“On being sane in insane places”

Can you prove that someone is sane? It would probably be difficult for the layperson, but is that something a professional could do? That is the question psychologist David Rosenhan attempted to answer in a 1973 study dubbed “the Rosenhan experiment”.

Stanford_Law_School_Yearbook_1975_Page-90

To tackle the issue (of feigned psychiatric disorders in psychiatric hospitals), Rosenhan first sent seven associates, along with himself, to gain admission to psychiatric hospitals. Three women and five men, all psychologically healthy, pretended to have aural and visual hallucinations in their attempts at twelve different hospitals. During assessment, they described hearing a faint voice saying the words “empty,” “hollow,” and “thud”. Once admitted, which they all were, they were to behave completely normally and claim that the voices had stopped.

All patients were eventually released after being diagnosed with schizophrenia in remission, but none were discovered to be faking their illness. This is made further interesting with the knowledge that they openly took notes on hospital operations, doctors, nurses, and other patients during their stay. The writing was often labelled as pathological and just another symptom of mental illness. And though all prescribed medicines were flushed down the toilets, this went unnoticed as well. Oddly, or not oddly at all, 35 real patients did claim the study members were tricksters investigating the hospital.

A scene from One Flew Over the Cuckoo's Nest (1975)
A scene from One Flew Over the Cuckoo’s Nest (1975)

After the experiment was published, staff at another hospital claimed that such an incident could never occur on their watch. A challenge was made: send frauds, and the hospital will find them. During three months, arranged with the hospital beforehand, Rosenhan was to send at least one fake patient. The doctors would then take note on each new patient to determine the likelihood of imitated disorders. By the end of this experiment, forty-one charlatans were found.

However, Rosenhan never sent fake patients to the hospital. All forty-one “fakes” were, in fact, truly suffering individuals. Rosenhan commented that:

But one thing is certain: any diagnostic process that lends itself too readily to massive errors of this sort cannot be a very reliable one.

There were many arguments made against the experiment however. A large one being: psychiatry bases its diagnoses almost entirely off patient feedback. If the patient is pretending to have a mental illness, is that something for which psychiatrists or therapists need to be looking? Dr. Kety (Professor of Psychiatry, Harvard Medical School, Boston, Mass.) had this comparison:

If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood, the behavior of the staff would be quite predictable. If they labeled and treated me as having a bleeding peptic ulcer, I doubt that I could argue convincingly that medical science does not know how to diagnose that condition.

Psychiatric diagnosis, according to Robert L. Spitzer) is not meant to help us understand the origins and processes of these disorders, but instead to “offer considerable help in the control of many mental disorders” (as Spitzer puts it in his critique). But this still leaves some valid concerns Dr Rosenhan makes in the video above. How we treat our mentally ill may need to be revised and changed.

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