Analyse the methods and implications of Rosenhan’s research on “Being Sane in Insane Places”

In 1973, Rosenhan conducted a field study to expose the effects and validity of labelling, in particular through professional diagnosis of psychological disorders. Although his results were greatly praised and have been highly influential in the field of clinical psychology, we mustn’t take Rosenhan’s research at face value, as alike every study his work has flaws.

Firstly however we must consider the implications of his research. Although it has led to stricter, better defined diagnosis of those with psychological disorders, the study was extremely unethical. The deception and misleading of the professionals breaches many of the ethical guidelines, and the participants themselves were put in extremely uncomfortable positions. An experiment such as this would not be accepted by the BPS today, however we must consider, does the insight this study provided into the problems of diagnosis and labelling overrule the embarrassment to the professionals and distress to the participants? This question is debatable.

Although to the eye Rosenhan‘s methods appear sound,  through reading his research paper it is easy to identify flaws. Anthony Clare stated that Rosenhan was “theorising in the absence of sufficient data”. He used an extremely small sample size of eight volunteers, therefore how can we know that perhaps the apparent hasty diagnosis for all the participants was not by chance? Another question that arises is the number of hospitals in the sample, as Rosenhan states there was twelve. Does this mean that four of these hospitals did not diagnose the volunteers with schizophrenia?

Rosenhan refused to identify the hospitals, as he believed it was a breach of their confidentiality. However this disallows anyone to back-up or challenge Rosenhan’s account at the hospitals, which in-turn prevents his research from gaining reliability and falsifiability. It appears through this that his research is not quite as valid as first meets the eye.

Hunter believed that one of the issues with the study was Rosenhan’s use of the word “normal”. “The pseudopatients did not behave normally in the hospital. Had their behaviour been normal, they would have talked to the nurses’ station and said ‘Look, I am a normal person who tried to see if I could get into the hospital by behaving in a crazy way or saying crazy things. It worked and I was admitted to the hospital but now I would like to be discharged from the hospital’”. Rosenhan in his own research paper complained of the conflicting meanings of terms such as “sane”, yet evidently he uses words himself in inaccurate contexts.

A programme created by the BBC named “How mad are you?” (2008) investigated the problems with diagnosis. In it, three mental health experts were challenged to see if they could make the distinction between “illness” and “health” in ten participants, five of which had various psychological disorders.  They were filmed during a week of activities, and the experts surprisingly found diagnosis difficult! As said by Ian Hulatt, “the public need to realise that you cannot just look at someone and make assumptions. When someone has been labelled with a disorder or episode of mental illness it’s very unhelpful to interpret everything they do through a poorly understood label.” This highlights the criticisms of Rosenhan’s study, as although it is common for one to blame the staff for not recognising the patients were completely sane, diagnosis of a disorder is a difficult process that inevitably can be subjectively influenced.

“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 behavior of the staff would be quite predictable. If they labelled and treated me as having a bleeding peptic ulcer, I doubt that I could argue convincingly that medical science does not know how to diagnose that condition”. As suggested by Kety (1975), The expert’s job is to diagnose; they do not expect an ‘actor’ as such to test them, therefore in my opinion Rosenhan’s study cannot be seen as detrimental to mental health experts’ reputation, rather the vicious, yet inevitable effect of expectations and labelling. However despite the criticisms, we cannot deny its influential grasp on psychology.


9 responses

  1. i think you brushed up on this point but in all fairness psychologistsare there to diagnose and trest mental disorders, if some one is complaining of all the symptoms of a disorder that exists then the psychologist will not be expecting them to be lieing, why would some one lie about that? and therefore think them to have the disorder. good post really interesting 🙂

    • Just so you know, symptoms that were presented don’t exist in any disorder. That is why they presented with very specific description: ” They said the voice, which was unfamiliar and the same sex as themselves, was often unclear but it sounded ’empty’, ‘hollow’, ‘thud’. These symptoms were partly chosen because they were similar to existential symptoms (Who am I? What is it all for?) which arise from concerns about how meaningless your life is. They were also chosen because there is no mention of existential psychosis in the literature. ” So those psychiatrists didnt really look into anything. If you hear a voice, you must be nuts.

  2. That is exactly my point, and what Kety suggested. Their job is to diagnose, therefore how can we blame them for doing exactly that? However we cannot criticise Rosenhan for ever completing this study, as despite it’s flaws, deception and ethical issues, the results have been a great influence on the now stricter process of modern diagnosis. It has also helped us realise the impact that labelling can have on not just the individual, but a whole society. The benefits of the research have definitely outweighed the costs to the participants and professionals here.

  3. Rosenhan’s study was very influential in changing diagnoses process in regards to mental illness’. However, it is interesting to read something highlighting the flaws in this study. You made an interesting point in regards to falsification, according to Popper (1902-1994) in scientific research falsification is integral in the measure of how scientific that particular theory or research indeed is. You also mentioned if a patient goes to a hospital saying; “diagnose me” it seems illogical to be surprised when that patient is diagnosed. Moreover, criticising them for making the diagnoses seems unethical, in law practice that would be interpreted as entrapment.

  4. I think that one of the biggest flaws in Rosenhan’s study is that professionals such as doctors are looking for something to be wrong with you. If you present them with a symptom they will try and find the cause because that is their job. I love the quote by Kety, I used it in my exam, but it sums up the problem. Also, on the topic of ethics, I think that the pseduo-patients would have been told what would be likely to happen, the problem was that they didn’t think that they would actually get submitted. The staff were just as much participants, as they were being observed and their behaviour recorded, for example how many times they completely ignored patients, they had no right to withdraw etc.

  5. That is an interesting point! Rosenhan doesn’t specifically state that the staff were participants, however they do contribute significantly towards the results therefore in a way they are. When taking this view, further ethical issues arise, as like you suggested, they did not agree to participate in the study. Therefore how could they have exercised their right to withdraw? The answer is they couldn’t, as deception occured. Perhaps this is why Rosenhan didn’t refer to the staff as participants, as he realised this would open up further ethical issues that people could criticise his study with.

  6. i think a major bias flaw of Rosenhams research was the professiosn of the sample .. yes the sample was small however their professions could have been a bigger mix for example Rosenham himself participated within the research therefore experimenter bias would have taken place.The other participants was a psychology graduate student,three psychologists, a paediatrician, a psychiatrist, a painter and a housewife, therefore many with a medical/scientific background in which could have affected the results.i also agree with your statement about how he classes ‘normal’ as this could have been bias (Benedict 1934 )suggested that normality and abnormality are not universal therefore who is to say that Rosenhams definition is correct.

  7. This is a really interesting post, and I’m surprised looking at all the flaws. What i find quite shockingly unethical is whats been mentioned about the staff actually being participants, they were observed and their behaviour recorded in the experiment and did not have the right to withdraw or guarenteed confidentiality. I know it is allowed to observe in public places without consent but I think in this case they were just as much participants as the people who were diagnosed.

    What i also think is a bit suspicious is how many were diagnosed with ‘Schizophrenia in remission’ this is not a very common diagnosis therefore its quite suspicious that many of the 8 were diagnosed with this. It suggests to me that the professionals did have their suspicions about their symtoms . However, I do think this study has huge benefits and the psychologgical diagnosis is much more thourough and strict today.

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