David Rosenhan
Introduction
David L. Rosenhan (November 22, 1929 – February 6, 2012) was an American psychologist who spent most of his career at Stanford University, where he was professor of law and of psychology. He is remembered for one of the most widely read and most fiercely debated articles in the history of psychology, "On Being Sane in Insane Places", published in Science in 1973. In it he reported that eight mentally healthy people who presented themselves at psychiatric hospitals complaining of a single false symptom were admitted, diagnosed with serious mental illness, and never detected by the staff, even though they behaved normally from the moment they were admitted.
The paper made Rosenhan famous well beyond academic psychology and is widely credited with accelerating the reform of psychiatric diagnosis and the deinstitutionalisation movement of the 1970s. It also made him a target. Psychiatrists attacked the study's logic when it appeared, and in 2019 the journalist Susannah Cahalan published an archival investigation arguing that the data behind it were distorted and possibly fabricated. Today Rosenhan is a figure who must be discussed in two voices at once: the author of a landmark critique of diagnostic labelling, and the subject of a serious fraud allegation that he did not live to answer.
Early Life and Education
Rosenhan was born in Jersey City, New Jersey, to Joseph and Nuna Lurie Rosenhan, and was educated as a boy in a yeshiva. He remained closely tied to the Jewish community throughout his life and served as a cantor for many years. His undergraduate and graduate training was unusually mixed for a psychologist of his generation: he took a bachelor's degree in mathematics from Yeshiva College in 1951, a master's degree in economics from Columbia University in 1953, and then a doctorate in psychology, also from Columbia, in 1958. His dissertation examined perceptual correlates of anxiety, and his early interests lay in perception, deviance and the ways observers classify behaviour as abnormal or normal.
Between degrees and after, he worked as a research psychologist for the Educational Testing Service, an experience that gave him a working knowledge of measurement and of the practical consequences that a classification can have for an individual's life. He was later a visiting fellow at Wolfson College, Oxford.
Academic and Professional Career
Rosenhan taught at Swarthmore College, Princeton University, Haverford College and the University of Pennsylvania before joining Stanford in 1971, where he remained until his retirement in 1998 and thereafter as professor emeritus. At Stanford he appointed himself to a problem that was then unfashionable: the application of experimental psychology to the practice of law. He wrote on the examination of expert witnesses, on jury selection and consulting, and on jury deliberation, building on the University of Chicago Law School Jury Project of the 1950s while pushing it toward questions that experimentalists could actually test, such as whether jurors can follow a judge's instruction to disregard evidence that has been ruled inadmissible.
He was a fellow of the American Association for the Advancement of Science and of several psychological societies, and served as president of both the American Psychology-Law Society and the American Board of Forensic Psychology. Colleagues remembered him as a spellbinding lecturer who was generous with junior faculty and students, and who used his research as a form of teaching. He published more than eighty books and research papers.
Major Contributions to Psychology
On Being Sane in Insane Places
Rosenhan conceived the pseudopatient study after hearing the psychiatrist R. D. Laing lecture. Eight people with no history of psychopathology, three women and five men, Rosenhan among them, telephoned twelve psychiatric hospitals in five states and complained of hearing voices, usually unclear, that said the words "empty", "hollow" or "thud". Those words were chosen because they hint at an existential crisis and because no published literature described them as psychotic symptoms. Everything else the volunteers reported about their lives was true; only their names and occupations were changed.
All eight were admitted. Seven were diagnosed with schizophrenia and one, at a private hospital, with manic-depressive psychosis. From admission onward the pseudopatients behaved normally and said they no longer heard voices. None was detected by the staff, although a number of the genuine patients worked out what was going on. Their stays ranged from seven to fifty-two days, averaging nineteen, and discharge typically required that they accept their diagnosis; most left with a diagnosis of schizophrenia in remission. Rosenhan drew two conclusions: that psychiatric diagnosis in that setting could not distinguish the sane from the insane, and that the experience of being a patient, which he described in terms of powerlessness, depersonalisation, segregation and self-labelling, was itself counter-therapeutic.
The contextual nature of psychiatric diagnosis
A research and teaching hospital challenged his results, so Rosenhan arranged a second study. He told the staff that one or more pseudopatients would try to gain admission over the following three months and asked them to rate every new admission on the likelihood that the patient was a fraud. Of 193 new patients, 41 were judged with confidence to be pseudopatients by at least one staff member; 23 were suspected by at least one psychiatrist, and 19 by a psychiatrist and one other staff member. Rosenhan had sent nobody. His 1975 report in the Journal of Abnormal Psychology argued that diagnosis is radically sensitive to context, and that when the stakes shift, the same profession that could not detect real impostors readily invents them.
Defining abnormality
With Martin Seligman, whom he later described as a close collaborator, Rosenhan proposed a widely taught list of seven features that mark behaviour as abnormal: suffering; maladaptiveness; vividness and unconventionality; unpredictability and loss of control; irrationality and incomprehensibility; observer discomfort; and violation of moral and ideal standards. The framework, presented in their abnormal psychology textbook, shifted attention from diagnosis as the naming of a disease entity to the social judgements through which deviance is recognised.
Psychology in the courtroom
Rosenhan's second legacy is institutional. He was one of the first scholars to bring experimental social psychology into the analysis of trial procedure, and he trained and attracted a stream of students interested in law and psychology. The field of psychology and law, now a substantial subdiscipline with its own journals and societies, owes much of its early shape to his advocacy at Stanford.
Major Publications
- Rosenhan, D. L. (1973). On being sane in insane places. Science, 179(4070), 250–258.
- Rosenhan, D. L. (1975). The contextual nature of psychiatric diagnosis. Journal of Abnormal Psychology, 84(5), 462–474.
- Rosenhan, D. L., & Seligman, M. E. P. (1984). Abnormal Psychology (1st ed.). New York: W. W. Norton.
Impact and Legacy
The 1973 paper is one of the most heavily cited articles in psychology and is routinely credited with helping to discredit the loose diagnostic practices that preceded the DSM-III. It gave vivid expression to labelling theory, the argument that once a person is tagged with a psychiatric diagnosis the tag reorganises how others read everything that person does and how the person reads himself. Reformers, civil-liberties lawyers and critics of institutional care used it for decades, and several reviewers have argued that it accelerated the move of patients out of large hospitals and into community care.
The criticism began immediately. Psychiatrists replied that diagnosis in much of medicine rests on the patient's report, so deceiving the clinician shows nothing about the validity of the diagnostic method. Robert Spitzer, in a 1975 critique, quoted Seymour Kety's analogy: a man who drinks a quart of blood and then presents at an emergency room vomiting blood would be treated for a bleeding ulcer, and it would prove nothing about gastroenterology if he were. Spitzer also argued that temporary symptom variation is common in mental disorders, so the staff's failure to unmask the pseudopatients did not demonstrate incompetence. Rosenhan's response was to fold these objections into his own theory, calling them evidence of the experimenter effect and of expectation bias, which is to say further instances of the phenomenon he was describing. Critics found that answer evasive.
The more serious challenge came much later. In The Great Pretender (2019), Susannah Cahalan examined the papers Rosenhan left behind and reported inconsistent data, misleading descriptions, and quotations from hospital records that were inaccurate or apparently invented. Despite an extensive search she could identify only two of the eight pseudopatients: Rosenhan himself, and a graduate student whose hospital records described symptoms far more serious than the single reported word, and whose account of his stay was rosier than the published narrative. Cahalan documented that Rosenhan had excluded that pseudopatient's data, had never published the further analysis he promised, and had not delivered the book on the experiment that he had announced. She raised the possibility that some or all of the six other pseudopatients were invented. In February 2023 the historian Andrew Scull of the University of California, San Diego, published a peer-reviewed article in History of Psychiatry supporting her allegations and calling the experiment a successful scientific fraud. Reviewing the book in Nature, Alison Abbott quoted a Stanford colleague, the psychologist Kenneth Gergen, as saying that some people in the department had called Rosenhan a fraud, while noting that Cahalan herself stopped short of certainty.
The defence rests on two arguments. The first is procedural: Rosenhan died in 2012 and never had the chance to answer the charges, and the surviving evidence, however suspicious, does not conclusively prove fabrication. The second is substantive and more durable: whatever happened to his data, the unreliability he described has been documented independently. Studies from the same era showed large national differences in diagnostic practice and demonstrated that a clinician's expectations, including expectations about a patient's race, could shift a diagnosis. The field did reform its criteria, and it did so for reasons that do not depend on eight pseudopatients. A balanced reading therefore treats the Rosenhan experiment as a culturally decisive demonstration with an evidentially fragile base: a study whose conclusions other work supports, but whose own methods can no longer be defended.
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References
- Rosenhan, D. L. (1973). On being sane in insane places. Science, 179(4070), 250-258.