The Rosenhan experiment - good short summary

The Rosenhan experiment was a famous experiment on the validity of the psychiatric diagnosis that the psychologist David Rosenhan carried out between 1968 and 1972.  It was published in 1973 in the journal Science under the title "On being sane in insane places " .  The study is considered an important and influential critique of psychiatric diagnosis . 

Rosenhan's experiment consisted of two parts. In the first part, healthy collaborators or "pseudopatients" (three women and eight men) simulated acoustic hallucinations to be admitted to twelve psychiatric hospitals in five states of the United States . All were effectively admitted and diagnosed with psychiatric illnesses. After being hospitalized, the pseudo-patients behaved normally and informed those in charge of the establishments that they were well and that they had not suffered any further hallucinations. Not only did the medical officers not detect any of the pseudo-patients, but they believed that they were manifesting symptoms of real mental illness. Several were held for months. All were forced to admit that they suffered from a mental illness and to accept medication with antipsychotics as a condition to be discharged. The second part took place when one of the psychiatric facilities challenged Rosenhan to send pseudopatients to his hospital for its staff to detect. Rosenhan agreed, and in the following weeks, of the 193 patients the hospital treated, it identified 41 as possible pseudopatients, 19 of whom had aroused the suspicions of at least one psychiatrist and one other staff member. Actually, Rosenhan hadn't sent anyone to the hospital. 

The study concluded: "It is clear that in mental hospitals we cannot distinguish the sane from the insane."  Likewise, he illustrated the dangers of depersonalization and labeling in psychiatric institutions. The study suggested that the use of community mental health facilities that were concerned with specific problems rather than establishing psychiatric labels could be a solution and recommended educating workers to make them more aware of the social psychology involved in those facilities.

The Rosenhan Experiment Explained

The Rosenhan experiment is a study conducted in 1973 in order to examine the validity of psychiatric diagnosis. Researcher David Rosenhan suspected that psychiatric criteria applied in diagnosis are not as objective as believed but rather context and personally determined.

In order to test his hypothesis Rosenhan wanted to commit healthy people to mental institutions and see how they are treated (hence the title of his article: "On Being Sane in Insane Places"). His study included two experiments testing unknowing real hospitals. In his first experiment Rosenhan sent healthy people to fake psychiatric symptoms which disappeared after they were hospitalized. These fake patients continued to be treated as abnormal though they presented no symptoms and were in fact completely sane (for a detailed account of the experiment see our summary of "On Being Sane in Insane Places" part 1). After the results of the first experiment, the second Rosenhan experiment informed institutions that fake patients will come to them within a given time frame. Rosenhan asked the institutes to try and pick up on the impostors and though a relatively high number of patients were suspected to be sane, Rosenhan in fact never sent anyone (for a detailed account of the experiment see our summary of "On Being Sane in Insane Places" part 2).

What the Rosenhan experiment shows is not only the unreliability of mental diagnosis (and maybe medical diagnosis in general), but something much deeper. In his article Rosenhan talks about the problem of "psychiatric labeling", a phenomenon by which once someone is considered to be insane the way he is perceived and treated by his surroundings will work to fulfill that prophecy. In the most broader sense, the Rosenhan study demonstrates how once we have an initial verdict on someone or something, everything we see from that point on will be understood based on that initial judgment, be it misguided or not. Rosenhan's experiment pushed forward the anti-psychiatry movement and the discourse on psychiatric labeling, but its meaning and implications run much deeper. 

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Summary: On Being Sane in Insane Places - David Rosenhan - part 2 (second Rosenhan experiment)

The second Rosenhan experiment

Hospitals that learned of the results of the first Rosenhan experiment (part 1 of the summary) described in "On Being Sane in Insane Places" could not believe that such errors can systematically occur. Rosenhan therefore devised a second experiment in which the local staff was notified in advance that within the upcoming three months a fake patient will try to get himself committed to their institute. All personal were requested to rate patients according to the chances that they are the fake patient. Reports were filled on 193 patients: 41 were rated a highly likely to be fake by at least one staff member, 23 were suspected by at least one psychiatrist and 19 were suspected by one psychiatrist and one staff member. In actual fact, no fake patients were ever committed to any of the hospitals as part of Rosenhan's study.  

The second Rosenhan experiment proves that the tendency for over-diagnosis can be reversed. Since 19 patients were suspected to be sane by a psychiatrist and a staff member, the credibility of diagnosis is undermined.

Rosenhan's study and psychiatric labeling

What the Rosenhan experiments shows is that once a person is labeled as deviant, all his actions will be labeled accordingly. The power of this labeling is so powerful that perfectly normal behaviors were ignored, misinterpreted or even coerced to fit the original diagnosis. Personal facts were distorted by professionals in order to fit in with schizophrenia. Even sadness or outbursts by the fake patients that were the result of being committed were misunderstood as being related to schizophrenia. Rosenhan's study also painted a very harsh image regarding the treatment of mental patients that are dehumanized by the staff that disregard their rights and treat them harshly.

Rosenahn concludes "On Being Sane in Insane Places" in wondering how many sane people are labeled and committed as mental patients. He claims that psychiatric labeling can have a life of its own with risk of becoming a self fulfilling prophecy in which even the person himself accepts the diagnosis and begins to act accordingly.

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Summary: On Being Sane in Insane Places - David Rosenhan - part 1 (first Rosenhan Experiment)

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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