The concept of being labeled ‘psychologically abnormal’ is thoroughly examined in Rosenhan’s study ‘On Being Sane in Insane Places’. This study sheds light on the significance and repercussions of diagnostic labeling. Rosenhan’s study tests the idea that ‘We cannot differentiate between the mentally sound and mentally unsound in psychiatric hospitals’ (Rosenhan, 1973). It is a groundbreaking criticism that assesses the accuracy of psychiatric diagnoses, the contextual aspects in their formulation, and the aftermath of being labeled as ‘psychologically abnormal’.
The purpose of Rosenhan’s study was to confirm a positive hypothesis. In the study, 8 participants with different backgrounds, including Rosenhan himself, were able to gain admission to 12 psychiatric hospitals across the US. The selection of these hospitals was random and included research-based, private, modern, old, and facilities with varying staff-patient ratios. The pseudo patients were able to enter these facilities by pretending to hear voices that reflected a personality disorder, using words like ‘hollow’ and ’empty’. Rosenhan chose these words to demonstrate that these voices may be a reflection of the individual’s life.
Upon admission to the hospital, Rosenhan asserts that the pseudo patients refrain from displaying any abnormal behavior and strive to lead a normal life within the institution. In order to be psychologically evaluated, Rosenhan instructs the pseudo patients not to modify any personal details such as their education or family background (except their name for security reasons). The study aims to investigate whether patients, once their initial symptoms have diminished, will receive a psychiatric diagnosis and the subsequent repercussions of being labeled as mentally ill.
The study resulted in 11 out of 12 participants being discharged with the diagnosis of ‘Schizophrenia, in remission’. Rosenhan extensively examines the consequences of being labeled with these diagnoses. The lack of acknowledgment of the sanity of the pseudo patients plays a crucial role in Rosenhan’s argument for the credibility of his study. Despite facing significant criticism for his findings and despite demonstrating the need for improvement in psychiatric diagnoses, many discredit Rosenhan’s study and cast doubt on its validity and reliability.
Rosenhan’s study (1973) raises numerous ethical questions that warrant close examination. His work focuses on key findings concerning the perception of individuals as “psychologically abnormal.” The study highlights several significant points: the lack of reliability in psychiatric diagnoses, the impact of diagnostic labeling, the influence of contextual factors on these labels, and the subsequent disempowerment experienced by labeled patients (Rosenhan, 1973).
By focusing on these areas, Rosenhan raises important questions regarding the value of psychiatric diagnoses and the reliability of our legal systems that endorse them. Rosenhan’s study serves as a significant foundation for further examination of these issues, as the evidence he presents strongly supports the idea that being diagnostically labeled has real consequences and can be easily done. The hospital staff’s use of the pseudo patient’s diagnoses in assessing their history highlights this (Rosenhan, 1973).
At the beginning of Rosenhans study, there is potential for criticism, particularly regarding his hypothesis. The validity of his experiment diminishes without a correctly formulated hypothesis. A critique by Millon argues that Rosenhans hypothesis contains politically incorrect terms, such as ‘sane’ and ‘insane’, and questions its demonstrable correctness. Millon suggests that participants may have altered their behavior once they became aware of the hypothesis, casting doubt on its validity.
This can be seen as a self-fulfilling prophecy, with Millon placing emphasis on participant bias in Rosenhan’s experiment due to the lack of blind controls (Millon, 1975). Additionally, it is important to acknowledge that Rosenhan diminishes the credibility of his study by including himself as a participant, which demonstrates experimenter bias and may explain why Millon’s controls were not implemented with his participants.
In another article, Spitzer also critiques the validity of Rosenhan’s hypothesis. By calling into question the validity of Rosenhan’s study, Spitzer argues that his investigation into the concept of being deemed ‘psychologically abnormal’ is compromised. Spitzer goes on to label Rosenhan’s study as “pseudo science” instead of scientific. Spitzer suggests that Rosenhan cannot criticize the institutions for labeling the pseudo patients because the evidence they provide upon admission and their behavior during hospitalization justifies such labeling (Spitzer, 1975).
According to Spitzer, individuals can be labeled as ‘Schizophrenic’ based on symptoms listed in the DMS-II such as nervousness, excessive note taking, and even expressing a desire to be admitted to a psychiatric ward. Spitzer argues that the hospital staffs’ diagnoses of the pseudo patients were correct, as they relied on the evidence at hand. This illustrates the occurrence of type 2 errors in diagnoses, and justifies the staffs’ decision to search for pseudo patients in a mental institution despite it not being their usual practice.
In his study, Millon (1975) delves deeper into this topic by proposing that considering type 2 errors in diagnoses could be seen as a safer option for both society and the patients themselves. Millon’s criticism of Rosenhan’s claim that it is simple to be branded as ‘psychologically abnormal’ shifts our attention towards the advantages of labeling certain behaviors in diagnoses. This viewpoint has garnered considerable favorable feedback as it demonstrates potential for growth within psychiatric institutions. However, it is crucial to acknowledge that being labeled as ‘psychologically abnormal’ has long-lasting and potentially perilous consequences.
According to Millon (1975), Rosenhan’s study demonstrates the need for improvement in diagnoses and the development of new syndrome groupings. Rosenhan emphasizes the contextual nature of diagnoses. Crown also views Rosenhan’s study as a valuable asset but suggests that conducting the research in the UK instead of the US would have yielded different results. Crown argues that the label of ‘Schizophrenic’ and being considered ‘psychologically abnormal’ is not as easily given in the UK.
This suggests that Rosenhans study is culturally biased and its relevance may not extend worldwide. Crown supports this notion by referencing the UK/US diagnostic research project (Crown, 1975). Rosenhans study and its subsequent criticisms offer significant evidence against the use of certain diagnoses in the DSM that imply ‘psychological abnormalities’. Spitzer argues that while diagnoses like ‘Schizophrenia in remission’ are accepted in this study, other diagnoses like ‘diagnoses deferred’ are not utilized (Spitzer, 1975).
Rosenhan’s study demonstrates the ease of psychological labeling and the limited understanding we have of mental illness and proper classifications. The study raises doubts about the clarity with which we can define “psychological abnormality”, as it encompasses various psychological states. The potential dangers of mislabeling, particularly in relation to prison sentences, have come to light in recent media coverage.
The importance of this in relation to Rosenhans study is that if psychological diagnoses can be questioned, then how many mentally stable people are sent to psychiatric facilities to avoid punishment in criminal cases? (Rosenhan, 1973). It is crucial to acknowledge the misuse of psychiatric labels when considering the definition of “psychotically abnormal” as the consequences should not be disregarded. This issue continues to be relevant in contemporary times and is directly linked to Rosenhans study, which despite being conducted in 1973, remains applicable.
While Rosenhan’s study provides crucial evidence on the concept of being ‘Psychologically abnormal,’ it is important to evaluate his work. After reviewing the criticism of Rosenhan’s study and his own reflection on the research, it becomes evident that essential data is missing, which would enhance its validity. The critique unanimously agrees that the diagnoses given were incorrect, but despite its ethical concerns and incompleteness mentioned earlier, the experiment opens doors for valuable future research on contextual diagnoses and the labeling of individuals as ‘psychologically abnormal.’
It appears that Rosenhan himself, rather than just the research, does not meet expectations. It is his own mistake that leaves the research incomplete without providing necessary modifications and analyzing his results accurately. He overlooks important aspects that could have been further investigated, such as identifying specific behaviors in diagnoses and enhancing the data to reinforce the research findings and minimize potential criticisms and applications.
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.
