Sanity vs. Insanity: The Rosenhan Experiment

A few weeks I started a discussion on sanity and insanity. What makes a person insane? You can find the discussion here.

I’d like to present you with a study performed by Rosenhan in 1973. It was published in the journal Science, titled “On being sane in insane places”. The study is still considered very important and influential.

Diagnosing healthy people with mental illnesses

The study was done in two parts. First, healthy participants were recruited, called the “pseudopatients”. They would briefly simulate auditory hallucinations. These pseudopatients would try to be admitted to twelve different psychiatric hospitals in five states in the USA. All were admitted and diagnosed with psychiatric disorders. After admission, the pseudopatients told the staff they were fine and acted like any normal patient would. However, the staff considered this as part of their illness and did not detect any of the pseudopatients. Some of the patients were even confined for months. All were forced to admit to having a mental illness and had to agree to taking anti-psychotic medication as a condition for release.

Failing to diagnose people with mental illnesses

The second part of the study is where Rosenhan asked the hospitals’ staff to detect pseudopatients. However, Rosenhan did not send any pseudopatients to these hospitals. Interestingly, the hospitals’ staff falsely identified many ordinary patients as pseudopatients.

Rosenhan’s conclusion

After performing this study, Rosenhan concluded in his article that

It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals.

He illustrated the dangers of dehumanization and labeling in psychiatric institutions. He suggested that it would be beneficial if hospitals’ staff would be trained to become more aware of the social psychology in their facilities and that the facilities in general should focus more on problems and behaviors instead of the psychiatric labels.

After the publication of Rosenhan’s article the whole psychiatric community exploded. There were those who defended the psychiatric hospitals, and also those who defended Rosenhan’s research. Unfortunately, this research has never been replicated to test it’s reliability. The Psychology Research Ethics Committee decided the research was not ethical, both for the pseudopatients and the real patients who were not admitted to the hospitals.

However, it accomplished what it intended: it got people and particularly those involved in psychiatry thinking on how they could improve the situation.

You can find Rosenhan’s article “On being sane in insane places” here.

The DSM

Since Rosenhan’s experiment the psychology and psychiatry community has been striving to become better at what they do,especially to avoid labeling. This is why there is the DSM (Diagnostic and Statistical Manual of Mental Disorders) with guidelines on the symptoms on an illness and guidelines on when one can diagnose a patient with a mental illness.

Currently, psychologists are using the DSM-IV-TR  (text revision), which was released in 2000. Ever since, the American Psychiatric Association has been working on the next installment, the DSM-V, in which a lot will be different to the current version. For instance, several types of schizophrenia have been proposed to be deleted entirely and the section on bipolar disorder will be extended. The biggest changes have been proposed in the section of the personality disorders. Some of the personality disorders will be merged with others and the definitions of some of them will be changed entirely.

The DSM-V is scheduled for publication in May, 2013. To read about the development of the newest version of the DSM, visit the DSM-5 homepage.

Please feel free to ask any questions if you have any!