Diagnosing mental illness is not the same process as that of a medical diagnosis, a fact that was given weight in what is now called the Rosenhan experiments. Seen as one of the most controversial cases in the history of diagnostic research, the Rosenhan experiments had shown the fallibility of the psychiatric process and the fundamental need for its reform. This is a summary of the two experiments.
In the 1970s, Dr. David Rosenhan performed a pair of ingenious studies designed to understand the then prevailing culture of psychiatric diagnosis.The results were very much surprising, ultimately serving as a reminder that there is still much to improve on how mental illness is diagnosed and cared for, something that still resonates until today. Here are the basic facts of the two Rosenhan experiments.
The First Experiment
Dr. Rosenhan recruited eight people, all diagnosed sane, to gain admission into 12 different psychiatric institutions by acting out as if they have a mental illness.These people came from varied backgrounds and lifestyles; one of them was even a psychiatrist. Each was told to call a selected hospital for appointment and to report that that they were “hearing voices of the existential kind”. They were also asked to simulate minor psychiatric symptoms (e.g. anxiety) during the clinical interview.
Now this first experiment’s objective is not just about whether fake psychiatric patients might gain admission to psychiatric institutions but of understanding what happens after it. After each of the volunteers were confined, they were then required to act normal, and to go about what they would normally do. (This is not a hard feat because remember, they are sane.) Each volunteer was also asked to write down notes about their hospital stay and to be on the lookout for anyone who might find them out.
However, no one found them out. The volunteers stayed with their respective institutions for an average of 27 days, and no one, from the doctors to the other hospital staff, had caught the lie. Each of the volunteers were discharged with a diagnoses of schizophrenia in remission, and no one had bothered to go beyond the initial diagnoses.
No one had found out that all 8 volunteers were, in fact, sane.
The Second Experiment
The next experiment continues from that of the results of the first. As the story goes, a teaching hospital had been privy to the results of the pseudopatient study and had affirmed that something like this “couldn’t happen to their hospital”. Taking the challenge, Rosenhan came up with an experiment designed to test this fact.
Rosenhan recruited 193 individuals to randomly go to the teaching hospital and be diagnosed for mental illness. The hospital staff were then instructed to diagnose the volunteers and then rate, on a scale of 1 to 10, which was a pseudopatient (a score of 1 or 2) and which was not.
The hospital gamely took the challenge and confidently found 41 out of 193 patients as faking it. There was some variation on which of the volunteers were suspect, with one psychiatrist rating 23 people with a possibility of mental illness and one other doctor spotting 19 on his list.
The problem, however, is that each of the 193 volunteers were actually psychiatric patients from other hospitals. Yes, none of them were faking it.
What the two experiments show is that psychiatric assessment is heavily influenced by the context it is embedded in. It seems that mental health professionals “looking for” pathology will find it, and consequently, the search for sanity will lead to the same result. Diagnoses is not necessarily objective.
This is not to say that diagnoses is not useful for there are are circumstances that would require such a process to be done. What this story does tell, however, is that the process has its kinks, and that all who profess to work in the field should be aware of its shortcomings.
Jaffe, E. (March 2006). Opening Skinner's Box causes controversy. Observer (APS)
Rosenhan, D. (1973). On being sane in insane places. Science, 179, 250-258.