Stuff You Should Know - How The Rosenhan Experiment Worked

Episode Date: September 29, 2022

In 1973 a study was published in Science where psychologist David Rosenhan revealed he had duped hundreds of psychiatric workers by planting perfectly sane pseudopatients within their hospitals and every last one went unnoticed.See omnystudio.com/listener for privacy information.

I'm Munga Shatikler and it turns out astrology is way more widespread than any of us want to believe. You can find it in Major League Baseball, international banks, K-pop groups, even the White House. But just when I thought I had a handle on this subject, something completely unbelievable happened to me and my whole view on astrology changed. Whether you're a skeptic or a believer, give me a few minutes because I think your ideas are about to change too.

Just a Skyline drive on the iHeartRadio app, Apple Podcast, or wherever you get your podcasts. Welcome to Stuff You Should Know, a production of iHeartRadio. Hey and welcome to the podcast. I'm Josh and there's Chuck and Jerry's here, Kvetching, and that makes this a normal episode of Stuff You Should Know. That's right, the continuing bucket of Josh's obsession with psychology and psychiatry. It's so interesting. I know, I love it.

These always come from you and they're always interesting. So let's do it. So we're talking today specifically about a particular study, a very famous psychology study. And the whole thing is kind of rooted in context that you have to know, which is that there was a time up until about the 50s when psychiatrists were considered like unquestionable, no matter how weird or brutal or potentially life-taking their methods were. If it was a psychiatrist saying this is needed for mental health, then society just went

along with it, right? But then at some point in time, there was kind of this backlash against that because people started questioning like, are you sure you guys know what you're talking about? And if you don't, what you're doing is even more horrific than we thought before. And I was trying to think of a good analogy, Chuck, and the best I could come up with is let's say you gave a group of church officials free reign to hunt witches, tortures suspected witches, violently exercised demons from people who were possessed, and then society figured out that not that those things don't exist, but that in this case, the church officials

themselves don't exist, right? So in this case, mental illness does exist, but the witch hunters aren't actually real. Their methods don't mean anything. They're completely made up. And that was the crisis of confidence that psychiatry was going through in the middle of the 20th century. People started doubting that it had any kind of veracity whatsoever, and that they were just torturing mentally ill people to try to figure it out as they went along.

Yeah. And I'm not going to get on some anti-medication, anti-psychiatry soapbox, but I will say this, and you know this about what's been going on in my private life, but I have seen a very sad situation of someone I love dearly in my own life over the past few years deteriorate because while conditions in like, let's just call them asylums, what they call them back then have certainly improved, there's still a lot of lines that can be drawn to doctors forgetting when it comes to mental illness, forgetting there's a human sitting there in front of them.

Then medication is being thrown at them, and again, the medication can be great, not going on some big tirade against anti-psychotic meds and things like that. But I've just seen it happen up close and impersonal, and it is still a very broken system in many ways, and it's really, really sad. Yeah, and what you just mentioned is it's a longstanding kind of tack that psychiatry has taken, which is they're battling the disease and the patient is just kind of an unfortunate casualty of that battle sometimes. You know what I mean?

Absolutely. And so finally, people stood up and said, wait, wait, wait, we need to rethink this psychiatry. You guys are giving people lobotomies, you're throwing powerful psychotropic medications at people that can rob them of their will and rob them of their personalities. We need to rethink this, and something called the anti-psychiatry movement started to develop, both in the general public and among some psychiatrists and psychologists themselves. And in the Church of Scientology. Yeah, Scientologists hate this stuff, but they really are kind of vehemently opposed

to the entire idea, it seems like, whereas this was more like the anti-psychiatry movement, especially within the profession, was like, okay, our goals are noble. What we're trying to do is worthwhile. We just don't know what we're talking about yet, and we need to figure out a better strategy. Yeah, and as we'll see, certain things like, if you listen to our episode on Tittacut Follies, things like that popped up here and there throughout history to make people really pump the brakes and go, wait a minute, how are we treating people with mental illness in this country?

Right, exactly. Like, what in the heck is going on? So, there was a person named R. D. Lang who was, didn't like to be like, fully put in the box of like, anti-psychiatry, but was certainly criticizing and questioning the fact that, hey, we're observing these behaviors, it's behavioral things that we're witnessing, and we're treating them biologically, and like, there's something missing here, there's a piece that's missing, and R. D. Lang was giving a lecture one time that was seen by a gentleman that we're talking about today, David Rosenhan, who was a psychologist.

And Rosenhan, I guess it touched a nerve with Rosenhan, or is it Rosenhan, do you know? I've always said, Han. Okay, Rosenhan, that's what we'll go with. We definitely won't switch back and forth over. No, well, we definitely won't say them both in succession. But Rosenhan said, hey, this lecture spoke to me, tagging someone as mentally ill, quote-unquote mentally ill, does humans a disservice because that's a tag that they live with, not only in the eyes of others, but to themselves, and it can cause real damage, and some of

these people aren't mentally ill, so we need to really take a look at this, and I have some ideas on how to tackle it. Yeah, and we should say in this episode, we're going to use the word sane and insane a lot, and nowadays you would call that healthy or mentally ill. And the reason we're kind of using it like that is, number one, that's the terms they use back then, but also it's different. It was a different understanding back then that there wasn't gradations of mental wellness. There was you were sane or else you were insane, and once you were insane or labeled insane,

you had that label for life. You were in remission, but you still had that label that you carried around for the rest of your life. Yeah, that's a good point. I'm glad you made that, actually. Thank you. Rose and Han, also at some point previous to this, underwent a experimental eight-day inpatient, and this was, Rose and Han wasn't like, or Rose and Han, oh, there I go, wasn't

saying, oh, I'm not feeling well. I'm going to try this. Rose and Han said, all right, I'm completely sane. I'm going to check myself in for eight days as an inpatient and see what happened, because I want to maybe convince some of my students to do this. After he did it, he was like, well, that was intense. I definitely am not going to ask my students to do this. What I'm going to do is design an experiment where we can have non-students do this, and

then I can tell them what happened. Right. And the basis of it was just one kind of very central question, right? Right. So, Rossine Han decided that he was going to design an experiment using those two experiences, and he wanted to see if psychiatrists could do the most basic part of their job, which is identify the difference between a sane person and an insane person. Yeah.

And this, it really did make me wonder if he was influenced at all by One Flew Over the Cuckoo's Nest. I don't know. I saw that he started this in 1969. When was that book published? 62 or 63. Oh, it's entirely possible. And it was a stage play, and the whole basis of One Flew Over the Cuckoo's Nest was, if

you haven't seen the movie or read the book, which is, they're both great. It was a gentleman who was always in trouble with the law, who basically saw a way around going to prison, and that was, let me try and convince them I'm insane and will be put in a cushy mental institution instead. So the whole basis of that, it's a little different, but was put a sane person in an insane asylum, again, words they used back then, and let's see if I can fool them. Yeah. And that was written by Ken Kesey, who figures big time into the electric Kool-Aid acid test.

He was actually on the ward of a state psychiatric facility in either Oregon or Washington. And he witnessed this stuff and ended up writing a book, and he was, as we'll see along with Rosenhan, man, Chuck, why did you do that to me? Along with Rosenhan and a bunch of other people along the years, he helped contribute to opening society's eyes to the ills of institutionalizing the mentally ill and how they were treated. Yeah, absolutely. So Rosenhan gets in there, I'm going to say, Han, looks like Han to me, and says, all right,

here's what I'll do, and this is all in the sort of pre-study, like, planning part. I'm going to call these people pseudo-patients. I'm going to gather together people who are what I would call perfectly sane. They've never had any history of mental illness. They would go to a psychiatric hospital, and they would say, hey, I'm hearing voices. If it was a man, they would say I'm hearing a man's voice. It was a woman. They would hear a woman's voice.

And it's sort of unclear what they're saying, but I'm hearing the words, empty or thud or hollow, and I figured I should talk to someone about it, and let's see what happens. Yeah, and so later, people who came in and studied and analyzed this believe that Rosenhan was trying to simulate existential symptoms, possibly an existential psychosis, that where somebody has some serious concerns about the meaning of existence all of a sudden, they're really concerned that they don't mean anything, that there's no purpose to life, and that he was trying to come up with that using those words. The thing is, after they presented themselves at the psychiatric facility, and they gave

this false initial complaint, they were also required to give a false name. They were also required to give a false occupation, because a lot of these pseudo-patients were actually psychologists and psychiatrists themselves, and that would have raised red flags for sure. But also, he was worried that they would have gotten special treatment. It would have altered the outcome of the data they were collecting. But other than that, other than those three things, the deception ended there. They were supposed to behave exactly like they normally would as themselves from that point on.

Yeah, so like when they did interviews and stuff, whether it was intake or just as they went, although we'll see that didn't happen a lot as they went, they were to describe their lives as they were, their personalities as they were, their relationships, their medical history. Everything was just straight up and on the straight and narrow. This is very key. They did not take the medications. They would do the old trick where you hide them, misery style, and then put them under

your mattress or something, or I guess flush them down the toilet. And they were, and of course, Rosenhan is saying that, it's very natural how it happens. It's funny. Rosenhan was saying, hey, if anything, this thing is biased in the favor of these institutions because this is the very barest thing that they should be able to tell if someone is sane or insane. And these are completely sane people, so they should really be recognized as frauds. This shouldn't be too hard for them.

Yeah. I mean, if you're presented with somebody who has a perfectly normal, perfectly healthy life background history, yeah, you should be able to recognize them as saints. So that was the premise of the whole thing. He also said that while they were in there, if they were accepted into the facility, they were to become, quote, paragons of cooperation, that if they were given an instruction from somebody on the staff, they were supposed to happily comply and follow it. They were supposed to just kind of go along and get along, not cause any waves or any

trouble. And he noticed that there's a built-in mechanism to kind of support people to be cooperative. And that is that they present themselves as psychiatric patients without anyone in these hospitals being informed that they were there. So they had no idea when they were going to get out. They needed to be on their best behavior and seem as sane as possible so that they could eventually get out. Yeah.

And this is where it really differs from Cuckoo's Nest because the main character there, McMurtry, was not cooperative at all. And that led to the tragic ending. But yeah, what a movie. What a book. Man. So great. I never read the book.

Is it as good as the movie or is it one of those rare things where the movie's even better than the book? They're both great. It's like great book, great movie. Yeah. Really good stuff. So the other thing he had, or claimed to have in his hip pocket, and you can put a pin in this, is a writ of habeas corpus for each patient in case they just were like, I got

to get out of here. Yeah. And the hospital's like, sorry, it doesn't work that way. A writ of habeas corpus has to do with reporting unlawful detentions. And so Rosenan said, I've got these on hand in case anybody has to get out. And I think he presented it to the pseudo patients that way too, right? Yeah. So don't worry.

If push comes to shove, I can get you out of there through the courts, basically. So it is really important to know when you're voluntarily checking yourself into a mental facility for the purposes of a deceptive study, right? And one of the things that Rosenan needed for this study was for his pseudo patients to take copious notes and observe everything, jot down interactions, jot down how they were treated, how other patients were treated. Just basically everything they could document, they were supposed to document. And Rosenan was initially really worried that this was going to kind of show the pseudo

patients hands. So they needed to take these notes secretly. And the pseudo patients figured out very quickly that no one at the psychiatric facility who worked there could have cared less that they were taking notes the entire time. And in fact, they actually, in at least one case, attributed it to their psychological condition. Yeah. I mean, this, I think it speaks to some of the result that we'll find, which was there,

a lot of time was not a lot of active participation from staff to patient. So they're like, I don't care. He's writing. Big whoop. Right. So there was a note in one of their files, patient engages in writing behavior, but that was it. They didn't think it was weird.

They didn't think that whatever happened, those patients just took notes on everything. They were insane. And so of course an insane person's going to do that. And so the pseudo patients were able to just take notes out in the open the entire time during their stays. I think when you write engages in and tech behavior on the end, you can make anything like Josh and Chuck exhibited podcasting behavior. Right.

And all of a sudden someone's coming after us. Right. All right. So the study is now designed. He starts, he's collected these pseudo patients, these volunteers, I guess, and he wants to collect data in the end. We should note that he did throw out the data from one participant because they, I think, kept making stuff up while they were in there and didn't didn't go with the reality of their

life. And then another, and I have no idea why this person's data wasn't excluded. I don't either. But another person tried, and this is very McMurtry-esque, although he hated Nurse Ratchet, but he tried to woo a nurse on the premises, said that he was a psychologist and actually provided psychotherapy to some other patients there. Yeah. And I suspect that they didn't throw that data out because it was Rosenhan himself.

Oh. That would be my guess, and he was like, my data's still good. I didn't think of that. Because he was one of the eight pseudo patients in all who went to 12 different places in this study. Very interesting. I think it's a great place for a break. Yep.

All right. We'll be right back. I'm Mangesh Atikular, and to be honest, I don't believe in astrology, but from the moment I was born, it's been a part of my life. In India, it's like smoking. You might not smoke, but you're going to get secondhand astrology. Lately, I've been wondering if the universe has been trying to tell me to stop running and pay attention, because maybe there is magic in the stars, if you're willing to

look for it. So I rounded up some friends and we dove in, and let me tell you, it got weird fast. Tantric curses, Major League Baseball teams, canceled marriages, K-pop, but just when I thought I had a handle on this sweet and curious show about astrology, my whole world came crashing down. Situation doesn't look good. There is risk to father. And my whole view on astrology?

It changed. Whether you're a skeptic or a believer, I think your ideas are going to change, too. Listen to Skyline Drive and the iHeart Radio app, Apple Podcast, or wherever you get your podcasts. All right, so it's 19, it's funny. It was published in Science in 1973, but I didn't see, I couldn't find anywhere when this happened. When did it actually happen?

I saw 69-72. Okay, it's weird. I looked in a bunch of places and it all just dived right into the thing without saying what year it was. Yeah, I noticed that, too. I found it in one place. All right, so 69-72, the Summers of Love, and eventually published in Science, which, of course, we've talked about it a lot.

It's one of, if not the most prestigious academic journal in US history, so it's not like it was published in Popular Mechanics or something like that. Hey, Popular Mechanics is pretty great. Or BuzzFeed, sorry. BuzzFeed? Let's say Highlights for Children. Oh, I love Highlights. Which is the one I was on the cover of?

Like Catholic Boys' Life or something? I was like Catholic. Oh, no. It was Nun's Life. It was spelled N-O-N-E, apostrophe S. So, where were we? All right. It's 1973. It's published in the Journal of Science.

It was called On Being Sane in Insane Places, and it's a really great read. You sent me the original article, and it's awesome. You can still find it and read it. It's a really good read because it doesn't take the form of a regular scientific academic journal. It doesn't have a lot of data, not a lot of statistics, not a lot of things. Methodology, like results, it's just sort of written out like this kind of challenge essay, which, as we'll see, ended up there being a lot of problems with it.

But it makes for a much better read than most things in science. Yeah. He starts a lot of paragraphs with, oh, here's another thing, too. So like I said, Rosenhan was one of the eight pseudo-patients. There were eight in all. Five of them were men, the other three were women, and five of the eight were somehow engaged in psychology or psychiatry. Plus him or including him, do you know?

I think including him. Okay. Yeah. I think he's included all of those. He sent them to 12 different facilities in five different states on the East Coast and West Coast. And they were all different kinds. He specifically tried to make a sample representative of the kind of facilities that you would find

throughout the United States. Yeah. One of them was a private hospital, 11 were state run, so not the biggest division there, but they did run the gamut from older kind of rundown places to newer places, some places had really good ratios of patient and staff, some had really cruddy ones and not nearly enough staff, some were research-based and oriented, some were not at all. So it seems at least that he had a pretty decent representation. Right.

He did. So again, in the design of his study, he has set it up to make it as easy as possible for anyone in these psychiatric facility staffs to notice that this person is actually not mentally ill at all. They're giving us all this information that's contrary to that. So like he said before, he biased it in favor of the psychiatric staff finding out that these people were sane. And he said that there were some things that he considered and then dismissed about why

they may have been admitted, because we haven't said it yet, but all eight were admitted in all 12 instances. And one of the reasons he considers that possibly affected the diagnosis and their admission was that they were nervous, like the pseudo-patients were nervous about being found out. They were nervous they were going to be embarrassed or shamed or maybe get into some sort of trouble. And so he said that might have contributed a little bit, but probably no, not enough to be admitted into a psychiatric facility. So he kind of dismisses that thought.

So what he says is that they were all really surprised at how easily they were admitted. Yeah. I mean, I think in the late 1960s, when you show up, say you're hearing voices in your head, they believe you and they say, all right, you're schizophrenic and welcome to the facility. Here's your outfit and here's your room and here's your pills. And that's basically what happened. I think they were all save one diagnosed with schizophrenia. The one was at the private run, interestingly, institution, and they were diagnosed as what

would now be bipolar disorder back then. They called it manic depressive psychosis, but they were all ushered in basically with open arms. Yeah. And I saw, and I think a big think article on this study, they pointed out that like, this is the opposite of what it's like when you try to get mental health treatment today. It's really hard. It's really expensive.

You don't just show up and they let you in and here's your gown and here's your pills kind of thing. So it's kind of interesting in that respect as well. But then once these pseudo patients were in the ward, again, they have diagnoses of schizophrenia now. There wasn't a single instance where any of their behavior was questioned by the staff or considered suspicious. And he obtained most of the reports from these visits and in the files, there's no questioning

or suspicion whatsoever about the pseudo patients at all. No. I mean, the reports were really good in that all the people were like model patients and cooperating and friendly and engaging. And like these things were noted, but no one ever said like, and we'll see, you know, some of them, well, we'll get to that point. So I think that's one of the more remarkable parts of it is how they noted that. But what they didn't note was like, you know what, this person doesn't seem like there's

anything going on with them at all. It was just sort of accepted like they're here. So this is what is going on with them. It's really interesting. But that was the staff, right? What about the other patients at the facility? Yeah. This I think is super fascinating.

They were the only ones that were onto it, the other patients. They were basically were like, you're not one of us and we can tell. And I try to remember in Cuckoo's Nest, I think he basically told everyone right away, like the other patients, like, I don't belong here. And he kind of became the de facto leader. But at these places with Rosenhan, they've, they basically said, hey, we don't think you're real. We think you're either a journalist trying to expose the facility or maybe you're, you

work for the facility and you're, you know, in there as a mole kind of checking on things. A secret shopper. Yeah. Exactly. But either way, we don't believe you. And it seems like in most cases, they were, and I love that you actually put sniffed off the case in the document because you put this together, but they were sniffed off the case generally by just being reassured by the pseudo patients that know, I'm just feeling better.

That's why I'm acting this way. Right. Can't you just see Mr. Martini saying like, I know you're checking up on the hospital. Yeah. Danny DeVito. Yeah, so there's the thing that Rosenhan points out, and he just kind of brushes past it, but it's kind of important. He says that while the other patients, you know, found them out immediately, none of

the pseudo patients were closely examined by the psychiatric staff, the actual psychiatrists. They had plenty of interaction with the nurses, the orderlies, you know, the people who, who interact with the patients day to day, but none of them in all 12 instances, all 12 visits, none of them were closely examined by a psychiatrist, and you can imagine that an inmate or a patient at one of these facilities is going to have the opportunity to really closely pay attention to you and interact with you and see your behavior. So it might have been easier for them just because they interacted with them more, but he defends this, you know, potential flaw in his design and saying like, these hospitals

had plenty of opportunity to closely examine the pseudo patients, and they didn't. So whether that was the reason they didn't find them out or not, it was still a huge failing of the psychiatric system and their process, and that they didn't even closely examine these people to see that, oh, no, actually, these people are faking. Yeah. And not to harp on cuckoo's nest, but it was written, you know, as a, as a real thing that Keezy did. And it was, that's what happened in that book.

He, you had this initial meeting with a psychiatrist where they diagnosed him. And then it's like, all right, this is where you live now. And these are the orderlies and these are the nurses and this is your life. There was no regular check-ins to see if anybody was getting better. And that was the whole point of this experiment and in a lot of ways was like, it wasn't being done right. These people are just being sent to live away because they were a hassle for their family. They were being sent to live somewhere else now.

Right. So one of the other themes of one flu or the cuckoo's nest is that, you know, Jack Nicholson is kind of slowly driven crazy, I guess you could say from being institutionalized. It was one of the main themes. And Rosenhan actually, I don't, maybe he did read that book because he accounted for this. He didn't report it, I think in the study, but in a memoir that was found after he died, he apparently had people visit, you know, friends visit the patients during their stay and then would interview the friends to see if they noticed any actual change in the pseudo

patients and that none of them did. There was no major, you know, noticeable effect of institutionalization that could have accounted for people, you know, mistaking them as, you know, having schizophrenia or something. Yeah. And this was over the course, what was the average stay? How many weeks? I think 19 days, almost three weeks for the average. Yeah.

So it's long enough to where someone could have said to a visitor like, hey, this place is really wearing on me, starting to lose it a little bit. And apparently that didn't happen. This is the part that I think really fascinated me was that the more sane they were, which was to say, sane appearing, the more that was looked at as a symptom of schizophrenia. So they would act completely normal, be super friendly and very cooperative and sort of like the writing behavior thing. When they looked at these notes, they would indicate this cooperation or just good sense

sometimes to do things as part of their problem. And we'll go over a few of them. It's shocking. There was one that lined up early for meals because I guess they were smart enough to know like, hey, I get at the front of the line, I get whatever, more food or the best food, the best chicken breast, I don't know. Well, I saw it explained is there's not a lot else to do or anticipate on the ward. So that's something to look forward to.

Yeah. So they noted that as an example of oral, acquisitive, psychotic behavior instead of just like being hungry and bored. Right. Exactly. That was a big recurring theme throughout, right? Yeah. This next one was really kind of funny.

This one pseudo patient was talking about their marriage and their home life and they said, you know, my life is pretty good. My wife and I get along. We have occasional arguments. Very rarely I spank my kids, which was, you know, something you did back then. So in that context, it was, you know, quote unquote, normal family life. And they said that his attempts to control emotionality with his wife and children are punctuated by angry outbursts and in the case of, in the case of the children, spankings.

Instead of just saying in marriage, they exhibited behaviors of being married, which is to say occasionally arguing. And again, in those days, like I was spanked when I was a kid, were you spanked? Yes, I was. And now it's by choice. No. Good for you. What was the other one?

What was the... Oh, so that same guy who was trying to control emotionality with his wife, they said that, so during his interview, intake interview, he said that when he was a kid, he'd been close to his mom, but kind of distant from his father. And then as he became an adult, he actually became close friends with his father and just not quite as close with his mom. Yeah. Welcome to adulthood.

Right. That turned into a considerable ambivalence in close relationships and that his effective stability is absent, meaning he's emotionally unstable. Yeah. That's what they gathered from that. You know, my brothers and sisters and me, we really fought a lot when we were young, but now that we're adults, we all get along really well. Right.

Exactly. Like, hmm. That is psychotic. So the Rosen hand goes to... He stops and points out like this is a kind of a major section in the study. He's saying like, this is the context of the hospital setting. This environment shapes people's perceptions. And he was saying that the people's very sane, very normal personal histories didn't affect

the diagnosis of schizophrenia. The diagnosis of schizophrenia altered everyone else's perception of their very sane and very normal personal histories. Yeah. And what really struck me was the... And this is something I think, like I said, you can still see today in some cases is the depersonalization that happened. It was kind of constant.

It seems like these patients were generally ignored. This is... Like I said, there wasn't a ton of raw data, but there was a little bit. And one of them was that there were close to 1,500 patient-initiated contacts with the staff. 1,468 times the eight pseudo-patients went up and engaged the staff somehow for some reason. And apparently less than 3% of those resulted in actual verbal engagement back to them.

So that tells me that they would just say something to them and be ignored 97% of the time. Right. Yeah. They would be ignored. They were powerless because they were stripped of rights. They were mistreated sometimes violently by the staff. They were just treated like they weren't there and they came to kind of question their self-worth

just as a part of the institutionalization process. And that was a big, big point from this study. And one of the lasting effects it had was pointing this out. And like you said, I think the average length of stay was 19 days. The shortest stay was seven days. The longest stay was 52 days. Yeah. Someone was digging it.

In 11 out of 12 of these visits, the pseudo-patients were diagnosed with schizophrenia. When they left, when they were determined to be able to return to society, they weren't labeled sane or cured or mentally healthy. They were labeled as having schizophrenia and remission. And that is what Rosenhan was talking about, that once you're labeled insane in our society, especially in the middle of the 20th century, you were insane for the rest of your life. Yeah. And you might not be actively insane at the moment.

Yeah. Absolutely. So, I say we take a break because we got a pretty good twist in the story coming up. And then we'll finish up about how this whole experiment is viewed these days right after this. I'm Mangesh Atikular, and to be honest, I don't believe in astrology, but from the moment I was born, it's been a part of my life. In India, it's like smoking.

You might not smoke, but you're going to get second-hand astrology. And lately, I've been wondering if the universe has been trying to tell me to stop running and pay attention, because maybe there is magic in the stars, if you're willing to look for it. So, I rounded up some friends and we dove in, and let me tell you, it got weird fast. Tantric curses, Major League Baseball teams, canceled marriages, K-pop. But just when I thought I had to handle on this sweet and curious show about astrology, my whole world came crashing down.

And my whole view on astrology? It changed. Whether you're a skeptic or a believer, I think your ideas are going to change too. Listen to Skyline Drive and the iHeart Radio app, Apple Podcast, or wherever you get your podcasts. Okay, Chuck, so there's an extra twist coming in. Rosenhan is just showing off at this point. He's running circles around the field of psychiatry, juggling bowling pins that are on fire for

fun, right? Sure. Apparently, somehow, this word of the study got out before the publication of the study. And some hospital challenged Rosenhan. They said this could not possibly happen at our hospital. So he actually worked with a research hospital and said, okay, the staff was informed that over the next three months, one or more pseudo patients was going to be admitted. And they had the staff rate the patients that were admitted over those three months to see

if they could figure out which one was actually faking. Game on. That's right. So of the 193 patients that were admitted to this hospital over a three-month period, there were 41 that were sniffed off the case as pseudo patients by at least one person on the nerfing staff. Nerfing? Yeah, they were nerfs.

It's the funnest staff. 23 were sniffed off the case by at least one psychiatrist, and 19 of them were suspected by at least a psychiatrist and at least one of the people on the nursing staff. So by at least one or the other, 40, 50, 64 of them were suspected as being pseudo patients. And how many pseudo patients did Rosenhan send their way? Zero. Not fair trick question. He's like Wallachian and the princess bride all of a sudden.

That's right. So yeah, he didn't deploy any pseudo patients to the hospital and just basically let them chase shadows to prove that not only could they not detect false negatives, they couldn't detect false positives correctly either. So in psychology, they call false positives and false negatives type one and type two errors. And he was basically showing like psychiatry is full of judging type one and type two errors. Yeah. I wonder if there was one person on the staff that was trying to talk everyone into like,

he's not sending any. I know it. I know this guy's just messing with this. They locked that guy up and gave him powerful anti-psychotic medication. Yeah. So again, I'm sure he was very pleased with himself after this challenge. Yeah. I'm sure too.

And this is at a time, and I mentioned Titicut Follies earlier. This is also a time when there was a lot of sort of inside looks at what was going on in these hospitals, thankfully, because so many of them were exposed in the early 70s. Geraldo Rivera, kind of one of the first ways he made a name for himself was the work he did exposing the Willowbrook State School for the developmentally disabled on Staten Island. Titicut Follies, Frederick Weisman, did the same thing in the late 60s. And I think even in the 1800s, a journalist named Nellie Bly did sort of the same thing,

going undercover to write a book called Ten Days in a Madhouse. And then of course, Ken Keezy. Yeah. There was Ken Keezy too. There was a life magazine spread from 1946 called, I think, Bedlam 46. And all of these things like really shocked the conscience of society over and over and over again. So together, including this wave of anti-psychiatry, Rosenhan's experiment with all these other

things helped kind of shape public perception and turn it against, if not psychiatry itself, certainly the large state-run, depersonalizing institutions that people were typically placed in when they suffered from mental illness. Yeah. And you shouldn't be surprised to learn that John F. Kennedy was the first president to really kind of try and tackle this in a substantive way, because he very famously had mental illness in his family. They had a lobotomy in his family, right?

Yeah, Rosemary. And so he got on it and said, let's put it under the guise of the federal government and get it out of the hands of the state. Was that a... That was more fat Tony than JFK. Oh, Mayor Quimby, come on, I know we're all frightened and horny, one of the greatest lines ever on the Simpsons. Totally.

Yeah, so he said, let's put it under the hands of the federal government. The state-run facilities are ignored and underfunded and it's an S show in there. He coined that term too. So he signed the Community Mental Health Act in 1963, but that was underfunded and that was also an S show. Yeah, so the responsibility for treating the mentally ill went from the states to the feds, but then the feds never funded that bill. So the treatment of the mentally ill and who was responsible was basically in limbo for

almost 20 years. And then Reagan came along and said, how about this? We'll just push it back to the states and we'll give them a little bit of funding, but not enough. And over the years, the kind of ping-ponging between institutions and community-based treatment, states responsibility and federal responsibility, all of these state-run beds, we're closing and closing and there are fewer and fewer of them. And so we end up where we are today, which is a mixture of community-based treatment,

state-run hospitals, they're definitely still there, and then private treatment. And all of them put together is just not enough. That's why it's so hard and so expensive to get treatment for mental health issues today in the United States. Yeah. And although you can't say this is the only reason, that's one of the reasons why so many people sadly in this country are unhoused today, including veterans, military veterans of the United States.

And it's just reprehensible, the blind eye that has been taken over the years. In the 1930s, there was something called the Penrose Hypothesis, which basically lays most of the blame on imprisonment of the mentally ill and the unhoused population, that's mentally ill, squarely the feet of de-instit- de-instit- I can do this. You can't sound it out. De-institutionalization. Hooked on phonics worked for you. Man, that is a...

When you look at that, that's a lot of letters. It is. It's a real bonehead word. I just gave myself a pat on the back. You should. You deserve it, man. Here. You say it right now.

Quick. De-institutionalization. Oh, you show off. You've been practicing. For once. Anyway. That doesn't mean anything. Anyone who listens to the podcast knows that me practicing has zero effect on my pronunciation.

That's true. The Penrose hypothesis lays the blame squarely on that word that you just said that's very long and impressive. There are statistics that help back that up. I think from 1880 to 2005, the percentage of people with mental illness in prison rose from less than 1% to 21%. What else about the unhoused? There was a study from the mid-90s that found that the population of the unhoused in the

United States was at 100,000 in 1980. Then in 1988, it was up to 400,000. Again, that spans the entire administration of Ronald Reagan. A lot of people lay this at his feet. Again, it's not that clear cut. The Penrose hypothesis is not cut and dried, but those are some pretty startling statistics. The idea that if you shut down giant state-run institutions and you don't have enough treatment facilities elsewhere, what's going to happen to those people?

It seems like a lot of them end up on the streets or in prison, and that's what America does with a large part of its mentally ill population today, especially ones that are people of color and other minorities too. Absolutely. As far as Rosenhan's experiment today, how it's viewed, why is that funny? Any time you say Rosenhan now, I'm just going to crack up. It's a little bit of a Stanford prison experiment view of it, which is, hey, this was interesting. We learned some things, but it was not rigorous scientifically.

There was no randomization. There was no control. There was no sampling or blinding. You didn't report how you train these participants. A lot of people have disregarded it. People that are well respected in the community, psychiatric community and psychological community is nonsense and bunk, and just heavily criticized. This one quote is, I think, pretty interesting.

It was a neuroscientist named Seymour Ketti that said, this is an explanation. If I were to drink a quart of blood and concealing what I'd done, come to the emergency room of any hospital and vomited blood, the behavior of the staff would be quite predictable. They would label and treat me as having a bleeding peptic ulcer, and I doubt that I could argue convincingly that medical science doesn't know how to diagnose that condition. This is taking you a little far in a different direction, I think, but I get the point. I saw it put a little more succinctly by a writer on Psychology Today who said, the only thing the study showed was that it is possible to deceive doctors by lying to them.

The study does have its detractors. If you don't share your data or your methodology, it's not a scientific paper at base, but Rosenhan's experiment has survived all these years because even its detractors say, well, it did a really good job of raising the issue of powerlessness and depersonalization in institutions, and that in and of itself makes it a worthwhile study, or paper at least, or essay. Yeah. I think it's super interesting and really interesting to read, and I think I agree.

I think it did expose a lot of things, but I don't think you could point to it as proof of anything necessarily, except that the system was pretty messed up. Yeah, and the system is still messed up. That initial thing that R.D. Lang hit on, that psychiatry treats behaviors it observes with biological medicine is still a problem. There's a guy who used to be the head of the National Institute of Mental Health, Thomas Insel, and he said, unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any

objective laboratory measure. Psychiatry still finds itself in the same place as ever, and it's now having to fend off a turf war that's been started by neuroscientists who are like, all this stuff is brain-based, and we're the ones who can look into the brain. We need to be taking over this stuff, and psychiatrists are like, nine in the tradition of Freud. And also, by the way, if people are listening, you said R.D., the initials, R.D. Lang, not R.D. Lang, if you're wondering what Howard Stern's one-time sidekick, comedian R.D.

Lang had to do with any of that. Didn't he hang out with Norm McDonald a lot too? Yeah, I think they were pals. Okay. I like R.D. Lang. He had some bad troubles for a while, I think he's doing better now. Nice. Yeah, R.I.P.

Norm McDonald too. Yeah. So as far as Rosenhan himself, there was a book a few years ago in 2019 from Susanna Cahalan, unless you misspelled Callahan. No, I really wish I had, because that's a tough one. It's probably Cahalan. It was called The Great Pretender, and Susanna was not very kind to Rosenhan and basically said, this guy's kind of a fraud.

I found instances where, first of all, he didn't have that writ of habeas corpus, and he said he did and told them he did, which is really not cool. What else? Well, some of the data, some of the numbers that he put out there don't match. She tracked one guy down, Bill Underwood, who's a pseudo-patient, and that particular pseudo-patient supposedly spent seven days in a hospital with 8,000 patients. He actually spent eight days in a hospital of 1,500 patients, which matters if Rosenhan was saying, no, I'm really kind of getting a random sample or a good sampling of hospitals

in America, big ones and small ones, et cetera. If he didn't have an 8,000-patient hospital and 1,500 was the tops, maybe that wasn't as random as you'd think. Yeah. And she also didn't quite, but came close to accusing him of flat-out making up about half the people. I don't know if this is because she only found three plus him and said, well, maybe he made up the rest, or was there like actual evidence that he may have just made up the rest?

The former, but she took out an ad basically as an editorial in The Lancet, which is a British, very respected British medical journal saying like, hey, I'm looking for the other pseudo-patients and got nothing, not a single bite, not a lead or anything. So she wonders if actually they didn't exist. Interesting. Yeah. And so the thing is though, it doesn't really matter. Even if he did make up half the data and half the pseudo-patients, it doesn't matter because

this study isn't based on the data. It's all about the fact that it kind of shown this light on the way people are treated and how the mentally ill were treated in the United States at that time. Yeah. You got anything else? No, good stuff. Nice work. Thanks, man.

Thank you. If you want to know more about Rosenhan, Rosenhan, whoever, you can look up this article on being sane and insane places all over the internet, and I think you'll enjoy it tremendously. And since I said that, it's time for Listener Mail. Listener Mail, I'm going to call this a couple of quick things on our mariachi episode. I'm not going to read this full email, but I did want to point this band out because I listened to it and they're awesome. This is from Jay Detman sent in this band, Mariachi L. Bronx, and they were originally

a punk band from LA, and apparently they did an acoustic set for a TV show, and they played it with a mariachi style just because it had that energy, and then they were like, hey, this is awesome, and that's kind of what they're known for now. And I played some of it, and it's really awesome. Well, these guys, a lot of them are Caucasian, and they wear those outfits, and they look awesome. Awesome, see? But the real email I'm going to read is from Marlena Maynard.

She-her-hers, who is a voice teacher, so I imagine Marlena from Nashville knows what she's talking about. Hey, guys, just listened to the episode about mariachi music. I love how you highlighted issues of class and race in the musical and academic world. I'm a classical singer and vocal coach, and as a professional in the field, we certainly have a long way to go in terms of equity and diversity. But Chuck, you mentioned that you love hearing many voices sing in harmony. You weren't sure if five-part harmony is a thing.

Ho-ho-ho! I have great news, which is that there isn't really an upper limit at all. Nice. Five-part harmony is fairly common in choral music. If a composer wants to fill out a chord, they can simply write another note, and the members of that section will know how to divide accordingly. You also will encounter a lot of pieces for eight voices, i.e., a double choir, or two soprano parts, two alto, two tenor, and two bass parts.

And then gives an example, which I think people should check out. It's called The Piece with Most Parts, with the most parts that I'm aware of, is Spem in Allium by Tomas Tallis, who's from the early 16th century, and it's got 40 vocal parts. Wow. So, with that up, Spem-i-n-a-l-i-u-m on YouTube, and then there's a couple of more. And also lists a Bach one, and this is Marlena's favorite five-part choral pieces, the second movement of Jesu Maina Freuda by J.S. Bach.

Very nice. So, go check all those out. Check out Mariachi L. Bronx, they've got a great tiny desk concert, among other things. Those are always fun to watch. Do you ever see those? Yeah. I saw one when we did the Mariachi one, the Flora, I can't remember, the all-woman four-piece Mariachi band from New York.

Yeah. Hats off to NPR, the tiny desk concert has long been one of my favorite things. So Chuck, since we're talking music, though, I want to just go ahead and give a shout-out, an announcement you could say. Ooh. You ready for this? Did your niece write an album? Not yet.

She's working on it. Instead, you asked for it and they're giving it to you on November 22nd in 23rd 2022, Diarrhea Planet is reuniting in Nashville. What's this because of us? I probably, I assume everything is because of us. No, I don't think it is, but I want to go to that show, I bet you that place is going to go off because they haven't been together in three or four years. No, they broke up in 2018, so they're going to be at the exit in Nashville November 22nd

and 23rd if you want to make a pilgrimage there. You know, I'm looking at my calendar, that's a bad time of year, Diarrhea Planet, at Thanksgiving. Right around my wife's birthday, but I've been in more trouble in my marriage, so Nashville's pretty close. I'm going to see Stevie Nicks, surely I can go to see Diarrhea Planet there. Emily's like, you skipped my birthday to see who? Yeah. The Phantom Planet with Jason Swartzman.

Oh man. So Chuck, who was the original, the two people who wrote in? Marlena is the vocal coach and Jay turned me on to Mariachi L. Bronx. That's right. Thanks Marlena and Jay. And if you want to point out some cool music we've never heard before, we love that kind of thing. You can send us an email to stuffpodcastatihartradio.com.

Stuff You Should Know is a production of I Heart Radio. For more podcasts, my heart radio, visit the I Heart Radio app, Apple podcasts, or wherever you listen to your favorite shows. I'm Munga Chauticular and it turns out astrology is way more widespread than any of us want to believe. You can find in Major League Baseball, International Banks, K-pop groups, even the White House. But just when I thought I had a handle on this subject, something completely unbelievable happened to me and my whole view on astrology changed.

Whether you're a skeptic or a believer, give me a few minutes because I think your ideas are about to change too. Listen to Skyline Drive on the I Heart Radio app, Apple podcasts, or wherever you get your podcasts.