Dr. Gavin Francis writes in the New York Review of Books:
David Rosenhan’s “On Being Sane in Insane Places,” published in Science in 1973.
Eight researchers, including Rosenhan, presented themselves at twelve psychiatric institutions, complaining that they were hearing indistinct voices, saying “empty,” “thud,” or “hollow”—terms chosen because they had not previously been reported in the literature. All said that they were undistressed by their “symptoms,” but all were admitted. “Immediately upon admission to the psychiatric ward,” reported Rosenhan, “the pseudopatient ceased simulating any symptoms of abnormality.” Eleven of the twelve episodes of admission resulted in a diagnosis of schizophrenia and just one, having been admitted to an expensive private hospital, was given what was then considered a more upmarket diagnosis—manic-depressive psychosis. All asked to be discharged as soon as they arrived on the ward, professing their symptoms gone, but their inpatient stays ranged from nine to fifty-two days (with nineteen days the average). When eventually discharged, the supposedly “schizophrenic” patients were told that their diagnoses were confirmed but that they were now “in remission.” (Aware of how sticky, consequential, and pejorative these labels can be, all had used pseudonyms.)
Rosenhan’s pseudopatients took notes throughout their hospital stays, recording clinician and attendant behavior, and clocking the time staff spent with patients. No clinicians asked to see these notes, or expressed any interest in them. Among the many scorching insights of the study was that the more elevated a clinician was within the hospital hierarchy, the less time he or she spent with patients. Abuse of patients in full view of other patients was routine, but stopped “abruptly” in the presence of other staff. (“Staff are credible witnesses,” Rosenhan wrote. “Patients are not.”) Rosenhan also concluded that fellow patients were better judges of sanity than clinicians. (“You’re not crazy,” he quotes one fellow patient as saying. “You’re a journalist or a professor. You’re checking up on the hospital.”)
