Appendix 40a - On Being Sane

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

On January 19, 1973, a landmark study was published in Science, "Being Sane in Insane Places," by D.L. Rosenhan.[459] Eight sane people gained admission to 12 psychiatric hospitals by simulating a single symptom, auditory hallucinations (they heard a voice say, "empty," "dull," and "thud"). As soon as they were admitted to the psychiatric ward they immediately ceased simulating any symptoms of abnormality. Despite their public "show" of sanity, the "pseudopatients" were never detected; most were hospitalized for weeks.[460] Eleven of the pseudopatients were diagnosed, initially and finally, paranoid schizophrenics, and a 12th was diagnosed a manic depressive psychotic.[461] The results, not surprisingly, provoked a furor in the psychiatric community.[462]

There were skeptics. Staff at other hospitals swore that such a thing could never happen at their institution. Rosenhan accepted the challenge. He informed the staff at one such teaching and research hospital that at some time during the following three months, one or more pseudopatients would attempt to be admitted to their psychiatric ward. The staff were ready. Three months passed. Out of the 191 patients admitted to the psych ward during those three months, 41 were alleged, with high confidence, to be pseudopatients by at least one member of the staff that had sustained contact with or primary responsibility for the patient. Twenty-three were considered suspect by at least one psychiatrist. So how many pseudopatients did Rosenhan actually send over? None. Rosenhan summarizes these studies with the words, "It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals."[463]

Physicians think they are doing something for you by labeling what you have a disease - Immanuel Kant

There were other far reaching implications of Rosenhan's work. The pseudopatient experiment offered a rare opportunity to study firsthand how psychiatric patients were treated. The twelve pseudopatients were administered, for example, a total of 2100 pills. The average contact with psychiatrists, psychologists, residents, and physicians combined was timed at 6.8 minutes a day.

They found that the schizophrenic label was so powerful that many of the pseudopatients' normal behaviors were overlooked entirely or profoundly misinterpreted. Patient-initiated encounters frequently took the following form:

Pseudopatient: 'Pardon me, Dr. X. Could you tell me when I am eligible for grounds privileges?'

Physician: 'Good morning Dave. How are you today?' (Moves off without waiting for a response).

Responses were collated; in fully 88% of the encounters with nurses or attendants and in 71% of the encounters with psychiatrists, the staff ignored questions and moved on head averted in this manner.

From the study:

Neither anecdotal nor 'hard' data can convey the overwhelming sense of powerlessness which invades the individual as he is continually exposed to the depersonalization of the psychiatric hospital.... At times, depersonalization reached such proportions that pseudopatients had the sense that they were invisible, or at least unworthy of account....

Other experiments followed up on Rosenhan's work - Appendix 40b.



[459] Rosenhan, DL. "Being Sane in Insane Places" Science 179(1973):250-258.

[460] Ibid.

[461] Rosenhan, DL. "The Contextual Nature of Psychiatric Diagnosis." Journal of Abnormal Psychiatry 84(1975):462-474.

[462] Spitzer, RL. "On Pseudoscience in Science, Logic in Remission, and Psychiatric Diagnosis." Journal of Abnormal Psychiatry 84(1975):442-452.

[463] Rosenhan, DL. "Being Sane in Insane Places" Science 179(1973):250-258.



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