The Rosenhan Study Never Proved Anything Anyway

David Rosenhan's infamous 1973 study "On Being Sane in Insane Places" has been in the news lately. The original study, published in the prominent journal Science, involved Rosenhan, a Stanford University psychologist, and several other healthy "pseudopatients" feigning psychotic symptoms to gain admission to hospitals in five U.S. states.

The main building of St. Elizabeth's Hospital in Washington, D.C., now boarded up and abandoned, was one site in Rosenhan's study.

Source: Public domain

Since Rosenhan and the others were diagnosed as mentally ill by the psychiatrists who examined them, Rosenhan confidently concluded, "It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals." The study went on to be interpreted as an invalidation of psychiatry, and its diagnosis, as a whole.

Now, a recent book titled The Great Pretender by Susannah Cahalan alleges Rosenhan fabricated his data. Regardless of whether Rosenhan was guilty of fraudulent research, one thing is clear: The Rosenhan study never proved anything in the first place. Even the psychiatrist Szasz, grouped alongside Rosenhan as an "antipsychiatrist" (a term Szasz abhorred), knew the study was nonsense. The whole thing was based on deceit.

Actually, the only thing the study showed was that it is possible to deceive doctors by lying to them. But this is nothing new: most of us learn this by the time we're in grade school, faking symptoms to avoid school or other childhood responsibilities.

What does any of this have to do with the legitimacy of psychiatry or the reality of mental illness? Plenty of medical diseases—readily identified as such—are diagnosed on the basis of symptoms (patients' subjective complaints). Anyone can walk into a doctor's office, complain of an inability to sleep, and be diagnosed and treated for insomnia. Similarly, migraine disorder, fibromyalgia, chronic pain, and a whole host of other real physical conditions are diagnosed on the basis of the patient's subjective report.

The most blatant problem with Rosenhan's study was that his "pseudopatients" were not pseudopatients at all—they were real patients faking real disease. The fact that some patients fake mental illness and are able to deceive the doctors who examine them says nothing about the legitimacy of the illnesses themselves.

The neuroscientist Seymour S. Kety, quoted by DSM-III chair Robert Spitzer, put it best: "If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood, the behavior of the staff would be quite predictable. If they labeled and treated me as having a bleeding peptic ulcer, I doubt that I could argue convincingly that medical science does not know how to diagnose that condition."

Nevertheless, Rosenhan’s study was published at a time when society was ripe for its conclusions. Szasz’s 1961 book The Myth of Mental Illness had become a bestseller, and psychiatry was beginning to look silly with claims by prominent psychiatrists that it had answers to all sorts of social ills from racism to war to poverty. This, combined with the fact that psychiatry still deemed homosexuality to be a mental disorder, left society seriously questioning the legitimacy of the field as a whole.

Yet a commonsense look at Rosenhan's study reveals that it didn't really show anything surprising at all. Some people can make others believe they are ill. But then again, any third-grader could tell you that.