The purpose of this survey was to prove the hypothesis that head-shrinkers can non faithfully state the difference between those patients who are sane and those who are insane.
Procedure
The survey consisted of two parts.
The chief survey is an illustration of a field experiment. The use ( Independent variable ) was the made up symptoms of imposter patients, the dependant variable was the head-shrinkers ‘ diagnostic admittance of the imposter patient and diagnostic labelling. The survey besides involved participant observation, since, one admitted, the imposter patients kept written records of how the ward as a whole operated, every bit good as how the personally were treated.
The first portion of the survey involved eight sane people ( a psychological science alumnus pupil in his 20s, three psychologists, a paediatrician, a head-shrinker, a painter, and a ‘housewife ‘ ) trying to derive admittance to 12 different infirmaries, in five different provinces in the USA. There were three adult females and five work forces.
These pseudo-patients telephoned the infirmary for an assignment, and arrived at the admittances office kicking that they had been hearing voices. They said the voice, which was unfamiliar and the same sex as themselves, was frequently ill-defined but it said ’empty ‘ , ‘hollow ‘ , ‘thud ‘ . These symptoms were partially chosen because they were similar to experiential symptoms ( Who am I? What is it all for? ) which arise from concerns about how nonmeaningful your life is. They were besides chosen because there is no reference of experiential psychosis in the literature.
The imposter patients gave a false name and occupation ( to protect their future wellness and employment records ) , but all other inside informations they gave were true including general ups and downs of life, relationships, events of life history and so on.
After they had been admitted to the psychiatric ward, the imposter patients stopped imitating any symptoms of abnormalcy. However, Rosenhan did observe that the imposter patients were nervous, perchance because of fright of being exposure as a fraud, and the freshness of the state of affairs.
The imposter patients took portion in ward activities, talking to patients and staff as they might normally. When asked how they were experiencing by staff they were all right and no longer experienced symptoms. Each imposter patient had been told they would hold to acquire out by their ain devices by converting staff they were sane.
The imposter patients exhausted clip composing notes about their observations. Initially this was done in secret although as it became clear that no 1 was bothered the note pickings was done more openly.
In four of the infirmaries the imposter patients carried out an observation of behavior of staff towards patients that illustrate the experience of being hospitalised on a psychiatric ward. The imposter patients approached a staff member with a petition, which took the undermentioned signifier: ‘Pardon me, Mr/Mrs/Dr X, could you state me when I will be presented at the staff meeting? ‘ . ( or ‘…when am I likely to be discharged? ‘ ) . See table 1.
In order to compare the consequences Rosenhan carried out a similar survey at Stanford University with pupils inquiring university staff a simple inquiry.
Consequences
All of the imposter patients disliked the experience and wished to be discharged instantly.
None of the imposter patients was detected and all but one were admitted with a diagnosing of schizophrenic disorder and were finally discharged with a diagnosing of ‘schizophrenia in remittal ‘ This diagnosing was made without one clear symptom of this upset. They remained in infirmary for 7 to 52 yearss ( mean 19 yearss ) , Visitors to the imposter patients observed ‘no serious behavioral effects ‘ . Although they were non detected by the staff, many of the other patients suspected their saneness ( 35 out of the 118 patients voiced their intuitions ) . Some patients voiced their intuitions really smartly for illustration ‘You ‘re non brainsick. You ‘re a journalist, or a professor. You ‘re look intoing up on the infirmary ‘ .
The imposter patients ‘ normal behaviors were frequently seen as facets of their supposed unwellness. For illustration, nursing records for three of the imposter patients showed that their authorship was seen as an facet of their pathological behavior. ‘Patient engages in composing behavior ‘ . Rosenhan notes that there is an tremendous convergence in the behavior of the sane and the insane. We all feel down sometimes, have tempers, go angry and so forth, but in the context of a psychiatric infirmary, these mundane human experiences and behaviors were interpreted as pathological.
Another illustration of where behavior was misinterpreted by staff as stemming from within the patient, instead than the environment, was when a head-shrinker pointed to a group of patients waiting outside the cafeteria half an hr before lunch period. To a group of registrars ( trainee head-shrinkers ) he suggested that such behavior was characteristic of an oral-acquisitive syndrome. However, a more likely account would be that the patients had small to make, and one of the few things to expect in a psychiatric infirmary is a repast.
In four of the infirmaries the imposter patients carried out an observation of behavior of staff towards patients that illustrate the experience of being hospitalised on a psychiatric ward. The consequences were compared with a university survey. In the university survey, about all the petitions were acknowledged and responded to unlike the psychiatric infirmary where the imposter patients were treated as if they were unseeable. See table 1.
Table 1: Responses of staff towards imposter patients petitions
Response
Percentage doing contact with patient
Psychiatrists
Nurses
Moves on with caput averted
71
88
Makes oculus contact
23
10
Pauses and confabs
2
4
Stops and negotiations
4
0.5
Rosenhan noted that experience of hospitalization for the imposter patients was one of depersonalization and impotence.
Powerlessness and depersonalization were apparent in the ways in which the patients were deprived of many human rights such as freedom of motion and privateness. Medical records were unfastened to al staff members irrespective of position or curative relationship with the patient and personal hygiene was monitored and many of the lavatories did non hold doors. Some of the ward orderlies would be barbarous to patients in full position of other patients but would halt every bit shortly as another staff member approached. This indicated that staff were believable informants but patients were non.
It was estimated that the imposter patients were given a sum of 2,100 medicine tablets, though merely two were swallowed. The remainder were either pocketed or flushed down the lavatory. Often, when the imposter patients visited the lavatories to dispose of their tablets they found the medicine of other patients that had already been placed at that place. Equally long as the patients were co-operative, so their behavior went unnoticed.
The records the imposter patients had made about the sum of clip the nurses stayed in the ward offices was about 90 per cent of the clip and the figure of times medical staff came onto the ward, and the sum of clip spent with head-shrinkers, psychologists, registrars and so Forth was, on norm, under seven proceedingss per twenty-four hours.
The Secondary Study
Procedure/Method
In the secondary survey, the staff of a instruction and research infirmary, which was aware of the first survey, was falsely informed that during the following three months one or more pseudo patients would try to be admitted into their infirmary. Staff members were asked to rate on a 10-point graduated table each new patient as to the likeliness of them being a imposter patient.
This false information was the manipulated independent variable, and the dependant variable was the figure of patients which staff later suspected of being pseudo patients.
Results/Findings of the Secondary Study
The tabular array shows that many patients of the infirmaries regular consumption were judged to be pseudo patients. For illustration, around 10 per cent of their regular consumption was judged by one head-shrinker and another staff member to be pseudo patients.
Table 2: Opinion of all admittances patients as to the likeliness that they are pseudo patients
Number of patients judged
193
Number of patients confidently judged as imposter patients by at least one staff member
41
Number of patients suspected by one head-shrinker
23
Number of patients suspected by one head-shrinker AND one other staff member
19
Explanation
Rosenhan claims that the survey demonstrates that head-shrinkers can non faithfully state the difference between people who are sane and those who are insane.
The chief experiment illustrated a failure to observe saneness, and the secondary survey demonstrated a failure to observe insanity.
Rosenhan explains that psychiatric labels tend to lodge in a manner that medical labels do non and that everything a patient does is interpreted in conformity with the diagnostic label once it has been applied.
He suggested that alternatively of labelling a individual as insane we should concentrate on the person ‘s specific jobs and behaviors.
Evaluation of the Procedure
Strengths
The participant observation meant that the imposter patients could see the ward from the patients ‘ position while besides keeping some grade of objectiveness.
The survey was a type of field experiment and was therefore reasonably ecologically valid whilst still pull offing to command many variables such as the imposter patients ‘ behavior.
Rosenhan used a scope of infirmaries. They were in different States, on both seashores, old/shabby and new, research-orientated and non, good staffed and ailing staffed, one private, federal or university funded. This allows the consequences to be generalised.
Failings
The hospital staff was deceived – this is, of class, unethical. Although Rosenhan did non hide the names of infirmaries or staff and attempted to extinguish any hints which might take to their designation
Rosenhan did observe that the experiences of the pseudo-patients could hold differed from that of existent patients who did non hold the comfort of cognizing that the diagnosing was false.
Possibly Rosenhan was being excessively hard on psychiatric infirmaries, particularly when it is of import for them to play safe in their diagnosing of abnormalcy because there is ever an call when a patient is let out of psychiatric attention and gets into problem. If you were to travel to the physicians kicking of tummy achings how would you anticipate to be treated?
Doctors and head-shrinkers are more likely to do a type two mistake ( that is, more likely to name a healthy individual sick ) than a type one mistake ( that is, naming a ill individual as healthy )
When Rosenhan did his survey the psychiatric categorization in usage was DSM-II. However, since so a new categorization has been introduced which was to turn to itself mostly to the whole job of undependability – particularly ill-defined standards. It is argued that with the newer categorization DSM-III, introduced in the 1980s, head-shrinkers would be less likely to do the mistakes they did. The DSM is presently in its 4th edition ( DSM-IV )
Evaluation of Explanation
The survey demonstrates both the restrictions of categorization and significantly the dismaying conditions in many psychiatric infirmaries. This has stimulated much further research and has lead to many establishments bettering their doctrine of attention.
Rosenhan, like other anti-psychiatrists, is reasoning that mental unwellness is a societal phenomenon. It is merely a effect of labelling. This is a really persuasive statement, although many people who suffer from a mental unwellness might differ and state that mental unwellness is a really existent job