Stanford professor who changed America with just one study was also a liar. Susan Cahalan. NY Post, Nov 2 2019. https://nypost.com/2019/11/02/stanford-professor-who-changed-america-with-just-one-study-was-also-a-liar/
About Stanford psychology and law professor David Rosenhan and his work
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His research work was also groundbreaking. In 1973, Rosenhan published the paper “On Being Sane in Insane Places” in the prestigious journal Science, and it was a sensation. The study, in which eight healthy volunteers went undercover as “pseudopatients” in 12 psychiatric hospitals across the country, discovered harrowing conditions that led to national outrage. His findings helped expedite the widespread closure of psychiatric institutions across the country, changing mental-health care in the US forever.
Fifty years later, I tried to find out how Rosenhan had convinced his subjects to go undercover as psychiatric patients and discovered a whole lot more. Yes, Rosenhan had charm. He had charisma. He had chutzpah to spare. And, as I eventually uncovered, he was also not what he appeared to be.
I stumbled across Rosenhan and his study six years ago while on a book tour for my memoir “Brain on Fire,” which chronicled my experiences with a dangerous misdiagnosis, when doctors believed that my autoimmune disorder was a serious mental illness. After my talk, a psychologist and researcher suggested that I could be considered a “modern-day pseudopatient” from Rosenhan’s famous study.
Rosenhan’s eight healthy pseudopatients allegedly each followed the same script to gain admittance to psychiatric hospitals around the country. They each told doctors that they heard voices that said, “Thud, empty, hollow.” Based on this one symptom alone, the study claimed, all of the pseudopatients were diagnosed with a mental illness — mostly schizophrenia.
And once they were labeled with a mental illness, it became impossible to prove otherwise. All eight were kept hospitalized for an average of 19 days — with the longest staying an unimaginable 52. They each left “against medical advice,” meaning the doctors believed that they were too sick to leave. A total of 2,100 pills — serious psychiatric drugs — were reportedly prescribed to these otherwise healthy individuals.
At the time, the collective American imagination was deeply suspicious of psychiatry and its institutions. It was the era of Ken Kesey’s “One Flew Over the Cuckoo’s Nest” and movies like “Shock Corridor” and “The Snake Pit.” Rosenhan — who was both an insider who studied abnormal psychology, and an outsider who was a psychologist rather than a psychiatrist — was the perfect person to pull back the curtain on psychiatry’s secrets.
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“It all started out as a dare,” Rosenhan told a local newspaper. “I was teaching psychology at Swarthmore College, and my students were saying that the course was too conceptual and abstract. So I said, ‘OK, if you really want to know what mental patients are like, become mental patients.’ ”
Soon after that, Rosenhan went undercover for nine days at Haverford State Hospital in Haverford, Pa., in February 1969. His diary and book describe a host of indignities: soiled bathrooms without doors, inedible food, sheer boredom and ennui, rank disregard by the staff and doctors. Rosenhan even witnessed an attendant sexually assault one of the more disturbed patients. The only time when Rosenhan was truly “seen” as a human by the staff was when an attendant mistook him for a doctor.
The experience was harrowing. After nine days he pushed for a release and made sure that his undergraduate students — who were planning to follow him as undercover patients into the hospital — would not be allowed to go. Colleagues described a shaken, changed man after his experience.
I dug deeper. If his own students were forbidden from pursuing the experiment after this dismaying event, who were the others who had willingly followed in Rosenhan’s footsteps? Why did they put their mental health — even their lives — on the line for this experiment?
The further I explored, the greater my concerns. With the exception of one paper defending “On Being Sane in Insane Places,” Rosenhan never again published any studies on psychiatric hospitalization, even though this subject made him an international success.
He had also landed a lucrative book deal and had even written eight chapters, well over a hundred pages of it. But then Rosenhan suddenly refused to turn over the manuscript. Seven years later his publisher sued him to return his advance. Why would he have given up on the subject that made him famous?
I also started to uncover serious inconsistencies between the documents I had found and the paper Rosenhan published in Science. For example, Rosenhan’s medical record during his undercover stay at Haverford found that he had not, as he had written in his published paper, only exhibited one symptom of “thud, empty, hollow.” Instead, he had told doctors that he put a “copper pot” up to his ears to drown out the noises and that he had been suicidal. This was a far more severe — and legitimately concerning — description of his illness than he had portrayed in his paper.
Meanwhile, I looked for the seven other pseudopatients and spent the next months of my life chasing ghosts. I hunted down rumors, pursuing one dead end after the next. I even hired a private detective, who got no further than I had.
After years of searching, I found only one pseudopatient who participated in the study and whose experience matched that of Rosenhan: Bill Underwood, who’d been a Stanford graduate student at the time.
The only other participant I discovered, Harry Lando, had a vastly different take. Lando had summed up his 19-day hospitalization at the US Public Health Service Hospital in San Francisco in one word: “positive.”
Even though he too was misdiagnosed with schizophrenia, Lando felt it was a healing environment that helped people get better.
“The hospital seemed to have a calming effect. Someone might come in agitated and then fairly quickly they would tend to calm down. It was a benign environment,” Lando, now a psychology professor at the University of Minnesota, recalled in an interview.
But instead of incorporating Lando into the study, Rosenhan dropped him from it.
Lando felt it was pretty obvious what had happened, and I agree: His data — the overall positive experience of his hospitalization — didn’t match Rosenhan’s thesis that institutions are uncaring, ineffective and even harmful places, and so they were discarded.
“Rosenhan was interested in diagnosis, and that’s fine, but you’ve got to respect and accept the data, even if the data are not supportive of your preconceptions,” Lando told me.
Rosenhan, I began to realize, may have been the ultimate unreliable narrator. And I believe it’s possible some of the other pseudopatients he mentioned in his study never existed at all.
As a result, I am now seriously questioning a study I had once admired and had originally planned to celebrate. In my new book “The Great Pretender” (Grand Central Publishing), out this week, I paint the picture of a brilliant but flawed psychologist who is likely also a fabulist.
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Psychologist Peter Gray told me that he sees the work of researchers such as Zimbardo and Rosenhan as prime examples of studies that “fit our biases … There is a kind of desire to expose the problems of society but in the process cut corners or even make up data.”
This may explain Rosenhan. He saw real problems in society: The country was warehousing very sick people in horror houses pretending to be hospitals, our diagnostic systems were flawed and psychiatrists in many ways had too much power — and very little substance. He saw how psychiatric labels degraded people and how doctors see patients through the prism of their mental illness. All of this was true. In many ways, it is still true.
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Check also Pseudopatient or pseudoscience: a reviewer's perspective. Mark Zimmerman. Journal of Nervous & Mental Disease 193(11):740-2, December 2005. https://www.researchgate.net/publication/7506090
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