Stanford psychology and law professor David Rosenhan can turn an audience into a packed lecture hall in just a few words.
"What is crazy?", He would ask students, his deep and resonant golden voice building and boom. "What are we here for? Some things will be black … Some will be white. But be prepared for shades of gray. ”
Rosenhan would know. His own life, as I would later understand, was full of gray.
He wasn't particularly attractive – the word often used to describe him was "balding" – but there was something magnetic, even seductive, about
his students called him a gift, describing his ability to "undress a group of two to three hundred students with dynamic lectures filled with sensation and poetry. One student remembered Rosenhan opening one of his lectures while sitting on a student's lap ̵
His research work was also revolutionary. In 1973, Rosenhan published in the prestigious journal Science, Being Healthy in Crazy Places, and it's a sensation. The study, in which eight healthy volunteers went undercover as "pseudo-hospitals" in 12 psychiatric hospitals across the country, found worsening conditions leading to national outrage. His discoveries helped accelerate the widespread incarceration of psychiatric institutions across the country, changing forever the mental health care in the United States.
Fifty years later, I tried to understand how Rosenhan convinced his subjects to go undercover as psychiatric patients, and I discovered much more. Yes, Rosenhan had a charm. He had charisma. He had zero to spare. And since I eventually found out, he wasn't what he looked like either.
I came across Rosenhan and his study six years ago while on a book tour of my memoir, Brain on Fire, which chronicled my experiences with a dangerous misdiagnosis when doctors believed my autoimmune disorder was a serious mental illness. After my talk, a psychologist and researcher suggested that I should be considered a "pseudopatient of the modern day" from Rosenhan's famous study.
Reading for the first time the study that night in my hotel room, I was struck by his introductory words: "If there is strength and madness, how do we know them?" Psychiatry has been struggling throughout its history to answer this question, and Rosenhan's book, with its rigorous collection of data, revealed the deep limitations of our attempt to answer it.
R The eight healthy Osenhan pseudo-hospitals, which are claimed to each follow the same scenario, to receive admission to psychiatric hospitals across the country. Each told the doctors that they had heard voices saying, "Thunder, empty, hollow." Based on this one symptom alone, according to the study, all pseudo-patients were diagnosed with a mental illness – mainly schizophrenia.
And after they were labeled with mental illness, it became impossible to prove otherwise. All eight were kept in hospital for an average of 19 days – the longest to remain unimaginable 52. Each left "against medical advice," meaning that doctors believed they were too sick to leave. These otherwise healthy individuals are reported to be prescribed a total of 2,100 pills – serious psychiatric medicines.
At that time, the collective American imagination was deeply suspicious of psychiatry and its institutions. It was the era of Ken Kissy's Flight Over the Cuckoo's Nest, and films like The Shock Corridor and The Snake Pit. Rosenhan – who was both an insider studying abnormal psychology and an outsider who was more of a psychologist than a psychiatrist – was the perfect person to pull the curtain on the secrets of psychiatry.
His document had a tremendous impact and triggered further movements in the world of mental health – helping to debunk Freudian psychoanalysis, drug psychiatry, and mental health advocacy, to name a few. His conclusions were "like a sword immersed in the heart of psychiatry," an article in the Journal of Nervous and Mental Illness, viewed three decades later.
When I read his report, I recognized my own experience of misdiagnosis in these nine pages, I saw the power of etiquette, the feeling of depersonalization as a psychiatric patient, the hopelessness.
I wanted to learn more about the study, about the participants who, at the insistence of the charismatic Rosenhan, would put their lives on the line to voluntarily perform such an insidious task.
So, I was surprised to find that so little has been written about his research beyond science. None of the pseudopatients became public, and Rosenhan, unfortunately, died in 2012. Instead, I started talking to the people who were closest to him throughout his life and career to try to figure out the professor who did one. coup.
"He had a moment," recalled a close friend, Florence Keller.
"If the party [a] was dead, it would come in and suddenly the party would come to life," his son Jack Rosenhan
"I think has always made people feel special," says his research assistant Nancy Horn.
Disappointed that I could never meet him, I was thrilled when Keller introduced me to a treasure trove of documents he had left behind – including many never-seen documents: his unpublished book, journal entries, and correspondence.
The first pseudopatient – David Lurie in his notes – was very clear about Rosenhan himself.
"It all started as a boldness," Rosenhan told the Cal. "I taught psychology at Swarthmore College and students told me that the course was too conceptual and abstract. So I said, "Well, if you really want to know what psychiatric patients are, become psychiatric patients."
Shortly afterwards, Rosenhan went undercover for nine days at Haverford State Hospital in Haverford, USA, in February. 1969 The diary and his book describe a number of actions: dirty, doorless baths, inedible food, clean boredom and suggestion, neglect on the part of staff and doctors. Rosenhan even witnessed the accompanying sexual assault of one of the more troubled patients. The only time Rosenhan was truly “regarded” as a staff member was when his companion accepted him as a doctor.
The experience is worsening. After nine days, he demanded release and made sure his students – who planned to follow him as undercover patients at the hospital – would not be admitted. Colleagues described a shaken, changed person after his experience.
I dug deeper. If his own students were forbidden to pursue the experiment after this disturbing event, what are the others who willingly followed Rosenhan's footsteps? Why did they put their mental health – even their lives – on the line for this experiment? With the exception of one document defending Being Crazy in Places, Rosenhan never published any psychiatric hospitalization studies, although this topic has earned him international success.
He also accepted a lucrative book deal and even had eight chapters written, over a hundred pages of it. But then Rosenhan suddenly refused to submit the manuscript. Seven years later, his publisher is suing him to pay back his advance. Why give up on a topic that made him famous?
I also began to discover serious discrepancies between the documents I had found and the book Rosenhan published in Science. For example, Rosenhan's medical record during his stay in Haverford found that, as he wrote in his published document, he did not show just one symptom of "dull, empty, hollow." Instead, he told doctors, that he had put a Copper Pot near his ears to silence the noise and that he had committed suicide. It was a far more difficult – and lawfully affecting – description of his illness than was presented in his document.
Rosenhan, I began to realize, was perhaps the ultimate unreliable storyteller. There may be some pseudopatients that he mentioned in his study that did not exist at all.
– Susannah Kahalan, author of The Big Press, by renowned psychology professor David Rosenhan
In the meantime, I sought out seven other pseudopoies and spent the next months of my life chasing ghosts. I was chasing rumors, chasing one dead end after the next. I even hired a private detective who was no farther from me.
After years of searching, I found only one pseudopatient who participated in the study and whose experience matched that of Rosenhan: Bill Andwood, who was Stanford
The only other participant I found, Harry Lando, had a very different opinion . Lando summed up his 19-day hospitalization at the US Public Health Hospital in San Francisco in one word: "positive."
Although he was misdiagnosed with schizophrenia, Lando thought it was a healing environment that helped people get better.
"The hospital seems to have had a calming effect. Someone might come in excited and then tend to calm down relatively quickly. It was a benign environment, "recalled in an interview with Lando, now a professor of psychology at the University of Minneapolis.
But instead of including Lando in the study, Rosenhan dropped it from him.
Lando felt it was pretty obvious what he was happened, and I agree: His data – the overall positive experience of his hospitalization – do not coincide with Rosenhan's thesis that institutions are wicked, ineffective, and even harmful places, and therefore discarded.
"Rosenhan was interested in diagnosis and this is fine, but you also have to respect you accept the data, even if the data does not support your prejudices, "Lando told me.
Rosenhan, I began to realize, was perhaps the best unreliable storyteller. And I believe it is possible that some of the other pseudo-patients that I mentioned in my study did not exist at all.
As a result, I now seriously question a study that I once admired and originally planned to celebrate. In my new book, Grand Central Publishing, this week, I paint a picture of a brilliant but inadequate psychologist who is probably also a plotter.
This was not what I wanted, and I feel conflicted about my findings. I was so glad to get into Rosenhan's world and get to know his mind and his loved ones – but I have no doubt that his creation, which touches our whole lives, is frivolous at best. And it's time for the world to see the study of what it really is.
It is not the first time a book published by a reputable journal has been called into serious question or even exposed as outright lies. There was a Dutch social psychologist, Diderick Stapel, once known for finding connections between filter train platforms and racist views at a Utrecht station, which is now known for fabricating data.
Philip Zimbardo, the architect of the famous prison study that took place in the Stanford basement in 1971, has also come under fire. Zimbardo and his researchers recruited students and assigned them roles as "prisoners" or "guards." the prisoners reacted like real prisoners. An average piece for 2018 tracked down the original participants in this study and raised serious problems – including the fact that Zimbardo brought up security to behave aggressively.
Psychologist Peter Gray told me that he sees the work of researchers like Zimbardo and Rosenhan as prime examples of studies that "respond to our biases … There is some desire to uncover the problems of society, but in the process of cutting ends or even to collect data. "
This may explain Rosenhan. He saw real problems in society: The country stored a lot of sick people in horror homes, pretending to be hospitals, our diagnostic systems were insufficient, and psychiatrists in many ways had too much power – and very little substance. He saw how psychiatric labels degrade people and how doctors see patients through the prism of their mental illness. All this was true. In many ways, this is still true.
But the problem is that research must be stable. We cannot make progress on a rotten basis.
By ignoring Lando's data and inventing other facts, Rosenhan missed the opportunity to create something three-dimensional, something a little softer but more honest. Instead, he helped perpetuate a dangerous half-truth.
Today, what we have is an epic-sized mental health crisis. Over 100,000 people with serious mental illness live on the streets until we are chronically short of safe housing and hospital beds for the sickest among us.
Whether Rosenhan was more measured in his hospital treatment if he included Lando's data, i.e. there is a chance for a different dialogue, less extreme in its security, to emerge from its exploration, and maybe, just maybe, we will be in a better place.