On being sane in insane places (1973) [pdf]
(weber.edu)59 points by dbgrman 6 hours ago
59 points by dbgrman 6 hours ago
Related. Others?
The Rosenhan Experiment: On Being Sane in Insane Places - https://news.ycombinator.com/item?id=45785783 - Nov 2025 (1 comment)
On Being Sane in Insane Places (1973) - https://news.ycombinator.com/item?id=32686098 - Sept 2022 (2 comments)
David Rosenhan’s fraudulent Thud experiment set back psychiatry for decades - https://news.ycombinator.com/item?id=22155529 - Jan 2020 (119 comments)
Troubling discrepancies in Rosenhan's “On Being Sane in Insane Places”? - https://news.ycombinator.com/item?id=21437852 - Nov 2019 (16 comments)
On being sane in insane places - https://news.ycombinator.com/item?id=10885181 - Jan 2016 (1 comment)
On being sane in insane places - https://news.ycombinator.com/item?id=4371212 - Aug 2012 (2 comments)
Rosenhan experiment (1973) - https://news.ycombinator.com/item?id=1469370 - June 2010 (2 comments)
If you've ever taken a depression screener at a wellness visit, that's a consequence of this work. This paper describes how unreliable psychiatric diagnosis used to be. There were standards, but they ultimately came down to physician judgment. This created demand for more objective standards, which resulted in the "checklist" approach that we have now.
It's true. You wouldn't believe how many people I've SIGECAPS'd during my medical training. I didn't realize this article was the beginning of this approach, but it certainly helped get care to people who previously wouldn't have received it. Though I'm sure there are also many who may require intervention that aren't captured by a SIGECAPS exam. The double edged sword of the checklist manifesto, though I overall think it has been beneficial.
SIGECAPS is an acronym taught in US medicine for the diagnosis of major depressive disorder: Sleep disturbance, Interest loss, Guilt, Energy loss, Concentration loss, Appetite changes, Psychomotor agitation, Suicidality. And must have Depressed mood or Anhedonia (inability to enjoy things previously enjoyable).
The history of the SIG E CAPS acronym is also interesting, I've heard it was short for SIG (old shorthand for "to be prescribed") Energy CAPsules.
I had to look up SIGECAPS before I read the rest of your comment. Big oof when I did. Never heard of Anhedonia, but I sure have it.
The awful thing is that with at least some of those screeners you can still get people on the other side who make whatever you're self-reporting worse. When my spouse answered honestly on a postpartum survey about how she was feeling the social worker they sent in picked at my infant son's mismatching socks and suggested that she was so old she was "set in her ways" and that having a child might be too big of an adjustment for her. It set her back in a huge way and knowing what I know now I'd go to all of those appointments with her and never answer any of that stuff honestly.
It doesn't really matter how "objective" your standard is if you're still relying on individuals to try to "address" whatever the patient is reporting. People still form a negative opinion and label you really quickly no matter how hard the profession fights that perception.
This study was a fraud: https://doi.org/10.1177/0957154x221150878
I have heard that, however there is truth in the assertions. I know two people currently in psychiatric hospital, with one seeming to be relatively sane just now but trapped in there, and another whose mental health is being affected detrimentally by the hospital environment. I've no doubt the latter could have recovered last year but for the fact she is being kept in an environment where her only contact with the outside world or nature is at the behest of hospital staff (who vary a lot in terms of attitude and even fluency in English).
This is one of those "important research with unbelievably flawed methods" sort of situations. Psych research before IRBs was crazy.
Nowadays there's a lot of FUTON bias in research. There's so much power in just hitting the streets or reaching out to your circle.
For the most part, you care the most about your circle, so if that isn't representative of the whole of society, it sounds like somebody else's problem. Who said all research needed to be perfect.
Reminds me of: Man’s Search for Meaning (1946) https://en.wikipedia.org/wiki/Man%27s_Search_for_Meaning
Hello from a wildcat alumnus class 2006, never thought I would see a weber state link in HN top 20.
We are trained to be scared of lone individuals and rural environments, when in fact most abuses occur within a hierarchy and urban settings. I feel the fatal flaw in human nature is so many are obedient to power without question, especially when power has some kind of uniform, but also within gangs etc.
In the hospital environment, power is partly conveyed by the clothes people where and if you do not conform or obey, then you are punished. It is a pattern we are conditioned into from nursery/kindergarten onwards.
This is from the seventies. I wonder if things would be different fifty years later.
I wonder the same. Have been reading up on literature related to ADD/ADHD diagnosis and prescription stimulants. It seems like there is little to no friction in getting a legit positive diagnosis. One can pretend to have issues securing a medication that is only meant for strong ADHD patients. I know someone who was able to get their hand on a lot of such stimulants, got addicted, went over the typical dosage, and is now suffering from psychosis.
I'd say yes. I have a book by Lauren Slater, called 'Opening Skinners Box' in which she researched many psychological experiments of the past, and subjected herself to similar conditions where she could, in an effort to understand better.
The chapter on 'Thud' ended with her visiting a psychiatric hospital of good reputation with an emergency room, she basically said the same things as the researchers in the paper. She was given some anti-psychotics and sent away.
> She was given some anti-psychotics and sent away
But that confirms the main point of the experiment, which was that people who didn't need psychiatric treatment were given it anyway.
It's only of secondary importance that the prescribed treatment changed from hospitalization in 1973 to drugs in 2004. The primary point is that there was no objective way to determine who genuinely needed treatment. She didn't, but was diagnosed anyway.
This objection is so obvious that she must have addressed it in the book. Do you remember if she did?
I happen to have the book handy.
> HERE’S WHAT’S DIFFERENT: I was not admitted. This is a very significant difference. No one even thought about admitting me. I was mislabeled but not locked up. Here’s another thing that’s different: every single medical professional was nice to me. Rosenhan and his confederates felt diminished by their diagnoses; I, for whatever reason, was treated with palpable kindness.
Seems she would disagree with your assessment that being prescribed some likely-harmless pills is the same as losing your freedom.
There's also a section earlier where she presents an argument the actual finding of the study is that mental healthcare is not set up to handle adversarial or dishonest patients, which is still a problem and a tough one to solve.
Like I say elsewhere I have visited two people in our local psychiatric unit. I haven't encountered any of the shrinks but the nurses vary a lot in attitude. The whole place is underfunded and I believe most people would become more mentally ill by being kept in this environment, which has little more than a TV to keep people motivated. The only view of the outdoors is through windows and almost no one is allowed to smoke even though this causes immense tension.
Could you please stop posting unsubstantive comments and flamebait? You've unfortunately been doing it repeatedly. It's not what this site is for, and destroys what it is for. Please don't create accounts to do this with.
If you wouldn't mind reviewing https://news.ycombinator.com/newsguidelines.html and taking the intended spirit of the site more to heart, we'd be grateful.
(We detached this subthread from https://news.ycombinator.com/item?id=46860103.)
It's unclear if this experiment actually happened the way Rosenhan claimed. A journalist went through Rosenhan's archives and tried to verify his story. She managed to track down one of the pseudopatients, who disputed some of Rosenhan's claims such as the amount of preparation, and whether Rosenhan had worked out a legal backup plan in case the institution refused to release the patient.[1] She also noted large discrepancies in various numbers. Apparently she wrote a book about the whole thing, but I haven't had the chance to read it.[2][3]
1. https://sci-hub.red/10.1038/d41586-019-03268-y
2. https://www.npr.org/2019/11/13/777172316/the-great-pretender...
3. https://www.susannahcahalan.com/the-great-pretender