Rosenhan 1973

to investigate whether clinicians can diagnose accurately
to gain insight into experience of diagnosis and being in an institution

- 8 pseudopatients - pseudonyms instead of real names with fake identities and professions
- 5 male, 3 female
- psychologist, painter, housewife, psychiatrist, psych grad student
- rosenhan was the first pseudopatient + was known about by the hospital administrator and chief psychologist

- ppts faked symptoms not related to sz
- same sex voice said 'empty, hollow, thud'
- 12 hospitals from the east and West coast in the USA. some private some public funded, old, new and understaffed + overstaffed
- ppts remained in hospitals from 7-52 days with an average of 19
- note taking behaviour labelled as a symptom of sz alongside queuing outside the cafeteria 30mins before lunch
- stopped any symptoms upon admission
- 11/12 discharged with sz in remission - 1 with manic depressive psychosis

- field expt using observations
- initially covert but it became open as staff noticed note taking and classed it as a symptom of a normal behaviour

- 35 / 118 patients on the ward recognised that the pseudopatients weren't actually ill
- results could be attributed to physicians strong bias towards type II errors
- once diagnosed, could not escape diagnosis
- all 12 hospitals resulted in type II errors both on admission and discharge
- 2.94% of recorded ppt initiated interactions resulted in verbal engagement
- 9.84% of patients scored at a research and teaching hospital were deemed very likely to have had no psychopathic traits on admission by both a psychiatrist and at least one other staff member

- sample of hospitals was varied and large
- more representative of hospital facilities and the wider population
- the results of the study represent a range of mental institutions so we can assume that their process of diagnosis and treatment of patients are applicable to other hospitals within the USA

- only hospitals from the USA
- cultural differences for example America uses DSM and UK uses ICD - completely different diagnostic systems and therefore there will be differences in how they diagnose patients

- covert observation increases realism
- less chance of unnatural behaviour caused by demand characteristics
- staff unaware and so acted naturally as they would have any other day at work
- their behaviour is a realistic reflection of mental institutions treatment of patients
- increases ecological validity allowing for correct results and accurate conclusions to be drawn about diagnosis and experience of institutions

- carefully controlled and planned
- each ppt had same symptom to follow
- repeatable to test for consistency in results
- in modern society or in another part of the world to see whether Diagnostic systems have improved or the experience of being in a mental institution

- ethic of staff - unaware no informed consent goes against BPS guidelines + no right to withdraw

- rosenhan described how the pseudopatients were nervous and anxious, highly distressing environment

- real patients in need of medical attention would have been deprived of treatment, that was given to pseudopatients

- pseudopatients had fake identities in order to prevent implications of being labelled as 'abnormal' with 'sz in remission'

- cost vs benefit can be questioned as it is wrong to make the pseudopatients distress, not get informed consent and take away treatment from real patients for the sake of staff observations

- rosenhans study has provided the clinical psychology industry with many important findings that have useful applications.
- it has had a social and political impact on the care system
- institutions have changed their working practices and focused their care of patients, changing the environment of hospitals.