Critical Evaluation of Rosenhans Study ‘on Being Sane in Insane Places’

The question of what it means to be labelled ‘psychologically abnormal’ is examined closely in Rosenhans study of ‘On Being Sane in Insane Places’. This study highlights the usefulness and consequences of being diagnostically labelled. Rosenhans study ‘On Being Sane in Insane Places’ tests the hypothesis that ‘We cannot distinguish the sane from the insane in psychiatric hospitals’. (Rosenhan, 1973) This study is an influential criticism in testing the validity of psychiatric diagnoses, contextual factors in reaching these diagnoses, and what happens after a patient has been diagnostically labelled as ’psychologically abnormal’.

The aim of Rosenhans study was to prove a positive hypothesis. During the study 8 participants of various backgrounds, including Rosenhan himself, gained admission in to 12 psychiatric hospitals across the US. These hospitals were a random selection, from research based to private, modern, old and with varied staff-patient ratios. The pseudo patients gained entry to the facilities by feigning that they could hear voices, reflective of a personality disorder, including words such as ‘hollow’ and ‘empty’. These words were selected by Rosenhan as an opportunity to demonstrate that these voices might be reflecting on the individual’s life.

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After admission to the hospital Rosenhan claims that the pseudo patients cease any abnormal behaviour and continue life within the institution and normally as possible. Rosenhan instructs the pseudo patients to not alter any personal information about themselves to the staff of the hospital such as their education or family background (except their name for security purposes) whilst being psychologically assessed. The study tests whether the patients, after their original symptoms have alleviated, will be given a psychiatric diagnoses and the consequences of being labelled as such.

The outcome of the study was that 11 out of 12 participants were discharged as having ‘Schizophrenia, in remission’. Rosenhan closely explores the penalties of being labelled by these diagnoses. Lack of recognition of the sanity of the pseudo patients is key in Rosenhans argument for the validity of his study. Rosenhan is excessively criticised for his findings, and although proving that there is room for further development in psychiatric diagnoses, many discredit his study and question its validity and reliability.

There are also many ethical questions that should be looked at closely when critiquing his work(Rosenhan, 1973). Rosenhan highlights key findings in his study, which directly relate to being viewed as ‘psychologically abnormal’. The most valid points he looks at are as follows: the unreliability of psychiatric diagnoses, the effects of diagnostic labelling and how contextual factors influence how these are viewed, and the further effects on patients being labelled, such as, becoming powerless (Rosenhan, 1973).

By focusing on these areas Rosenhan brings to light many important questions, such as, how valuable are psychiatric diagnoses? If there is any room for doubt, then in turn, how reliable are our legal systems that support these? Rosenhans study is an important framework for examining these issues further and the evidence he presents greatly support the notion that there are real consequences of being diagnostically labelled, but also how easy it is to do so. This is brought to light by the staff in the hospitals using the pseudo patient’s diagnoses in context when assessing their past (Rosenhan, 1973).

From the outset of Rosenhans study he leaves room for criticism, any many focus directly on his hypothesis. Without the use of a correctly used hypothesis his experiment reduces in validity. An article written by Millon comments that not only does Rosenhans hypothesis have ‘misused terms’ such as ‘sane’ and ‘insane’ which are not politically correct, but he claims his hypothesis is proved correct, which is largely debatable. Millon critiques this by suggesting that because the participants are aware of the hypothesis, it is possible they have changed their behaviour once institutionalised.

This can be viewed as a self-fulfilling prophecy, but Millon mainly focuses on the experiment being affected by participant bias, as Rosenhan does not enforce blind controls (Millon, 1975). It should also be noted when looking at the above, that Rosenhan further reduces the validity of his experiment by involving himself as a participant, which shows experimenter bias, and also may be key to why the controls Millon looks at were not enforced with his participants.

In another article written by Spitzer, the validity of Rosenhans hypothesis is also critiqued. By questioning the validity of Rosenhans study, his work in to what it means to be deemed ‘psychologically abnormal’ is tainted. Spitzer criticises the study as scientific and instead calls it ‘pseudo science’, (Spitzer, 1975). Spitzer suggests that Rosenhan cannot criticise the institutions for labelling the pseudo patients because the evidence they present when asking for admittance, and then they’re behaviour following hospitalisation, warrants this.

He references lists of symptoms from the DMS-II and points out that the nervousness, excessive note taking, and actually asking to be admitted to a psychiatric ward is enough evidence to label an individual as ‘Schizophrenic’. Spitzer suggests that based on the evidence present that hospital staffs were correct to diagnose and label the pseudo patients. This highlights the use of type 2 errors in diagnoses, and as the staff would not normally be looking for pseudo patients in a mental institution, that they’re right to do so.

Millon explores this area further by suggesting the use of type 2 errors in diagnoses could be viewed as safer for society and the patients themselves (Millon, 1975). By criticising Rosenhans suggestion that it is easy to be labelled as ‘psychologically abnormal’, we can focus on the benefits of labelling specific behaviours in diagnoses and this point receives a lot of positive criticism as it shows room for development in psychiatric institutions. The consequences of being labelled ‘psychologically abnormal’ are long term and potentially dangerous.

Millon elaborates this point by suggesting Rosenhans study is valid enough to show improvement is needed in diagnoses, and also the need to develop new syndrome groupings (Millon, 1975). It is key to note that Rosenhan repeatedly points out the contextual nature of diagnoses. Crown, commends Rosenhans study as a valuable asset when focusing on the above. However, he suggests that if the research had been performed in the UK rather than the US, different findings would have come to light. He suggests the label of ‘Schizophrenic’ and therefore being ‘psychologically abnormal’ is not given so lightly in the UK.

This proposes that Rosenhans study is culturally bias and may not be relevant worldwide. Crown concretes this by highlighting research by the UK/US diagnostic research project (Crown, 1975). When questioning diagnoses that suggest ‘psychological abnormalities’ Rosenhans study and subsequent criticisms provide key evidence as to why other diagnoses in the DSM are not used. Spitzer points out that although the diagnoses of ‘Schizophrenia in remission’ are acceptable in this experiment, why other diagnoses such as ‘diagnoses deferred’ are not used (Spitzer, 1975).

Rosenhans entire study concretes this point, and the ease of psychological labelling. This in turn shows how little we still know regarding mental illness and the correct classifications, otherwise how can a diagnoses be so greatly debated. Rosenhans study clearly shows there is still doubt about how clearly we can define ‘psychological abnormality’. Abnormality can be seen as an umbrella terms covering many different areas of psychological states. Dangers have been highlighted in mislabelling, especially recently in the media, regarding prison sentences.

When referencing the relevance of this back to Rosenhans study, if there is room for question in psychological diagnoses, then how many sane individuals are sent to psychiatric facilities to avoid criminal consequences? (Rosenhan, 1973). The misuse of psychological labels should be recognised when looking at what it means to be ‘psychotically abnormal’ the consequences should be in no way, lightly dismissed. This is a modern day topic directly relating to Rosenhans study, which shows that although the study was in 1973 and may be viewed as ‘out of date’, it is still relevant.

Even though Rosenhans study is vital evidence in what it means to be ‘Psychologically abnormal’ it is important to critique his work. After reading all the criticism on Rosenhans study and his reflection on the research, it is clear that the research is missing vital data that would strengthen its validity. It seems that all the criticism agree that the diagnoses given were wrong, but the experiment, although perhaps unethical and incomplete, as explored earlier, pave way for some valuable further research in to contextual diagnoses and being labeled ‘psychologically abnormal’.

It seems that it is Rosenhan himself, and not merely the research, that fails to meet with expectations. It is his personal error that leaves the research “work half done”, (Rosenhan, 1973), without correctly giving further alterations that could be placed, and evaluating his findings. He misses out vital areas he could have explored further, such as labeling specific behaviours in diagnoses, (Millon, 1975), and by developing data further he could have strengthened the findings of his research and left less room for criticism and implementations.

Reference List

Crown, S. (1975). ‘On being sane in insane places’: a Comment from England . Journal of Abnormal Psychology , 453-455. Millon, T. (1975). Reflections on Rosenhans, ‘On being sane in insane places’. Journal of Abnormal Psychology , 84, 456-461. Rosenhan, D. (1973, January). ‘On being sane in insane places’. Science 179 , 250-8. Spitzer, R. L. (1975). On Psuedoscience in science, Logic in Remission and Psychiatric DIagnoses: A critique on Rosenahns, ‘On being sane in insane places’. Journal of Abnormal Psychology , 84, 442-452.

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