In the history of psychiatric research, few studies have made an impact as profound as David Rosenhan’s 1973 paper, “On Being Sane in Insane Places.” It challenged the validity of psychiatric diagnosis and exposed the depersonalisation of patients in mental hospitals. Decades later, journalist Susannah Cahalan revisited the same study in her 2019 book, The Great Pretender, only to uncover troubling questions about its accuracy and documentation. Together, their work presents more than a disagreement. It is a reminder that no matter how compelling a message may be, research must rest on a foundation of reliable records and sound methodology.
Rosenhan’s Experiment
Rosenhan led a group of eight pseudopatients who each presented themselves at different psychiatric hospitals claiming to hear voices. Once admitted, they behaved entirely normally and reported no further symptoms. Despite this, all were diagnosed with serious mental illnesses, mostly schizophrenia, and were prescribed strong antipsychotic medication. The average hospital stay was 19 days, with one patient held for 52 days. None were identified by staff as imposters, although other patients often suspected the truth.
In a second phase, a hospital challenged Rosenhan to send more pseudopatients as a test of their ability to detect imposters. Over the following months, the staff identified 41 such individuals. In reality, Rosenhan had sent no one. This revealed how psychiatric labels could cloud judgement and foster error.
The study was published in Science and quickly became one of the most influential critiques of psychiatry. It led to greater scrutiny of mental health institutions, the development of new diagnostic manuals, and the closure of many asylums.
Cahalan’s Re-examination
Susannah Cahalan approached Rosenhan’s study with admiration, but her investigative journey revealed serious flaws. Despite extensive effort, she was only able to locate two of the supposed eight pseudopatients. The others could not be verified. Hospital records, raw data, and detailed transcripts were either missing or had never been released. Even more concerning, one of the individuals who had taken part described their experience positively, in contrast to Rosenhan’s bleak narrative.
Cahalan also discovered an unpublished manuscript written by Rosenhan. It contained inconsistencies and altered case details, raising concerns that parts of the study may have been exaggerated or fictionalised. This lack of transparency stood in sharp contrast to the study’s enduring influence.
Scientific Integrity
Rosenhan’s core argument about the dangers of psychiatric labelling was valid. However, the absence of clear documentation raises questions about the reliability of his findings. The study lacked:
Clear and replicable methodology Comprehensive records and raw data Transparency in patient selection and hospital procedures
Scientific research depends on verifiability. Without access to original data, no study can be replicated or properly critiqued. Rosenhan’s failure to preserve and share such records weakens the credibility of what was once considered a foundational piece of psychiatric literature.
Why This Still Matters
The debate between Rosenhan and Cahalan is not only about psychiatry. It highlights a broader concern within science: the need for rigorous, accountable research practices. Especially in fields that affect people’s lives so directly, such as mental health, ethical research must be rooted in truth and open to scrutiny.
Public trust in science depends not only on powerful stories, but on the integrity of the research behind them. Narrative alone cannot replace evidence. Researchers must ensure that their work can withstand examination, even many years after it is published.
Conclusion
Rosenhan’s study brought attention to real issues in mental health care, and Cahalan’s investigation reminded us that lasting change must be based on fact, not fiction. Their contrasting accounts demonstrate that bold claims require careful evidence. Proper documentation, transparent methods, and reproducibility are not optional features of good science. They are its very foundation. Without them, the line between truth and assumption becomes dangerously unclear.
References
Cahalan, S. (2019). The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness. New York, NY: Grand Central Publishing.
Rosenhan, D. L. (1973). On being sane in insane places. Science, 179(4070), 250–258. https://doi.org/10.1126/science.179.4070.250
Spiegel, A. (2008, July 31). On being sane in insane places: Revisiting a classic study. NPR. https://www.npr.org/templates/story/story.php?storyId=93646216
Carey, B. (2019, November 27). The Rosenhan experiment: On being sane in insane places. The New York Times. https://www.nytimes.com/2019/11/27/books/review/the-great-pretender-susannah-cahalan.html