by Toan Truong, Twitter thread
Could psychiatrists tell if someone was actually insane?
Stanford psychologist David Rosenhan wanted to find the answer...
In 1973, he sent 8 perfectly normal people to mental hospitals across the US.
• 1 painter
• 1 housewife
• 1 pediatrician
• 1 psychiatrist
• 3 psychologists
• Rosenhan himself
Their mission?
Infiltrate hospitals.
The "pseudopatients" had simple instructions:
• Say you hear a voice saying "empty" or "hollow."
• No other symptoms
• Take detailed notes
• Try to get out by convincing staff you're sane
Then, they scattered across 5 different states.
Walking into the hospitals, each pseudopatient told their real-life stories.
Real names.
Real jobs.
Real families.
The only lie? A voice saying, "Empty."
What happened next shocked even Rosenhan...
ALL 8 were admitted immediately.
The diagnoses?
• 7 with "schizophrenia"
• 1 with "manic-depressive psychosis"
Not a single doctor caught on. But the real nightmare was just beginning..
Inside, the pseudopatients maintained normal behavior:
• Followed all rules
• Engaged in conversations
• Took notes on their experience
• Made friends with other patients
Yet everything they did was seen through the lens of illness.
Staff interpreted normal behaviors as symptoms:
• Writing notes? "Patient engages in compulsive writing behavior."
• Being friendly? "Patient shows inappropriate affect."
• Being neat? "Patient exhibits obsessive tendencies."
The label of "INSANE" colored everything.
The most fascinating part?
The actual patients often saw through the act. 35 patients approached them saying variations of:
"You're not crazy. You're a journalist or professor checking on the hospital."
Yet highly trained professionals?
Completely fooled.
The average stay lasted 19 days.
Shortest? 7 days.
Longest? 52 days.
The only way out?
Admit they were mentally ill and take powerful antipsychotic drugs.
The drugs were secretly pocketed, but the numbers are staggering:
• 2,100 pills prescribed total
• All were completely unnecessary
• Some caused permanent side effects
The final diagnosis for release? "Schizophrenia in remission"
Life inside was dehumanizing:
• Staff avoided eye contact
• Questions were ignored
• Personal space violated
• Basic rights denied
One nurse recorded a pseudopatient's behavior: "Patient engages in writing behavior"
When Rosenhan published his findings in Science magazine, the psychiatric community erupted in outrage.
One prestigious hospital challenged him:
"Send your fake patients. We'll catch them."
Rosenhan agreed.
What happened next was incredible...
Over 3 months, the hospital proudly reported catching 41 of the new 193 patients were imposters.
The twist? Rosenhan hadn't sent anyone. Their fear of being fooled made them see fake patients everywhere.
This became known as "The Rosenhan Effect"
The study "On Being Sane in Insane Places" revolutionized psychiatry.
It led to:
• Closing of many asylums
• Major diagnostic reforms
• Patient rights movement
• Deinstitutionalization movement
• Creation of modern DSM system
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This goes on in yeshivas too. People see what is in their professional interest to see.
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