Thinking back on Rosenhan

Psychology has a difficult time with scientific methodology.  The Diagnostic and Statistical Manual – the bible for diagnosing mental illness, personality disorders, etc. is a document where consensus has been important.  The ed psych folks – with IQ tests and the g factor –  do tend to have a record of replicable research.  It’s hard to do science when everything is a case study – Psychologist Hans Eysenck termed Freud as “a genius, not of science, but of propaganda, not of rigorous proof, but of persuasion, not of the design of experiments, but of literary art.”  I have to give them credit – doing science at the individual level is challenging.  So I’m looking back to 1973, when Rosenhan published “On Being Sane in Insane Places.”  The whole article is worth reading.

The summary:

  • Between 1969 and 1972, Prof. David Rosenhan, a psychiatrist at Stanford University, sent eight pseudo-patients to 12 psychiatric hospitals without revealing this to the staff. None of the pseudo-patients had any symptoms or history of mental disorders.
  • In all 12 instances, pseudo-patients were diagnosed with a mental disorder and hospitalised. In no instance was the misdiagnosis discovered during hospitalisation.
  • In some of the 12 hospital stays, pseudo-patients observed significant deficits in patient-staff contact.
  • In a follow-up study at one hospital, Prof. Rosenhan asked staff to rate patients seeking admission on a 10-point scale, from “highly likely to be a (healthy) pseudo-patient” (1 or 2) to “least likely to be a pseudo-patient.” Staff were aware of the previous study, and told one or more pseudo-patients would be sent their way, unannounced. Forty-one (21.24%) of 193 patients received a 1 or 2 score. No pseudo-patients were, in fact, sent.
  • These findings provided convincing evidence against the accuracy and validity of psychiatric diagnoses.
  • The current state of psychiatric diagnoses is still broadly at odds with recent neurological findings, leading to uncertainty regarding their accuracy. A number of interventions are proposed or underway to correct this. None counts with widespread support yet.

There’s a good read between the summary and Rosenhan’s conclusion:

It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals. The hospital itself imposes a special environment in which the meanings of behaviour can easily be misunderstood.

Rosenhan 1973, p. 257

Years ago, reading Rosenhan convinced me that psychologists may not have the answers – but with his death, and the anonymity of his “pseudo-patients”, his study is hard to falsify too.

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