Rosenhan experiment

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http://en.wikipedia.org/wiki/Rosenhan_experiment

The Rosenhan experiment was a famous experiment into the validity of psychiatric diagnosis conducted by David Rosenhan in 1972. It was published in the journal Science under the title “On being sane in insane places“.

Rosenhan’s study consisted of two parts. The first involved the use of healthy associates or ‘pseudopatients’, who briefly simulated auditory hallucinations in an attempt to gain admission to 12 different psychiatric hospitals in 5 different states in various locations in the United States. The second involved asking staff at a psychiatric hospital to detect non-existent ‘fake’ patients. In the first case hospital staff failed to detect a single pseudopatient, in the second the staff falsely detected large numbers of genuine patients as impostors. The study is considered an important and influential criticism of psychiatric diagnosis.

The study concluded “It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals” and also illustrated the dangers of depersonalization and labelling in psychiatric institutions. It suggested that the use of community mental health facilities which concentrated on specific problems and behaviors rather than psychiatric labels might be a solution and recommended education to make psychiatric workers more aware of the social psychology of their facilities.

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[edit] The Pseudopatient Experiment

For the purposes of the study, eight ‘pseudopatients’ (associates of Rosenhan selected to be a group of varied and healthy individuals) attempted to gain admission into psychiatric hospitals. During psychiatric assessment they claimed to be hearing voices that were often unclear, but noticeably said the words “empty”, “hollow” and “thud”. No other psychiatric symptoms were claimed, and apart from giving false names and employment details, further biographical details were truthfully reported. If admitted, the pseudopatients were asked to ‘act normally’, report that they felt fine and no longer heard voices.

The pseudopatients were: a psychology graduate student in his twenties, three psychologists, a pediatrician, a psychiatrist, a painter and a housewife. None had a history of mental illness. After being admitted, the experimental subjects acted normally and did not display any obvious psychopathology. Subjects were to remain as inpatients until they were discharged by the staff at their hospitals, who were not privy to the experiment and believed the subjects to be real psychiatric patients.

All eight were admitted, seven with a diagnosis of schizophrenia, the last with bipolar disorder. None of the pseudopatients were detected during their admission by hospital staff, although other psychiatric patients seemed to be able to correctly identify them as impostors. While the staff failed to identify sanity, in the first three hospitalisations notes of patient responses were kept and 35 of the total of 118 patients did express a suspicion that the pseudopatients were sane. All were discharged with a diagnosis of schizophrenia “in remission”. Their stays ranged from 7 to 52 days and the average was 19 days.

During their stay, hospital notes indicated that staff interpreted much of the pseudopatient’s behaviour in terms of mental illness. For example, the note-taking of one individual was listed as “writing behaviour” and considered pathological.

[edit] The non-existent impostor experiment

For this experiment, Rosenhan used a well-known research and teaching hospital, whose staff had heard of the results of the initial study but claimed that similar errors could not be made at their institution. Rosenhan arranged with them that during a three month period, one or more pseudopatients would attempt to gain admission and the staff would rate every incoming patient as to the likelihood they were an impostor. Out of 193 patients, 41 were considered to be impostors and a further 42 were considered suspect. In reality, Rosenhan had sent no pseudopatients and all patients suspected as impostors by the hospital staff were genuine patients (unless they were other impostors unknown to the study, which seems quite unlikely). This led to a conclusion that “any diagnostic process that lends itself too readily to massive errors of this sort cannot be a very reliable one”. Studies by others found similarly problematic diagnostic results.

[edit] Related experiments

Temerlin split 25 psychiatrists into two groups and had them listen to an actor acting in the picture of mental health. One group was told that the actor “was a very interesting man because he looked neurotic, but actually was quite psychotic” while the other was told nothing. Sixty percent of the former group diagnosed psychoses, most often schizophrenia, while none of the control group did so.

Loring and Powell gave 290 psychiatrists a transcript of a patient interview and told half of them that the patients were black and half white and concluded of the results that “Clinicians appear to ascribe violence, suspiciousness, and dangerousness to black clients even though the case studies are the same as the case studies for the white clients”.

[edit] Impact

Rosenhan published his findings in Science, criticising the validity of psychiatric diagnosis and the disempowering and demeaning nature of patient care experienced by the associates in the study. His article generated an explosion of controversy.

Many defended psychiatry, arguing that as psychiatric diagnosis relies largely on the patient’s report of their experiences, faking their presence no more demonstrates problems with psychiatric diagnosis than lying about other medical symptoms. In this vein psychiatrist Robert Spitzer claimed in a 1975 criticism of Rosenhan’s study:

If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood, the behaviour of the staff would be quite predictable. If they labelled and treated me as having a peptic ulcer, I doubt I could argue convincingly that medical science does not know how to diagnose that condition.

However, Spitzer believed that despite the perceived shortcomings of Rosenhan’s study, there was still a laxness in the field. He played an important role updating psychiatric diagnosis, eventually resulting in the DSM-IV, in an attempt to make it more rigorous and reliable.

Lauren Slater claimed in her 2004 book Opening Skinner’s Box to have repeated Rosenhan’s study by presenting at the emergency rooms of multiple hospitals with a single auditory hallucination. She claimed that she was not admitted to any of the hospitals but was given prescriptions for antipsychotics and antidepressants. Her claims were questioned by Robert Spitzer and others, and she replied through her attorney to say that she considered her work to be an “anecdote, not systematic research, and certainly not a ‘replication’ of Rosenhan’s study.”

[edit] References

  • Rosenhan, D. (1973) On being sane in insane places. Science, 179, 250-8. Full text as PDF
  • Slater, L. (2004) Opening Skinner’s Box: Great Psychological Experiments of the Twentieth Century. ISBN 0-393-05095-5.
  • Spitzer, R.L. (1975) On pseudoscience in science, logic in remission, and psychiatric diagnosis: a critique of Rosenhan’s “On being sane in insane places”. Journal of Abnormal Psychology, 84 (5), 442-52.

[edit] See also

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4 thoughts on “Rosenhan experiment”

  1. There has always been some doubt as to the real effectiveness of psychiatric treatments as cures. By that I mean that diagnosis has hardly improved from that devised by Cicero in Roman times. More often than not it, relies on the patient identifying their own symptoms “I feel depressed” or “I feel suicidal” etc and then prescribing treatments accordingly. the Rosenhaum experiment kinda enforces this point of view.

    Therapy via a stranger, has all but replaced that performed via friends and family, and we are now creating a whole group of drug dependent, mentally ill people who are not cured; they are just controlled by the drugs, or rather their own expectations of what taking the drugs will do.

    I have blogged on the subject of how treatments have developed over the last few thousand years myself (very briefly LOL) and it was therefore interesting to come across your blog on this experiment (I remember reading about this years ago but had forgotten it).

    If anyone is interested, take a look at it. Don’t worry I am not looking for links … it merely overlaps the subject of this blog.

    http://no-pc.blogspot.com/2007/04/is-modern-mental-health-treatment.html

  2. No-PC,

    Thanks for the link! You are welcome to link away in the comments as long as you are not some kind of spam bot and it relates to the topic, like you did here.

    I know for sure that different kinds of counseling are useful, effective and often necessary, but I can’t speak for psychiatry. I personally think the way it is practiced today is dishonest and uncaring, but thats my opinion.

    I think with an accurate diagnosis and medication as a temporary first step we would be making some progress. This could buy some time to work on the cause of the issue while minimizing symptoms.

    Another opinion of mine is that psychiatry is just as broken as the rest of the medical biz with their unhealthy alliance with pharmaceutical corps. Mental health has a longer lasting stigma attached to it though.

    Look at ecopsychology and related schools of thought to see that we are integrating a lot of those ancient techniques.

  3. Its a serious thing because paying someone money outside of the salary cap is a huge breach of nfl rules and they were doing it to injure players. Which can cause all sorts of legal ramifications if it continues. The head coach over sees everything and is ultimately responsible for the actions of his team and his coaches. Its nice for an orginization, unlike the ncaa, to actually punish coaches for these types of incidents. This is a much more serious issue than lot of people realize. There are so many things that can come from paying someone to injure another person and all of them are negative.

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