Rosenhan (1973) (Validity & Reliability of Diagnosis)

Objective

• The objective of this study was to test the reliability and validity of psychiatric diagnoses by exploring whether mental health professionals could accurately distinguish between real patients and pseudo-patients (people who feigned mental illness). The study aimed to investigate whether the psychiatric system was capable of distinguishing between those who genuinely suffered from mental disorders and those who did not, questioning the diagnostic accuracy of mental health professionals.

Method

This study was a field experiment that used a naturalistic observational approach.

• Participants: The study involved 8 healthy individuals, referred to as pseudo-patients, who were chosen to simulate mental illness. These pseudo-patients consisted of 5 men and 3 women, all of whom were psychologically healthy, with no history of mental illness.
  

• Procedure:

• The pseudo-patients feigned symptoms of auditory hallucinations (e.g., hearing voices saying words like "empty," "hollow," and "thud"). They presented themselves to psychiatric hospitals and requested admission, claiming they were hearing these voices.
  

• Once admitted, the pseudo-patients behaved normally, refraining from exhibiting any further symptoms or malingering. They did not engage in any unusual behavior and acted in a way that was consistent with their pre-admission personalities and lifestyles.

Throughout their hospital stay, the pseudo-patients observed how hospital staff (psychiatrists, nurses, etc.) interacted with them, whether their behavior was identified as normal or symptomatic, and if they were correctly diagnosed.

outcome

• iagnosis: Despite exhibiting no symptoms once admitted, all 8 pseudo-patients were diagnosed with schizophrenia, which was the most common diagnosis given. The lengths of hospitalizations ranged from 7 to 52 days.
  
  

• Identification by Staff: None of the hospital staff correctly identified the pseudo-patients as impostors. Interestingly, some staff members mistakenly interpreted the pseudo-patients' normal behaviour (such as note-taking or expressing doubt about their diagnosis) as symptoms of their supposed mental illness.
  
  

• Implications: The study revealed significant flaws in psychiatric diagnostic procedures, highlighting the difficulty in distinguishing between genuine patients and individuals who feigned illness. This raised critical questions about the reliability and accuracy of psychiatric diagnoses, particularly in institutional settings.
  
  

ethical considerations

• Deception: One of the most significant ethical concerns was the use of deception. The pseudo-patients lied about their symptoms, leading to their admission into psychiatric hospitals. While they behaved normally during their stay, this deception could be seen as problematic, especially considering the potential emotional distress caused to the hospital staff and the other patients who might have been affected by the presence of individuals pretending to be mentally ill.
  
  

• Informed Consent: The staff at the hospitals were unaware of the study and did not give consent to participate, which raises questions about their rights and autonomy. Additionally, the patients in the hospitals were also unaware of the study, meaning their consent to be observed was not obtained.
  

Potential Harm to Staff: The staff members, especially those who made misjudgments about the pseudo-patients, might have suffered from embarrassment or distress due to their inability to detect the impostors. This could potentially damage their professional confidence or reputation.

gaps

• Ethical Issues: While the study provided valuable insights into the reliability of psychiatric diagnoses, the ethical concerns surrounding deception and lack of informed consent cannot be overlooked. The psychological harm caused to both the hospital staff and the other patients is a valid concern. The study’s design raises questions about whether the potential benefits outweighed the ethical risks involved.
  
  

• Focus on Institutional Practices: The study focused more on the functioning of psychiatric institutions (how staff responded to patients) than on the accuracy of psychiatric diagnoses themselves. While the findings suggest flaws in diagnostic practices, they do not definitively address the validity of diagnoses in other contexts, such as outpatient clinics or research settings.
  
  

Sample and Generalizability: The sample size of 8 pseudo-patients is relatively small, which limits the generalizability of the results. Furthermore, these participants were all individuals with no prior psychiatric history, and their behaviour might not represent how other types of patients might be perceived or treated.

Relevence

• Normality vs. Abnormality in Psychology: The study speaks directly to concepts of normality and abnormality, as it questions the criteria by which mental health professionals distinguish between those who are mentally ill and those who are not. It challenges the reliability of psychiatric diagnoses in determining what constitutes "normal" and "abnormal" behaviour.
  

• Reliability and Validity of Psychiatric Diagnoses: The study highlights concerns about the reliability of psychiatric diagnoses and how easily mental health professionals can make mistakes when assessing patients. This casts doubt on the consistency of psychiatric assessments across different individuals and contexts.
  

• Ethical Considerations in Psychological Research: The use of deception and the potential harm to both staff and patients raise significant ethical questions. The study underscores the importance of ethical considerations, particularly in research involving vulnerable populations or professional settings.