Rosenhan Experiment: Sanity, Diagnosis, and Psychiatry

Introduction

Insanity is often described as a combination of behaviors brought about by certain mental disorders, pointing toward abnormality and a deranged state of mind. The word insane, however, is not a medical term. Psychiatrists and other medical practitioners typically refer to such states as psychosis, characterized by delusions and hallucinations. Although the majority of patients are diagnosed with mental disorders without great difficulty, the reliability and validity of these diagnoses are frequently questioned.

In fact, many people judged to be sane and competent are more dangerous to themselves, their families, and their communities than the supposedly "insane" patients confined to psychiatric wards for extended periods. In light of the doubt cast on the various diagnostic categories that distinguish the sane from the insane, David Rosenhan sought to determine how capable hospital staff were at differentiating genuinely sick patients from those who were actually sane and present only for research purposes. This paper examines the experiments Rosenhan and his team conducted, their findings, and the broader implications of their results.

The Rosenhan Experiment

Conducted in the 1970s, the Rosenhan experiment was destined to leave its mark on history as one of the most significant challenges to the validity of psychiatric diagnosis. Rosenhan, himself a psychologist, together with three women and four other men — referred to as pseudopatients — feigned hallucinations in the form of hearing voices in order to be admitted as patients. The pseudopatients were admitted to 12 different hospitals located across five different states, and only Rosenhan's identity was made known to the head psychologist and the hospital administrator (Rosenhan, 1973). All other pseudopatients used aliases and concealed their true professions, although the details of their life circumstances and personal history remained unchanged.

After being admitted, the pseudopatients abandoned all behaviors that had pointed toward abnormality. They participated in all activities required by the facility and sometimes openly took notes to assist in the research. Rosenhan (1973) also describes a second experiment conducted at one particular hospital that had heard of Rosenhan's research and challenged his team, confident that the same diagnostic mistakes could not occur in their facility.

Findings

The findings of the experiment were rather surprising, as none of the pseudopatients were detected as frauds by hospital staff. In the initial hospitalizations, it was actually 35 real patients who were able to detect that the pseudopatients were sane — some voicing their suspicions openly and accusing them of being journalists or professors due to their note-taking habits (Rosenhan, 1973). The pseudopatients' behaviors, though entirely normal, were consistently interpreted as evidence of pathological disorders. For instance, note-taking was taken as proof of disturbance, and one pseudopatient observed writing was recorded as having schizophrenia.

Staff believed it was the pseudopatients' responsibility to demonstrate that they were improving. As a result, the pseudopatients were compelled to take more than 2,100 medication tablets, despite showing no genuine signs of illness. They were kept in the hospital for an average of 19 days, during which they observed that there was little to occupy their time beyond eating. In one telling incident, a psychiatrist pointed to a group of patients who had gathered in the cafeteria half an hour before lunch and immediately concluded that this behavior was a sign of "oral-acquisitive syndrome," entirely disregarding the fact that the patients had nothing else to do. Rosenhan (1973) describes the hospital experience as deeply depersonalizing: the pseudopatients frequently felt powerless, lacked privacy, and had little freedom of movement.

The second experiment produced even more striking results. After Rosenhan purportedly arranged to send pseudopatients to the challenging hospital, staff there identified 41 out of 193 patients as potential pseudopatients, with 23 flagged by a psychiatrist alone and 19 flagged by both a psychiatrist and other staff members. In fact, Rosenhan had sent no pseudopatients to that hospital at all.

Conclusion

Beyond demonstrating the errors made in diagnosing patients with mental illness, this study also sheds light on the poor conditions evident in psychiatric institutions where patients are sent for treatment or observation. The study does, however, have a few notable weaknesses. The pseudopatients were aware that their diagnoses were inaccurate, which may have shaped their behavior and perceptions in ways that genuine patients would not experience. The second experiment also raises ethical concerns, as the hospital and its staff were deceived.

Despite these limitations, Rosenhan's study was successful on several fronts: it incorporated a variety of hospitals, allowed pseudopatients to gain firsthand experience by interacting with real patients, and produced findings with genuine practical significance. The study encouraged psychiatrists and other physicians to base diagnoses on an individual's specific presenting problems rather than on broad categorical labels. It also provided an important foundation for the development of improved psychiatric classification systems to be researched and applied in clinical practice.

References

Rosenhan, D. L. (1973). On being sane in insane places. Science, 179. Retrieved February 13, 2015, from http://psychrights.org/articles/Rosenham.htm