In this video I discuss David Rosenhan’s well-known study in which pseudo-patients went for psychiatric consultations and described a single symptom of hearing voices. I discuss how this study raised questions about recognition and diagnosis of mental illness, interpretations of personal history or behavior as pathological, and the possible effects of labeling for people diagnosed with a psychological disorder.
On Being Sane in Insane Places – David Rosenhan (1973) https://www.canonsociaalwerk.eu/1971_stigma/1973%20Rosenhan%20Being%20sane%20in%20insane%20places%20OCR.pdf
Video Transcript
Hi, I’m Michael Corayer and this is Psych Exam Review. In the past few videos we’ve looked at some problems of defining normality and abnormality and the difficulties of determining when traits and behaviors might represent symptoms of psychological disorder. So in this video we’re going to look at a classic study which shows how these issues can influence real-life diagnosis of mental illness. This is a study conducted by David Rosenhan and it was titled “Being Sane in Insane Places” and published in 1973.
When this paper was published it sent shockwaves through the mental health community and the reason for that is that it pointed out a number of problems associated with the recognition and diagnosis of mental illness by psychiatrists. It raised issues related to the treatment that patients received in institutions and the potential long-term consequences of receiving a diagnosis of a psychological disorder. So what Rosenhan did was he had eight pseudo-patients and these were three women and five men and they went to 12 different institutions and they had a consultation with a psychiatrist where they reported a single symptom of mental illness that they were hearing voices. So they had this auditory hallucination and they were hearing voices saying words like “thud” or “hollow” and otherwise they reported being normal. They gave personal histories answered questions about their family background and with the exception that they gave false names and occupations to disguise the fact that they worked in the mental health field. They answered the questions truthfully and based on this consultation in all twelve cases these pseudo-patients were given diagnosis of a mental illness.
In 11 cases the diagnosis was schizophrenia and in one case there was a diagnosis of manic depressive psychosis. And it’s worth noting that the psychiatrists often interpreted these personal histories as pathological even though of course in real life these personal histories had not led to mental illness. So they probably weren’t pathological personal histories that would have led to the development of a psychological disorder because of course these were pseudo patients they weren’t actually suffering from psychological disorder. And so this points out the assumption that psychiatrists were making which is that people seeking psychiatric consultations probably have a mental illness and need help and that there probably is something pathological that has led to these symptoms that they are experiencing.
And we make this same assumption often in physical health. So doctors probably assume that if somebody comes in to see them and they say they’re experiencing symptoms that the doctors trust that the person really does need help they really have some sort of illness and the point of meeting with the person is to identify what the illness is not question whether or not an illness exists. And so psychiatrists make this same assumption. They assume that people come to see them because they have a problem and they are more likely to focus their attention on identifying the problem rather than questioning whether or not it’s there in the first place. And the study also raised some issues related to treatment. So all of these pseudo-patients were admitted to the institutions and as soon as they were admitted they said that they were no longer experiencing this symptom. They were no longer hearing the voices and so this raises the question how do you convince people that you’re sane? How do you convince people that you no longer have any symptoms of a mental illness and you should be released from the institution?
So the average duration before the patients were released was 19 days and the shortest day was 7 days and the longest of 52 days, where the patient was held in the institution and not allowed to leave. And during their stay the patients tried their best to engage in normal behavior, but we’ve already seen the difficulties of defining what exactly that means. How do you convince somebody that you’re normal? How do you convince somebody that you’re sane? And Rosenhan notes, of course, that the patients probably also had some stress, anxiety, and fear because in many cases they were not expecting to be admitted to the institution in the first place. So now they have this problem, how do I get out of here? And now I’ve been diagnosed with a mental illness and I have to convince people that I don’t actually have it.
Another issue related here is that the staff had a tendency to interpret what we might think of as normal behaviors as being pathological behaviors, as being symptoms related to the diagnosis. So these pseudo patients were journaling; they were keeping track of their experiences keeping notes so that this could be collected for the study and this was interpreted as being obsessive note-taking. And yet these same behaviors were recognized by other patients as indicating that the person was actually normal and sane, and so other patients of the institutions made comments to these patients, that they thought they were journalists or professors or people who are checking up on the hospital. And so it’s kind of strange that the other patients in the institution seem to be able to recognize this normal behavior better than the staff who are working at these institutions; the psychiatrists who these pseudo-patients were meeting with and the nurses and other staff. And none of the hospitals recognized that the pseudo-patients were faking.
So even when they were released they weren’t released and said “oh you know it’s a misdiagnosis, you probably didn’t actually have schizophrenia, you know so you’re fine”. Instead it was “well you had schizophrenia and now your symptoms are in remission” so they were often labeled as “schizophrenic in remission” and this is a label that, of course would follow them in the future. And this brings up the issue of the stickiness of labels in mental health and the possibility of stigma. So we have this tendency to think of disorders as lasting traits rather than temporary illnesses. So when somebody suffers from schizophrenia we then have this tendency to think that this is a schizophrenic person who could relapse into schizophrenia at any moment. They are schizophrenic in remission rather than saying well they have this illness and now they don’t anymore like we would be more likely to do for a physical illness. You know, you have some infection and then you’re healed and you no longer have any symptoms related that infection and we don’t think of you as still having it.
And so this is not to say that labels are always bad things in mental health and in many cases labels are helpful for patients because it lets them know that other people have gone through the same experiences that, you know, the psychiatrists have some understanding of the illness and some possible courses of treatment. And so you could imagine if you went to a doctor with a number of physical symptoms and the doctor said he never heard of anything like this, this is totally bizarre, that would be fairly distressing to you compared with the doctor saying “okay yeah here’s what you have, we know what it is, and here’s the possible treatments”. So the same applies to mental illness. So in many cases labels are useful but we have to be careful that they don’t follow people for too long, don’t become attached to that person’s identity.
And so what Rosenhan’s study helps to demonstrate is a number of the assumptions that people make when it comes to mental illness and these are assumptions that are made even by psychiatrists themselves. So after the study was published Rosenhan told these institutions that they could expect he would send more pseudo-patients in the future they should be on guard for more pseudo patients. They should be more careful in the diagnosis that they’re giving out and in the months that followed many of these institutions reported they have found dozens of pseudo patients that they believed had been sent by Rosenhan. At which point he reported that he had actually not sent any. So this shows the opposite problem work now the assumption was that there were pseudo-patients coming in and so there may be people who actually were experiencing some symptoms of mental illness and who are dismissed by the psychiatrists because they were believed to be faking or they were believed to be pseudo patients sent by Rosenhan, when in fact they weren’t.
Okay so that’s Rosenhan’s classic study Being Sane in Insane Places, I’ll post a link in the video description where you can read the original study. I hope you found this helpful, if so, please like the video and subscribe to the channel for more. Thanks for watching!
