8 February 2020 | New Scientist | 39presented an entirely different portrait to that
in his paper. One of the foundational principles
of “On Being Sane in Insane Places” was that
all of the pseudopatients presented with just
one symptom: voices that said “thud, empty,
hollow”. Rosenhan didn’t follow his own script.
The admitting psychiatrist Frank “Lewis”
Bartlett wrote that David Lurie was so
disturbed by the voices that he had put copper
over his ears – an almost cliched example of
the “tinfoil hat delusion” commonly reported
by people experiencing serious mental health
problems. “He has felt that he is ‘sensitive
to radio signals and hear[s] what people
are thinking’,” Bartlett wrote. Hallucinations
and disturbances in thought patterns,
particularly believing you can hear or control
other people’s thoughts, are considered key
symptoms of schizophrenia, so would have
contributed to his misdiagnosis.Suspicious symptoms
Rosenhan also claimed that his wife “did not
know how disturbed and helpless and useless”
he was, that he had “thought of suicide” and
believed that “everyone would be better off if
he was not around”. Such ideation and threats
of self-harm would provide strong grounds
for immediate and necessary hospitalisation.
“To not hospitalise such a patient would be
professionally unethical, and, in almost every
circumstance, malpractice,” says Michael
Meade, chairman of psychiatry at Santa Clara
Valley Health and Hospital System in San Jose,
California. Intentionally or not, Rosenhan
had served up a realistic characterisation of
a man experiencing something more serious
than the one-symptom portrait of illness his
pseudopatients were supposed to describe.
The discovery of such inconsistencies
prompted me to try to track down the other
pseudopatients who participated in the study.
I found the first with relative ease, thanks
to a stray handwritten note on an outline
for Rosenhan’s unpublished book, which
mentioned the last name Underwood.
This led me to Bill Underwood, a retired
software engineer living in Austin, Texas, who
had volunteered to be a pseudopatient while
taking Rosenhan’s psychopathology seminar
during his graduate studies at Stanford.
Underwood described the seven days he spent
at what was then Agnews State Mental Hospital
in Santa Clara, California, as harrowing – he
was medicated, misdiagnosed and mistreated.
He says he was hardly prepped for his
undercover role, and that Rosenhan told him
nothing about data collection or how >“ He concluded
that it was
impossible
to distinguish
insanity
from sanity”
Many psychiatric
hospitals were
closed as mental
health care shifted
to communitiesprisons in his book Asylums, while pop culture
spread fear and distrust. Meanwhile, the field
faced an internal reckoning as it moved away
from Sigmund Freud’s psychoanalysis.
By the late 1980s, nearly 80 per cent of
all introduction-to-psychology textbooks
included Rosenhan’s study. Despite virulent
criticism from psychiatrists, who claimed
when the study was first published that it was
misleading and unscientific, it is still presented
uncritically in many textbooks today.
Beyond the original nine-page paper in
Science, which largely focuses on Rosenhan’s
experience – the bad food, boredom, pacing,
the neglect and even abuse of fellow patients
he witnessed – scant public information exists
about the study. The eight participants never
revealed themselves, and Rosenhan wrote
nothing further on the topic before his death
in 2012. But in the course of my research, I
gained access to a trove of documents he left
behind – decades of correspondence, diary
entries and even an unpublished book on
the experiment – and interviewed his family
and hundreds of friends and colleagues.
It quickly became clear that some things
didn’t match up. In Rosenhan’s files, I found
his Haverford Hospital medical records, which