A famous psychology study from the early 1970’s by Rosenhan may have as much (or more) value today as it did when it was first published. Rosenhan was curious if mental health professionals could reliably distinguish between sane and insane (terms used at the time) individuals in psychiatric settings? Rosenhan attempted to demonstrate that if healthy people entered psychiatric hospitals, they would be admitted and misdiagnosed, and that the resulting psychiatric labels would stick to them, leading their behavior to be interpreted as pathological. Today, while great strides have been made normalizing mental health, we still battle with confirmation bias and stigmas that prevent some individuals from seeking help.
Overcoming stigmas and confirmation bias
For the famous study several “pseudopatients” faked auditory hallucinations by claiming they heard voices saying words like “empty,” “hollow,” or “thud” to see if those self-reported symptoms were enough for admittance to a mental health hospital. Based on only the fake symptoms all individuals were diagnosed with mental illness (schizophrenia) and admitted to hospitals across the country. While this news may not surprise you, what followed should be very concerning.
After all the pseudopatients were admitted, they stopped faking the symptoms that got them admitted to the hospital and began to behave normally, but staff continued to interpret their behavior as pathological. In fact, based solely on the original faked symptoms the pseudopatients remained hospitalized between 7 and 52 days (an average of 19 days per patient). What Rosenhan learned from the study was that while it’s remarkably easy to get admitted to a psychiatric hospital, it’s almost impossible to get out. Rosenhan also found that once someone is labeled with a mental illness, others often interpret all of their behaviors through that lens. This common error can lead to confirmation bias, known as the tendency to search for, interpret, favor and recall information in a way that confirms or supports one’s prior beliefs or values. Applying confirmation bias to the Rosenhan study and the big takeaway is once people identify a person as mentally unwell, that bias is nearly impossible to break.
Using what we know about the Rosenhan study and applying it to today and we see that while many more people are seeking mental health support, there are still many others resistant to seeking help for fear they will be labelled in some negative light. I have witnessed this personally, as I have had countless “hallway” conversations with individuals, only to trail off quickly upon the invitation to meet at my office for an appointment. Talking to me in a hallway, parking lot, or coffee shop is not threatening and wards off stigmas and confirmation bias, whereas all of that changes if you walk through my office door.
Again, mental health is looked at very different today than the early 1970’s when Rosenhan conducted his famous experiment, but we still have a long way to go. Even today, simply using the word “mental” implies incurable, deep-seated psychopathology to some people, and the potential accompanying stigma is too much to bear so treatment is not pursued. Rosenhan’s study revealed many important findings, most notably that diagnosing psychopathology is incredibly difficult (i.e. pseudopatients feigned symptoms and all were admitted), and that once labelled it is almost impossible to lose the label — even when symptoms have dissipated.
Final thoughts
The Rosenhan study is a great contribution to the field of psychology, and illustrates the tricky nature of both properly diagnosing mental illness, and preventing diagnostic labels from becoming the sole descriptors of individuals. Additionally, while more people today seek mental health support, there are still many others who would benefit from assistance but refuse to seek help for fear of a permanent label (confirmation bias) and the concerns around perceived stigmas that people seeking help are permanently damaged in some way.
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