What is the Rosenhan experiment?

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In a powerful and illuminating study of the validity of psychiatric diagnoses, David L. Rosenhan of 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.
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Introduction

In a powerful and illuminating study of the validity of psychiatric diagnoses, David L. Rosenhan of 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. Each of these imposters, or pseudopatients, falsely reported a single psychiatric symptom: vague 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.

Hospital staff never did. On the basis of the one complaint alone, all eight people were admitted to twelve different hospitals (some did it twice) and 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 on the psychiatric ward.

These notes, a typical aspect of participant-observation research, provided much information about the daily activities on 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 act normally 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 about 10 to 20 percent of new admissions to be faking. However, none of those identified was actually an experimental imposter.

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. One, labels have a powerful influence on the way mental health workers perceive and interpret actions. Two, the mental health system is biased toward seeing pathology in anyone who walks in the door. Three, determining who is psychologically disordered is not always clear. Four, 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. According to the DSM-5, most psychiatric disorders can be diagnosed only if the symptoms occur over a long period of time and interfere significantly with the patient's life, which, if the standards were correctly applied, would rule out Rosenhan's pseudopatients.

The study was also used at the time as a basis for suggestions of reforms of inpatient psychiatric care facilities, though that was not Rosenhan’s aim in conducting the study. In the twenty-first century, the Rosenhan experiment has inspired a number of 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 to evaluate the validity of psychiatric diagnoses in general.

Rosenhan’s original experiment is often listed as one of the classic psychology experiments of the twentieth century. The original article, “On Being Sane in Insane Places,” which was published in the journal Science in 1973, has been reprinted in books listing key readings in psychology, introductory readings in 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.

Bibliography

Crown, Sidney. “’On Being Sane in Insane Places’: A Comment from England.” Journal of Abnormal Psychology 84.5 (Oct. 1975): 453–55. Print.

Goddard, Murray J. “Personal Accounts: On Being Possibly Sane in Possibly Insane Places.” Psychiatric Services 62.8 (2011): 831–32. Print.

Lazarus, Arthur. “Improving Psychiatric Services through Mystery Shopping.” Psychiatric Services 60.7 (2009): 972–73. Print.

Millon, Theodore. “Reflections on Rosenhan’s ’On Being Sane in Insane Places.’” Journal of Abnormal Psychology 84.5 (Oct. 1975): 456–61. Print.

Polak, Paul R., et al. “On Treating the Insane in Sane Places.” Journal of Community Psychology 5.4 (Oct. 1977): 380–87. Print.

Rhodes, Karin. “Taking the Mystery out of ’Mystery Shopper’ Studies.” New England Journal of Medicine 365.6 (2011): 484–86. Print.

Rosenhan, David L. “On Being Sane in Insane Places.” Science 179 (Jan. 1973): 250–58. Print.

Slater, Lauren. Opening Skinner’s Box: Great Psychological Experiments of the Twentieth Century. New York: Norton, 2004. Print.