The Rosenhan Study - The Influence of Labels

4 Key excerpts on "The Rosenhan Study - The Influence of Labels"

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  eBook - ePub

  Clinical Psychology: Revisiting the Classic Studies

  • Graham C.L. Davey, Graham C.L. Davey, Author(Authors)
  • 2019(Publication Date)
  • SAGE Publications Ltd

    (Publisher)

  1 Defining ‘Insanity’: Building on Rosenhan (1973)

  Rosenhan, D.L. (1973) On being sane in insane places, Science, 179: 250–8

  Richard P. Bentall

  Background: Psychiatry’s Perfect Storm

  David Rosenhan was not a clinical psychologist and spent most of his academic career at Stanford University working on the interface between psychology and law (he died in 2012; Ross & Kavanagh, 2013). Nonetheless, his 1973 paper ‘On being sane in insane places’, which was published in the prestigious American journal Science, has long been regarded as one of the most controversial studies in the history of psychiatry and clinical psychology, and has been regularly singled out as one of the most influential ever conducted in the field (for example, as one of the 10 greatest psychology experiments ever conducted in Lauren Slater’s (2004) book Opening Skinner’s Box: Great Psychological Experiments of the Twentieth Century, about which more later).

  In the study Rosenhan claimed to show that psychiatrists at that time were unable to distinguish between severe mental illness (insanity) and normal behaviour, a conclusion that has since been contested by many commentators. Certainly, as we will see, both the methodology of the study and Rosenhan’s interpretation of the findings can be challenged. However, without a doubt, and whatever its merits as an experiment, the study has cast a penetrating light on some of the most intractable disputes in the study of mental illness. It was not only the product of a long history of debate and disagreement about the nature of mental illness, it also shaped the way this debate1 developed over the following half century until the present day. That debate cannot be understood without considering the history of psychiatry in the modern period.

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  Revisiting Psychology

  A student's guide to critical thought

  • Jared M. Bartels, William E Herman(Authors)
  • 2018(Publication Date)
  • Bloomsbury Academic

    (Publisher)

  The study that is the focus of this chapter suggested that each of these options (A, B, C, & D) has the potential to color the interpretations of clinicians and nurses in psychiatric facilities to the degree that they cannot recognize normal behavior when they see it. That student in the hallway of the psychology department exhibiting behaviors suggestive of test anxiety is, behind the walls of the psychiatric institution, exhibiting pathological behavior. However, such bold claims demand a closer look at the study from which such conclusions are drawn. Let’s take a look.

  Study background

  David Rosenhan’s view of psychiatry was evident in the title of his celebrated study “On being sane in insane places.” In other words, the psychiatric institution was to blame for mental illness, not the person. In an attempt to investigate life within a mental institution, Rosenhan and seven colleagues gained admission to 12 psychiatric hospitals in the USA. Rosenhan and company (as pseudopatients, but actually researchers) entered the hospitals complaining of voices in their head saying “empty,” “hollow,” and “thud.” The voices or auditory hallucinations were the only symptom they reported. Other than this fictitious symptom and the use of a pseudonym or phony name, the pseudopatients presented their life histories as they actually were – relatively normal. All received a diagnosis of mental illness, and in all but one case the diagnosis was schizophrenia (note the strong interrater reliability in diagnosis here). Once admitted to the institutional setting, the pseudopatients stopped faking the hallucinations and were compliant with staff orders, spent a lot of their time taking notes, and documented their observations at the hospital. Rosenhan (1973) provided several anecdotes about how the pseudopatients were mistreated in the hospitals and how their behavior, even perfectly normal behavior, was now interpreted by staff through the lens of mental illness or psychopathology.

  We now invite you to go back in history to better understand the social/ cultural context of Rosenhan’s research. The early 1970s might be seen as an outgrowth of the powerful events of the 1960s in the USA. The war in Vietnam had intensified and led more and more people to questions such as: Why are we fighting this war? It was not only this war in Southeast Asia that was questioned. The radical nature of this time soon caused people to select other domains that might ameliorate the ills of society. The Civil Rights Movement, Women’s Liberation, prison reform (after the Attica Prison riot/rebellion in 1971), and the Mental Health Movement were just some of the arenas where protests occurred and change was demanded. Within such a milieu and related to the Rosenhan study, we acknowledge the influence of a radical book (banned by some high school libraries) as a key benchmark for this era. This landmark book, One Flew Over the Cuckoo’s Nest

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  Psychoanalysis, Classic Social Psychology and Moral Living

  Let the Conversation Begin

  • Paul Marcus(Author)
  • 2019(Publication Date)
  • Routledge

    (Publisher)

  Also worth mentioning is that psychiatrists, like all of us, have the tendency to assume that others have internal qualities that correspond to their observable behaviors. Such an assumption is often made even when external factors could have influenced behavior. Characterizing someone as having a personality trait, like schizophrenia, that corresponds to his or her observed behavior (e.g., auditory hallucination) is called “correspondent inference.” The idea is that when a correspondent inference follows the initial interpretation of a behavior, it completes a first impression—an initial mental representation (the knowledge-fund an individual has stored in memory) of what the other person is like. This can occur automatically and unconsciously. “Correspondence bias,” the belief that people’s acts reflect their inner qualities rather than situational pressures, have accounted for the unanticipated findings of many of the classic social psychology experiments, like Milgram’s paradoxical finding that ordinary people often obey orders that injure innocent victims. Or in the case of Rosenhan’s study, perfectly normal people were diagnosed and treated as psychotic in a state hospital for an average of nineteen days and were misdiagnosed as “schizophrenic, in remission” when released. The diagnosing psychiatrist and treatment staff assumed that one behavior they observed at admission, the pseudo-patient’s auditory hallucination, must reflect the person’s inner characteristics (i.e., schizophrenia) even though other causative alternatives of the situation might explain the behavior (e.g., the auditory hallucination was a harmless, transient phenomenon; a self-serving fabrication relating to family dynamics; a result of alcohol or drug abuse; organically caused; or from toxic psychosis, which vanished as quickly as it came and was not evident during weeks of hospitalization).

  I have only skimmed the surface of the social psychology research on impression formation and decision-making, but it should be apparent that making a conventional psychiatric diagnosis in an inpatient setting, as in Rosenhan’s study, or in other clinical settings, let alone a credible one, is a very dicey enterprise. There are many criticisms of actual diagnostic practice, specifically of psychiatric classification, the main ones being that diagnostic classes are heterogeneous and they are neither reliable nor valid. In fact, as Barlow and Durand noted in their discussion of the DSM-5 (American Psychiatric Association, 2013), “it has been clear to most professionals involved in this process that an exclusive reliance on discrete diagnostic categories [like in the Rosenhan study] has not achieved its objective in achieving a satisfactory system of nosology” (Barlow & Durand, 2015, p. 95). Moreover, in addition to the problems of comorbidity (the concurrent existence of two chronic diseases or conditions in a patient) and the uncertain boundary between diagnostic categories, “little evidence has emerged validating these categories such as discovering specific underlying causes associated with each category. In fact, not one biological marker, such as a laboratory test, that would clearly distinguish one disorder from another has been discovered” (ibid.).10

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  Medical Power and Social Knowledge

  • Bryan S Turner(Author)
  • 1995(Publication Date)
  • SAGE Publications Ltd

    (Publisher)

  It was, then, not any specific mental state that accounted for Hinckley’s mental hospitalization, but rather his illegal and violent actions in the context of such allegedly delusional dispositions. The labelling of inmates as ‘crazy’ and staff as sane in psychiatric facilities presents us with a further ironic example. An ethnographic study of staff and clients in a community clinic in California (Luske, 1990) pointed out that psychiatric staff orientate themselves to labelled psychotics through ‘reverse role-modelling’ and possess a ‘closet insanity’ which, when expressed, is difficult to differentiate from the experiences of clients. The major difference appeared to be that staff referred to a number of rationalizations that explained their bizarre experiences and beliefs, whereas patients offered few such alibis. Stripped away from the rituals of psychiatric diagnosis, the insanity of the inmates and that of the staff may be, on closer scrutiny, difficult to disentangle. For Luske, the fact that staff and patients inhabit the same world for long stretches of time and are marginalized from the wider contexts of economic activity makes this mirroring all the more probable. Perhaps the most powerful example of the arbitrariness of psychiatric classification is the Rosenhan experiment (Rosenhan, 1973). In an entertaining and engaging prose style in the prestigious journal Science, Rosenhan, a psychologist, reported the results of a study which purported to show that psychiatric staff were incapable of discerning between sanity and insanity. In the experiment, eight ‘pseudopatients’ presented themselves to psychiatric hospitals claiming to be hearing voices that uttered ‘empty’, ‘hollow’ or ‘thud’. All were admitted and after admission immediately ceased fabricating psychiatric symptoms. Most were given a diagnosis of schizophrenia and remained on hospital wards for varying lengths of time until discharged with a diagnosis of schizophrenia ‘in remission’

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