pathological behaviour.
How did the ppts behave in hospital?	In the hospital, the pseudo patients were instructed to behave normally once they were admitted to the psychiatric ward and other than some understandable nervousness and tension about being found out, the pseudo patients behaved perfectly normally.
How did ppts make notes and did they follow ward routine?	They spent their time talking to other patients, and making notes of observations of life on the ward. Initially the notes were made surreptitiously but it soon became apparent that the staff didn't care and the pseudo patients secretly didn't take their medication but otherwise followed ward routine.
What were the reports from the nurses of them like?	The reports from the nurses showed that the patients were friendly, cooperative and "exhibited no abnormal indications".
What was the condition in the study about getting discharged?	The pseudo patients didn't know when they would be discharged - one of the conditions of taking part in the study was that they had to get out themselves.
What did another hospital claim after the results for study 1 was published? How did Rosenhan respond to this and how did this affect hospital routine?	After the results of this research were publicized, staff in another hospital (that hadn't received any pseudo patients) challenged Rosenhan claiming that it wouldn't happen in their hospital to which Rosenhan informed them that in the next 3 months 1/more pseudo patients would present themselves and in response to this the staff were asked to rate on a 10 point scale their confidence level (1-confident) that a person was genuinely ill and judgement was obtained on 193 patients admitted for psychiatric treatment during this time
What did the mini study Rosenhan did consist of?	Rosenhan also included a mini study of the way staff responded to pseudo patients. In 4 of the hospitals, pseudo patients approached a staff member with the following questions "Pardon me, Mr/Mrs/Dr X could you tell me when I will be eligible for ground privileges?" or "When am I likely to be discharged?". The pseudo patients did this as normally as possible and avoided asking any particular person more than once a day.
What were all but one of the pseudo patients diagnosed with and what do these results show?	All the pseudo patients were admitted and all but one were diagnosed with schizophrenia and each was eventually discharged with a diagnosis of schizophrenia "in remission" and the length of hospitalization varied from 7-52 days with an average of 19 days and these results show the profound effect of a "label" on our perception of people - once a person is labelled as "abnormal" this means that all subsequent data about him/her are interpreted in that light because such labels are "stick" - e.g. label schizophrenia "in remission" suggesting they were still schizophrenic but temporarily sane
What was found about staff-patient contact?	There was also very limited contact between staff and patients - on avg nurses emerged fro the cage 11.3 times per shift whereas psychiatrists only appeared 6.7 times per day.
What was the most common response from the staff in study 3?	From study 3, the most common response from a member of staff was a brief reply as they continued walking past or without making eye contact - only 4% of the psychiatrists and 0.5% of the nurses stopped.
What doe the behaviour of the staff towards the patients show?	The behaviour of the staff serves to show how patient were depersonalized because contact was avoided and in general staff treated the patients with little respect punishing them for small incidents and beating them - such treatment is depersonalizing and creates an overwhelming sense of powerlessness
What was the result with the control with the woman approaching?	In contrast, as a control when a young women approached staff members on the Stanford University campus and asked them questions all the staff members stopped and answered all questions maintaining eye contact.
How were the drugs/tablets a source of depersonalization?	Another source of depersonalization was the use of psychotropic drugs - during the research, the pseudo patients were given a total of 2100 tablets - Rosenhan suggested that drugs convince staff that treatment is being conducted and therefore further patient contact isn't necessary.
What were the results of study 2?	The results of study 2 were that over the 3 months, 193 patients none of which were pseudo patients were admitted for treatment but 41 were judged to be pseudo patients by at least one staff member, 23 were suspected by at least 1 psychiatrist and 19 were suspected by a psychiatrist and one other member of staff.
What did the psychiatrists in study 1 do and why did they do this?	In study 1, psychiatrists failed to detect pseudo patients sanity despite the fact that they were clearly sane - this is perhaps because doctors have a strong bias towards a Type 2 error - they are inclined to call a healthy person sick (a false positive) than a sick person healthy (a false negative - a type 1 error) - it's clearly more dangerous to misdiagnose illness than health and err on the side of caution.
What did the hospital staff in study 2 do and why?	In study 2, the hospital staff were now making more type 1 errors (calling a sick person healthy) presumably because they were trying to avoid making Type 2 errors
What was frightening about Rosenhan's conclusion about study 2?	Rosenhan concluded that that we prefer to invent knowledge (e.g. labelling someone as schizophrenic) rather than admit we don't know - this is frightening. How may people in our psychiatric institutions are sane one wonders, but not recognized as such? Once hospitalized, the patient is socialized by the bizarre setting, a process Goffman (1961) called "mortification"
What method did Rosenhan use and why is it an advantage?	Rosenhan used covert, naturalistic participant observation which is an advantage as it ensured doctors, patients and nurses behaved naturally so demand characteristics and the social desirability bias didn’t affect them increasing internal validity of findings.
What did the participant observation ensure?	The participant observation meant that the pseudo patients could experience the ward from the patient’s perspective while also maintaining some degree of objectivity.
What kind of data was gained from the method?	This method also allows both quantitative data (e.g. important numbers such as how many patients etc.) and qualitative data (e.g. way doctors and nurses behaved towards patients, patients’ perspective) which provide both comparable statistical data as well as detailed data.
How was internal validity decreased by the harshness of the method? What aspect of the psychiatrist's behaviour is understandable when taking this into consideration?	The actual method of that Rosenhan employed may have been too harsh lowering internal validity of results – perhaps he was being too hard on psychiatric hospitals, especially when it’s important for them to play safe in their diagnosis of abnormality because there’s always an outcry when a patient is let out of psychiatric care and gets into trouble. When taking this into consideration it’s understandable why the psychiatrists made type 2 errors in the first study.
How was the reliability of the 2nd study different to the first?	The conclusions from the first study were based on the experience of eight pseudo patients in a number of different however in the second hospital only one hospital was involved – so although startling evidence was found of doctors making type 1 errors in the second hospital the consistency of the findings weren’t really high (only one hospital) lowering reliability of findings.
How does the range of hospitals Rosenhan used allow generalisability?	Rosenhan used a range of hospitals. They were in different States, on both coasts, both old and new, research-oriented and not, well staffed and poorly staffed, one private, federal or university funded – this allows generalisability of results.
How does the field experiment increase generalisability?	The study was a type of field experiment and therefore had high external validity as it had high mundane realism due to naturalistic setting and therefore high ecological validity which again improves generalisability of results.
Why are the results from the study startling when considering the participant?	The participants in this study were staff (nurses and doctors) who are not vulnerable people – they are in fact trained health-professionals who the general public trust and this makes the conclusions drawn from the study even more startling.
How were ethics dealt with in terms of consent and confidentiality?Justification?	However the hospital staff were deceived and this is unethical due to lack of informed consent. This could be taken especially seriously as it was in a hospital setting where confidentiality of vulnerable patient information is essential although Rosenhan did conceal the names of hospitals/staff and attempted to eliminate any clues which might lead to their identification. Also it could be argued that his findings would be invalid if participants were aware of the aims of the study
What did Lauren Slater (2004) find?	Lauren Slater (2004) SUPPORTS single, unsystematic study, presented herself at 9 hospitals with a single auditory hallucination (word: thud) as Rosenhan's pseudopatients had done, also previously diagnosed with clinical depression wasn't admitted to any hospitals but given prescriptions for drugs and psychotic depression diagnosis
How does Slater (2004) support Rosenhan?	Research may not support Rosenhan's conclusions as Slater not admitted to any hospitals but does SUPPORT in a way as Slater offered treatment = drugs 2004 equivalent of hospitalisation in 1973
What did Spitzer (1976) find that contradicts Rosenhan's research?	Spitzer (1976) CONTRADICTS investigated individuals admitted with schizophrenia in his own and 12 other hospitals (US), found discharge dia. 'schizophrenia in remission' given rarely unusual diagnosis reflects unusual pseudopatient symptoms
How does Spitzer's findings contradict rosenhan?	CONTRADICTS Rosenhan as Spitzer concluded the pseudopatient's discharge diagnosis due to patients' behaviour, not setting in which diagnoses made
What did Loring and Powell (1988) find?	Loring and Powell (1988) SUPPORTS/DEVELOPS  Gave psychiatrists transcripts of a patient interview half of the psychiatrists were told the patient was black while the other half were told the patient was white  The clinicians labeled the black patient as violent, suspicious and dangerous even though the case studies are the same as for the white patients
How do Loring and Powell's findings develop Rosenhan?	DEVELOPS by suggesting today the diagnoses are influence by stereotypical views established by society and it SUPPORTS the idea that schizophrenia is social construct.
What did Langwieler and Linden (1993) find?	. Langwieler and Linden (1993) SUPPORTS/DEVELOPS sent a trained pseudopatient to 4 physicians each with different professional background diagnosticians proposed 4 different diagnoses and 4 different treatments even though pseudopatients symptoms were the same
How does Langwieler and Linden's research support and develop Rosenhan?	SUPPORTS Rosenhan's research, and DEVELOPS by suggesting today the situation symptoms are found in can be still be more important than symptoms for a diagnosis, important situational factors: occupation/class of doctor matters as well

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