The Fraud That Transformed Psychiatry Series, Transcript P15

Shidonna Raven
2 days ago
5 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

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.

Alexis Pedrick: One of the pseudopatients was described as a famous abstract painter, the only one admitted to a private psychiatric facility. But Susannah started pulling one thread from Rosenhan’s notes about her, and it quickly came apart. First, Rosenhan claimed that he paid for the stay himself, but she was supposedly there for 53 days, which would have been extremely expensive.

Then there was this. David wrote that during her stay, the hospital invited him to come consult on a case, and it just happened to be her case. What a coincidence, especially since Rosenhan wasn’t even a clinical psychologist. Susannah also found something else odd. Letters from people David knew who had really been patients in psychiatric hospitals were tucked into the notes for his book, and some of those details were surprisingly similar to some of his supposed pseudo patients.

When Susannah started writing the book, she really admired David Rosenhan and wanted to tell the stories of the pseudopatients.

Susannah Cahalan: I didn’t have any radar about this. I wasn’t like, oh, I’m going to unmask this. You know, I’m going to figure out the truth. It was more like, who would do this and why? And how did it affect the rest of their lives?

Alexis Pedrick: After the book came out, Susannah went out to dinner with two of the people who knew David best, two psychologists named Florence Keller and Lee Ross.

Susannah Cahalan: She was the one who said to me, maybe he made this all up. And also, you know, Lee Ross is this great kind of giant in psychology, so insightful and smart. And he was pretty convinced Rosenhan had at least fabricated parts of the, of his study. I mean, I think that’s undeniable. The question is how much really.

Alexis Pedrick: Chapter Four. The Aftermath.

Archived Audio of Dr. Rosenhan in Conversation: Do you think that Asians can, can get better going into institutions today as they are in this country? I really don’t. By and large, I think that psychiatric hospitals are non-therapeutic and would look forward to their being closed.

Alexis Pedrick: Psychiatric hospitals reached their peak numbers in 1955 and then gradually started declining into the ‘60s before Rosenhan’s study.

Susannah Cahalan: What happened with Rosenhan is it started the process of uniting left and right over this issue. You have this kind of financial perspective of, well, we’ll save money by closing these hospitals. Then you have this patient rights perspective of people shouldn’t be there.

Archived Audio of Dr. Rosenhan in Conversation: If you’re saying that mental institutions are not good places for people with emotional or mental problems to be, what can we do to help people with problems? You’ve got me over a barrel, Carol. I’m not sure. It’s so much easier to say no about something than to say yes.

Alexis Pedrick: But Rosenhan did have a prime example of how a psychiatric facility could be therapeutic, in Harry Lando’s experience.

Harry Lando: And I guess that’s where now I would really resent Rosenhan because he painted this incredibly negative picture and the reality is that in general, that was accurate, but to fail to recognize the exceptions and that there were places that were really good was an incredible lost opportunity, and I think it’s had major repercussions.

Alexis Pedrick: Rosenhan got his wish. Psychiatric hospitals closed, and for a lot of them, it was good riddance.

Susannah Cahalan: They should have disappeared because these were horrible places, but what was left was just kind of an emptiness. You know, what do you do now?

Alexis Pedrick: When asylums were closed, they were supposed to be replaced by a model called community care, and in theory, it’s great. Everyone who needs psychiatric care can get it while living in their own community, but it never really materialized. And today, the major centers of inpatient psychiatry in the U.S. are in prisons. But it wasn’t just the asylum system that felt the impact of the study. It prompted psychiatrists to completely change their system of diagnosing. They set out to revise psychiatry’s bible, the book that categorizes mental illness. It’s called the Diagnostic and Statistical Manual of Mental Disorders, or the DSM. There had already been two versions, now they needed another one.

Susannah Cahalan: They started the DSM III right after. This study was published and in the resulting publicity, so it was definitely a reaction to what was going on.

Alexis Pedrick: A serious, anti-Freudian, biologically minded psychiatrist was tapped to lead the revision, Robert Spitzer. His goal was to get rid of the Freudian influence, remove the psychobabble.

Susannah Cahalan: In general, it was a reaction to this kind of very loose, Freudian, uh, schizophrenia could be a million different things under the Freudian model.

Andrew Scull: The Freudians saw symptoms as the tip of the iceberg, the thing you needed to get behind. What Spitzer did was say, no, the symptoms are the disease, basically.

Alexis Pedrick: Robert Spitzer was not a fan of David Rosenhan or his study. He was a man of hard data, references, and classification. The vagueness of the Science article screamed sham to him, and he let Everyone in his orbit know it

Susannah Cahalan: Spitzer wrote two, maybe three articles. I think there were actually three articles about the study and he actually, he hosted a conference based on taking down this study. And he was the kind of guy I think that once he got something in his crosshairs, he wanted to chase it down. And he was really a tough guy and he really went after this study big time.

Alexis Pedrick: The problem was that his audience was other psychiatrists. So, it didn’t get out into the mainstream like Rosenhan’s study had. So, all he could do was use the opportunity to rewrite the DSM.

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