When Psychiatrists Pretended to Be Mentally Ill

In the annals of psychology, one experiment stands out as a seismic shock to the field of psychiatry and mental health. The Rosenhan Experiment, led by the audacious psychiatrist David Rosenhan, rattled the foundations of psychiatric diagnosis and institutionalization in 1973. This article takes you on a journey through this thought-provoking experiment, revealing its profound implications for our understanding of mental illness and the flaws within the psychiatric system.

Picture this: the year is 1972, and eight individuals voluntarily present themselves to twelve different psychiatric facilities scattered across the United States. What do they have in common? They all report hearing a single word – “thud,” “empty,” or “hollow.” Other than this peculiar shared experience, they appear to be a disparate group. Seven of them are diagnosed with schizophrenia, while one is labeled with manic depression. Intriguingly, once admitted, all eight claim the voices have ceased, and they feel perfectly normal. Nevertheless, they endure hospitalization ranging from seven to fifty-two days, enduring a cocktail of antipsychotic medications before finally being discharged with a diagnosis of “schizophrenia in remission.”

The Anti-Psychiatry Movement

To understand the motivations behind the Rosenhan Experiment, we must delve into the backdrop of the anti-psychiatry movement of the 20th century. Influential figures like R.D. Laing, Thomas Szasz, and Erving Goffman were outspoken critics of the psychiatric establishment. They were deeply concerned about the dehumanizing impact of psychiatric diagnoses and institutionalization, viewing psychiatry as a tool of social and political repression.

In the height of the Cold War, psychiatric diagnosis and institutionalization were not only a matter of mental health but also a potent political weapon. In communist regimes like the Soviet Union and East Germany, dissidents were often forcibly committed to mental hospitals, silencing their opposition. In Western countries, figures like Thomas Szasz argued that psychiatric labels were used to enforce societal norms, citing examples like “drapetomania” and the classification of homosexuality as a mental illness until 1974.

The Power of Psychiatric Labels

David Rosenhan shared these concerns about the impact of psychiatric diagnoses and labels, particularly in perpetuating stigma. He believed that incorrect or excessive diagnoses could have severe consequences for individuals and communities. In his influential 1973 paper, “On Being Sane in Insane Places,” he highlighted the enduring stigma attached to mental illness.

The Long Shadow of Psychiatric Labels

Rosenhan pointed out that psychiatric labels have a lasting impact on individuals and society. Unlike a misdiagnosed physical ailment, mental health diagnoses are rarely corrected. The label remains, marking the individual as inadequate. It’s a far cry from the way physical illnesses are treated, where the joy of a misdiagnosis is celebrated, while mental diagnoses rarely see such revisions.

The Birth of an Experiment

The genesis of the Rosenhan Experiment dates back to 1969 when David Rosenhan, a psychology professor at Swarthmore College, decided to send his students to a nearby mental hospital for a more practical understanding of schizophrenia. After nine harrowing days as a patient himself, he abandoned the idea of exposing his students to the system. However, this experience planted the seed of an audacious experiment aimed at revealing the flaws in the mental health system.

Enter the Pseudopatients

In 1973, David Rosenhan and a team of eight individuals embarked on an experiment that would become the Rosenhan Experiment. These eight individuals, known as “pseudopatients,” included a doctoral student, a pediatrician, a painter, a housewife, three psychologists, and Rosenhan himself. To maintain anonymity and protect their professions, they adopted fictitious names. However, they did not alter any other aspect of their lives or personalities. The only symptom they exhibited was hearing a voice saying “thud,” “empty,” or “hollow.” These phrases were chosen because they implied a hypothetical condition known as “existential psychosis,” which had never been reported.

Inside the Asylums

Once admitted to their respective hospitals, the pseudopatients ceased reporting any symptoms and behaved as they would in their everyday lives. Their goal was to secure their release by convincing the staff they were sane while concealing their participation in the experiment. Surprisingly, their abrupt cessation of symptoms and return to normalcy did not lead to changes in their diagnoses or raise suspicions among the hospital staff. Instead, the staff interpreted every behavior on the ward as symptomatic of the alleged mental illness.

The Troubling Diagnosis

One striking example of misinterpretation was the pseudopatients’ habit of taking detailed notes on fellow patients and hospital staff. This was labeled as “patient engaged in writing behavior.” Yet, no staff member inquired about the content of their notes, highlighting the staff’s confirmation bias. Another incident involved a pseudopatient’s entirely normal relationship with their parents being pathologized and linked to psychosis, while outbursts of rage, typical of mental illness, were ignored.

Suspicion Among Patients

Interestingly, it was the fellow patients who often saw through the masquerade. When records were later accessible, 35 out of 118 patients on the ward reported suspicions about the pseudopatients. Some accused them of being journalists documenting life in the hospital.

Rosenhan’s Conclusion

Rosenhan attributed the failure of the physicians to detect the deception to a systemic flaw. The staff was so engrossed in confirming their initial diagnoses that they were blinded to any evidence of normalcy. This led Rosenhan to question the objective reliability of psychiatric diagnoses, emphasizing the impact of psychiatric labels on individuals and society at large.

The Rosenhan Experiment served as a wake-up call to the psychiatric establishment, prompting critical reevaluation of the field. It sparked debates on the reliability of psychiatric diagnoses, the power of labels, and the treatment of mental illness. In subsequent years, changes were made to psychiatric practices and institutional procedures.

A Bold Challenge to the Status Quo

In conclusion, the Rosenhan Experiment was a bold challenge to the status quo of psychiatric diagnosis and institutionalization. It revealed the enduring impact of psychiatric labels and the confirmation bias that permeated the mental health system. While the experiment faced ethical criticism, it triggered a paradigm shift in psychiatry, ultimately aiming to improve the understanding and treatment of mental illness. It stands as a testament to the power of one audacious experiment to ignite change in an entire field, shedding light on the complex intersection of mental health, diagnosis, and societal perception.