Rosenhan+-+Period+2

=D.L. Rosenhan's Study on __Being Sane in Insane Places__=

**Background and Aims of the Study:**
The background of the study was that it was conducted during the 1960-Anti-Psychiatry Movement, where people began to criticize the psychiatric medical model for insanity. Rosenhan, especially, was a critic of the psychiatric classification in the medical model, and called it unreliable. Because of this, he wanted to test the hypothesis that psychiatrists cannot reliably tell the difference between people who are sane and people who are insane. The main aim of the study was to use pseudo-patients to gain entrance to a mental institution by faking insanity. While there, participants would start to display normal, sane behavior within to see if the institution would notice the distinction between insanity and being sane. Also, it is to extend efforts to find out more about life for insane hospitalized patients.

Participant Group:
The participant group included eight sane people (3 Women, 5 Men). Of these eight confederates, they had varying careers: 1 Psych Grad Student, Three Psychologists, 1 Psychiatrist, 1 Pediatrician, 1 Painter, 1 Housewife

Research Method:
The research method was a field experiment in the first infiltration of the pseudo-patients.

The second part of the study was kind of like a self-report, where the hospital staff would give data to the researchers about who they thought was a pseudo-patient.

Data Collection Process:
The data was collected through written recordings and participant observation of the treatment at these hospitals by the eight participants. These eight participants recorded conditions and statistics on varying aspects of the institution, which included: the conditions of the bathrooms, the treatment by the nurses, doctors, and staff, the average time of psychiatric evaluation per day, the amount of medication, and negative treatment by the staff.

Type of Data Collected:
Both Qualitative and Quantitative data on the conditions of the institution and treatment by the staff (qualitative) and the average psychiatric visit and times ignored by the staff (quantitative).

Procedure:
The field experiment was conducted by deceiving the hospital staff and psychiatrists. The hospital staff did not know about the fake insane participants. There was 12 different hospitals used from 5 different states. The participants were inducted into the institution by complaining to the hospital that they were hearing voices (in their own words) : empty, hollow and thud. Once admitted, patients stopped all insane behavior and acted normal (however, they displayed nervousness of the hospital setting). Diagnosed with schizophrenia, and when they were finally discharged, they still were considered individuals with schizophrenia in remission. Staff did not recognize their sanity, while the patients knew the pseudo-patients were normal (35 of 118). Normal participants put into extreme situation; they all took part in ward activities. The participants had to stay until the staff discharged them.

In the second part of the study, the hospitals, in advance, would be contacted and told that there would be pseudo-patients admitted to the hospitals. They were instructed to rate which of these 193 patients were pseudo, using a 10 point scale. There was no known pseudopatient sent to any hospital during that time by the researchers.

Independent variables included the symptoms of pseudo-patients; Dependent variables were the diagnostic label and psychiatrists' admission.

Special/Equipment and Materials:
Materials included written records by the participants (paper and writing instruments) on the hospital life

Results:
Overall, normal behavior was misinterpreted because of the situation. For example, writing notes down in a hospital and the staff stated that the "patients engaged in writing behavior." And arriving early for lunch was "Oral Acquisitive Syndrome" - Behavior distorted to fit in with theory.

If they approached staff with simple requests (1300 attempts)- 88% ignore and walk away, 10% made eye contact, and 2% talked to them (dehumanization). For psychiatrists (1800 attempts) : 71% ignored and walked away 23%, 6% talked to them. 90% of the time, nurses stayed in their office. Each real patient, spent less than 7 times a day.

Also, the average stay at the hospital before being discharged was 19 days. There was a range of 7-52 days at the hospital.

A recording of almost 2,100 medication tablets had to be flushed down in the toilets by the participants. This behavior was copied from the patients. The staff did not mind.

On the second task, 41 patients out of 193 total were alleged with high confidence by either the psychiatrists or the staff to be pseudo, while 42 were suspects of this. 19 Patients were alleged with high confidence by both a psychiatrist and a hospital staff member/nurse to be pseudo.

Conclusions:
Major aspect noticed in such institutions: powerlessness and depersonalization - 1) Medical Records were open to all staff - regardless of status or therapeutic relationship. 2) Personal hygiene was monitored - toilets had no doors. 3) Some of the ward orderlies were brutal to patients in front of other patients, and would stop such hateful behavior while staff was around. 4) Staff were credible sources of reliability and information, patients were not

The study demonstrates both the limitations of classification. Pointed out the appalling conditions in many psychiatric hospitals. Stimulated further research and lead to many institutions improving their philosophy of care (usefulness) Lack of Monitoring, Distortion of Behavior, and Lack of Normal Interaction were all common among such hospitals.

Strengths:
Participant observation - object perspective from a patient at the ward, who was treated like a patient. Field Experiment - High Ecological validity Wide range of hospitals used - Easy generalizable

Weaknesses:
Ethics - Hospital staff deceived Experiences of the pseudo-patients could have differed from that of real patients, who did not have the comfort that the diagnosis was false. Type 2 Error should be considered - Doctors/psychiatrists are more likely to call a healthy person sick DSM II used when Rosenhan used study; new DSM introduced aspects that addressed unreliability. Maybe the hospitals were erring on the side of caution. Rosenhan arguing that mental conditions are a social phenomenon - many people who suffer from a mental illness might disagree.

Ecological Validity:
Very high because of the use of deception, to ensure participants were treated like real patients, and the research method was a field experiment/naturalistic observation, making it more reliable and valid.

Ethics:
The study was unethical because of the use of deception, to deceive the hospitals that these pseudo-patients were actual patients. The study also breached confidentiality between the staff/psychiatrists and the patients and the privacy of both the nurses/psychiatrists/other staff members/ and the patients.