The Fraud That Transformed Psychiatry Series, Transcript P8

Shidonna Raven
11 hours ago
13 min read

July 23, 2024

Source: The Scince History Institute

Photo / Image Source: Unsplash,

Host: Alexis Pedrick

Senior Producer: Mariel Carr

Producer: Rigoberto Hernandez

Associate Producer: Sarah Kaplan

Audio Engineer: Jonathan Pfeffer

“Color Theme” composed by Jonathan Pfeffer. Additional music by Blue Dot Sessions

Psychology professor David Rosenhan made waves with his “On Being Sane in Insane Places” study, but decades later its legitimacy was questioned.

WFGD Studio

Transcript

Alexis Pedrick: After that first day, he was able to spit out the Thorazine and flush it down the toilet.

Bill Underwood: And one time, I remember I went in there, it’s been about three minutes since I had taken the pills, went into the toilet to get rid of my, uh, Thorazine, and there were already some pills in the bottom of the toilet when I got there. So I was clearly not the only one who was following that procedure.

Alexis Pedrick: This was valuable information about how drugs were used in hospitals, and David Rosenhan would go on to talk about this experience of Bill’s.

Archived Audio of Dr. Rosenhan in Conversation: We were not alone in spitting out our medication. We’d get to the bathroom and find the bottom of the toilet bowl lying with pink and yellow little things from all the patients we’ve gotten there before us. We got very little treatment except drugs, medications, and in that sense, drugs, however good they may be, have done a real disservice to patients and to staff because there you are in the hospital and the nurse and the physician are feeding you medications and they feel that the medications are getting you better. And consequently, there’s nothing else that needs to be done.

Alexis Pedrick: Like David, Bill felt ignored by the staff, invisible.

Bill Underwood: We didn’t get a lot of attention from the ward attendants. I remember one day early in my time there, I went up to one of the ward attendants to point out that there was something going on with a couple of guys over at the side of the yard. And he just turned his back and walked away from me. I thought, geez, this is not the kind of interaction I am used to having with people. Not the sort of reaction I would expect.

Alexis Pedrick: It was an unpleasant feeling, but the lack of attention was also potentially dangerous.

Bill Underwood: Early one morning before breakfast, one of the nurses woke me up. And said, uh, Mr. Dixon, uh, wake up, you have diabetes. You need to go to this medical facility in the hospital here. And so I thought, good lord, you know, I had no idea I was diabetic.

Alexis Pedrick: But it turned out that the nurse had confused him with another patient with the same name.

Bill Underwood: And it turns out it was the other Dixon. I was 20 years younger than him. I had red hair and a beard. He was clean shaven and had black hair. But, you know, other than that, we looked just alike. But anyway, it made me feel like they were not paying very close attention. So, there were people who were paying attention to what I was doing, but it was not the staff people. And so, to me, that, that is a statement about the extent to which the staff were really attending to what I was doing. Or maybe they were just saying, okay, he’s not causing trouble. I need to focus on these other people. Whatever the reason, there were a lot of people who were paying more attention to me than the staff. And those people were my fellow patients.

Archived Audio of Dr. Rosenhan in Conversation: Did patients suspect that you weren’t another patient with psychological problems? Man, they sure did. Nobody ever spotted it except the patients. The patients would walk right up to me and say, ‘You are not, you’re not a patient. You’re a college professor or you’re a journalist.’ One of the clues they had is that the moment we got into the hospital, we would constantly write. I had a big yellow pad and everything that was going on, I would grab my pen, I’d write it down. We wrote reams of stuff. The patients would see us writing and immediately infer, well, he’s observing and he is writing. He must be a journalist or a professor. Staff would see us writing and they never made such an inference. It would say patient engages in writing behavior. Writing behavior being one subset of crazy schizophrenic behavior that people engage in when they’re nutsy.

Alexis Pedrick: Susannah found her second pseudopatient through Bill Underwood, and his experience was very different from both David and Bill’s.

Harry Lando: I’m Harry Lando. I knew David Rosenhan because he was my major professor when I was at Stanford. I was taking this small seminar from Rosenhan, and in that seminar he talked up the study. I also remember he invited us over to his house, uh, for dinner. And his wife made this fantastic gourmet meal and it just, you know, it sounded like kind of an exciting opportunity. And so, you know, Bill and I decided to go ahead with it.

Alexis Pedrick: Harry called up his hospital from a phone booth in San Francisco and gave the same script. He’d been hearing voices, dull, empty, thud.

Harry Lando: A psychiatrist from the hospital interviewed me right then and there in the phone booth, and the psychiatrist got the impression that I might be suicidal. He kept saying, you’re forcing my hand. I was nervous. I answered his questions. I’m sure I didn’t deliberately say anything that would suggest I was suicidal.

Alexis Pedrick: He was ultimately diagnosed with chronic undifferentiated schizophrenia.

Harry Lando: I later understood that that’s kind of a wastebasket diagnosis, kind of a catch all.

Alexis Pedrick: Harry knew his experience was going to be different as soon as he walked into the hospital.

Harry Lando: You get a sense of a place, and it just was a benign atmosphere. It was not dark and dingy. I had visited Bill before that, and it was just an incredibly depressing environment. This was well lit, open, the doors were not locked. And so immediately there was a, I think, a much more comforting vibe.

Alexis Pedrick: Even Harry’s accidental experience with Thorazine was different.

Harry Lando: And Rosenhan had told us about tonguing pills and so forth, not swallowing them, but that first night they gave me liquid Thorazine, which I was not going to tongue, and I think I was so wired that I didn’t even notice any effect of the Thorazine. I just remember, I think, feeling surprisingly calm.

Alexis Pedrick: Surprisingly calm is how you could sum up Harry’s entire story.

Harry Lando: I felt very comfortable in the hospital. Rosenhan talked about for the nurse’s station being off limits, which was not at all true here. You know, we would go in, we used to have jam sessions with the nurses. You know, they were amazingly approachable. I even developed a serious crush on one of the nurses. The ways that Rosenhan described his experience, that was not going to happen with him. There was a patient whose wife came out from New York on the bus and got to San Francisco, had no money, no place to stay, and a nurse put her up in her own home. And I feel myself being emotional when I actually say that.

Alexis Pedrick: All of this seemed to have a positive effect on the other patients.

Harry Lando: One of the things I really saw was a lot of empathy and caring among the patients for other patients. Often, you know, a new patient would come in highly agitated, and then usually within 24 hours they would calm down significantly. But there was a patient that came in, and we were doing group therapy and stuff, and she turned her chair away, you know, not facing the group, and she kept saying she’s been damned by God, and other people who were in the group were, you know, quoting Bible passages at her saying God is all forgiving these kind of things.

Alexis Pedrick: Rosenhan was surprised by Harry’s experience and intrigued.

Harry Lando: He seemed so excited that I was having the experience I was having and kept talking about how he wanted to do more with that and whatever. And then that never happened. And so the next thing I knew, the Science article had come out, and I was a footnote.

Alexis Pedrick: And this is where things take a turn. David Rosenhan didn’t include Harry Lando in the study. Instead, he wrote in a footnote, “Data from a ninth pseudopatient are not incorporated in the report because, although his sanity went undetected, he falsified aspects of his personal history. His experimental behaviors, therefore, were not identical to those of the other pseudopatients.” Harry felt terrible, like he had somehow failed.

Harry Lando: I think that I felt like at that time that, yeah, I was responsible because I had had details that were not accurate, even though I made no effort to act in an abnormal way when I was in the hospital.

Alexis Pedrick: But Harry didn’t fail. It was only years later when Susannah Cahalan interviewed him that he got the full picture.

Harry Lando: There were things I took at face value that turned out not to be accurate. And it became pretty clear that if I had had an experience similar to Bill’s, that I would have been included and Susannah found that I had been in an earlier draft. It just didn’t fit with his thesis.

Alexis Pedrick: Chapter Three. The Fraud.

Not including Harry in the study seemed a bit suspect, but there were other things that caught Susannah’s attention too.

Susannah Cahalan: What was interesting to me was, in the timeline of when this would have been squared away, he would have been one of the final people involved, because the paper was actually submitted to Science shortly thereafter. So I thought, there is a lot of mistakes here.

Alexis Pedrick: David Rosenhan wrote in the study that a legal document called a writ of habeas corpus was prepared for each of the entering pseudopatients during any every hospitalization. Basically, if one of the hospitals refused to release a pseudopatient, a lawyer would present this document and they’d be forced to go to court where the whole charade would be unveiled and the pseudopatient would be released. But Susannah found they didn’t exist.

Susannah Cahalan: There were no writs of habeas corpus that David Rosenhan claimed to have filed that was never done. There seemed to be no safety protocols in place.

Alexis Pedrick: And then there was this question. Why didn’t Rosenhan warn Bill Underwood about the potential hazard of Thorazine’s coating melting and burning your tongue?

Susannah Cahalan: And I thought, gosh, if this is his eighth pseudopatient, he should have learned a little bit by then. You know, it just was strange to me.

Alexis Pedrick: The more Susannah dug, the sloppier things got. Numbers seemed off. Rosenhan wrote in the study that the pseudopatients were administered 2,000 pills, but in an interview, he says 5,000.

Susannah Cahalan: The numbers would be, like, staggeringly off. And also kind of, ridiculous too. I, you know, there would be a hospital that would be enormous. And, and I’d look at the area they’d say, and there’d be no hospital that in that area that fit that bill. So there was just kind of all of these signs. I didn’t know where they were pointing, but they were not, they didn’t make sense for a kind of a legitimate Science article to have this many kind of inconsistencies.

Alexis Pedrick: But it was one interview that started to unravel the entire story. During a phone call, a psychologist who had worked with David Rosenhan told Susannah a funny story about him.

Susannah Cahalan: He had these parties, and at one party, Rosenhan was kind of regaling the room with his stories of being a pseudopatient, and he marched everyone upstairs, opened his closet, and he took out a wig. And he said, this was the wig that I wore as a pseudopatient. And I’m on the phone, we’re laughing about him kind of dancing around, putting the wig on and I thanked him for the end of the interview. I hung up the phone. And then I remembered that there was a medical record that was, uh, you know, of the David Rosenhan pseudopatient. And there was a picture attached to that record. And it’s very grainy. It’s very hard to see clearly. But you can very much see. The light gleaming off his bald head. He was not wearing any wig at all. That was a complete fabrication. And it was so strange to me to lie about that. Why would he lie about that?

Alexis Pedrick: If you lie about a wig, what else are you lying about? Something big, it turns out.

Susannah Cahalan: I think the smoking gun for me was the medical record. So that was just astounding. And when I saw that, that was when I knew I had something more serious going on here than a wig.

Alexis Pedrick: Rosenhan didn’t include his or anyone’s whole medical report in the final Science article. The reason he gave was that he didn’t want to reveal which hospitals they stayed in. But he does include a whole paragraph, quoted directly from someone’s medical report, and by comparing it to things Rosenhan said about his own stay, it’s clear that it was his own. Here’s what the paragraph in the Science article says, “This white, 39-year-old male manifests a long history of considerable ambivalence in close relationships. A warm relationship with his mother cools during his adolescence.” And here’s what David Rosenhan said in an interview.

Archived Audio of Dr. Rosenhan in Conversation: He asked me such questions as, how did you get along with your parents? And I told them my mother was my very close friend while I was growing up, but the relationship sort of cooled when adolescence came.

Alexis Pedrick: The Science article quote from the medical record goes on. “A distant relationship to his father is described as becoming very intense.”

Archived Audio of Dr. Rosenhan in Conversation: My father and I weren’t such good friends when I was a kid, but he was my best friend during my adolescence and early adulthood until he died.

Alexis Pedrick: “His attempts to control emotionality are punctuated by angry outbursts and spankings.”

Archived Audio of Dr. Rosenhan in Conversation: Do you ever spank your children? To which I responded, my son twice, my daughter once, in fact. He never inquired under what conditions do you spank your children, or did you spank your children? What becomes very interesting is how they interpret it. So you take this, what I consider to be unexceptional case history, uh, was interpreted as reflecting my enormous ambivalence in interpersonal relationships.

Alexis Pedrick: This excerpt from Rosenhan’s medical record was used in the Science article as evidence that once someone was inside the walls of a mental institution, psychiatrists were primed to see mental illness. There was just one problem.

Susannah Cahalan: So you have a whole part that is supposedly word for word from the medical record. It was very Freudian. It was psychoanalytic. It was about the father and the mother and this relationship, and it was entirely made up.

Alexis Pedrick: Susannah had David Rosenhan’s actual medical record. And after the wig revelation, she looked more closely at it. It revealed the hospital where he’d been, Haverford State Hospital. And at first, it tracks with the symptoms every pseudo patient was supposed to claim. But then Rosenhan went off script. Way off.

Susannah Cahalan: I found the medical record that Rosenhan had said things like, I put copper pots over my ears to drown out the noises, and that he had been suicidal for many months. I mean, these are very serious symptoms.

Alexis Pedrick: “He has felt that he is sensitive to radio signals and hear what people are thinking. He realized that these experiences are unreal, but cannot accept their reality. One reason for coming to the hospital was because things are quote, ‘better insulated in a hospital.’”

Susannah Cahalan: These are very serious symptoms, and understandably, a psychiatrist looking at it would be concerned. And, you know, even psychiatrists that I showed today, they said the suicidality would be an issue. That there’s such a crisis in mental health care, they probably wouldn’t get a bed. But if there was a bed available, maybe he would have gotten a bed today. The suicidality thing really shocked me.

Alexis Pedrick: None of these details made it into the article itself, or any of the scores of lectures or interviews Rosenhan gave after the Science article was published.

Susannah Cahalan: It was a fiction, it was a fantasy that, that, that, that Rosenhan made up, and he published it in Science. And it was shocking to me.

Alexis Pedrick: Finding the real medical report gave Susannah a whole new level of skepticism about the study, and she realized something else was off.

Susannah Cahalan: Almost every detail in the article was about David Rosenhan’s time in the hospital from his Haverford State Hospital visit in ‘69. And I know that because I had his notes from Haverford. And, oh, there are almost no other details about the other seven. However, there were still some details about Harry’s hospitalization that were used in the study, one involving flirting with a nurse.

Harry Lando: He kind of had it both ways because I was a footnote, I wasn’t included, but there were several references in the article to what was very clearly my experience.

Alexis Pedrick: Remember, Harry’s data was dropped from the study because it didn’t fit Rosenhan’s thesis.

Susannah Cahalan: But Harry made it in? Wouldn’t you think he’d have enough detail from the other six to not have to use the one he claims to have discarded? That really kind of pinged something in me, and I really started to look at the archive and the information that it had in a different light.

Alexis Pedrick: Throughout the years she worked on her book, Susannah tried over and over again to identify the other six pseudopatients. She wrote to medical journals looking for people who knew anything. She made a speech at an American Psychiatric Association meeting. She even hired a private detective and the only two pseudopatients any of these efforts ever pointed to were Bill Underwood and Harry Lando. Still, Susannah held out hope that someone would read the book and come forward. But the book came out in 2019.

Susannah Cahalan: No one’s come forward. Like, someone would’ve, and now I’ve completely given it up because the book’s come out.

Alexis Pedrick: We may never know definitively if there were any other pseudo patients besides David Rosenhan, Bill Underwood, and Harry Lando and his footnote. But here’s what we do know. David Rosenhan attended a conference in 1970 where an editor from Science was also present.

Susannah Cahalan: And I believe, this is conjecture, but I believe that’s where science got their knowledge about this and said to him, make this into a study, add some other people into this, and we’ll publish this. That’s my theory. And I think he had a harder time convincing people to get to do that than he thought he would. And I think kind of it was down to the wire, and he was putting a lot of pressure. Harry remembers that he was putting a lot of pressure on the students to take part in the study, and people really didn’t want a lot to do with it. And I think he was kind of back against the wall and either he delivered or he didn’t.

Alexis Pedrick: After the Science article came out, Rosenhan got offered a book deal.

Susannah Cahalan: The big book was the next step to really cement your legacy. He got a deal. He paid part of his advance. And he never delivered the book. So I had the book. It was almost, I would say, three quarters the way done, maybe, maybe a little bit less.

Alexis Pedrick: It was here, in the unfinished book, where Susannah found all the details about the other pseudopatients.

Susannah Cahalan: Now this is an interesting part. So the detailed notes seemed to come while he was writing the book.

Alexis Pedrick: That is, after the study came out.

Susannah Cahalan: Interestingly, the other pseudopatients, though there were tons of details, all of them felt off. It didn’t feel real. The parts that felt real really were David’s own experience. That was really kind of jumped off the page and, and really kind of shined, but the rest just really did not make much sense.

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