When eight people pretended to hear voices to show that psychiatry was wrong: lights and shadows from Rosenhan's experiment

In mid-1972, eight people showed up at different psychiatric facilities in the United States. They had never been ill, nor did they appear to have had any type of history of interest; however, they had only recently heard voices of the same sex. They were not clear, they did not understand each other well, but they seemed to say things like "empty", "blow" and "hole". They were admitted.

The most common diagnosis was schizophrenia, but just after being hospitalized, the voices disappeared. Told like this, it seems like magic, almost a miracle. However, the reality is much more prosaic: it was all a lie, a lie that shook the pillars of modern psychiatry.

How to distinguish crazy from sane?

"If sanity and madness exist, how to recognize them? The question is not capricious or insane in itself. As much as we are personally convinced that we can distinguish normal from abnormal, the evidence is simply not convincing. ” These are the opening lines of one of the best-known and most controversial texts in the history of mental health: 'On Being Sane In Insane Places', the article from Rosenhan's experiment.

Published in Science In 1973, after an intense decade in which many activists had tried to challenge the methods, practices and foundations of mental health at the time, the work of David Rosenhan, professor at Stanford University, was one of the great arguments that they paid some of the great psychiatric reforms of that time. Hastily, it would have to be said.

One day, while listening to a talk by R. D. Laing, one of the most influential voices in the antipsychiatric movement, Rosenhan realized that she did not know for sure what reliability, validity or accuracy psychiatric diagnoses had. Were we correctly identifying those who had a mental health problem?

From the eight pseudo patients to the 41 false patients

David Rosenhan

To find out, Rosenhan selected seven other healthy collaborators (the 'pseudopatients') and presented at 12 psychiatric hospitals in five North American states. The team was made up of people of different ages, genders and professions. None had a history of mental illness, and although different pseudonyms were used, all the data in their medical records was real.

Sneak into a psychiatric

The plan was simply that during the initial psychiatric evaluation, the pseudo-patients claimed to be hearing voices of the same sex that were not well understood. They chose certain words that, according to the psychiatric literature, had something to do with existential crisis and psychosis. That was all.

And it worked, the pseudopatients were admitted to the 12 psychiatric hospitals they went to. Rosenhan tried that they were of different type and condition. There were from poorly financed rural insane asylums to high-end private centers to internationally renowned urban hospitals. All itched: On all occasions except one, the pseudopatients were diagnosed with schizophrenia.

Once inside, the experiment protocol required pseudo patients to behave normally. They would explain that they had stopped hearing voices and would be cooperative with hospital health personnel. However, leaving was not going to be as easy as entering: Rosenhan's eight spent, on average, 19 days interned (7 the least and 52 the most).

And they were only able to leave after admitting they had a mental health problem and agreeing to be treated with antipsychotics. Of course, with a diagnosis of "schizophrenia in remission". Meanwhile, almost a third of normal patients were able to identify pseudo patients with impostors.

False impostors

That was the first experiment, the next was carried out in a hospital linked to a University and whose staff had heard of the experiment, but doubted that such an error could occur at their center. Rosenhan and her team informed staff that at some point (over the next three months) one or more pseudo patients would attempt to be admitted to the psychiatric hospital.

During those months, 193 people tried to be admitted and the hospital identified 41 as possible pseudo patients. The income rate dropped in those three months. Rosenhan had not sent anyone and interpreted the result as just another sample of how inaccurate the psychiatric diagnostic system was.

In his article ScienceRosenhan explains that all the pseudo-patients felt a deep sense of dehumanization and pointed out how difficult it was to get rid of such stigmatizing diagnoses as these. According to the descriptions of his team, although the staff seemed to have good will, the violation of privacy, abuse (sometimes even physical) and depersonalization were common in psychiatry at the time. However, the experiment leaves a lot to be desired.

Rosenhan's problems

Actually, and although it is one of the most used experiments against psychiatry, the truth is that it is not too solid. As Jussim (2017) pointed out, we are talking about an experiment with a very small sample of people who went to the doctor claiming symptoms that, according to current knowledge, were closely linked to psychosis and schizophrenia. In addition, most of the pseudo-patients (who remember, they had voluntarily come to be admitted) remained two weeks in the centers being treated.

Actually, as soon as we think about what psychiatrists should have done we see that it is not unreasonable. Seymour S. Kety in his criticism of Rosenhan's study commented that

"If I drank a liter of blood and went to the emergency room of any hospital to vomit it, the behavior of the staff would be quite predictable: if I was labeled and treated as if I had a bleeding peptic ulcer, I doubt if I could convincingly argue that Medicine does not know how to diagnose that condition. "

And he was quite right. Psychiatry, unlike other branches of medicine, cannot resort to other tests to confirm different diseases.Is two weeks of monitoring to people who had explained having symptoms widely related to existential crises and who had come voluntarily too long? Isn't the diagnosis of "schizophrenia in remission" justified when at the time that meant "the patient shows no signs of the disease"? (Jussim, 2017)

Another important aspect is that during the second experiment (that of the false impostors) the only reasonable conclusions with the figures that Rosenhan gives indicate that the methods of the time were 94% accurate (Jussim, 2017). Needless to say, 94% is not a bad number for the time we are talking about.

I do not mean that the psychiatric system worked well: it did not. It was a real nonsense and practically all the countries in the world. For a time, I collected stories from Spanish psychiatrists from before the 80s and they were really wild. In that regard, Rosenhan was a key study in breaking the status quo and alleviating much suffering. Although, as is often the case with activism, it was an unfair study: it is not a study that can still be used today as if it were a valid argument. We know it is not.

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