How has the Rosenhan Experiment advanced the discipline of Psychology (Past Academic Essay)

The following essay was written whilst I was a student attending Northumbria University between 2021-23. The question asked was to choose any one ‘classic’ study [in which I chose the Rosenhan experiment] and show how it has both advanced the discipline of Psychology in comparison to work published previously; in addition to how it has made a contribution to work that was subsequently published. The question also stated that "In cases where some seminal studies might not have sufficient literature preceding them, you might focus on the historical, social or cultural forces that shaped the ideas enshrined in the classical study. Although you are not required to have an even (50-50) split between the ‘before and ‘after’ sections, the balance between the two sections should not be skewed towards either one of those sections beyond a 30-70 or 70-30 split."

What distinguishes the sane from the insane? A sane person is considered reasonable or sensible, whereas someone who is insane is considered to be in a state of mind that prevents normal perception, behaviour, or social interaction. However, what is the borderline between the two? When does someone cross from being sane to being insane? And who has the authority to define such a state?

Between 1969 and 1972, Professor David Rosenhan created the Rosenhan Experiment. This experiment aimed to find whether 'the sane can be distinguished from the insane (and whether degrees of insanity can be distinguished from each other)' to show that the environments and contexts in which observers find the patients are more likely to create a diagnosis than the characteristics of the person themselves. (Rosenhan, D. L., 1973) Rosenhan's study was published in a time of extreme scepticism that was aimed at psychiatry. His study 'provided support for the growing anti-psychiatry movement and was used to justify a trend toward deinstitutionalisation'. (Cahalan, S., 2022)

The experiment had eight pseudo-patients sent to twelve psychiatric hospitals without informing the staff that they were not actual patients. Each of the patients had no symptoms or any history of psychiatric disorders. The pseudo- patients were diagnosed with psychiatric disorders and hospitalised for treatment in all twelve cases. It was never once assumed that the patients may have been misdiagnosed throughout treatment. Later, Prof. Rosenhan conducted a follow-up study where he revealed what had occurred in the first study to the staff. He then asked the staff members to rate the patients seeking admission on a 10-point scale, with "10" being very likely to be a pseudo patient and "1" being very unlikely to be a pseudo-patient. Staff rated 41 of the patients out of 193 to have a score of 1-2, but no pseudo-patients had been sent. This classic study provided convincing evidence against the accuracy and validity of psychiatric diagnoses. This study was then published in 1973. 

Prior to the publication of Rosenhan's experiment in 1973, the most significant psychological influence was the 1900's publications of Sigmund Freud and his Interpretation of Dreams. Freud believed that dreams ‘allow people to express unconscious wishes they find unacceptable in real life’. (SparkNotes. 2022) According to Freud, all dreams had hidden meanings that were a symbolic representation of human desires. After this, The British Psychological Society was established in 1901, which grouped psychologists and made Psychology an accredited practice within Britain. In 1906, Ivan Pavlov published a study on classical conditioning, where he trained animals into an unconscious learning state using associations between an unconditioned stimulus and a neutral stimulus. (Wolpe J, Plaud JJ., 1997)

In 1913, Carl Jung challenged Freud's studies by developing his theory of analytical psychology. In this same year, John B. Watson published his conception of behaviourism, which had the goal of determining the prediction and control of behaviour. Then in 1920, Watson and Rosalie Rayner published research on classical conditioning of fear with their subject, Little Albert. This study aimed to condition Little Albert to associate a rat with loud noises, thus associating an animal with fear. This showed that fears might be based on other extenuating circumstances. 

In 1942, Carl Rogers developed the practice of client-centred therapy, which encouraged respect for patients. In 1952 the first Diagnostic and Statistical Manual of Mental Disorders was published, allowing psychiatrists and psychologists to diagnose their patients. Then in 1954, Abraham Maslow published "Motivation and Personality," describing his theory of a hierarchy of needs. This study showed that humans are more satisfied when higher up in the hierarchy of needs. This meant that they had the basic needs at the bottom of the hierarchy, such as food and clothing, but they also had safety by having jobs, love and belonging, esteem, and self-actualisation. 

This information shows that prior to the Rosenhan experiment, the accuracy of diagnoses was never brought into question. There were many resources to make diagnoses of patients. However, there was no question whether the diagnoses were valid or not. 

Four decades after the publication of the Rosenhan experiment, it is still taught in the majority of introductory psychology courses. The Rosenhan study advanced psychology because it disputed the published edition of the first Diagnostic and Statistical Manual of Mental Disorders. The Rosenhan study 'is considered an essential and influential criticism of psychiatric diagnosis as it showed that there was a problem within the psychiatric hospitals where patients were being misdiagnosed and mistreated. (Kchessler. 2022)

Most importantly, Rosenhan identified the issue of labelling and how it can negatively impact an individual's health. He proved that it is not difficult to be diagnosed as mentally ill but that it is tough to discard that diagnosis and its meanings about the individual. In other words, if someone has been diagnosed with schizophrenia because of their symptoms, then it creates an identity for them. They must follow through with their symptoms; it is no longer an illness but a personality.

This theory may have influenced one example of Dialectical Behavioural Therapy (DBT). DBT focuses on individuals with personality disorders, but others are encouraged to try the techniques. This type of therapy concentrates on the behaviours of individuals rather than the diagnosis itself because it will allow the person to enter remission and weaken those behaviours. It teaches individuals to act appropriately during arguments, regulate emotions, and be aware of the present moment. This type of therapy has been regarded as one of the 'most effective therapy for individuals struggling with 'self-harm behaviours like cutting and chronic suicidal ideation' and 'sexual trauma survivors'. (4 Differences Between CBT and DBT..., 2022)

The Rosenhan experiment destigmatises mental illness, not to include labelling individuals with negative connotations; for example, if someone is labelled with Histrionic Personality Disorder, they are typically seen as attention-seeking, so they may be disregarded when entering a medical setting. Whereas if there was a focus on the symptoms rather than the label, professionals might be more open to listening to them and treating them more effectively. 

The Rosenhan experiment inspired many new studies and reviews that were subsequently published. One example would be the BBC study on mental illness and social stigma. The BBC produced a program in November 2008 inspired by Rosenhan's experiment, which explored the 'relationship between character traits and mental illness and considers the social implications of an inaccurate diagnosis of the latter'. (Progler Y., 2009) This used ten volunteers, five of whom were previously diagnosed with psychiatric disorders. They also recruited a psychiatrist, a professor of clinical psychology, and a psychiatric nurse. Each of the recruited participants had no prior knowledge about one another before the study took place. 

This study aimed to acknowledge six types of mental illness, including 'depression, social anxiety disorder, schizophrenia, obsessive-compulsive disorder, bipolar disorder and the eating disorders anorexia and bulimia’. (ibid., Progler Y., 2009) The first three tasks returned inconclusively, but by the end of the fourth task, the psychiatric professionals declared that 'none of the volunteers indicates the classic signs of depression’. (ibid., Progler Y., 2009) After the fifth task, the professionals correctly identified a volunteer with OCD based on their observations of how they handled a cleaning task. However, the professionals were incorrect in selecting another volunteer they diagnosed incorrectly. Later in the study, the professionals also diagnosed three other individuals, which were incorrect. These included a diagnosis of Bipolar Disorder and Schizophrenia. This only supports Rosenhan's argument that diagnoses can be incorrect and have the potential to stigmatise an individual, causing many more problems within their life. 

Another publication inspired by Rosenhan was a review produced by Theodore Millon. In Millon's Reflections on Rosenhan's "On being sane in insane places," there is an argument that Rosenhan's experiment is seriously flawed and the 'nosological alternative he proposes is logically deficient’. (Millon, T., 1975) This paper points out the weakness of Rosenhan's study design and methodology and disputes Rosenhan's assumptions underlying his proposal. Later in his review, Millon described Rosenhan's work as 'faulty and careless'. (ibid., Millon, T., 1975)

Firstly is the methodology; Rosenhan claims it is impossible to distinguish between mentally sane individuals and mentally insane individuals within psychiatric hospitals. Millon explains how the term 'insane' ultimately diminishes Rosenhan's entire hypothesis as it is a diagnostic term. Aside from this, the place where the experiment took place was not a controlled environment, and it is strongly suggested that the mentally ill patients may have influenced the mentally sane individuals to pursue a diagnosis actively. In addition to this, the fact that they were placed within an institution would have affected the behaviour of individuals. They would have had to ask for grounds privileges, food, and bathing. Whether the individual was cooperative or not, these influences would have influenced their behaviours and made them appear more mentally unwell than they were. 

Millon also criticised Rosenhan's study design as the individuals would not have been admitted to a psychiatric facility in their current state. They did not display symptoms of mental illness and would have been turned away as sane. Millon explains how the experiment may have been more compelling if he had introduced new clinicians to a psychiatric facility and requested them to diagnose each patient with no prior knowledge.

Regardless of all of this knowledge, psychiatrists still aim to diagnose patients whilst in care facilities to provide them with the most appropriate support. If an individual has a diagnosis of schizoaffective disorder, it would be most appropriate to provide them with mood stabilisers, antipsychotics, and therapy, whereas mood stabilisers may not be necessary if someone has a diagnosis of schizophrenia. This shows that a diagnosis is sometimes still appropriate, and the fact that diagnoses are still given to this day shows that Rosenhan failed in his efforts to abolish this practice altogether. 

In conclusion, where is the line drawn between the sane and the insane? Prof. Rosenhan would say that there is no line between sanity and insanity, there is merely differing symptoms on a broad spectrum of sanity. The Rosenhan experiment has contributed to psychology in destigmatising mental illness. The study has its faults in its conduct, but its message is still highly relevant in our society. Mental illness should not be a label that segregates the sane from the insane, and it should be a list of behaviours that the individual can work on and overcome so that they can still live a productive and fulfilling life. 

Referenced

• Cahalan, S. (n.d.). The Rosenhan Experiment. New Scientist. Retrieved March 7, 2022, from https://www.newscientist.com/definition/the-rosenhan-experiment/ 

• Kchessler. (n.d.). Abnormal psychology. Lumen. Retrieved March 7, 2022, from https://courses.lumenlearning.com/hvcc-abnormalpsychology/chapter/real-stories/

• Millon, T. (1975). Reflections on Rosenhan's "On being sane in insane places." Journal of Abnormal Psychology, 84(5), 456–461. https://doi.org/10.1037/h0077120

• Progler Y. (2009). Mental illness and social stigma: notes on "How Mad Are You?". Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 14(5), 331–334.

• Rosenhan, D. L. (1973). On being sane in insane places. Science, 179(4070)

• SparkNotes. (n.d.). States of Consciousness. Sparknotes. Retrieved March 7, 2022, from https://www.sparknotes.com/psychology/psych101/consciousness/section3/ 

• Wolpe J, Plaud JJ. Pavlov's contributions to behavior therapy. The obvious and not so obvious. Am Psychol. 1997;52(9):966-72.

• 4 Differences Between CBT and DBT and How to Tell Which is Right for You | Skyland Trail. Retrieved 7 March 2022, from https://www.skylandtrail.org/4-differences-between-cbt-and-dbt-and-how-to-tell-which-is-right-for-you/

To cite this:

Article Title:
Author:	Mx. R.J. Gittins
Publisher:	SheThinkDifferent (The Unseen Spectrum)
Date Written:	Spring 2022
Date Published:	August 2024