D.L.Rosenhan's
"On Being Sane in Insane Places", also called the "Rosenhan experiment" is a critical study regarding the validity of psychiatric
diagnosis.
The
background for Rosenhan's study is the question of how can we tell sanity from insanity,
arguing that there are many inconsistencies regarding the credibility and applicability
of concepts of mental health and psychopathology which might be cultural dependent. Rosenhan holds that at the heart of the diagnosis of insanity lies
one crucial issue: do the characteristics that lead to a diagnosis come from
the patient of the surrounding context? Rosenhan suspects that the approach of
determining the occurrence of mental condition based of a catalog of symptoms
is not as objective as thought and is highly effected by the tendencies of the
person doing the diagnosis.
In
order to test his hypothesis Rosenhan thought of an experiment in which normal people
are committed to mental institutions in order to see how they are diagnosed. If
they are declared sane then the system can be trusted. But if
"fakers" will be diagnosed as suffering from mental illness this will
attest to a context related bias.
The first Rosenhan experiment
Rosenhan
therefore devised two experiments for his study described in "On Being Sane
in Insane Places". In the first experiment of the study eight sane people committed
themselves to twelve psychiatric institutes without their crew being aware. Aside
from Rosenhan himself the experiment included 3 psychologists, one psychology
student, a pediatrician, a psychiatrist, a painter and a homemaker. Hospitals
chosen for the experiment were also varied.
In
their sessions the fake patients complained of auditory hallucinations in which
very unclear voices utter vague words. The name, occupation and symptoms of the
patients were made up but their personal history and behavior were authentic. None
of them had any past of present pathological behavior.
The
fake symptoms disappeared right after the patients were admitted, although some
of the cases presented mild and passing anxiety. Patients acted inside the
institution as they would act outside of it, and they were obviously motivated
to be declared sane in order to be discharged. Nurse reports confirm that they
were friendly, cooperative and did not exhibit any abnormal behavior.
The
fake patients kept (first hidden and then overt) accounts of their experience.
Fake patients in the first Rosenhan experiment spent 17 to 52 days in the
institutions (an average of 19 days). They all displayed normative behavior but
were all but one discharged with a diagnosis of "schizophrenia in remission". None of the files indicated any doubts regarding the
diagnosis. Once diagnosed, nobody thought of second guessing the initial
judgment. They were not thoroughly examined but not due to lack of time. The
other real patients in the institute noticed that the fake patients were normal but
the staff did not and they even thought them to be a researcher or journalist.
Rosenhan concluded his first experiment in "On Being Sane in Insane Places"
with the assertion that doctors tend to over-diagnose in order to be on the
safe side and not miss a sick person. But this tendency can cause damage when adopted
by psychiatrists due to the social and legal repercussions of a mental
condition.
The second Rosenhan experiment will be discussed in part 2 of the summary of "On Being Sane in Insane Places".
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