Psychology › Mental health & disorders › The DSM, psychiatry's diagnostic manual (now DSM-5-TR)
Rosenhan's 'On Being Sane in Insane Places'
1973; questioned 2019· Finding or experiment
Weak or failed to replicateFamous but not holding up in careful repeats.
A famous 1973 study claiming psychiatric hospitals could not tell sane people from ill ones; its honesty is now seriously doubted.
See it on the Psychology map →What it says
Stanford psychologist David Rosenhan reported in Science that he and seven other healthy volunteers got admitted to 12 US hospitals by saying a voice said 'empty', 'hollow' and 'thud'. Once inside they acted normally, yet nearly all were diagnosed with schizophrenia and held an average of 19 days. In 2019 journalist Susannah Cahalan, working from Rosenhan's private papers, found his own records contradicted his account and could confirm only one of the seven other pseudopatients.
Why it matters
It fed public distrust of psychiatry and the push for the explicit diagnostic checklists of DSM-III (1980). It is now a lesson in checking famous studies.
The evidence
The original Science paper, Robert Spitzer's 1975 critique, and Cahalan's book The Great Pretender (2019), based on Rosenhan's notes, records and interviews.
Open questions
Whether the other pseudopatients existed is unresolved; Rosenhan died in 2012. Even his critics agree that diagnoses of that era were often unreliable.
Connections (2)
▸Rosenhan's 'On Being Sane in Insane Places' helped spur stricter criteria in The DSM, psychiatry's diagnostic manual (now DSM-5-TR)Mixed evidence
The connection
Rosenhan's study seemed to show that psychiatric diagnosis was arbitrary. Together with surveys showing poor agreement between psychiatrists, it added pressure on the American Psychiatric Association to replace vague descriptions with explicit criteria, which Robert Spitzer delivered in DSM-III in 1980.
Who showed it and when
Science, January 1973; Spitzer, who led the DSM-III task force from 1974, publicly rebutted Rosenhan in 1975.
How solid is it?
Historians and Spitzer's own accounts cite the study as part of the climate, but Spitzer's team was already working on criteria, so its exact influence is debated.
Open questions
If, as Cahalan argues, the study was partly fabricated, a flawed paper helped drive a reform many still consider necessary.
▸Rosenhan's 'On Being Sane in Insane Places' claimed sane people were labeled with Schizophrenia and psychosisWeak or failed to replicate
The connection
Rosenhan said that in all but one of 12 admissions his pseudopatients, who reported a single hallucination and then acted normally, were diagnosed with schizophrenia and discharged 'in remission', arguing the label stuck no matter how they behaved.
Who showed it and when
Twelve US psychiatric hospitals, from Rosenhan's own 1969 stay into the early 1970s; reported in Science in 1973.
How solid is it?
Doubts are serious: Cahalan found Rosenhan's own records described more symptoms than he reported, and she could trace only one of his seven reported companions, plus one whose positive stay he left out.
Open questions
Spitzer noted 'in remission' was a rare discharge label, suggesting staff saw little illness; critics say a reported voice reasonably suggests psychosis.