The aim of this study was to test the hypothesis that psychiatrists cannot reliably tell the difference between people who are mentally stable and those who are mentally unstable.
In 1970, 8 mentally stable people were granted admission into 12 different hospitals. They all told the same story of how they would hear a voice inside their head, it was unclear but often said “empty”, “hollow” and “thud”.
Right after they were admitted, the patients stopped showing any signs of abnormality. They took part in activities and talked to faculty and other patients as they would normally.
None of the psychiatrists ever stopped to say “I think they are getting better” or “they seem absolutely fine now” In fact, nurses and psychiatrists took normal activity such as walking or writing and attempted to represent it as a form of pathological behavior.
For example, staff would point to patients waiting outside the lunchroom as a form of oral-acquisitive syndrome, when really they were just bored and were anticipating their meal.
It’s interesting to note that even though staff didn’t recognize that these people were completely fine, patients recognized that they didn’t seem to have any problems.
This study highlights how powerful labels can be.
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Wow…this also potentially bespeaks how the people who are charged with making these patients better are only trying to create terminology and atmosphere that keep them institutionalized.
That’s pretty disturbing.
To anyone saying “well they said they heard voices obviously the doctors are going to look at them with a weary eye”
You missed the point.
They were supposed to detect the patients getting better and instead of being able to tell that, they took any action that the patients performed and totally distorted it and blew it to epic proportions to make them seem completely and utterly abnormal to a point where the patients were institutionalized for months.
Also, sixpenceee, you missed the second part to this experiment - equally chilling, in my opinion. One hospital’s administration was angered by Rosenhan’s experiment, and challenged him to send impostor patients - mentally stable people masquerading as mentally unstable people - to their facilities. Their staff would then turn those pseudopatients away. Long story short, Rosenhan OK’d this part of the experiment. 193 people went to that hospital in that experiment period looking for help. They flagged 41 people as impostors and had doubts about another 42.
Rosenhan sent no one.
The staff of this hospital flagged impostor patients where none had existed.
That’s really worrying…
This is terrifying
This was conducted in 1970, so I wonder how much has changed since then
HELLO LADIES AND GENTLEMEN I WROTE A PAPER ON THIS AND GOT AN A* FOR IT
Literally, my exact title was ‘To what extent are the results of Rosenhan’s 1973 pseudopatient study relevant in modern psychiatric diagnosis?’, so I hope you’ll forgive me in being a little overly excited here.
First of all, it’s important to note that the original study was flawed. My favourite critical essay was written by Robert Spitzer, and it really is worth a read. It changed my opinion on this study from ‘absolutely groundbreaking’ to ‘interesting, but needs to be taken with a grain of salt’.
So first of all, Spitzer identifies the three different ways in which sanity could be detected. These were:
- The researchers realising the people were faking their ‘insanity’ in the first place (eg at admission)
- The researchers noting a ceasing in behaviours and realising the patient had never been insane at all
- The researchers noting a ceasing in behaviours and declaring the once-insane patient now sane
The first one, Spitzer argues, has absolutely nothing to do with the validity of psychiatric diagnosis. It really doesn’t. Imagine the following: I go to the emergency room and vomit blood everywhere. “I have no idea what is happening!” I cry, as everyone panics and treats me for internal bleeding. In reality, I swallowed a gallon of animal blood before I entered the emergency room for this exact purpose. Could you use this as evidence that the doctors cannot diagnose internal bleeding reliably? Hell no! Because I lied. These patients lied. If we say ‘schizophrenia is hearing voices’ (very very very loose definition) and people turn up and go ‘yo i’m hearing voices’, you are going to diagnose schizophrenia. It is the duty of the people seeing you NOT to lie. No, method one is a moot point.
And the second one? Again, why on Earth would they see a ceasing of symptoms and go ‘WELL THEY WERE OBVIOUSLY LYING’. Why would you lie to gain entry to a hospital? Why would you turn up and claim to be hearing a voice when you weren’t? That’s not something they were expecting or screening for. If someone turns up in tears and tells you they’re hearing a voice and they think they need to come into hospital, you’re going to believe them. To go back to analogies, it’s like phoning up Sky and going “Hi, my TV isn’t working?” and ‘following their advice’, then claiming their engineers don’t know anything at all because your TV was actually working all along! Hahaha! No. Whether doctors can distinguish real mental illness from feigned mental illness is an interesting point that has absolutely nothing to do with this study.
The third one, then, is the only valid one: and, if you agree with Spitzer, it occurred. Every single person was released with a diagnosis of ‘schizophrenia in remission*’. That was not a label given lightly. Hell, when Spitzer looked over records from his own hospital, he found 1% of discharged schizophrenia patients were considered ‘in remission’. As for why it took ‘so long’? The same reason that you wouldn’t accept someone into hospital with chest pain and then discharge them the second it stopped. Psychological symptoms are unpredictable. It’s understandable to want to wait things out.
Twisting typical behaviours into psychiatric symptoms is very real, and it sucks. Believe me, I’ve experienced it- apparently ‘helping stack the dishwasher’ was actually an attempt to frantically burn calories by my vicious anorexic self. Go figure, right? I’m not saying psychiatric diagnosis is perfect, but I am saying that Rosenhan was unfairly harsh at times.
As for whether or not it’s still applicable now, there are a few things to consider. First of all is the DSM. We’re on 5 right now, and when Rosenhan was rocking about, were on 2. It was a mess. It was vague and messy and you could basically diagnose anyone with anything. If you have any experience with the current DSM, you’ll know it’s a lot more like a checklist. For example, these days, acquiring a schizophrenia diagnosis requires you to meet a number of criteria, with sentences like ‘shows two of the following five symptoms for a minimum of four weeks’ and so on. It’s quantifiable, it’s measurable, and whilst you can argue whether or not that’s a good thing, it does make false positive wayyy rarer.
(Spitzer did a bunch of DSM stuff. You may have guessed by now that i have a massive psychology boner for Spitzer.)
Now, we can’t do any straight-up modern-day replications, because of ethics boards and shit, but there have been some similar things.
- Lauren Slater claims to have done her own version of the study, turning up at various psych waiting rooms and claiming to hear a voice. She says she was prescribed antidepressants and antipsychotics at each appointment, despite saying she wasn’t depressed. It’s worth considering, though, that many notable psychiatrists do not believe this study actually took place, and Slater backpedalled a lot when questioned about it.
- The BBC documentary ‘How Mad Are You?’ had psychiatrists diagnose mental illness (or a lack of mental illness) in ten people- five disordered, five healthy. The psychiatrists were not allowed to use any official tests, and instead worked on observation and various tasks (eg a stand up comedy gig to try and root out any social anxiety). A Channel 4 documentary called ‘World’s Maddest Job Interview’ did a very similar thing, and frankly I don’t want to talk about these any more. The psychiatrists had a fairly rocky rate of success, yes, but they weren’t using their ACTUAL TESTS. 'Did you know some doctors can't reliably diagnose cancerous tumours without scanning their patients??!?!' As far as I'm concerned, these shows have no psychological merit.
- Ten Days In A Mad House doesn’t really count, as it was written in 1887, but it’s a fuckin good read all the same. Nellie Bly basically went ‘HMMM I WONDER IF’ and faked her way into an asylum. She pretty much claimed the same thing as Rosenhan- that doctors could not distinguish madness from sanity- BUT lied and twisted the truth a bunch while doing it. So, again, contentious.
My personal stance on things? Psychiatric staff are suspicious, but they probably need to be. Do you know how many anorexics turn up on wards only to claim they can eat fine now and don’t need any more help? How many people hide self harm scars? Denial is human nature, and I’m pretty sure we’d all be equally outraged if someone went ‘wait, I have to STAY on the ward??? the voices have gone! def. gone. just totally gone. just like that’ and was immediately let go.
Don’t get me wrong: I love this study. I think Rosenhan raised excellent, excellent points about the treatment of mental illness (if you read his original paper, On Being Sane In Insane Places, you’ll find that a great deal of the paper actually deals with the ill treatment of the mentally unwell as opposed to the reliability of diagnosis), and I am all for the psychiatric profession constantly challenging themselves and improving. I simply feel it is important to place this study in the correct context and to look at the information surrounding it before we use it to condemn modern psychiatric medicine.
peace out yo xoxo
* one person was diagnosed with something slightly different, but it was still considered to be in remission