Rosenhan (1973)

12 hospitals, 8 pseudo-patients – all sane people (including Rosenhan himself)

5 men and 3 women – psychology graduate in his 20s, three psychologists, a paediatrician, a psychiatrist, a painter, and a housewife.

Once in the hospitals the pseudo-patients became participant observers

The participants were the psychiatrists, doctors, nurses and other members of staff – genuine patients also became participants

All researchers used fake names, and those in the mental health professions also used fake occupations. No other alterations of a person, history or circumstances were made.

Relationships with people in their lives were described as they were or had been. Frustrations and upsets were described along with joys and satisfaction.

The presence of the pseudo-patients and the nature of the research program were not known to hospital staff. However, Rosenhan’s presence was known to the hospital administrator and chief psychologist.

Pseudo-patients arranged appointments with the hospitals, reporting that they had been hearing voices which were unclear, unfamiliar, of the same sex as themselves, and said ‘empty’, ‘hollow’, and ’thud. Once admitted, pseudo-patients immediately behaved normally. When asked by staff how they were feeling, they indicated that they were fine and that they no longer experienced symptoms.

Researchers observed the behaviour of staff and genuine patients and recorded their observations in a note book. Initially, this was done ‘secretly’, but it soon became clear that no one cared, and were later written in public.

A young lady approached individual faculty members who seemed to be walking to a meeting or teaching engagement. She asked them 6 questions.

When the findings were published, a research and teaching hospital doubted that such an error could occur in their hospital.

Rosenhan warned them that one or more pseudo-patients would present themselves over the next 3 months.

None were sent.

Each member of staff was asked to rate each patient who arrived at admissions according to the likelihood they were pseudo. A 10 point scale was used, with one and reflecting high confidence that the patient was not genuine.

All the pseudo-patients were admitted, and remained there for between 8 – 52 days. 7/8 pseudos were diagnosed as schizophrenic, the other as manic-depressive (bipolar). When discharged, the pseudos left with the diagnosis of ‘schizophrenic in remission’.

None of the staff asked about the patients writing notes, and just assumes the behaviour was part of their illness, even making comments in their records ‘patient engages in writing behaviour’. Other behaviour was misinterpreted – pacing corridors through boredom = anxiety, queuing early for lunch = a characteristic of the oral-acquisitive nature of their syndrome.

If someone has been labelled insane, those behaviours will be perceived in a totally different way because the label distorts the interpretation of even the most normal activity or event.

One of the pseudo-patients talked about his childhood and family which seemed to be a typical example of how individuals experience changes in relationships with parents as they grow up. The case notes of this particular pseudo talked about him having a ‘long history of considerable ambivalence in close relationships, which begins in early childhood’. 

Pseudo-patients’ visitors said they saw no changes in their behaviour as a result of being hospitalised.

Many real patients detected the pseudo-patients’ sanity – 35/118 genuine patients voiced suspicions in the first 3 hospitalisations recognising they were fakes.

2100 pills were handed out to the pseudo-patients, all but two were flushed down the toilet. As long as the behaviour of the patients was acceptable whilst on the wards, such as actions were not noticed.

Personal hygiene and waste evacuation were often monitored. Many water closets has no doors.

Their movements were watched and restricted, they had virtually no contact with staff. They also suffered from a minimum of personal privacy – some hospitals had no toilet doors, some examinations were conducted in semi-public rooms, and on one occasion a nurse was observed adjusting her bra in full view of the patients.

There were instances of serious physical abuse to patients. Sometimes these were observed by other patients, who were presumably considered to be irrelevant, but such instances of abuse of power were immediately stopped when another member of staff appeared.