In 1973, David Rosenhan conducted the Rosenhan experiment to evaluate the credibility of psychiatric diagnosis, which served as a significant critique of psychiatric practice. The experiment comprised two sections. Initially, mentally stable individuals feigned experiencing auditory hallucinations for a short duration to secure admission into 12 psychiatric hospitals situated in different states across the United States. Surprisingly, all participants were admitted and diagnosed with mental disorders.
Upon admission, the pseudopatients behaved normally and informed the staff that they were healthy and no longer had hallucinations. They all admitted to having a mental disorder and agreed to take antipsychotic medication in order to leave the hospital. Their average stay was 19 days, except for one person who was diagnosed with “schizophrenia in remission” upon release. In his next research phase, Rosenhan encountered resistance from a dissatisfied hospital that asked him to send pseudopatients for their staff to identify.
Supporting Rosenhan’s findings, the hospital staff correctly labeled 41 out of 193 new patients as potentially being pseudopatients. Out of these individuals, 19 raised suspicion from both a psychiatrist and another staff member. It is crucial to acknowledge that Rosenhan did not physically send anyone to the hospital for this study. The overall conclusion drawn from this research was that psychiatric hospitals lack the ability to differentiate between sanity and insanity. Additionally, the study shed light on the dangers associated with dehumanization and labeling within such establishments.
The recommendation was made to use community mental health facilities that focus on addressing specific problems and behaviors instead of psychiatric labels. The suggestion also included the need for educating psychiatric workers on the social psychology of their facilities. However, this study has received criticism and has been accused of presenting pseudoscience as science. To conduct the pseudopatient experiment, Rosenhan himself and seven mentally healthy associates, referred to as “pseudopatients”, pretended to experience auditory hallucinations in order to obtain admission to psychiatric hospitals.
The experiment enlisted various pseudopatients, comprising a psychology graduate student, three psychologists, a pediatrician, a psychiatrist, a painter, and a housewife. Before the experiment commenced, none of them had any mental health disorders. To maintain objectivity and prevent favoritism or excessive focus, individuals with mental health backgrounds assumed fictitious roles in unrelated industries. While false names and professional information were utilized, all other personal details remained truthful.
During their initial psychiatric evaluation, the patients disclosed experiencing auditory hallucinations of voices from individuals who shared the same gender. The voices were often unclear but consistently uttered the words “empty,” “hollow,” and “thud,” without any further communication. These specific words were chosen as they had an ambiguous connection to a crisis of existence and lacked any previous literature associating them with psychotic symptoms. No other mental health symptoms were reported by the patients. If admitted, the pseudopatients were instructed to exhibit normal behavior and assert that they no longer perceived any auditory hallucinations.
Hospital records reveal that staff at 12 psychiatric hospitals in the United States, ranging from underfunded rural facilities to prestigious urban university-run hospitals, considered all pseudopatients to be friendly and cooperative. Despite presenting identical symptoms, seven pseudopatients were diagnosed with schizophrenia at the public hospitals, while one received a more hopeful diagnosis of manic-depressive psychosis, which typically leads to better clinical outcomes, at the private hospital.
According to Rosenhan, the duration of their stays at the hospital ranged from 7 to 52 days, with an average of 19 days. All of the patients were discharged with a diagnosis of schizophrenia “in remission”. Rosenhan interprets this as evidence that mental illness is perceived as a lifelong stigma rather than a curable condition. Interestingly, despite openly documenting their observations on the staff and fellow patients, none of the pseudopatients were recognized as impostors by the hospital staff. However, many of the other psychiatric patients were able to correctly identify them as impostors.
During the initial three hospitalizations, 35 out of the total 118 patients conveyed a suspicion that the pseudopatients were of sound mind. Some even speculated that they might be researchers or journalists assigned to investigate the hospital. The hospital staff made notes indicating that much of the pseudopatients’ actions were interpreted as signs of mental illness. For instance, a nurse labeled one pseudopatient’s act of taking notes as “writing behavior” and deemed it to be pathological. The regular biographies of the patients were transformed in the hospital records to align with the expectations associated with schizophrenia, which were in line with the prevailing theories about its causes at that time.
The participants, acting as patients, had to find a way to leave the hospital independently by convincing the hospital administration. Despite having a lawyer available for emergencies, it was clear that the participants would not be willingly discharged with such little notice. After being admitted and diagnosed, the only means of being released was if the participants agreed with the psychiatrists that they were mentally ill and started taking antipsychotic medications. Later on, they disposed of these medications by flushing them down the toilet. None of the staff members observed or reported this action.
Rosenhan and the other pseudopatients described feeling dehumanized, having their privacy violated, and experiencing boredom during their time in the hospital. Their personal belongings were searched without reason, and they were occasionally monitored while using the bathroom. The patients noted that while the staff appeared to have good intentions, they often treated them as objects and stripped them of their humanity. The staff would frequently engage in lengthy discussions about patients as if they were absent from the room, and only interacted with patients when it was necessary for official duties.
Some attendants engaged in verbal and physical abuse of patients when other staff members were not around. A doctor referred to a group of patients waiting outside the cafeteria for lunch as experiencing “oral-acquisitive” psychiatric symptoms. On average, patients had only 6.8 minutes of contact with doctors per day. In the non-existent impostor experiment, Rosenhan conducted his study in a renowned research and teaching hospital. The hospital staff had been aware of the initial study’s findings but believed that similar mistakes could not occur at their institution.
During a three month period, Rosenhan arranged for one or more pseudopatients to try and be admitted, with the staff rating each incoming patient on the probability that they were an impostor. Out of the 193 patients, 41 were deemed to be impostors and an additional 42 were deemed suspicious. In truth, Rosenhan did not send any pseudopatients, and all patients suspected by the staff of being impostors were actually regular patients. As a result, it was concluded that any diagnostic process that enables such widespread errors cannot be considered trustworthy.
Further research has discovered similar issues in diagnostic outcomes, endorsing the concerns raised by Rosenhan. His study, which emphasized the lack of dependability in psychiatric diagnosis and its negative impact on patients’ well-being, was published in the journal Science. This publication sparked intense debate, as proponents of psychiatry argued that using patients’ self-reported experiences for diagnosis is equivalent to deceiving about other medical conditions.
