Textbook fail

Back in the 1970s, eight mentally well people, including psychologist David Rosenhan, presented themselves at psychiatric hospitals, where they showed signs of mild anxiety and complained of auditory hallucinations, specifically words like "empty" and "hollow". All were admitted and either diagnosed with schizophrenia or, in one case, manic depression, and, despite acting "normal" after arrival, they were kept in hospital for an average of 19 days. On discharge all were described as having schizophrenia (or depression) "in remission".

This was Rosenhan's classic study "On Being Sane in Insane Places" which he claimed showed the stigmatising power of psychiatric labels and the inability of psychiatric staff to distinguish normality from supposed abnormality, as have many others since.

But from a methodological perspective, the study was problematic for a number of reasons and Rosenhan's interpretation has been hotly disputed. In their highly regarded book on psychology myths, Scott Lilienfeld and his co-authors discuss the problem with Rosenhan's study at length, such as the fact that in the 70s "in remission" was a very rare discharge diagnosis that actually showed psychiatric staff had realised the "pseudo patients" were mentally well.

Ultimately, Lilienfeld et al argue that it is a myth that "psychiatric labels cause harm by stigmatising people" and that the overly gullible interpretation of the Rosenhan study has helped propagate this myth. Others may disagree, but it's at least fair to say that Rosenhan's study had serious issues and that not all psychologists agree that psychiatric labels are in themselves harmful (consider too research that's found that while clients say psychiatric labels can be difficult to deal with, they can also be beneficial in some ways, in terms of helping them understand their experiences and helping them to access appropriate treatments).

So, how is this classic study covered in textbooks relating to clinical psychology and mental health (the sub-discipline usually referred to on university courses as "abnormal psychology")? In a new survey of 12 contemporary abnormal psych textbooks in the journal Teaching of Psychology, Jared Bartels and Daniel Peters found that half of them still give space to Rosenhan's flawed study, but only two include any criticism or alternative interpretation of it at all.

This is a small survey and we're not told the titles of the books, but the findings suggest that the problem of uncritical textbook coverage of social psychology's classic, myth-like studies, such as the Stanford Prison Experiment and Milgram's "obedience research", may also extend to the realm of classic mental health-related research. Is it that textbook authors are unaware of the criticisms of the Rosenhan study? Possibly, although Bartels and Peters surmise that perhaps authors know of the issues and alternative interpretations, but that these "shortcomings … are considered less important than the edifying message of the stigmatising effect of labels".

Further reading

—Coverage of Rosenhan's "On Being Sane in Insane Places" in Abnormal Psychology Textbooks

About the author

Christian Jarrett (@Psych_Writer) is Editor of BPS Research Digest