On being sane in insane places - Rosenhan, D.L. (1973)

Aims

The main aim of the study was to test that psychiatrists cannot determine between those who are sane and those who are insane.

Participants

Part 1:
  • Eight sane people (3 women, 5 men). Known as pseudo patients.
  • Careers of the eight - A psychology graduate, three psychologists, a pediatrician, a psychiatrist, a painter and a housewife.

  • Part 2:
  • None - staff in teaching hospitals were falsely informed.
  • Research Method

    Part 1:
  • Field experiment (naturalistic observation).

  • Part 2:
  • Field experiment - observed how the staff reacted but, the staff also gave their own information on who was a pseudo patient (self report?).
  • Procedure


    Part 1:
  • Eight pseudo patients were attempting to gain admission to 12 different psychiatric hospitals.
  • Pseudo patients telephoned the hospital for an appointment and arrived saying that they "heard voices". They said the voices were unfamiliar, same gender as themselves, and the voices often said "empty", "hollow", and "thud".
  • Pseudo patients were given a false name and job but details of their lives were true (ex. relationships, up and downs of life, etc).
  • After pseudo patients were admitted, they stopped simulation any symptoms that they were previously "experiencing". They took place in regular psychiatric activities.
  • Pseudo patients spent time writing down their observations.
  • Each was diagnosed with Schizophrenia and were released with the psychiatrists felt that they were in remission.
  • Within the hospital, some of the other patients realized that they were faking their Schizophrenia but, the hospital staff didn't recognize this.

  • Part 2:
  • For this study, the staff was aware the the previous study (part one). They were then falsely informed that during the next three months, a pseudo patient would attempt to gain admission.
  • Staff members asked to rate their patients on a 10-point scale for the likelihood of them being a pseudo patient.
  • Findings


    Part 1:
  • All of the pseudo patients didn't like the experience and wanted to be discharged immediately.
  • None of the pseudo patients were detected as being sane and all discharged with the diagnosis of Schizophrenia in remission. Remained in the hospital for 7 to 52 days (19 days was the average).
  • The patients that detected their suspicions of sanity (35 out of 118) said things such as, "You're not crazy".
  • Behaviors of the patients were misinterpreted by the staff many times and the pseudo patients were treated as if they were invisible.
  • Pseudo patients were given a total of 2.100 medication tablet but only two were swallowed - the others were disposed of without the staff's knowledge.

  • Part 2:
  • Many of the hospital's regular patients were judged to be pseudo patients. About 10% of the regular ones were judged by one psychiatrist and a staff member to be a pseudo patient.


  • Strengths


  • Both qualitative and quantitative data.
  • Field experiment = high ecological validity.
  • Wide range of hospitals - results can be generalized.

  • Ecological Validity


  • High ecological validity. This is due to the fact that the settings and environments were real, with real use of medical equipment and professional psychiatrists and staff.
  • Field experiment adds to the high ecological validity rate.
  • Explanations


  • The experience for the pseudo patients was mainly of depersonalization and powerlessness - patients deprived of privacy (medical records open to all staff and personal hygiene monitored).
  • Rosenhan states that the study demonstrates that psychiatrists cannot tell the difference between people who are sane and people who are insane.
  • Part 1 showed the failure to detect a sane person.
  • Part 2 showed the failure to detect an insane person.
  • Psychiatric labels are more likely to stick - everything a person does is interpreted by the label given.
  • Rosenhan suggests that instead of labeling people, psychiatrists should focus on the person's behaviors and problems.


  • Weaknesses


  • Hospital staff was deceived - unethical.
  • Experience of pseudo patients could have differed from actual patients.
  • Doctors more likely to make a type 2 error than a type 1 error.

  • Ethics


    Unethical. Due to the use of deception on the hospital staff.

    Rosenhan, D.L. (1973)


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