Rosenhan experiment
The Rosenhan experiment, conducted by psychologist David L. Rosenhan in the early 1970s, investigated the validity of psychiatric diagnoses by examining how mental health professionals identified mental illness. In this controversial study, eight individuals without any psychiatric history feigned auditory hallucinations to gain admission to twelve different mental hospitals across the United States. Despite providing truthful information about their lives and claiming to no longer hear voices, all participants were diagnosed with severe mental disorders, primarily schizophrenia, and remained hospitalized for an average of nineteen days. The study highlighted significant issues within psychiatric institutions, such as the staff's limited interaction with patients and their tendency to misinterpret normal behavior as symptomatic of mental illness.
Rosenhan's findings raised critical questions about the reliability of psychiatric diagnoses and the impact of labeling on both patients and staff perceptions. This experiment prompted discussions regarding the biases present in mental health evaluations and led to reforms in psychiatric care and diagnostic practices. While the study has faced scrutiny over its methodology, its implications continue to resonate across psychology, sociology, and mental health fields, making it a landmark investigation into the nature of mental illness and the functioning of psychiatric institutions.
Rosenhan experiment
- DATE: 1973
- TYPE OF PSYCHOLOGY: Social psychology
Introduction
In a powerful and illuminating studysometimes called the Thud experimentof the validity of psychiatric diagnoses, David L. Rosenhan, a professor of law and psychology at Stanford University, persuaded eight people who had no history of psychiatric illness to present themselves at various mental hospitals in five states on the East and West Coasts of the United States between 1969 and 1972. Each of these imposters, or pseudopatients, falsely reported a single psychiatric symptomvague auditory hallucinations. For example, imposters stated that they occasionally heard the words “thud,” “empty,” and “hollow.” Aside from lying about the occasional voices, everything else these imposters said and did was honest, including the responses they gave during extensive admission interviews and large batteries of tests. Rosenhan wanted to see how long it would take for the hospital staff to recognize the normality of the imposters.
The hospital staff never did. Based on one complaint alone, all eight people were admitted to twelve different hospitalssome participated twiceand kept there from seven to fifty-two days. Their average length of stay was nineteen days, despite the fact that after they were admitted, each person responded honestly to questions about significant life events, said that they no longer heard voices, and attempted to interact normally with staff members. Indeed, the imposters had a hard time convincing the staff that they were well and no longer needed to be hospitalized.
On the basis of the behavior that they observed, hospital personnel diagnosed each person as severely abnormal. Most diagnoses were schizophrenia, which is a severe disorder. Even when they were discharged, most of these imposters left with the label “schizophrenia—in remission.” Labeling had a powerful, long-lasting effect.
Although the hospital staff never detected any of the imposters, many of the other inpatients did. Patients came forward and said something like, “You’re not crazy. You’re a journalist or a professor checking up on the hospital.” In part, patients figured out the ruse because the imposters openly kept notes about their experiences in the psychiatric ward.
These notes, a typical aspect of participant-observation research, provided much information about the daily activities in a psychiatric ward. These imposters noted that the hospital staff spent surprisingly little time interacting with patients, an average of only 6.8 minutes per day. Mostly, staff members segregated themselves from patients in a glassed-off enclosure, where they could observe but did not have to respond to patients. When staff did interact with patients, treatment was often depersonalizing, including avoiding patients and ignoring their questions. Staff often behaved in an authoritarian manner, and the imposters grew to feel powerless, invisible, and bored. Hospital staff interpreted every behavior as a symptom of a mental disorder. For example, note-taking was seen as a sign of obsession, and pacing the corridor out of boredom was viewed as a sign of nervousness. Further, these imposters noted the largely normal quality of the real patients’ behavior, concluding that people with genuine mental illness behave like individuals without mental illness most of the time.
In a follow-up experiment, Rosenhan alerted hospital staff to the possibility that people who presented for admission were imposters. In this follow-up study, staff judged ten to twenty percent of new admissions as faking. However, none of those identified were actually experimental imposters.
Long-Term Implications
In Rosenhan’s study, the label “schizophrenic” distorted how hospital staff viewed each of the imposters on the ward. Rosenhan concluded that hospitals impose a special environment in which mental health professionals can easily misunderstand the meanings of behavior. Attitudes can bias how people view others’ behavior.
The results illustrate several important points. First, labels have a powerful influence on the way mental health workers perceive and interpret actions. Second, the mental health system is biased toward seeing pathology in anyone who walks in the door. Third, determining who is psychologically disordered is not always clear. Fourth, psychiatric diagnoses have questionable validity.
Rosenhan’s controversial study stimulated a lot of critical discussion and examination of psychiatric institutions. Rosenhan actually proposed that psychiatrists and other mental health professionals stop diagnosing personality and instead label specific behaviors. The mental health field did not make this step, but psychiatry moved to improve the reliability of diagnoses in subsequent editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the fifth edition of which was published by the American Psychiatric Association in 2013 and its text revised edition in 2022 (DSM-5-TR). According to the DSM-5, most psychiatric disorders can be diagnosed only if the symptoms occur over a long period and interfere significantly with the patient's life, which, if the standards were correctly applied, would rule out Rosenhan's pseudopatients. However, the second edition (DSM-II), released near the time of the experiments, touted the ability of professionals to distinguish between individuals with and without mental illnesses. The study's findings provided a basis for suggestions for reforms of inpatient psychiatric care facilities, though that was not Rosenhan’s goal. The DSM-III reflected the revolution in American psychology that resulted from the experiment. In the twenty-first century, the Rosenhan experiment has inspired many studies involving pseudopatients—or, as they are sometimes called, “mystery shoppers”—intended to evaluate the quality of patient life and care in various facilities rather than the validity of psychiatric diagnoses in general.
Rosenhan’s original experiment is considered one of the classic psychology experiments of the twentieth century. The original article, “On Being Sane in Insane Places,” published in the journal Science in 1973, has been reprinted in books listing key psychology readings, introductory sociology, and examples of participant observation in qualitative health research. The extensive discussion of this study in other fields, such as social work and law, reflects tremendous breadth across disciplines.
Decades after the experiments in 2019, author Susannah Cahalan’s The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness criticized the validity of Rosenhan’s work. Her research found that the supposed participants in the study were impossible to find except for one unreliable person claiming to have participated. Additionally, an examination of Rosenhan’s notes on the data and techniques used in the experiments found discrepancies and inaccurate documentation. This assertion sparked an interest in the study’s findings, and several researchers who looked into the data found similar inconsistencies, supporting Cahalan's theory.
Bibliography
Agarwal, Atul. "'On Being Sane in Insane Places…it is a Work Half Done.” Indian Journal of Psychiatry, vol. 65, no. 5, 2023, pp. 601-3. doi:10.4103/indianjpsychiatry.indianjpsychiatry‗773‗22.
Crown, Sidney. “'On Being Sane in Insane Places': A Comment from England.” Journal of Abnormal Psychology, vol. 84, no. 5, 1975, pp. 453–55.
Goddard, Murray J. “Personal Accounts: On Being Possibly Sane in Possibly Insane Places.” Psychiatric Services, vol. 62, no. 8, 2011, pp. 831–2. doi:10.1176/ps.62.8.pss6208‗0831.
Lazarus, Arthur. “Improving Psychiatric Services through Mystery Shopping.” Psychiatric Services, vol. 60, no. 7, 2009, pp. 972–73, doi.org/10.1176/appi.ps.60.7.972.
Millon, Theodore. “Reflections on Rosenhan’s 'On Being Sane in Insane Places.'” Journal of Abnormal Psychology, vol. 84, no. 5, 1975, pp. 456–61.
Navidad, Angel E. "Rosenhan (1973) Experiment – ‘On Being Sane in Insane Places.’" Simply Psychology, 7 Sept. 2023, www.simplypsychology.org/rosenhan‗experiment.html. Accessed 1 Oct. 2024.
Polak, Paul R., et al. “On Treating the Insane in Sane Places.” Journal of Community Psychology, vol. 5, no. 4, 1977, pp. 380–87, doi.org/10.1002/1520-6629(197710)5:4<380::AID-JCOP2290050413>3.0.CO;2-R.
Rhodes, Karin. “Taking the Mystery out of ’Mystery Shopper’ Studies.” New England Journal of Medicine, vol. 365. no. 6, 2011, pp. 484–86. doi:10.1056/NEJMp1107779.
Rosenhan, David L. “On Being Sane in Insane Places.” Science, vol. 179, 1973, pp. 250–58. doi:10.1126/science.179.4070.250.
Scull, Andrew. “Rosenhan Revisited: Successful Scientific Fraud.” History of Psychiatry, vol. 34, no. 2, 2023, pp. 180–95, doi.org/10.1177/0957154X221150878.
Slater, Lauren. Opening Skinner’s Box: Great Psychological Experiments of the Twentieth Century. New York, Norton, 2004.