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In 1973, one of the most influential and frightening experiments in psychology was published. It was an experiment designed to test how mental health professionals identified and diagnosed mental illness and their inherent biases. The results were jarring enough to completely change how doctors handled psychiatric care. Learn more about the Rosenhan Experiment on this episode of Everything Everywhere Daily. This episode is sponsored by Mint Mobile. There are things in life that you do not want to be transparent, like your swimsuit or your search history. But when it comes to your wireless bill, transparency is everything. That's why Mint Mobile's wireless plans have no gimmicks and no gotchas, just high speed data and reliable coverage on the T Mobile 5G network. And right now, all plans are $15 a month, even the unlimited plan. It works on your current phone, your current phone number, and you can keep all of your contacts. That's why I recommend Mint Mobile. To get your new wireless plan for just $15 a month, go to mintmobile.comeed that's mintmobile.comeed cut your wireless bill to 15 bucks a month at mintmobile.comeed that's it. There's no catch. $45 upfront payment required, equivalent to $15 a month new customers on first three month plan only speed slower above 40gb on unlimited plan. Additional taxes, fees and restrictions apply. See Mint Mobile for details. This episode is sponsored by what Could Go Right? The news has a way of making it feel like everything is getting worse. But what if that isn't the whole story? What Could Go Right is a podcast that challenges the constant narrative of doom by asking a simple but powerful what Could Go Right? Hosted by Zachary Carabelle, each episode takes on a major issue shaping our world. Can we achieve superabundance without triggering AI doom? Will artificial intelligence and drones really bring about the apocalypse? Is there value in admitting what we simply don't know? Through conversations with leading thinkers, policymakers, scientists, and cultural voices, what Could Go Right explores not only what is going wrong, but but the progress already being made and why it matters. When the people building the world's most powerful technology are just as worried about it as the rest of us, is there still hope for a positive outcome? Go and listen to the full episode to hear more revelations from Sebastian Malaby and Zachary Carabelle about the future of artificial intelligence and the motivations of the men driving its development. Listen to what Could Go Right on Apple Podcasts, Spotify, or wherever you listen to podcasts. New episodes drop every Wednesday. I want you to imagine the following nightmare scenario you are a perfectly sane person who has been committed to a psychiatric hospital involuntarily, perhaps even maliciously? Would the doctors be able to tell that you shouldn't be there, or would they keep you committed? Regardless, this exact situation was subjected to an experiment in the early 1970s, and the results were terrifying. The man behind the study was David Rosenhan, a professor of psychology and law at Stanford University from 1971 to 1989. While working at Stanford, Rosenhan was known for applying psychological principles to legal topics such as witnesses and juries. He also published over 80 research papers and books. Despite his background in law, Rosenhan is best known for his 1973 paper, which is the subject of this episode. It focused on psychiatric hospitals and how expectations of mental illness led to misdiagnosis. Rosenhan took the perspective that psychological abnormality has seven maladaptiveness, suffering, unconventionality, observer discomfort, violation of moral standards, unpredictability, and irrationality. Rosenhan's experiment was designed to determine the validity of psychiatric diagnoses. His key question was whether the characteristics people show that determine diagnosis come from the patients themselves or from the environment or context around them. To test this, Rosenhan recruited eight students with no history of psychiatric illness to go to different mental hospitals. The students were sent to five different US states between 1969 and 1972, and some participated more than once. These students can also be referred to as pseudopatients, meaning people pretending to be patients or impostors. Each pseudo patient was told to go to a psychiatric hospital and falsely report a single symptom, vaguely hearing auditory hallucinations. To keep the experiment variables equal, all impostors reported hearing words such as hollow, thought, and empty. All other aspects of their life were reported honestly. Once they reported the auditory hallucinations, the students were given extensive admissions interviews which determined whether they were to be admitted and remain in the hospital despite none of them expressing any other psychiatric symptoms that would justify admission, all of them were admitted. All of the pseudopatients were admitted despite experiencing no other psychiatric symptoms. Once in the hospital, they were also given extensive interviews and tests to determine their sanity. Once admitted, the imposters claimed that they no longer heard voices, were honest about their significant life events, and acted normally with the staff. And despite this, the staff did not see them as sane. Among the 12 hospitals tested, none of the staff recognized that the pseudo patients didn't belong there, despite only complaining about auditory hallucinations once, the imposters were kept in the hospital for seven to 52 days, with an average stay of 19 days based on the behavior that the staff claimed to have observed in the hospital while they were acting normally, each pseudopatient was diagnosed with a serious mental abnormality. The main diagnosis given to the pseudo patients was schizophrenia. Schizophrenia is a severe mental disorder in which a person experiences psychosis, including hearing voices, which is an auditory hallucination. There are many symptoms of schizophrenia beyond auditory hallucinations. Many people diagnosed with the disorder may also experience visual hallucinations, exhibit disorganized speech, experience illusions, show diminished emotional expression, struggle with memory and focus, and have catatonic behavior, among other symptoms. To be diagnosed with schizophrenia, a person needs to experience at least two of its symptoms over at most a month long period. If fewer than two symptoms are present, the diagnosis wouldn't apply. While this specific criterion wasn't officially developed until 1980, the point is to show that psychiatrists should have been able to identify that the patients did not exhibit enough traits to to warrant a diagnosis. As the patients in Rosenhan's experiment reported auditory hallucinations only once and they went away. A diagnosis of schizophrenia would not be adequate or accurate as there wasn't a persistent condition. However, when the pseudopatients were discharged, many were given the label schizophrenia in remission. It actually gets more shocking. Although the hospital staff did not identify the impostors, there were people who did. The patients. Many fellow patients approached the impostors and told them that they were likely journalists or professors checking up on the hospital. Other patients were able to identify the ruse because the impostors openly took notes about their experience in the psychiatric ward. These notes were telling, providing insight into how a psychiatric ward functions. The notes themselves resembled participant observation research in which researchers recorded their opinions and experiences of the hospital staff. A common thread in these observations was that the hospital staff spent little time interacting with their patients. On average, the staff spent only 6.8 minutes with each imposter every day. Every pseudo patient reported that the staff segregated themselves away from the patients. They typically stood behind a glass enclosure where they could see the patient but couldn't respond to behavior. The impostor's notes highlighted that staff interactions with patients were inadequate. Patients were often treated impersonally, meaning they were ignored when they had questions, While the staff behaved in an authoritarian manner. Many of the pseudo patients reported feeling bored, invisible, and powerless. The staff noticed these feelings but identified them as symptoms of mental disorder rather than rather than signs of mistreatment. For example, when patients were pacing in their rooms just to pass the time, the observers interpreted it as a sign of nervousness rather than boredom. The note Taking was viewed by the hospital staff as a sign of obsession rather than a way of recording their treatment. Many of the imposters felt that most of the real patient behavior was similar to their own, leading them to believe that people with genuine mental illness often act like, quote unquote normal people most of the time. Rosenhan's findings were published in the prestigious journal Science in 1973 under the title On Being Sane in Insane Places. Rosenhan later conducted a follow up experiment. He told hospital staff that one or more pseudo patients would be admitted to their care. He directed the staff to rate each potential patient on a scale of 1 to 10. If a person was rated 1 or 2, the staff believed that they were likely a pseudopatient and were healthy. If they were ranked higher, they were believed to be truly mentally ill. The experiment lasted three months. During this period, the staff reported that 41 of the 193 admitted patients received a score of 1 or 2, accounting for 21% of all patients. After the three month period, Rosenham revealed that no pseudo patients had ever been sent to the hospital. This offered further evidence of the previous biases of mental health institutions. Following the publication of Rosenhan's study, other psychologists conducted similar experiments that focused on internal biases. While the experiments tested different phenomena, all showed internal biases in the general population and among mental health professionals. For example, in an exercise conducted in 2008 by the BBC Science program Horizon, two episodes of the show titled How Mad are youe? Followed three experts as they studied 10 different subjects. The experts were told that five of the subjects were previously diagnosed with a mental health condition while the other five never had one. Their challenge was to identify the five subjects with behavior based diagnoses. The experts were not allowed to speak to the subjects or learn about their history. They simply observed whether each person appeared to have a mental health diagnosis based on looks and behavior. The experts only managed to identify two of the five patients based on their behavior, incorrectly claimed that two others had a mental health diagnosis and misdiagnosed another one. The purpose of the experiment was different from what Rosenhan was testing. Instead of offering a critique of mental health professionals diagnoses, it aimed to bring awareness to the public stigmatization of mental health. The goal was to show the audience that mental illness isn't always obvious and that those who are diagnosed can in many cases behave like everybody else. Despite Rosenhan's experiment leading to a revolution in psychiatry, it's also been controversial. It remains debated because psychiatrists challenged his findings and argued that diagnoses relied on patients own reports of symptoms and experiences by lying about their symptoms. Psychiatrists argued that the issue was not the diagnosis themselves, but the patient's fault. False reports of their symptoms. One psychiatrist compared the experiment to drinking a quart of blood and then going to the emergency room and reporting throwing up blood. If the patient did not report drinking the blood, the doctor would believe they had a serious internal issue. The idea is that psychiatrists can only work with the information that they're given about the patient. It was also pointed out that psychiatrists don't expect their patients to be faking their symptoms. So the real life implications of the experiment lacked a basis in reality. Rosenhan's study revealed glaring weaknesses of mental health institutions. It showed that the label of schizophrenia warped how hospital staff would view patients and their symptoms. Rosenand concluded that hospitals are uniquely positioned to misdiagnose behavior because of personal attitudes and biases which can lead to mistakes. This led to critical discussions occurring around psychiatric institutions. This led to improvements in diagnostic reliability, most evident in updates to the Diagnostic and Statistical Manual of Mental Disorders, otherwise known as the dsm. When Rosenhan's experiments were being conducted, only two versions of the DSM had been released. At this time. The manual put more trust in the ability of psychiatrists to determine who had mental disorders. Rosenhan's experiment led to the third version of the DSM which incorporated criteria checklists to more accurately evaluate patients. Additionally, the newfound lack of trust in psychiatric hospitals led led to many of them being closed. The revelations in the Rosenhan experiment also led to psychiatric institutions reforming themselves. Institutions began to treat patients with more respect and they also challenged how the label of behavior of patients like note taking as something normal rather than a surefire sign of mental abnormality. Almost 50 years after the paper was published, however, there was a dramatic twist to the entire story. Accusations arose that the results of the Rosenhan experiment may have been fraudulent. In the 2019 book the Great Pretender, Susanna Callahan questioned the validity of the experiment after examining documents Rosenhan left behind when he died in 2012. While analyzing the data, Callahan noticed a potential distortion of the results. She found that there were misleading descriptions, fabricated and inaccurate quotes from psychiatric records and inconsistent data. Another concern Callahan noted was that she could only identify two of the eight pseudopatients. The two she managed to identify were Rosenhan himself and one of his graduate students. Given that the graduate student's testimony was inconsistent with Rosenhan's presentation of his research and the inability to find the other six pseudo patients, Callahan believes that Rosenhan may have fabricated the other six participants to further his experiment's agenda. The review of Callahan's book was later published in the journal History of Psychology, and the review agreed with Callahan's findings and suggested that Rosenhan's experiment was fraudulent. The interesting thing is that the reason why Callahan even bothered to investigate the study is that she was misdiagnosed with a mental illness. If it is indeed true that Rosenhan fabricated his study, it doesn't mean his conclusions are wrong, it just means that someone needs to replicate the study, although the results after 50 years might be totally different given the different climate today. Regardless of whether Rosenhan faked his results, the experiment itself did lead to many positive reforms in the field of psychology. It led doctors to change how they care for their patients, reforms in how we diagnose mental illness, and more awareness of internal biases around mental health. The executive producer of Everything Everywhere Daily is Charles Daniel. The associate producers are Austin Otkin and Cameron Kiefer. Research and writing for this episode was provided by Olivia Ashe. My big thanks go to everyone who supports the show over on Patreon. Your support helps make this podcast possible, and I also want to remind everyone about the community groups on Facebook and Discord. This is where everything happens that's outside of the show. As always, if you leave a review on any major podcast app or in the above community groups, you too can have it read in the show.