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The Rosenhan Study - The Influence of Labels

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The Rosenhan Study - The Influence of Labels

When you break a bone, you can get an x-ray to see that the bone is broken, and get a cast to help it heal. When you get a big cut, you can see the blood and understand that you need stitches.

When you are struggling with mental health, what symptoms can you and others see? How do other people know what symptoms you are experiencing?

  • What is the Rosenhan study on the influence of labels?
  • What was Rosenhan's hypothesis, and what were the central questions in the study?
  • What was the outcome of Rosenhan's study?
  • Why is Rosenhan's study on the influence of labels useful?
  • What are the strengths and weaknesses of Rosenhan's study?

The Rosenhan Study on the Influence of Labels

David Rosenhan, an American psychologist, conducted a study (1973) based on the idea that sanity and insanity are not that different from each other. He wondered if a person's symptoms lead to a diagnosis, or if the biases and training of the clinician determine the diagnosis. He also wanted to know if labels (i.e., diagnoses) lead hospital staff to interpret behaviors in a certain way.

Rosenhan developed his study to see if staff in a psychiatric section of a hospital would misdiagnose patients. His participants were three women and five men (including himself), all with no mental health problems or diagnoses. The study took place in 12 separate hospitals. Some of the psychiatric wards had a higher staff-to-patient ratio, some were older, one was private, and some were in different states.

As they were being interviewed by clinicians, the participants reported that they were hearing voices, which is a common symptom of schizophrenia. This was the only symptom the participants reported. The participants answered all other questions that the clinicians asked truthfully. At the time, that one symptom alone was enough for all of the participants to be admitted to the hospital!

Once the participants were admitted, they immediately stopped lying about hearing voices and acted completely normal. Rosenhan and his participants had to act well enough to be discharged. A condition of the study was that the participants could not choose to leave and go home; they had to wait until they were officially discharged by hospital staff. In other words, the hospital staff had to believe that the participants were well enough to leave.

The Rosenhan Study - the influence of labels, a female patient talking with a female doctor, StudySmarterPseudopatient or real patient, pexels.com

Rosenhan's Hypothesis on the Influence of Labels

Rosenhan had several hypotheses or predictions about the outcome of this study:

  • If the participants reported hearing voices, they would be diagnosed as schizophrenic.
  • If the participants were diagnosed with schizophrenia, they would be admitted to the psychiatric section of a hospital.
  • If the participants entered a psychiatric hospital for symptoms of schizophrenia, the hospital staff would be unable to determine that the participants in the study were not schizophrenic.
  • If the hospital staff were unable to determine the participants were not schizophrenic, the participants would not be discharged from the hospital unless they were deemed to be better.

Rosenhan's Central Research Questions

Rosenhan's study centered on the validity of a mental health diagnosis. Would a trained professional who had dedicated years of their life to education and treatment of mental health disorders be able to determine if someone was lying? He wondered if any of the clinicians would be able to figure out the ruse, or if the impact of the label of schizophrenia would cloud the clinician's judgment.

Another question he focused on was the distinction between someone with a diagnosed mental illness and someone without one. Is there actually a difference? Can anyone really tell? Are mental health disorders just extreme examples of things that many people experience at some point in life? He wondered if the actions of his participants would be perceived differently simply if they were labeled as schizophrenic. He questioned how different those with mental health disorders actually are from the general population.

The Rosenhan Study - the influence of labels, a red stamp of approval, StudySmarterLabels and treatment, pixabay.com

The Outcome of the Influence of Labels Study

Rosenhan's results were in line with his predictions. In other words, he was able to affirm his hypotheses. None of the participants were identified by staff members as not having schizophrenia. The mental health clinicians were completely unable to tell the difference between the symptoms of actual patients and the lack of symptoms of participants in the study.

Even in the psychiatric hospital, the label of schizophrenia caused staff members and doctors to view and treat the participants differently than they would otherwise. The staff completely misinterpreted the stories and actions of the participants.

Rosenhan provides an example of a participant who told a psychiatrist about his relationship with his parents. Nothing bad ever happened, but he was closer to his mother growing up than his father. As he got older, he became closer to his father. Currently, he was close with his wife and rarely fought with her, and he rarely spanked his kids. All of this sounds pretty normal, right?

Despite the participant's lack of any mental health symptoms, the account from the psychiatrist reports,

This white 39-year-old male . . . manifests a long history of considerable ambivalence in close relationships, which began in early childhood. A warm relationship with his mother cools during his adolescence. A distant relationship to his father is described as becoming very intense ... And while he says that he has several good friends, one senses considerable ambivalence embedded in those relationships."

The psychiatrist viewed the participant’s story and actions through the lens of the schizophrenic label. Other behaviors of participants were misinterpreted as well. A nurse saw a participant pacing the hallways and asked if he was nervous. He said that he was just bored. A participant got upset at a nurse, and another staff member assumed it was related to his mental health. It was just that the nurse was annoying the participant. The staff always viewed the behaviors of the patients as a result of their diagnosis rather than other, normal factors.

The Rosenhan Study - the influence of labels, a doctor talking to a patient in a hallway, StudySmarterClinician interpretations, pexels.com

The Usefulness of the Influence of Labels Study

One interesting finding of the study was about the real patients in the hospitals. While the hospital staff members were completely unable to recognize that the participants in the study were not actually schizophrenic, many of the patients in the psychiatric ward had no problem seeing that the participants suffered from no mental health symptoms! Maybe the staff did not pay enough attention to the participants. If the staff treated the participants the same way they treat people in real life, would they have noticed that they seemed to be fine?

There was also a second part to Rosenhan's study. This time, the staff members at the hospital were told that there would be one person admitted who was a pseudopatient, and it was their responsibility to identify that patient. At least one staff member believed 41 of the total admitted patients were the pseudopatient, at least one psychiatrist believed 23 of them were the pseudopatient, and both a psychiatrist and a staff member believed 19 of them were the pseudopatient.

The best part? None of those 193 patients was Rosenhan’s pseudopatient. They were all actual patients!

When the mental health clinicians in the hospitals were told that the participants were schizophrenic (even though they were not), their actions and attitudes were interpreted through the schizophrenic label. These clinicians even viewed the participants’ stories differently when they knew they were diagnosed with schizophrenia. This shows just how impactful a label can be.

Just like the doctors and nurses in the hospitals, we may view and treat people differently when we know about someone’s mental health struggles. It might cause us to treat them worse, or maybe with more compassion than we normally would. Either way, it changes the way we interact with them. Many mental health disorders are stigmatized. Those that suffer from them are viewed as crazy, and this impacts how they are treated by others.

The world has changed a lot since 1973. Rosenhan's study highlighted not only the misdiagnosis of mental disorders and the biases of clinicians, but also the ease of diagnosis and admittance to treatment. All someone had to do was say that they were hearing voices to be admitted to a psychiatric hospital.

Thankfully, this is not the case today in the US. Psychiatric hospitalization is treated more as a last resort than a first treatment. Scribner (2001) conducted a study similar to Rosenhan's, with updates to account for changes in culture and technology. He was unable to produce similar results. Rather than participants being diagnosed and admitted right away, they had a hard time getting admitted at all.

The Strengths and Weaknesses of Rosenhan's Study

A strength of the study is the wide variety of hospitals that Rosenhan selected for his study. They varied from small to large, old to new, public to private. Diversity in his selection of hospitals increased the generalizability of his study results.

Another strength of the study is that none of the clinicians knew they were part of the study. This allowed them to act as they always did and not change their behaviors because they knew they were being watched. If they knew they were part of a psychological study, they might have noticed an admitted participant who wasn't experiencing any symptoms.

A weakness of the study is how much time has passed and how much has changed since it was first published. This study was a product of its time, but the findings are unable to be replicated now. The majority of the study took place after the participants were admitted to a hospital, but this is difficult to achieve now. Given how difficult it can be to get treatment for mental health disorders today, the focus of a new study could be how to navigate the obstacles to getting treatment. Another weakness is that all of the hospitals were located in the United States. While this allows the results to be generalized across American hospitals, the results can only be applied within the US.

The Rosenhan Study - The Influence of Labels - Key takeaways

  • David Rosenhan (1973), an American psychologist, conducted a study to see if a diagnosis is determined by a person's symptoms or the biases and training of the clinician.
    • The participants used in the study were three women and five men (including himself), all with no mental health problems or diagnoses.
    • The study took place in 12 separate hospitals.
  • Once the participants were admitted, they immediately stopped lying about hearing voices and acted completely normal. Rosenhan and his participants had to act well enough to be discharged.
  • Rosenhan's results were in line with his predictions. None of the participants were identified by staff members as not having schizophrenia.
    • Many of the real patients in the psychiatric wards had no problem seeing that the participants suffered from no mental health symptoms!
  • In the second part of Rosenhan's study, staff members at the hospital were told that there would be one person admitted who was a pseudopatient, and it was their responsibility to identify that patient.
    • Out of 193 patients admitted to the hospital, 83 were believed to be the pseudopatient. The best part? None of those 193 patients was actually Rosenhan’s pseudopatient.
  • Scribner (2001) conducted a study similar to Rosenhan's, with updates to account for changes in culture and technology. He was unable to produce similar results.

Frequently Asked Questions about The Rosenhan Study - The Influence of Labels

Rosenhan’s central question is if mental health clinicians can actually determine who is suffering from a mental disorder, and who is not. 

The Rosenhan study showed that people are unable to determine who has a mental health disorder, and who does not. 

Rosenhan’s study on labeling is about how psychiatric labels affect clinicians' interpretations of behavior.

Rosenhan’s study is useful because it demonstrates the power of labels to cause biased interpretations.

Rosenhan hypothesized that mental health clinicians would not be able to determine who was a fake patient and who was a real one. 

Final The Rosenhan Study - The Influence of Labels Quiz

Question

What was Rosenhan's main hypothesis?

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Answer

Rosenhan hypothesized that the hospital staff would be unable to determine that the participants in the study were not schizophrenic

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Question

How did the participants get admitted to the mental health hospitals?

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Answer

They reported that they heard voices

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Question

What symptoms were the participants showing in the hospitals? 

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Answer

None! Once they were admitted, they had no symptoms of any mental health diagnosis. 

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Question

What were the participants labeled with?

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Answer

When they were in the hospital, they were labeled as schizophrenic. When they were discharged, they were labeled as schizophrenic in remission. 

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Question

What did Rosenhan find?

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Answer

The clinicians were unable to determine that the participants were not actually struggling with mental illness and simply viewed the participants' behavior as in line with schizophrenia. 

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Question

What is an interesting finding from the study?

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Answer

The actual patients in the hospital were able to determine that the participants were fake patients 

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Question

What is Rosenhan's central question in the study?

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Answer

Rosenhan’s central question is if mental health clinicians can actually determine who is suffering from a mental disorder and who is not

Show question

Question

Why is Rosenhan's study useful?

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Answer

Rosenhan’s study is useful because it makes us question the accuracy of mental health diagnoses and shows the importance that labels have

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Question

What do we learn about labeling from Rosenhan's study?

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Answer

We learn that labels have more power than we realize. Once you get a label (whether accurate or not), it sticks, and everything you do will be viewed to fit in with that label. 

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Question

What did Rosenhan's follow up study show?

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Answer

When hospital staff knew they were a part of a study trying to determine who was not a real patient, they presumed that dozens of people who were actual patients were the fake patient.

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Question

Why can't this study be replicated nowadays?

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Answer

Society now doesn't give people treatment for mental health disorders as it used to

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Question

What are a couple of strengths of this study?

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Answer

Variety of hospitals, clinicians did not know they were partaking the study, all participants reported the same symptom

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Question

Why is this study important in showing the influence of labels?

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Answer

It shows that once someone was labeled as schizophrenic, all of their prior and future behaviors were attributed to that label

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Question

​​​​​Is there actually a difference in how people with mental health disorders and those without act?


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Answer

Good question! It depends on everything! Clearly in this study, there was no difference reported (or the label of schizophrenia was so powerful that even if there were behavioral differences, they weren't able to be seen)

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Question

Why do you think the actual patients were able to determine that the participants were fake patients?

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Answer

Maybe their judgment wasn't clouded by the schizophrenia diagnosis. Maybe, since they were in a psychiatric hospital, they didn't hold the same stigma surrounding mental illnesses that clinicians do and therefore could see past the label. 

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Question

True or False: David Rosenhan wondered if a person's symptoms lead to a diagnosis, or if the biases and training of the clinician determine the diagnosis. 

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Answer

True 

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Question

In what year did Rosenhan conduct his study on the influence of labels? 

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Answer

1973

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