Rosenhan experiment

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The Rosenhan experiment was a famous experiment into the validity of psychiatric diagnosis conducted by David Rosenhan in 1972. It was published in the journal Science under the title "On being sane in insane places."[1]

Rosenhan's study consisted of two parts. The first involved the use of healthy associates or "pseudopatients," who briefly simulated auditory hallucinations in an attempt to gain admission to 12 different psychiatric hospitals in five different states in various locations in the United States. The second involved asking staff at a psychiatric hospital to detect non-existent "fake" patients. In the first case hospital staff failed to detect a single pseudopatient, in the second the staff falsely identified large numbers of genuine patients as impostors. The study is considered an important and influential criticism of psychiatric diagnosis.

The study concluded, "It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals" and also illustrated the dangers of depersonalization and labeling in psychiatric institutions. It suggested that the use of community mental health facilities which concentrated on specific problems and behaviors rather than psychiatric labels might be a solution and recommended education to make psychiatric workers more aware of the social psychology of their facilities.

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[edit] The pseudopatient experiment

For the purposes of the study, eight "pseudopatients" (associates of Rosenhan selected to be a group of varied and healthy individuals) attempted to gain admission to psychiatric hospitals. During psychiatric assessment they claimed to be hearing voices that were often unclear, but which seemed to pronounce the words "hollow", "empty", and "thud." No other psychiatric symptoms were claimed, and apart from giving false names and employment details, further biographical details were truthfully reported. If admitted, the pseudopatients were asked to "act normally," report that they felt fine and no longer heard voices.

The pseudopatients were: a psychology graduate student in his twenties, three psychologists, a pediatrician, a psychiatrist, a painter and a housewife. None had a history of mental illness. If admitted, they were to act normally and not display any obvious psychopathology. Subjects were to remain as inpatients until they were discharged by the staff at their hospitals, who were not privy to the experiment and believed the subjects to be real psychiatric patients.

All eight were admitted, seven with a diagnosis of schizophrenia, the last with manic-depression. Even after admission, none of the pseudopatients were identified as impostors by the hospital staff, although other psychiatric patients seemed to be able to correctly identify them as impostors. In the first three hospitalizations notes of remarks made by patients to pseudopatients were kept and 35 of the total of 118 patients expressed a suspicion that the pseudopatients were sane. All of the pseudopatients were discharged with a diagnosis of schizophrenia "in remission." Their stays ranged from 7 to 52 days and the average was 19 days.

Hospital notes indicated that staff interpreted much of the pseudopatient's behaviour in terms of mental illness. For example, one observer, apparently oblivious to the irony, labeled the note-taking of one pseudopatient as "writing behavior" and considered it pathological. In contrast, actual patients would accuse them of being researchers or journalists based entirely on the same writing behavior. Once admitted and diagnosed, the pseudopatients were not able to obtain their release until they agreed with the psychiatrists that they were mentally ill and took antipsychotic medications.

"I told friends, I told my family, 'I can get out when I can get out. That's all. I'll be there for a couple of days and I'll get out.' Nobody knew I'd be there for two months … The only way out was to point out that they're [the psychiatrists were] correct. They had said I was insane, 'I am insane; but I am getting better.' That was an affirmation of their view of me." David Rosenhan in the BBC program "The Trap."[2]

[edit] The non-existent impostor experiment

For this experiment, Rosenhan used a well-known research and teaching hospital, whose staff had heard of the results of the initial study but claimed that similar errors could not be made at their institution. Rosenhan arranged with them that during a three month period, one or more pseudopatients would attempt to gain admission and the staff would rate every incoming patient as to the likelihood they were an impostor. Out of 193 patients, 41 were considered to be impostors and a further 42 were considered suspect. In reality, Rosenhan had sent no pseudopatients and all patients suspected as impostors by the hospital staff were genuine patients. This led to a conclusion that "any diagnostic process that lends itself too readily to massive errors of this sort cannot be a very reliable one". Studies by others found similarly problematic diagnostic results.

[edit] Related experiments

Maurice K. Temerlin split 25 psychiatrists into two groups and had them listen to an actor portraying a character of normal mental health. One group was told that the actor "was a very interesting man because he looked neurotic, but actually was quite psychotic" while the other was told nothing. Sixty percent of the former group diagnosed psychoses, most often schizophrenia, while none of the control group did so.[3]

In 1988, Loring and Powell gave 290 psychiatrists a transcript of a patient interview and told half of them that the patients were black and the other half white; they concluded of the results that "Clinicians appear to ascribe violence, suspiciousness, and dangerousness to black clients even though the case studies are the same as the case studies for the white clients".[4]

In 2008, the BBC's Horizon science programme performed a somewhat related experiment over two episodes entitled "How Mad Are You?". The experiment involved ten subjects, five living with previously-diagnosed mental health conditions, and five with no such diagnosis. They were observed by three experts in mental health diagnoses and their challenge was to identify the five with mental health problems.[5]

[edit] Impact

Rosenhan published his findings in Science, criticizing the validity of psychiatric diagnosis and the disempowering and demeaning nature of patient care experienced by the associates in the study. His article generated an explosion of controversy.

Many defended psychiatry, arguing that psychiatric diagnosis must rely heavily on the patients' own reports of their experiences. Hence, mis-diagnosis in the presence of fake symptoms no more demonstrates problems with psychiatric diagnosis than would lying about other medical symptoms. However, this defense cannot apply to the non-existent impostor experiment.

[edit] See also

[edit] References

  1. ^ Rosenhan DL (January 1973). "On being sane in insane places". Science (New York, N.Y.) 179 (70): 250–8. doi:10.1126/science.179.4070.250. PMID 4683124. http://web.archive.org/web/20041117175255/http://web.cocc.edu/lminorevans/on_being_sane_in_insane_places.htm. 
  2. ^ An excerpt from the BBC program with this statement by David Rosen can be viewed here.
  3. ^ The Scientific Review of Mental Health Practice
  4. ^ Loring M, Powell B (March 1988). "Gender, race, and DSM-III: a study of the objectivity of psychiatric diagnostic behavior". Journal of health and social behavior 29 (1): 1–22. PMID 3367027. 
  5. ^ BBC Headroom
  • Spitzer RL (October 1975). "On pseudoscience in science, logic in remission, and psychiatric diagnosis: a critique of Rosenhan's "On being sane in insane places"". Journal of abnormal psychology 84 (5): 442–52. PMID 1194504. 
  • Slater, Lauren (2004). Opening Skinner's Box: Great Psychological Experiments of the Twentieth Century. W. W. Norton. pp. 64–94. ISBN 0-393-05095-5. 
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