“On Being Sane in Insane Places”

1972

David L. Rosenhan (1929–2012)

I have never received a psychiatric diagnosis or had a history of mental illness. Yet when I show up at the psychiatric hospital admissions office, reporting that I am hearing voices saying words like “empty,” “hollow,” and “thud,” I am admitted with a diagnosis of schizophrenia, a serious mental illness marked by a break with reality.

This was the ruse used by psychologist David Rosenhan and seven colleagues to gain admission to psychiatric hospitals. His aim was to study what happens when sane people are placed in places reserved for the insane: can the sane be distinguished from those who have been diagnosed as mentally ill?

Rosenhan’s group consisted of three psychologists, a painter, a housewife, a pediatrician, a psychiatrist, and a graduate student. They were admitted to twelve different mental hospitals without questioning, and they were prescribed medications, which they did not take. When their case histories were taken, they told the truth. Once admitted, they acted completely normal, just as they did in everyday life outside the institution. They were never detected as frauds by the psychiatrists or nurses, though many of their fellow patients did suspect them. All the pseudopatients were eventually discharged, but only after they “accepted” their diagnosis.

After this study was published, in 1972, Rosenhan did a comparative study in which a hospital was told that over the following three months, a pseudopatient would attempt to be admitted. Out of 193 admissions, eighty-five were suspected of being pseudopatients. None was.

The study aroused considerable controversy and incurred attempts to discredit it by the psychiatric profession. Rosenhan argued that the ambiguity and imprecision of psychiatric diagnoses held long-lasting and negative consequences for those diagnosed. It was especially harmful since it was clear that in many cases, mental health professionals could not distinguish the sane from the insane.

SEE ALSO American Classification of Mental Disorders (1918), The Presentation of Self in Everyday Life (1959), Women and Madness (1972), DSM-III (1980)

Saint Elizabeth’s psychiatric hospital in Washington, D.C., is one site where the Rosenhan experiment occurred.