In 1973, psychologist David Rosenhan wanted to determine how accurate psychiatric diagnosis was in mental institutions. To this end, he conducted an experiment titled “On being sane in insane places”, which included two parts.
In the first part of the experiment, he involved 8 mentally healthy associates, also known throughout the experiment as ‘pseudopatients’, who claimed to experience auditory hallucinations, in order to be admitted into 12 different psychiatric hospitals. Once in, they would simply act normally, telling the nurses and doctors that their hallucinations were gone and that they felt perfectly fine. After spending an average of 19 days in the hospital, and after they were forced to admit to having a mental disorder and agree to take anti-psychotic medication, the pseudopatients were released. With the exception of one, they were all diagnosed with schizophrenia ‘in remission’.
The second part of the Rosenhan experiment, involved a rather upset hospital administrator, who took offence at the first part of the experiment. He launched a challenge towards Rosenhan, to send his pseudopatients to his hospital, with the addition that his staff would be more than capable of ‘detecting’ the fake patients. Rosenhan agreed to the challenge. In the next few weeks, of the 193 patients of the mental facility, 41 were identified as potential pseudopatients, 19 of which were also suspected by at least one psychiatrist as faking their illnesses. In reality, Rosenhan had sent no one to the hospital.
David Rosenhan concluded that it was clear that one cannot distinguish the sane patients from the insane ones inside a mental institution. The study brought to light the dangers of dehumanization inside psychiatric hospitals. The conclusions of this experiment also suggested that the psychiatric institutions should focus more on specific issues and behaviors, as opposed to psychiatric labels. Despite this, the experiment received a lot of criticism, even being called pseudoscience.
Rosenhan’s findings were published in ‘Science’ and it criticized the validity of psychiatric diagnosis. More so, he also described the patient care experience of his ‘pseudopatients’ as being demeaning. This article generated a lot of controversy. Psychiatry defenders argued that a psychiatric diagnosis is based largely on what the patient reports, his experiences and feelings. Faking mental illnesses proves the reliability of psychiatric diagnosis, as much as faking medical symptoms would prove the reliability of the medical diagnosis.
Despite the controversy, Rosenhan’s experiment accelerated the mental facilities’ reform and the deinstitutionalization of patients, in which the long-term psychiatric hospitals were replaced with community mental health services, which were less isolated. This reduced the population of a mental institution, shortened stays and, more importantly, eliminated the maladaptive behaviors.