Evaluation Of Rosenhan’s ‘Sane In Insane Places’ (1973)

Strengths:

– The investigation was carried out in hospitals with staff who were unaware of the experiment. Therefore, the study could be said to have high ecological validity.

– The hospitals used were varied (old and new, private and public), allowing for generalisation. This is further supported through the use of the twelve hospitals which were involved in the study.

– The pseudo-patients admitted themselves under a different name, meaning that their identities were protected. Ethically-speaking, this is a strength, as the individuals do not need to associate themselves with the label that was attached to them as a result of being admitted.

– Participant Observation – the pseudo-patients were able to experience the ward from a patient’s perspective, whilst also maintaining some degree of objectivity.

– Doctors are likely to err on the side of caution, meaning that they are more likely to admit a patient who is ‘healthy’ if they are not sure – the ‘better to be safe than sorry’ principle.

Weaknesses:

– The hospital staff and patients were deceived. They did not have the decision to withdraw from the experiment or give their consent. Therefore, the study could be seen to be unethical.

– Rosenhan may have been too hard on psychiatric hospitals as the pseudo-patients were simulating symptoms of schizophrenia. They were merely following the guidelines of the DSM.

– An older classification was used – at the time, DSM-II was in use. The introduction on the DSM-III in 1980’s helped to eliminate unreliability. This meant that psychiatrists were less likely to make errors.

Criticisms:

Validity:

– Seymour Ketty (1974) criticised Rosenhan’s deception from a validity perspective, saying: “If I were to drink a quart of blood and, concealing what I had done, had come to the emergency room of any hospital vomiting blood, the behaviour of the staff would be quite predictable.” Ketty’s point was that psychiatrists will hardly expect someone to carry out deception in order to be admitted to a psychiatric hospital.

Reliability:

– Robert Spitzer (1976) notes that the diagnosis, ‘Schizophrenia-in-Remission’, is extremely rare. He examined the records of 12 other American hospitals and found that in 11 cases, ‘S-I-R’ was either never used or used only for a handful of patients each year. Therefore, Spitzer claims that psychiatrists’ discharge diagnosis was due to how the pseudo-patients behaved, not because they couldn’t tell they were normal.

Rosenhan (1973) – ‘Sane In Insane Places’

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There is a long history of attempting to understand and classify abnormal behaviour. As has been previously stated, there is a lot of difficulty defining abnormality. In the 1960’s, a number of psychiatrists decided to come together and fiercely criticise the medical approach to abnormality. From this, the Anti-Psychiatry Movement was born. R.D. Laing and Rosenhan were supporters of this movement.

As a result of the Anti-Psychiatry Movement, Rosenhan set out to demonstrate just how unreliable psychiatric classification can be. He argued that ‘psychiatric diagnoses’ were in the mind of the observers. This led to his study, ‘Sane In Insane Places’.

Aim: To investigate whether psychiatrists were able to distinguish between people who are perceived to be ‘sane’ and those who are labelled as ‘insane’.

Procedure:

– The experiment itself was a field experiment.

– The Independent Variable (IV) was the symptoms of the patients.

– The Dependent Variable (DV) was the psychiatrics’ admission and diagnostic label of the ‘patient’

– It was a participant observation.

Eight patients (consisting of five men and three women) tried to gain admittance to 12 different hospitals in five different states in the USA. The following were comprised on a psychology student, three psychologists, a paediatrician, a psychiatrist, a painter, and a housewife. This included Rosenhan himself.

These pseudo-patients telephoned the hospital for an appointment, and arrived at the admissions office complaining they had been hearing voices. They said the voice, which was unclear and the same sex as themselves, said ‘hollow’, ‘thud’ and ’empty’. These symptoms were partly chosen as concerns arise about the meanings of the individual’s life.

After they had been admitted to the psychiatric ward, the pseudo-patients stopped simulating symptoms of abnormality. They then told staff they were fine and no longer experience symptoms.

Results:

None of the pseudo-patients were detected, and were all (bar one) admitted with a diagnosis of schizophrenia and were eventually discharged bearing the label ‘schizophrenia in remission’. They remained in hospital for 7 to 52 days (an average of 19 days each). Although they were not detected by staff, many of the patients suspected they were ‘sane’.

The pseudo-patients’ normal behaviours were often seen as aspects of their supposed illness. For example, nursing records for three of the pseudo-patients showed that their witing was seen as an aspect of their pathological behaviour. Rosenhan notes that their is enormous overlap in the behaviours of the ‘sane’ and the ‘insane’.

Psychiatrists and nurses made little contact with the patients, according to the participants. Powerlessness and depersonalisation were also experienced. It was estimated that the pseudo-patients were given a total of 2,100 tablets, though only two were swallowed.

There was a follow-up study conducted after this initial experiment by Rosenhan himself:

Rosenhan informed staff at a teaching hospital that sometime in the next three months, one or more pseudo-patients would attempt to be admitted. Each staff member was asked to rate patients presenting themselves on a scale of 1 to 10 to reflect the likelihood of them being the pseudo-patient.

Judgements were given on 193 patients admitted for psychiatric treatment. 41 were judged with high confidence by at least one staff member to be pseudo-patients, 23 were considered suspect by at least one psychiatrist, and 19 were thought to be pseudo-patients by one psychiatrist and another staff member. There were actually no genuine pseudo-patients involved in this study.

The conclusions that Rosenhan drew from both studies gave insight into the world of psychiatry and diagnosis. His argument was that individuals are not insane all of the time but, once a person is labelled ‘insane’, all their behaviour is understood through that label.

Sources:

– Brain, C. (2009). Edexcel A2 psychology. London: Philip Allan