Everything Everywhere Daily: History, Science, Geography & More - The Rosenhan Experiment

Starting point is 00:00:00 In 1973, one of the most influential and frightening experiments in psychology was published. It was an experiment designed to test how mental health professionals identified and diagnosed mental illness and their inherent biases. The results were jarring enough to completely change how doctors handled psychiatric care. Learn more about the Rosenhan experiment on this episode of Everything Everywhere Daily. This episode is sponsored by What Could Go Right. The news is a way of making it feel like everything is getting worse. But what if that isn't the whole story? What could go right is a podcast that challenges the constant narrative of doom by asking a simple but powerful question. What could go right? Hosted by Zachary Carabelle, each episode

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Starting point is 00:03:32 While working at Stanford, Rosenhan was known for applying psychological principles to legal topics, such as witnesses and juries. He also published over 80 research papers and books. Despite its background in law, Rosenhan is best known for his 1973 paper, which is the subject of this episode. It focused on psychiatric hospitals and how expectations of mental illness led to misdiagnosis. Rosenhan took the perspective that psychological abnormality has seven features. Maladaptiveness, suffering, unconventionality, observer discomfort, violation of moral standards, unpredictability and irrationality.

Starting point is 00:04:10 Rosenhan's experiment was designed to determine the validity of psychiatric diagnoses. His key question was whether the characteristics people show that determined diagnosis come from the patients themselves or from the environment or context around them. To test this, Rosenhan recruited eight students with no history of psychiatric illness to go to different mental hospitals. The students were sent to five different U.S. states between nine, 1969 and 1972, and some participated more than once. These students can also be referred to as pseudopacients, meaning people pretending to be patients

Starting point is 00:04:48 or impostors. Each pseudopatient was told to go to a psychiatric hospital and falsely report a single symptom, vaguely hearing auditory hallucinations. To keep the experiment variables equal, all impostors reported hearing words such as hollow, thought and empty. All other aspects of their life were reported honestly. Once they reported the auditory hallucinations, these students were given extensive admissions interviews, which determined whether they were to be admitted and remain in the hospital. Despite none of them expressing any other psychiatric symptoms that would justify a mission, all of them were admitted. All of the

Starting point is 00:05:29 pseudopacients were admitted despite experiencing no other psychiatric symptoms. Once in the hospital, also given extensive interviews and tests to determine their sanity. Once admitted, the impostors claimed that they no longer heard voices, were honest about their significant life events, and acted normally with the staff. And despite this, the staff did not see them as sane. Among the 12 hospitals tested, none of the staff recognized that the pseudopatients didn't belong there. Despite only complaining about auditory hallucinations, Once, the imposters were kept in the hospital for 7 to 52 days with an average stay of 19 days. Based on the behavior that the staff claimed to have observed in the hospital while they were acting normally,

Starting point is 00:06:19 each pseudopatient was diagnosed with a serious mental abnormality. The main diagnosis given to the pseudopatients was schizophrenia. Schizophrenia is a severe mental disorder in which a person experiences psychosis, including hearing voices, which is an auditory hallucination. There are many symptoms of schizophrenia beyond auditory hallucinations. Many people diagnosed with a disorder may also experience visual hallucinations, exhibit disorganized speech, experience illusions, show diminished emotional expression, struggle with memory and focus, and have catatonic behavior, among other symptoms.

Starting point is 00:06:56 To be diagnosed with schizophrenia, a person needs to experience at least two of its symptoms over at most a month-long period. If fewer than two symptoms are present, the diagnosis wouldn't apply. While this specific criterion wasn't officially developed until 1980, the point is to show that psychiatrists should have been able to identify that the patients did not exhibit enough traits to warrant a diagnosis. As the patients in Rosenhand's experiment reported auditory hallucinations only once, and they went away, a diagnosis of schizophrenia,

Starting point is 00:07:31 would not be adequate or accurate as there wasn't a persistent condition. However, when the pseudopatients were discharged, many were given the label, schizophrenia in remission. It actually gets more shocking. Although the hospital staff did not identify the imposters, there were people who did. The patients. Many fellow patients approached the impostors and told them that they were likely journalists or professors checking up on the hospital.

Starting point is 00:08:00 Other patients were able to identify the ruse because the impostors openly took notes about their experience in the psychiatric ward. These notes were telling, providing insight into how a psychiatric ward functions. The notes themselves resembled participant observation research, in which researchers recorded their opinions and experiences of the hospital staff. A common thread in these observations was that the hospital staff spent little time interacting with their patients. On average, the staff spent only 6.8 minutes with each imposter every day. Every suit of patient reported that the staff segregated themselves away from the patients. They typically stood behind a glass enclosure where they could see the patient but couldn't respond to behavior. The impostor's notes highlighted that staff interactions with patients were inadequate.

Starting point is 00:08:53 Patients were often treated impersonally, meaning they were ignored when they had questions while the staff behaved in an authoritarian manner. Many of the pseudopacients reported feeling bored, invisible, and powerless. The staff noticed these feelings, but identified them as symptoms of mental disorder rather than signs of mistreatment. For example, when patients were pacing in their rooms just to pass the time, the observers interpreted it as a sign of nervousness rather than boredom. The note-taking was viewed by the hospital staff as a sign of obsession rather than a way of recording their treatment.

Starting point is 00:09:27 Many of the impostors felt that most of the real patient behavior was similar to their own, leading them to believe that people with genuine mental illness often act like, quote-unquote, normal people most of the time. Rosenhan's findings were published in the prestigious journal Science in 1973 under the title On Being Sane in Insane Places. Rosenhan later conducted a follow-up experiment. He told hospital staff that one or more pseudopacients would be admitted to their care. He directed the staff to rate each potential

Starting point is 00:10:03 patient on a scale of 1 to 10. If a person was rated 1 or 2, the staff believed that they were likely a pseudopatient and were healthy. If they were ranked higher, they were believed to be truly mentally ill. The experiment lasted three months. During this period, the staff reported that 41 of the 193 admitted patients received a score of 1 or 2, accounting for 21% of all patients. After the three-month period, Rosenham revealed that no pseudopatients had ever been sent to the hospital. This offered further evidence of the previous biases of mental health institutions. Following the publication of Rosenhan's study, other psychologists conducted similar experiments that focused on internal biases. While the experiments tested different phenomenon, all showed internal biases in the general population and among mental health professionals.

Starting point is 00:10:55 For example, in an exercise conducted in 2008 by the BBC Science Program Horizon, two episodes of the show titled How Mad Are You, followed three experts as they studied 10 different subjects. The experts were told that five of the subjects were previously diagnosed with a mental health condition while the other five never had one. Their challenge was to identify the five subjects with behavior-based diagnoses. The experts were not allowed to speak to the subjects or learn about their history. They simply observed whether each person appeared to have a mental health

Starting point is 00:11:30 diagnosis based on looks and behavior. The experts only managed to identify two of the five patients based on their behavior, incorrectly claimed that two others had a mental health diagnosis, and misdiagnosed another one. The purpose of the experiment was different from what Rosenhan was testing. Instead of offering a critique of mental health professionals and diagnoses, it aimed to bring awareness to the public stigmatization of mental health. The goal was to show the audience that mental illness isn't always obvious, and that those who are diagnosed can, in many cases, behave like everybody else. Despite Rosenhan's experiment leading to a revolution in psychiatry, it's also been controversial.

Starting point is 00:12:11 It remains debated because psychiatrists challenged his findings and argued that diagnoses relied on patients' own reports of symptoms and experiences. By lying about their symptoms, psychiatrists argued that the issue was not the diagnosis themselves, but the patient's false reports of their symptoms. One psychiatrist compared the experiment to drinking a quart of blood and then going to the emergency room and reporting throwing up blood. If the patient did not report drinking the blood, the doctor would believe they had a serious internal issue.

Starting point is 00:12:43 The idea is that psychiatrists can only work with the information that they're given about the patient. It was also pointed out that psychiatrists don't expect their patients to be faking their symptoms, so the real-life implications of the experiment lacked a basis in reality. Rosenhan's study revealed glaring weaknesses of mental health institutions. It showed that the label of schizophrenia warped how hospital staff would view patients and their symptoms. Rosenann concluded that hospitals are uniquely positioned to misdiagnosed behavior because of personal attitudes and biases, which can lead to mistakes.

Starting point is 00:13:18 This led to critical discussions occurring around psychiatric institutions. This led to improvements in diagnostic reliability, most evident in updates to the Diagnostic Manual of Mental Disorders, otherwise known as the DSM. When Rosenhan's experiments were being conducted, only two versions of the DSM had been released. At this time, the manual put more trust in the ability of psychiatrists to determine who had mental disorders. Rosenhan's experiment led to the third version of the first version of, the DSM, which incorporated criteria checklists to more accurately evaluate patients.

Starting point is 00:13:54 Additionally, the newfound lack of trust in psychiatric hospitals led to many of them being closed. The revelations in the Rosenhan experiment also led to psychiatric institutions reforming themselves. Institutions began to treat patients with more respect, and they also challenged how the label of behavior of patients, like note-taking, as something normal rather than a sure-fire sign of mental abnormality. Almost 50 years after the paper was published, however, there was a dramatic twist to the entire story. Accusations arose that the results of the Rosenhan experiment may have been fraudulent.

Starting point is 00:14:33 In the 2019 book, The Great Pretender, Susanna Callahan questioned the validity of the experiment after examining documents Rosenhand left behind when he died in 2012. While analyzing the data, Callahan noticed a potential dissuant. distortion of the results. She found that there were misleading descriptions, fabricated in inaccurate quotes from psychiatric records, and inconsistent data. Another concern Callahan noted was that she could only identify two of the eight pseudopacients. The two she managed to identify were Rosenhan himself and one of his graduate students. Given that the graduate student's testimony was inconsistent with Rosenhan's presentation of his research and the inability to find the other

Starting point is 00:15:14 six pseudopacients, Callahan believes that Rosenhan may have fabricated the other six participants to further his experiment's agenda. The review of Callahan's book was later published in the journal History of Psychology, and the review agreed with Callahan's findings and suggested that Rosenhan's experiment was fraudulent. The interesting thing is that the reason why Callahan even bothered to investigate the study is that she was misdiagnosed with a mental illness. If it is indeed true that Rosenhan fabricated his study, it doesn't mean his conclusions are wrong. It just means that someone needs to replicate the study, although the results after 50 years might be totally different, given the different climate today.

Starting point is 00:15:59 Regardless of whether Rosenhan faked his results, the experiment itself did lead to many positive reforms in the field of psychology. It led doctors to change how they care for their patients, reforms in how we diagnose mental illness, and more awareness of internal biases around mental health. The executive producer of Everything Everywhere Daily is Charles Daniel. The associate producers are Austin Otkin and Cameron Kiefer. Research and writing for this episode was provided by Olivia Ash. My big thanks go to everyone who supports the show over on Patreon.

Starting point is 00:16:34 Your support helps make this podcast possible. And I also want to remind everyone about the community groups on Facebook and Discord. This is where everything happens that's outside of the show. As always, if you leave a review on any major podcast app or in the above community groups, you too can have it read on the show.

Everything Everywhere Daily: History, Science, Geography & More - The Rosenhan Experiment

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