On Being Sane in Insane Places

“On Being Sane in Insane Places” refers to a controversial study conducted by Stanford professor David Rosenhan in 1973. In this study, Rosenhan examined how pseudo-patients faking mental illness were treated within psychiatric hospitals once they gained admission and then acted “sane.” Specifically, eight pseudo-patients sought treatment from 12 psychiatric hospitals around the country, claiming they heard voices. Of the 12 cases, 11 were diagnosed as schizophrenic, and one case was diagnosed as manic-depressive with psychosis. Once admitted to the hospital, Rosenhan instructed pseudo-patients to act completely normal and report a cessation of their symptoms to see if providers would notice if either they were sane or how long it would take to be discharged. All pseudo-patients went undetected as “sane” by treatment staff and were kept in the hospitals for an average of 19 days, with some kept up to 52 days. Additionally, discharged patients were labeled as having schizophrenia-in-remission, versus being labeled “sane.” Based on these findings, Rosenhan (1973) concluded that we “cannot distinguish the sane from the insane in psychiatric hospitals” (p. 257).

While this study used an extremely small sample, it had a lasting impact on how society viewed the treatment and rights of the mentally ill. Specifically, the study allegedly contributed to movements such as deinstitutionalization, anti-psychiatry, and awareness of patient rights. However, critics argue that Rosenhan’s 1973 study had a negative impact on the mental health community, calling it "pseudoscience" and blaming it for being part of the reason that there are now too few psychiatric institutions for patients to receive help. Additionally, further research into Rosenhan’s 1973 study called his methodologies into question. For example, author Susan Calahan found that one pseudo-patient was excluded from the study becaue they reported being treated well by hospital staff. Other critics note skepticism of findings, such as Rosenhan (1973) reporting that patients were discharged with the label “schizophrenia in remission”. According to Spitzer's own research (1973), hospitals rarely gave this diagnosis. Despite rampant criticism of this study, it remains notable in sparking the conversation on how we as a country and healthcare system treat the mentally ill.

**Further Reading:**

1. Calahan, S. (2019). *The great pretender: The undercover mission that changed our understanding of madness.* Grand Central Publishing.
2. Appel, J. (2019, March 7). *At Psychiatric Emergency Rooms, Fake Patients Take a Heavy Toll*. Undark Magazine. https://undark.org/2019/03/07/the-malingering-pandemic/

1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Rosenhan, D.L. (1973). On being sane in insane places. *Science, 179*(4070), 250-258. DOI: 10.1126/science.179.4070.250.
2. ↑ 2.0 2.1 2.2 2.3 2.4 Schaub, M. (2019, November 4). *‘The Great Pretender’ seeks the truth about ‘On Being Sane in Insane Places.’* NPR. https://www.npr.org/2019/11/04/776036170/the-great-pretender-seeks-the-truth-about-on-being-sane-in-insane-places.
3. ↑ 3.0 3.1 3.2 Spitzer, R.L. (1975). On pseudoscience in science, logic in remission, and psychiatric diagnosis: A critique of Rosenhan's "On Being Sane in Insane Places." *Journal of Abnormal Psychology, 84*(5), 442-452. https://doi.org/10.1037/h0077124.
Discussion Questions:

1. What impact do you believe this had on psychiatric hospitals? Do you believe this actually had effect on how little hospitals there are today?
2. What are some possible negative side effects that the pseudo patients could have walked away with after this study was conducted?
3. If you were to replicate this study, how could you make it ethical?