Rosenhan: A Tainted Legacy?

In the 60s and 70s, a movement was sweeping through the USA termed the Anti-Psychiatry movement. Now this movement was not driven by a fear of psychiatry due to the fear that is associated with the mentally ill. It was actually the complete opposite. The movement had academics and even psychiatrists who spoke vehemently against the practice of psychiatry. They thought that psychiatry was a pseudoscience masking itself as a medical practice. A prominent name in this movement was David L. Rosenhan.

David L. Rosenhan

The Rosenhan Experiment

In 1973, Rosenhan published the findings of an experiment he had conducted across psychiatric facilities in the USA. He sent 8 ‘pseudo-patients’, including himself, to 12 psychiatric hospitals in the USA and told them to report the same complaint. ‘A thud’. All patients told the psychiatrists that they could hear a thud or a banging noise when it wasn’t there.

When they got to the hospitals, they were admitted into the hospital with a diagnosis of schizophrenia in all the cases except one. The ‘patients’ then acted normally in the institution showing no signs of a mental illness. Rosenhan had expected that if psychiatry was a real science, the lies of the patients would be caught immediately and they would be discharged. Contrary to those expectations, the patients were discharged 19 days later on an average with one patient being admitted for 52 days!

The patients shared their experiences of being abused in the hospital and how they had been given the diagnosis of schizophrenia ‘in remission’. Rosenhan said that the psychiatrists had given a label to the completely normal ‘patients’ that was going to stay with them for life showing how psychiatry is simply a quest for labelling the people with made-up illnesses.

The Impact

The study sent shockwaves in the media. The Anti-Psychiatry movement which had been going on for a decade already had new impetus. Calls were made to close psychiatric facilities. Indeed, many psychiatric facilities were closed and multiple patients discharged. Psychiatrists and their expertise was not taken seriously anymore. Psychiatry was under attack!

Psychiatrists were forced to go back to the drawing board about how mental illnesses were diagnosed. Out of this came out the DSM-III in 1980 which was the first step in creating biological criteria to diagnose mental illnesses.

The study was not without critics though. Many questioned the methodology of the study and if it really meant anything in the larger picture.

The Critics

Critics like Spitzer (1975) pointed out that the study had various logical fallacies and undermined the good faith that the doctor and a patient share. His argument was that if a patient were to lie to a doctor and not report the true symptoms, then it would be impossible for any doctor to have an accurate diagnosis immediately. More so in psychiatry, where the lack of a standard, biological test of felt emotions, thoughts and stress doesn’t exist!

If you drank a litre of blood and went to the hospital claiming to vomiting blood, it is obvious that you would get admitted immediately. And once the symptoms, you would be discharged a few days later. Just as it happened in the psychiatric facilities.

Did Rosenhan Lie?

The most damning criticism to Rosenhan’s study actually came decades later in 2019. Susannah Cahalan, an author discovered that Rosenhan had lied about a lot of things that he reported in the paper.

For eg. He said that the patients only reported a thud sound but the doctor’s notes from that time show that one patient reported symptoms like hearing sounds, thinking they had been put in by secret agents, putting in copper plates to block out the noise and thoughts of suicide. But who was this pseudo-patient who went so far off the script?

It was Rosenhan himself.

This wasn’t all.

One of the pseudo-patients came forward to share how his experiences were dropped from the study because they were so positive! And after all these years, Cahalan only managed to find 2 of the pseudo-patients from the study. She also found contradictions in the notes and drafts of Rosenhan’s work.

Given how much attention the work got, and how Rosenhan rarely talked about the work a few years later, didn’t publish the book on the experiment that he had promised, may give us an idea that all isn’t what it seems.

So, was Rosenhan a pioneer who changed how see the mentally ill and psychiatry or was he a fraud who faked his data to make his claim to fame? Share your thoughts in the comments!

2 Replies to “Rosenhan: A Tainted Legacy?”

  1. Highly interesting. In any case the history of treating mentally ill patients is really shameful and almost cruel. Reforms took place but it isis sti close to a drop in the ocean. In any case, thanks for this interesting subject you discussed.

  2. I think I remember this study a little. One thing that came out of it was the First Day.

    Rosenhan reported that he was not spoken to, informed of anything, and had no idea where his belongings now were during his first 24 hours.

    He believed that for a real frightened patient, this would only add to the fear.

    After this, Hospitals tried to change the First Day.
    A Nurse had to sit with the new patient all day, showing them the toilets, their bed, and helping them get tea and coffee.
    They also showed the Patient where all their belongings were.

    On my First Day, a Nurse stayed with me all day, and talked to me.
    It did help a little to settle the fear.
    I always felt that this could mark a good Hospital from a bad one.

    In another Hospital, I had no such attention, and was just ignored.
    Not all Hospitals adopted the practice.

    But it is a good practice, and it did come after this experiment.

    I also believe the if more Doctors spent time as a Patient in a Mental Hospital, then they might change how they operate. At least he made the effort to challenge himself to walk in those doors and face the system.
    He showed courage at the very least, even if the study was flawed.

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