D.L. Rosenhan and the evaluation of sanity

2012-12-01

in Geek stuff, Psychology, Science

One interesting bit of research described in Sam Harris’ The Moral Landscape concerns the ability of psychiatric hospitals to distinguish the sane from the insane:

Of course, there are many other other ways in which we can be misled by context. Few studies illustrate this more powerfully than one conducted by the psychologist David L. Rosenhan, in which he and seven confederates had themselves committed to psychiatric hospitals in five different states in order to determine whether mental health professionals could detect the presence of the sane among the mentally ill. In order to get committed, each researcher complained of hearing a voice repeating the words “empty,” “hollow,” and “thud.” Beyond that, each behaved perfectly normally. Upon winning admission to the psychiatric ward, the pseudopatients stopped complaining of their symptoms and immediately sought to convince the doctors, nurses, and staff that they felt fine and were fit to be released. This proved surprisingly difficult. While these genuinely sane patients wanted to leave the hospital, repeatedly declared that they experienced no symptoms, and became “paragons of cooperation,” their average length of hospitalization was nineteen days (ranging from seven to fifty-two days), during which they were bombarded with an astounding range of powerful drugs (which they discreetly deposited in the toilet). None were pronounced healthy. Each was ultimately discharged with a diagnosis of schizophrenia “in remission” (with the exception of one who received a diagnosis of bipolar disorder). Interestingly, while the doctors, nurses, and staff were apparently blind to the presence of normal people on the ward, actual mental patients frequently remarked on the obvious sanity of the researchers, saying things like “You’re not crazy. You’re a journalist.”

In a brilliant response to the skeptics at one hospital who had heard of this research before it was published, Rosenhan announced that he would send a few confederates their way and challenged them to spot the coming pseudopatients. The hospital kept vigil, while Rosenhan, in fact, sent no one. This did not stop the hospital from “detecting” a steady stream of psedopatients. Over a period of a few months fully 10 percent of their new patients were deemed to be shamming by both a psychiatrist and a member of the staff. While we have all grown familiar with phenomena of this sort, it is startling to see the principle so clearly demonstrated: expectation can be, if not everything, almost everything. Rosenhan concluded his paper with this damning summary: “It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals.”

Harris, Sam. The Moral Landscape. p.141-2 (hardcover)

I believe this is the research being referenced: Rosenhan, D.L. “On Being Sane in Insane Places.Santa Clara Lawyer 379 (1972-1973).

This doesn’t seem like the most scientific or ethical research, but it is certainly interesting.

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{ 1 comment… read it below or add one }

. December 2, 2012 at 1:07 am

On being sane in insane places.
(PMID:4683124)

Rosenhan DL
Science (New York, N.Y.) [1973, 179(4070):250-258]

Type: Journal Article
DOI: 10.1126/science.179.4070.250

Abstract

It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals. The hospital itself imposes a special environment in which the meanings of behavior can easily be misunderstood. The consequences to patients hospitalized in such an environment-the powerlessness, depersonalization, segregation, mortification, and self-labeling-seem undoubtedly countertherapeutic. I do not, even now, understand this problem well enough to perceive solutions. But two matters seem to have some promise. The first concerns the proliferation of community mental health facilities, of crisis intervention centers, of the human potential movement, and of behavior therapies that, for all of their own problems, tend to avoid psychiatric labels, to focus on specific problems and behaviors, and to retain the individual in a relatively non-pejorative environment. Clearly, to the extent that we refrain from sending the distressed to insane places, our impressions of them are less likely to be distorted. (The risk of distorted perceptions, it seems to me, is always present, since we are much more sensitive to an individual’s behaviors and verbalizations than we are to the subtle contextual stimuli that often promote them. At issue here is a matter of magnitude. And, as I have shown, the magnitude of distortion is exceedingly high in the extreme context that is a psychiatric hospital.) The second matter that might prove promising speaks to the need to increase the sensitivity of mental health workers and researchers to the Catch 22 position of psychiatric patients. Simply reading materials in this area will be of help to some such workers and researchers. For others, directly experiencing the impact of psychiatric hospitalization will be of enormous use. Clearly, further research into the social psychology of such total institutions will both facilitate treatment and deepen understanding. I and the other pseudopatients in the psychiatric setting had distinctly negative reactions. We do not pretend to describe the subjective experiences of true patients. Theirs may be different from ours, particularly with the passage of time and the necessary process of adaptation to one’s environment. But we can and do speak to the relatively more objective indices of treatment within the hospital. It could be a mistake, and a very unfortunate one, to consider that what happened to us derived from malice or stupidity on the part of the staff. Quite the contrary, our overwhelming impression of them was of people who really cared, who were committed and who were uncommonly intelligent. Where they failed, as they sometimes did painfully, it would be more accurate to attribute those failures to the environment in which they, too, found themselves than to personal callousness. Their perceptions and behavior were controlled by the situation, rather than being motivated by a malicious disposition. In a more benign environment, one that was less attached to global diagnosis, their behaviors and judgments might have been more benign and effective.

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