40 | New Scientist | 8 February 2020
to interact with the patients or staff. In fact,
Underwood didn’t recall collecting much
if any data. This made me wonder, how did
Rosenhan get such specific figures for things
like the total number of minutes psychiatrists
spent on the ward, numbers so precise they
came down to a decimal point?
Underwood led me to another of Rosenhan’s
former students, Harry Lando, now a public
health psychologist at the University of
Minnesota. Although his misdiagnosis with
schizophrenia and 19-day hospitalisation
match the account in Rosenhan’s paper,
little else does. Indeed, Lando wrote about
his hospitalisation in an overlooked paper
called “On Being Sane in Insane Places: A
supplemental report” in 1976. The takeaway?
Lando had a positive experience. He described
the ward he was on as a healing, comforting
environment, where the staff truly cared for
the patients and they recovered.
In further handwritten notes he made
while in hospital, Lando described touching
moments of compassion and connection.
However, none of this made it into the Science
paper. Rosenhan instead dropped Lando
from his study, making him only a footnote:
“Data from a ninth pseudopatient are not
incorporated in this report because, although
his sanity went undetected, he falsified aspects
of his personal history, including his marital
status and parental relationships,” Rosenhan
wrote. Yet some details from Lando’s 19-day
hospitalisation, including his flirtation with
a nurse, did make it into the paper.
What’s more, an earlier draft of the paper,
which I found in Rosenhan’s files, featured nine
pseudopatients and no footnote, leading me to
believe that Lando hadn’t yet been removed.
Yet the draft listed the same number of pills
taken, the same average length of stay and the
same number of minutes psychiatrists spent
on the ward as the published version. Not one
number changed after he was taken out.
“Rosenhan was interested in diagnosis, and
that’s fine, but you’ve got to respect and accept
the data,” Lando told me. “Clearly, he had his
idea, his hypothesis and he was going to
confirm that hypothesis.”Adding it all up
What about the other participants? I spent
years trying to find them and even hired a
private investigator. Lando and Underwood
only knew of each other, and even Rosenhan’s
long-time research assistant could only recall
their two names. I could find no proof that the
other pseudopatients existed.beds available, compared with nearly 70,000
in the 1980s. The UK now has 1000 fewer beds
than it needs to meet mental health demand,
while the US is a staggering 95,000 beds short.
Many psychiatric hospitals were neglectful,
even harmful places. Rosenhan raised valid
points about their disturbing limitations,
the view of psychiatric illness as less worthy
of our sympathy and support than physical
illness, the lack of validity of psychiatric
labels and the role of priming in diagnosis.
Yet by excluding and exaggerating data, he
presented a sensationalised and oversimplified
take on these complex issues. We are worse
off because of it.
Today, many people with untreated mental
health problems are living on the streets or
are in prison. When Rosenhan conducted
his study, 5 per cent of prisoners in the US
met the criteria for serious mental illness;
today, it is at least 20 per cent. According to
a Harvard Medical School report, more than
100,000 people with serious mental health
problems in the US are homeless.
People with mental illness are still often
stigmatised and poorly treated. Most of the
world contends with lack of beds, improper
funding and shortages of mental health care
professionals. By 2025, the US could be more
than 15,000 psychiatrists short.
It is time to reassess the paths that took us
here, and, in so doing, begin to set things right.
Rosenhan may not have created these issues,
but by only pretending to expose their true
nature, he contributed to a culture that has
caused harm to the people in greatest need. ❚This isn’t the first time a classic study of
mental health has come under fire. In October,
researchers at King’s College London identified
26 papers written by world-renowned British
psychologist Hans Eysenck, who died in 1997,
as “unsafe”. Among other things, Eysenck had
claimed that personality had a bigger impact
on someone’s cancer risk than smoking.
Even the conclusions of Stanley Milgram’s
famous 1960s experiments on obedience
to authority, in which participants subjected
unseen people to increasingly painful shocks
when told to do so by experimenters, have
recently been cast into doubt, following the
identification of serious methodological issues.
If Rosenhan had merely exaggerated the
findings of a small, anecdotal study, I wouldn’t
be writing about him. But the effects of his
paper can still be felt today. Within 10 years of
its publication, the resident population in state
and county psychiatric hospitals in the US had
nearly halved, from 255,000 to 132,000. In the
UK, there has been a similar drop in places for
people in need of in-patient mental health
treatment: today there are fewer than 20,000Susannah Cahalan is the
author of The Great Pretender.
Her previous book was Brain on
Fire. She is based in New YorkOne Flew Over
the Cuckoo’s Nest
brought mistrust
of psychiatry to
the silver screenCOLLECTONCHRISTOPH
EL
/ALAMY^ STOCK
PHOT
O“ Despite years
of hunting, I
found no proof
that the other
pseudopatients
ever existed”