The Rosenhan experiment was just brought up in the Britney Spears diagnosis event. And then I read that same article this morning. https://boards.straightdope.com/t/britney-spears-diagnosis
I just saw the story of this Hawaiin man on my local morning TV news.
Guess I am one too then. 
I was going to post this Hawaii incident in the Britney Spears thread because Rosenhan was mentioned, but it seemed rather off-topic there. Anyway, I searched for Rosenhan (to find the Britney thread) and found this thread. This seems like the much-more relevant thread to be discussing this case.
Washington Post has a article also, a bit more detailed than the Guardian article I mentioned above. One new facet seems to be (surprise, surprise!) that all the officials up and down the line are stonewalling or trying to bury this.
I still want to know how the Rosenhan experiment is viewed in modern psychology/psychiatry, as OP originally asked.
I have a bit of a story to relate: About the time the Rosenhan experiment was first making headlines (mid-1970s), I was in out-patient therapy with a shrink for one-hour (50 minute) sessions once a week. I asked him what he thought of Rosenhan.
His response was eyebrow-raising hostile. He basically said it was a very bad, no good, badly designed trashy experiment that proved nothing useful and just gave psychiatry a bad name.
Something related that I’ve wondered: Is this experiment taught or studied in psychology classes at any level? I took “Intro Psych 101” (the typical Freshman overview class) a few years just before that.
Among other topics, the class covered some of the famous psychology experiments and theories. Abraham Maslow’s “Pyramid of Human Needs” was there of course. Frederick Taylor’s Time-and-Motion study was mentioned. Stanley Milgram’s “Obedience to Authority” experiment was covered of course – that led to new ethical rules and changes in how psychology experiments are done to this day. And there was Joseph Brady’s “Executive Monkey” experiment – we learned that it was botched anyway because the monkey that died of a heart attack was found to have had a bad heart along.
I don’t recall Zimbardo’s Mock Prisoner experiment being covered. I think, at the time, that was before it happened.
But Rosenhan? I suspect that it is covered with stony silence. I suspect that it is never mentioned at all in introductory psych classes, and possibly not at all in any classes. I suspect that the prevailing professional attitude toward Rosenhan is that it is all baloney, and let’s all just pretend it never happened.
That’s my guess.
Do any of the psychologist / psychiatrist / adjacent professionals of the Dope have any comment to share? Were you taught about Rosenhan in any of your course work? If so, what was the attitude about it?
Me too. Surely there are some professional psychiatrists here?
There’s a 2019 book by Susannah Cahalan called The Great Pretender that looks at the experiment in some depth. She concludes that a lot of it was faked - most of the pseudo-patients were made up, and Rosenhan did much more than pretend to have auditory hallucinations. Most damning, he actually told the doctor he was suicidal, which makes it more understandable why he would be committed.
Interesting Ted Talk on the subject: Strange answers to the psychopath test
Thank you!
(As described in book by Susannah Cahalan.)
This doesn’t seem right. I read the Rosenhan report. I don’t recall any mention that Rosenhan himself was one of the pseudopatients.
From the report itself (PDF):
I was the first pseudopatient and my presence was known to the hospital administration and
chief psychologist and, so far as I can tell, to them alone.
The author got other details of the experiment, such as what Rosenhan told the doctors, from Rosenhan’s notes.
I don’t know anything about the experiment or how it is viewed today, but I would just like to recount the experience of a friend of my wife’s. After a marriage, a child, and a divorce she was somehow not able to get established. Her father somehow contrived to get her admitted to a mental hospital where she was dosed with anti-psychotics. Around then, the NY Review published an article by Marcia Angell (retired editor-in-chief) of the NE J of Medicine that went into great length about the dangers of these drugs. My wife smuggled her a photocopy of the article. She then contrived to leave on a day pass, promising to take her pills, a promise she ignored. She hid out with a friend and then got on to a plane to Germany, heading to the town where she had been born and still had relatives. With initial help from social welfare, she got established, got a job (teaching German to refugees) and a boyfriend and seems happy as lark. She is now teaching English to Germans. She is as sane as any of us. (I might ask whether her father is.)
I read Rosenhan in both masters and doctoral training, but it wasn’t examined critically and I have a lot of trouble with the study design. I’ve taught Rosenhan to over a thousand therapist trainees and undergrads. It evokes strong responses and disagreements, so it’s great for diagnostic and ethics classes as well as for critical thinking (what does your textbook say vs. what does the actual study say?). Parts of Cahalan are great for this.
I agree with many of Cahalan’s assertions based on her interviews and document review, but it’s not the blockbuster gotcha she makes it out to be. If she’d stuck to evidence and then speculated, I’d teach with her book, but she strays into yellower journalism than I can use in my classes.
Contemporary psych hospitals don’t really want to keep people. The paradigm shifted a lot in the 70s and 80s, in part due to Rosenhan, in part to Kennedy, in part to managed care and other fiscal structuring. While some people might be on a commitment or forensic sentence, it can be pretty hard to get even an overnight hospitalization for many psych issues that present acutely. The triage is a lot more stringent, beds are scarce, and the purpose of acute psych hospitalization has shifted to stabilization and a management plan. It’s why I won’t do psych evals inpatient; there’s often inadequate time to finish the assessment, report turnaround is expected in a ridiculously short window, and the results often don’t get to or can’t be discussed and checked with the patient. All that said, there are forensic and long-term/chronic settings where you can sit with the patient and do an eval that’s thorough, double-checked with the person and their collaterals, and incorporates useful diagnostic info for treatment planning, interventions nursing/mental health staff can enact in the milieu, and discharge considerations. Does that happen everywhere? No. Is it what I tried to do and teach students to value? Yes.
I suppose I might be an adjacent professional, but I am neither a psychologist nor a psychiatrist. I do, however have a BS in psychology which I received in 1986 and the Rosenhan study absolutely came up in at least one of my courses. I seem to recall the attitude being that the study really didn’t prove much of anything - sure, the diagnosis influenced how behaviors and relationships were viewed but the fact that people who falsely reported auditory hallucinations ( or suicidal thoughts) were diagnosed with psychiatric disorders is no different than the fact that people who lie about ( or deliberately induce ) physical symptoms sometimes get a medical diagnosis. And while the “pseudopatients” had difficulty getting released without agreeing they were mentally ill and agreeing to take anti-psychotics, I don’t recall any of them even trying to get out by telling the truth. * Instead, they were told to act normally after admission and report that they no longer heard voices.
* that they had never had heard any voices and it was all faked as part of a study. Which may not have worked but isn’t quite the same as " I don’t hear voices anymore"
Hmm. It’s been a while since I read it. I missed that detail, or else (less likely) I forgot. If I had noted that detail, I think I would remember it.
@susan and @doreen , thank you for your comments. These address OP’s question better than much of the original discussion nine years ago, IMO.
This sounds bad. You seem to be saying that voluntary patients who seek an eval are likely to get a very inadequate rush-job interview. What is the likely result? Are these people going to be admitted as an in-patient based on that? Can patients thus admitted easily get out these days if they so decide? Are wrongful or knee-jerk diagnoses common because of this?
How can they check with patients’ “collaterals” these days? Does HIPAA get in the way of this? Does HIPAA thus impede getting thorough and accurate diagnoses and treatments?
@doreen – Of course, the pseudo-pts lied to get admitted. That was the expected part. But their claimed hallucinations were minor and benign, it seemed. They heard a voice saying “thud” or similar. Should pts be admitted and confined to a hospital for such minor complaints? Would that be typical today?
The bigger complaint in Rosenhan was that, once admitted, and they ceased complaining of hearing voices, no staff ever recognized that they weren’t insane. Other patients did, though. Instead, their every normal behaviors were seen as behaviors of a crazy person. (“Patient exhibits writing behavior.”) That was the real point that Rosenhan seemed to be making.
Those were the days when One Flew Over The Cuckoo’s Nest was also much in the news (both the book and the movie). That was fiction of course, but very much captured the public’s imagination. How influential was Cuckoo’s Nest in re-shaping attitudes in the mental health profession?
They absolutely wouldn’t be admitted today - and they certainly wouldn’t be held involuntarily.
About the patients lying - yes, of course they lied. But the attitude that was presented in my undergrad psych class(es) was something like this :
" Yes, they lied about symptoms to be admitted and then claimed they were no longer having symptoms and no one recognized that they were not mentally ill - instead they left with a diagnosis of “schizophrenia in remission”. But when a patient who doesn’t have diabetes fakes symptoms and then stops faking and the medical records say he has 'well-controlled diabetes" , nobody complains that the physician didn’t detect that the patient was faking - only the psychologists/psychiatrists are supposed to be lie detectors. " And while that shouldn’t be the end of the conversation, it isn’t entirely wrong.
Wasn’t even my major, but we learned about this experiment in one of my undergrad classes — including the oh-so-memorable “empty, hollow, thud” wording (as well as the equally-memorable quip in response about, y’know, vomiting blood).
To clarify, I’m talking about evaluation once the person is admitted, but yes, still a rush job and therefore not the sort of evaluation you’d want for yourself or a family member.
On intake assessment, there’s a provisional diagnosis, often describing the acute problem(s) the person presents with, sometimes with rule outs (for example, hey, unit staff, see if this is meth vs. bipolar mania).
For many people these days, discharge is a matter of stating convincingly, “I’m not suicidal anymore” or “I am no longer hearing and seeing things other people don’t,” plus staff observation and evaluation that supports this. If you say your thinking has cleared but also keep asserting that you are allergic to hydrogen and insisting that everyone around you must wear a “hydrogen absorption unit” that you made in art therapy, no, the staff is gong to err on the side of caution. It’s worth noting, though, that most psych hospitalization in the US these days is acute (like, 8 days inpatient would be long), not like in the Rosenhan era. There’s a legal mandate to provide the fright level of care–not too little, not too much. If inpatient looks like too high a degree of care, you might be discharged to a day program, or go back to work but sleep at the hospital for awhile. Depends on the program structure.
There are also some people who are chronic drug users, or have chronic mental illness, who might be admitted if they meet legal requirements for prodromal (early) symptoms. If my auntie has previously been hospitalized because she starts feeling really great, stops her meds, and then preaches the Gospel of Auntie in the middle of the freeway, her family might bring her in and she might be admitted before standing in traffic when nephew notices that 25 new rosaries are in her purse and she feels “Great, super, one thousand percent, halleluiah Julia ebullia!”
HIPAA means collaterals can’t be contacted without patient consent (or, if the patient has a guardian or a hearing with an administrative law judge that goes this way, whoever holds their privilege). Unemancipated minors have no right to privacy; the privilege is help by parent(s) or guardian. There’s nothing to stop collaterals from giving a report to someone on staff if they initiate it (for example, “Has he told you he’s been putting all his nail clippings in a baggie under the mattress because he thinks they can be used to put a spell on him, and we’re not from a culture that has that belief?” If a person doesn’t give consent, in some systems that is a functional obstacle in that they may not be allowed to go out on a day pass with a person not known to the facility.