twentyonelizards:

green-217:

did-you-kno:

In a 1970s experiment, a Stanford
psychologist and 7 other mentally
healthy participants got themselves
admitted to 12 different psychiatric
hospitals across the US by pretending
to hear voices. Once inside, they began
acting normally, but all 12 hospitals
diagnosed each of them with disorders,
forced them to take drugs, and required
them all to admit they had a disease
before they could be released. Source Source 2

This was the study ‘being sane in insane places’ by David Rosenhan. The purpose of the study was to determine whether or not the staff of asylums could truly determine a person’s sanity after being admitted.

Rosenhan ans his colleagues did not pretend to hear voices, they pretended to hear a ‘hollow thud’- something with no basis in psychology. From the get go they were offering the doctors and nurses a chance to deny them entry, but despite the fact that the thing they were faking wasn’t even a real symptom, they were all admitted.

That very day, the moment of their admission, they went back to acting normal. They went about their day as normally as possible, and waited to see if the staff of each hospital they were in would notice. They stopped reporting hearing the noise that got them admitted.

The staff never noticed.

Some of the patients did.

Despite this, all of them were eventually released, but none were declared sane on release. Some were in the hospital for 2 weeks, one remained for over 50 days.

What the study proved was that it became impossible to establish sane from insane in the setting of a mental hospital. To retest, after Rosenhan came forward with his findings, he told asylums all over the nation that they’d be doing the experiment again, but with more participants this time. After a certain period, he would ask the head doctors of the ‘targeted’ asylums which patients they believed were faking it.

All of the hospitals reported at least one person.

No one was actually sent in.

This reiterated the original claim, proving for all that the perception of sanity is reliant on location and societal standards.

Yeah, no.

I did my Extended Project on the Rosenhan study (British qualification you can do at 17-ish years old- got the highest grade possible, aww yiss) because I loved it and thought it was revolutionary. I am here to tell you, with extreme malice, that Rosenhan’s study is heavily flawed and not applicable to the modern day. The more I read about this study, the more I examined it, the more it fell apart. Here’s why.

(Disclaimer: I will likely use language here like ‘sane/insane’, which does not really have a place in modern psychiatry, but is used heavily in these pieces.)

First and most importantly: I strongly recommend giving Spitzer’s rebuttal a read, as he really tears the fuckin’ thing apart. Like, just the title: 

“On pseudoscience in science, logic in remission, and psychiatric diagnosis: A critique of Rosenhan’s “On being sane in insane places”.

Fucking ouch, right? My boy Robert doesn’t pull his punches. Anyway, some main things to keep in mind:

1) This study was conducted in 1973, when psychiatrists still used the DSM-II, an incredibly vague manual that still listed homosexuality as a mental illness. We are, unsurprisingly, no longer using this manual. The study is now forty-five years old. That should be enough to give you pause.

2) There are, Spitzer proposes, three ways in which the psychiatric hospital staff could reacted. They could have realised the people in question were faking at their first presentation; they could have realised the people in question were faking after they got admitted to hospital and stopped acting ‘insane’; they could have never thought the people were faking and instead concluded they got better. They did the latter.

This is not a failure. The first option, I’m sure you’ll agree, would have been terrible- the last thing we need is psychiatrists accusing people of making things up because their symptoms don’t exactly fit a certain model of how things should go. The second tends to be what people think should have happened… but why? It isn’t exactly uncommon for people who were very unwell to begin behaving ‘normally’ when hospitalised, claiming that they’re fine, actually. It can be a result of many things, ranging from a feeling of safety and comfort to a desperate need to get out now. It’s not uncommon at all. What would have been weird would be to jump to ‘this person clearly made it up and is part of an elaborate Ruse to expose us’ rather than going… ‘hey, we’re going to keep you here for a little while to make sure you’re okay before we send you home’. Rosenhan was not testing diagnostic ability; he was testing truth-detecting ability, which is not the same thing. 

3) They lied. Most psychiatric diagnosis can ONLY be done using self-report. If you lie… what do you expect? A group of people presenting as psychotic and then being outraged that they were diagnosed psychotic is ridiculous. My boy Kety puts it best (paraphrased here): ‘if I drink a bucket of blood and present in the emergency room vomiting blood, and the doctors do not correctly identify that I had drunk a bucket of blood, then that does not mean I can claim doctors do not understand gastric ulcers’. 

4) The follow-up study… kind of horribly petty, to be honest? All you did was make a hospital paranoid and make people lose out on treatment. Again, this is based on lies- Rosenhan’s study involves a huge amount of him lying and then being outraged when people believe the lie.

5) An unimportant note, but potentially an illustrative one: part of the reason for choosing the words they did was that patients hearing them had ‘never been reported in the literature’. Rosenhan seems to think this should tip psychiatrists off that they were being lied to. If there’s a masterlist of all acceptable psychoses somewhere, I’ll concede this one to Dave, but for the time being, it shows a… really weird expectation of how the diagnostic process should work. Rosenhan seems to think that diagnosis is when you examine and instantly know all about them, even the things that they didn’t tell you, rather than just… listening… to what they have to say….

Don’t get me wrong, On Being Sane In Insane Places has some excellent observations about the nature of diagnosis and illness. I would especially like to highlight the sections on how you are viewed when you are a mental patient; how simply taking notes becomes ‘writing behaviour’ and waiting for lunch because you’re bored is ‘oral obsession’. That’s the good shit. It’s also worth considering that at least one person was held for much longer than they needed to be (I believe nine weeks?). This study doesn’t hold nothing of value, but as a mentally ill person and a scientist I get very frustrated as how it’s used at the ultimate ‘gotcha!’ at psychiatry.

tl;dr: Do not use a study conducted in a dozen American hospitals by Rosenhan and his bored friends forty-five years ago that involved lying about symptoms to conclude that modern psychiatry is untrustworthy.