19 Jan 08 – Rosenhan, Pseudopatients, and “Insanity”?

19 January 2008

On this day in 1973, David Rosenhan’s article entitled, “On Being Sane in Insane Places” was published in the eminently well-respected scientific journal Science.  This was a highly provocative article summarizing the findings of a study that involved eight “pseudopatients” (one graduate student, three psychologists, a pediatrician, a psychiatrist, a painter, and a housewife) being admitted to twelve different hospitals in five different states on the East and West coasts.  Each of these pseudopatients was admitted after complaining about hearing voices saying relatively innocuous words such as, “empty,” “hollow,” and “thud.”  While the facts of these pseudopatients’ names, vocations, and employment were altered, no further alterations in life histories and circumstances were made.  All of these, debatably, “normal” individuals were admitted to the psychiatric ward.  All but one was admitted with a diagnosis of schizophrenia.

Following admission to the psychiatric ward, these pseudopatients ceased presentation of any symptoms of abnormality and began tracking their interactions in notebooks.  In the absence of “abnormal” symptoms, it was quite common for other patients on the ward to tell the pseudopatients that they did not belong there.  The psychiatric staff, however, did not surmise this.  In fact, the length of hospitalization for these pseudopatients lasted anywhere from seven to fifty-two days, with an average stay of about nineteen days.  During this time, these eight pseudopatients were given approximately 2,100 pills, including antidepressants and antipsychotics (none of which they ingested). 

Rosenhan noted that even the pseudopatients’ tracking of their experience was taken as evidence of psychological disturbance.  Rosenhan suggested that the reason for this misinterpretation is that the behaviors of these pseudopatients were interpreted with reference to symptoms of psychological disorder.  In other words, because these individuals were disordered, and because the location of the disorder, in atomistic fashion, continues to remain within the individual, the behaviors must be indicative of the disorder.  In the end, all of the pseudopatients were discharged with a diagnosis of schizophrenia “in remission,” an indication that the schizophrenia may merely be in hiding but remains within the individual just as a remitting form of cancer remains within a treated cancer patient.

There was much debate regarding this study subsequent to its publication.  Much of the debate focused on the methodological problems.  Still, it is difficult to doubt the role of biases in interpreting not only others’ behaviors but also the results of investigation.  In fact, our values and biases appear to have clear relevance to our clinical decisions in psychology as well as our interpretations of research data.  It is encouraging that such a well-respected journal as Science would publish such a thought-provoking and dialogue engaging article as this.

Fuel for thought, I guess… head to my website GivingPsychologyAway.net for more fuel for thought regarding psychology.