This article presents a summary of Rosenhan’s famous experiment of pseudopatients in a mental health institution.
Table of Contents
Bibliography
Rosenhan, D. L. (1973). On being sane in insane places. Science, 179(4070), 250–258. https://doi.org/10.1126/science.179.4070.250
Debates in mental health
“However much we may be personally convinced that we can tell the normal from the abnormal, the evidence is simply not compelling.” (p.250)
One of the ideas addressed in the paper is to discuss how sanity and insanity are defined. How people responded to patients in the mental health institution reflected that even ‘normal’ behaviour such as writing in the notebook or just waiting for food was considered abnormal because patients were already diagnosed and institutionalised. This raises a key question of whether what is normal is based on the behaviour or on the environment. “.. do the salient characteristics that lead to diagnoses reside in the patients themselves or in he environments and contexts in which observers find them?” (p. 251)
Another debate addressed by the paper is that of universalism vs cultural relativism. Rosenhan argues that there is no specific definition of sanity. “Finally, as early as 1934 Benedict suggested that normality and abnormality are not universal (2) What is viewed as normal in one culture may be seen as quite aberrant in another. Thus notions of normality and abnormality may not be quite as accurate as people believe they are.” (p. 250) This indicates that there may be errors in diagnosis.
Diagnosis, Symptoms and the striking resemblance to Existential Quest
Pseudopatients in the study reported hallucinating and hearing voices that were unclear but could be deciphered to say “empty”, “hollow”, “thud”. “The choice of these symptoms was occasioned by their apparent similarity to existential symptoms. Such symptoms are alleged to arise from painful concerns about the perceived meaninglessness of one’s life.” (p.251) Yet, in the institutions, they were refereed to as diagnosable symptoms of halluciantion and schizophrenia.
Mental illness and labels
Patients could recognise pseudopatients as sane or normal whereas the staff did not.
Staff and physicians are more likely to work with type 2 error (false positive) or call a healthy person sick. This is equally true for medical illness but there is no stigma attached to medical illness which is accorded to mental illness.
Labelling is in fact irreversible in mental illness. Once a pseudopatient is diagnosed, it is not possible to remove the tag from the person. This tag of a specific mental illness will alter other’s perception of him.
[[empathy in teachers]]
The study showed that when pseudo patients initiated conversations, most psychiatrists and internists chose to not respond. However, university faculty members responded to 100% of the questions and queries irrespective of how hurried and busy they were.
This indicates that teachers in their training and profession are seen to be more expressive in their concern towards patients than trained doctors.
“The general degree of cooperative responses is considerably higher for these university groups than it was for pseudopatients in psychiatric hospitals.” (p. 255)
Power, Hierarchies and Mental Illness
Hierarchies in the institutions displayed a great degree of power assertion and powerlessness by those in position of authority and those who were considered mentally ill. In many instances, pseudopatients observed staff misbehaving or meting out excessive punishments to the patients in the psychiatric institution. The presence of another staff member reduced such abusive behaviour. Rosenhan writes, “Staff are credible witnesses. Patients are not.” (p. 256) In other words, should a patient have dared to complain against the staff, his word would not be taken seriously and not invite any action. The study also reports that the staff spoke about patients in front of them but without acknowledging their presence.
Depesonalisation of Patients during treatment
What causes depersonalisation? This is as true for the pseudopatients in the study as for the sane in the outside world. People’s attitudes towards others makes them treat them as sub human.
“First, are attitudes held by all of us toward the mentally ill-including those who treat them-attitudes characterized by fear, distrust, and horrible expectations on the one hand, and benevolent intentions on the other. Our ambivalence leads, in this instance as in others, to avoidance. Second, and not entirely separate, the hierarchical structure of the psychiatric hospital facilitates depersonalization. Those who are at the top have least to do with patients, and their behavior inspires the rest of the staff.” (p.256)
Concluding Remarks
The classic research study is insightful and the follow up study also is a strong indication of the validity of the data. Rosenhan subsequently informed hospitals that he would send a group of pseudopatients to institutions. On the declared days, staff and doctors diagnosed far fewer people with mental illnesses than on other days. They were also able to identify specific people as pseudopatients. Where as Rosenhan, had in fact, sent none.
So much for diagnosis!