What is the Rosenhan Experiment

The study that never existed

According to the Rosenhan study, eight healthy volunteers were referred to various psychiatric hospitals under false names as pseudo-patients, who only acted out their symptoms. The result rocked US psychiatry.

A national outcry about the poor conditions in the US psychiatric institutions and the sometimes humiliating behavior of the medical and nursing staff towards the patients were the result. Rosenhan's study led to the closure of numerous mental health facilities across the United States and forever changed mental health care in the United States.

Author victim of a misdiagnosis

Cahalan has a personal connection with US psychiatry. She “stumbled” over the Rosenhan study on a reading tour for her first book “Fire in the head: My time of madness”, in which she processed her time in psychiatry as a case of extreme care.

But Cahalan was the victim of a misdiagnosis. Cahalan was in the wrong place in psychiatry, as it turned out later - she “only” suffered from a recently discovered autoimmune disease. If this was recognized, she could be treated quickly and leave the psychiatry.

Pop culture also criticizes psychiatry

Almost fifty years after the study was published, research by Cahalan for her book "The Great Pretender" on Rosenhan and his study revealed that none of this is true and that the study did not even take place in the manner described, as Cahalan did in an article writes for the "New York Post".

The zeitgeist also apparently played a major role: At the beginning of the 1970s, people in the USA were deeply suspicious of psychiatry and its institutions, according to Cahalan. Books and films such as Ken Kesey's “One Flew Over the Cuckoo's Nest”, filmed by Milos Forman with Jack Nicholson in the lead role, “Shock Corridor” and “The Snake Pit” shaped the popular culture criticism of psychiatry and its dominant approaches.

Strange voices: "dull", "empty" and "hollow"

According to the study published by Rosenhan, his eight healthy patients all followed the same simple script to enter the psychiatric facilities Rosenhan selected across the country. You should tell the doctors that they heard a strange voice that says “dull,” “empty,” and “hollow”. Based on this single symptom, the study claimed, all pseudo-patients were diagnosed with a mental illness - mostly schizophrenia. Once diagnosed, it was difficult to prove otherwise, it said.

All eight were admitted for an average of 19 days, according to the Rosenhan study. The longest stay was 52 days until discharge from the clinic. All of them left the hospitals against the express recommendation of the doctors in charge of them. In total, they - those affected also kept a secret book about their medication according to the study - were given 2,100 pills, i.e. heavy medication.

After its publication in the renowned journal “Science” in early 1973, the study triggered a reform movement in US psychiatry. In the course of the heated debate, for example, patient rights were strengthened and the closed departments were reformed.

Looking for the pseudo-patient

But Cahalan's research now shows that the experiment was never carried out. The first pseudo-patient - "David Lurie" - was according to Cahalan Rosenhan himself. In 1969 he allowed himself to be admitted under the pseudonym for nine days. His experiences were apparently so shocking that the psychology professor then made sure not to repeat the experiment with his students who were interested in it.

This puzzled Cahalan during her research. Then who were the other patients that Rosenhan mentioned in his study? Rosenhan, who had achieved fame and recognition with just one study, only published one additional paper as a defense and no other study on psychiatry in hospitals.

Numerous inconsistencies

During her research, Cahalan noticed more and more inconsistencies between the written documents she discovered and Rosenhan's final study. So she discovered the medical record of "David Lurie", that is, of Rosenhan. According to these records, patient “Lurie” showed different symptoms than the voices identified. He told the doctors that he put a copper pot over his ears to block out the noises and that he had suicidal intentions - symptoms much more severe than the study reported.

In her search for Rosenhans pseudo-patients, after lengthy research, Cahalan initially only found one, as the magazine "Nature" writes. She had previously interviewed numerous people who knew Rosenhan in order to track down the pseudo-patients. Cahalan also searched through numerous medical records - without success.

"Just explains how to hide the pills in your mouth"

Eventually, however, she got lucky and found a pseudo-patient - former Stanford student Bill Underwood. Underwood's account eventually cast doubt on the outcome of the entire study. Rosenhan's draft for his study describes how precisely and in detail he prepared his pseudo-patients for a stay in psychiatry.

Underwood could only remember a brief introduction, however. The main focus was on how best to hide the pills in the mouth so as not to swallow the medication, the "Nature" article goes on to say.

Cahalan also found inconsistencies in the numbers. According to Rosenhan, Underwood is said to have spent seven days in a hospital with 8,000 patients, but, as Cahalan found out, he was housed in a hospital with 1,500 patients for eight days. Until Cahalan found him, it had never occurred to Underwood that something might be wrong with the study, that Rosenhan's study might have been falsified.

Positive stay was not included

Through Underwood, Cahalan finally found a second pseudo-patient named Harry Lando, as the "New York Times" writes. According to Rosenhans' study, data from Lando's psychiatric stay were excluded for technical reasons. Allegedly, he is said to have falsified some of his personal information when he was admitted. Lando, who would have been pseudo patient number nine, was, as Cahalan discovered, but removed from the study because his experiences were too positive. Lando was admitted to a clinic in San Francisco for 19 days.

The patients were able to organize their own day there. The medical staff did not wear uniforms either, i.e. no work clothes. Lando attended group therapies and also took a day trip to the beach. "The hospital seemed to have a calming effect," he later told Cahalan. Rosenhan commented on his assessment of Lando's experiences on his notes in block letters with "He likes it" and excluded Lando from the study.

Diagnostic manual rewritten

“Perhaps in the study one would have had the thought that there are institutions that do something right,” says Cahalan, that perhaps not all of them should be demonized. Instead, Rosenhans study gave the growing anti-psychiatry movement a scientific coating, according to the New York Times. In the space of a decade, dozens of psychiatric hospitals in the United States have closed and the number of psychiatric patients has dropped 50 percent.

The American Psychiatric Society completely rewrote its diagnostic manual, the newspaper continues. Freud’s terminology was deleted from the manual and replaced by rigid checklists for standardized diagnoses.

A more extreme story was a better fit

If Rosenhan had published something less drastic, but something more subtle, the likelihood would have been very high that it would not have received any public attention and therefore had no impact, according to the New York Times in a review of the book. In 1973 the public was ready to believe the more extreme story he told in his study.

His study received so much attention and caused quite a stir precisely because it fitted into the anti-establishment current. The zeitgeist of the time was shaped by the Watergate affair involving US President Richard Nixon, who finally resigned, and the paranoia that resulted from it. Rosenhan's study was perfectly tailored to it.

Peter Bauer, ORF.at