This is a Classic Study so everyone learns it and the Examiner will expect you to know it in detail. While the Exam could ask general questions about the procedure or evaluation, it could also ask specific questions, like, What did the pseudopatients say about their symptoms? or, What explanations did Rosenhan give for the failure of the hospital staff to diagnose the pseudopatients? or, What made this study ethical (or unethical)?
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ROSENHAN (1973)
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ROSENHAN'S STUDY
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Rosenhan refers to mental health diagnoses as "labels" which are attached to patients. His study shows that these labels are often attached wrongly. He also claims that these labels, once attached, are very hard to change or remove.
A psychiatric label has a life and an influence of its own - David Rosenhan |
Rosenhan refers to the "stickiness" of labels
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Rosenhan points out a number of things that support the idea of mental health diagnosis as a label:
- During his own clinical interview, Rosenhan described his own family life with only the normal amount of friction and disappointment. The psychiatrist recorded "ambivalence" (conflict) and "affective instability" (unstable emotions). This is because the symptom of hearing voices made the psychiatrist suspect schizophrenia, so he found evidence of it in Rosenhan's background. This shows that the label of mental illness CREATES the diagnosis, rather than the other way round.
- Other pseudopatients experienced similar things. 3 pseudopatients had their note-taking recorded on their medical record as "writing behaviour" as if it were a symptom of mental illness. One pseudopatient walked the corridors to relieve boredom, but a nurse interpreted this as his being "nervous". A psychiatrist pointed out patients arriving early at the cafeteria as an example of "the oral-acquisitive nature of the syndrome" but in fact there is nothing to do in a hospital but wait for mealtimes.
The pseudopatients, who spent a lot of time with the other patients, noticed that they behaved in a sane way most of the time, with occasional episodes of abnormal behaviour.
Rosenhan describes how labels affected the staff. For example, outbursts of anger or frustration from patients were treated by the staff as symptoms of their illness, even when they were clearly provoked by the staff themselves being rude or the hospital procedures being burdensome. The "bizarre setting" of the psychiatric hospital makes it hard for patients to behave normally or for staff to recognise normal behaviour when they see it. This adds to the power of labels. Rosenhan wonders whether patients come to believe these labels. |
Homer: This isn't fair! How can you tell who's sane and who's insane?
Doctor: Well, we have a very simple method. [stamps Homer's hand with a stamp that reads "INSANE"] Whoever has that stamp on his hand is insane. |
Such labels, conferred by mental health professionals, are as influential on the patient as they are on his relatives and friends, and it should not surprise anyone that the diagnosis acts on all of them as a self-fulfilling prophecy. Eventually, the patient himself accepts the diagnosis ... and behaves accordingly - David Rosenhan
The SELF-FULFILLING PROPHECY is an important concept from the Labeling Theory, which you will study in more detail as part of Criminal Psychology. It occurs when people accept the label they have been given and it becomes true about them.
ANOTHER FOLLOW-ON STUDY
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EVALUATING ROSENHAN AO3
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A different ethical issue with Rosenhan’s study is that it contributed to a crisis of public confidence in the American mental health system - which may have prevented people who genuinely needed help from seeking it.
However, Rosenhan wasn't the only critic of psychiatry at the time. Two years after Rosenhan, "One Flew Over The Cuckoo's Nest" (1975) dramatised many of the same problems in mental health care. It won the Best Film Oscar.
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Rosenhan may be criticised for failing in a duty of care towards his own researchers - the pseudopatients. He put them in a harmful environment where they experienced tension and stress. None of them were physically abused but they witnessed physical abuse going on. They were instructed in how to avoid taking medication, but if they had been forced to take medication, it could have produced side-effects on them.
However, Rosenhan took a few precautions. In his own case, he notified the hospital manager and chief psychologist of what he was doing. For all the pseudopatients, he prepared lawyers who would intervene to get the pseudopatients out of hospitals if they requested it.
However, Rosenhan took a few precautions. In his own case, he notified the hospital manager and chief psychologist of what he was doing. For all the pseudopatients, he prepared lawyers who would intervene to get the pseudopatients out of hospitals if they requested it.
Start with an evaluation point and back it up with evidence.
Evaluation + evidence = "logical chain of reasoning"
Issues & Debates (like contributions) make great conclusions
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EXEMPLAR ESSAY
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