Rosenhan’s paper continues to be cited hundreds of times a year, and its alleged findings are seen as crucial evidence of psychiatry’s failings. Yet based on the findings of an investigative journalist, Susannah Cahalan, and on records she shared with the author, we now know that this research is a spectacularly successful case of scientific fraud.

[Keywords: American psychiatry, David Rosenhan, DSM-III, scientific fraud, Susannah Cahalan]

…His paper in Science was his only important contribution to the social psychological literature, albeit one that made him famous for decades. He never revisited the topic in any academic journal, and published nothing of comparable impact for the rest of his career…At least 70 newspapers, both regional and national, gave prominent attention to his study. Television and radio shows interviewed Rosenhan. A major commercial publisher offered him a lucrative contract for a book based on his research, an offer Rosenhan accepted with alacrity. Harvard University even sent out feelers about a possible appointment to its faculty. Rosenhan’s exposure of psychiatry’s flaws caused a sensation. No wonder so many practitioners rushed to register their objections in the pages of Science, which, quite extraordinarily, devoted 9 pages of a subsequent issue to their howls of protest, and to Rosenhan’s response. That in itself was a measure of how powerfully this exposé resonated outside the cloistered world of academia.

…A recent survey of 12 leading textbooks on abnormal psychology, for example, found that half of them still gave extensive attention to Rosenhan’s paper, summarizing its design and endorsing its basic findings. Only two of them acknowledged any criticisms of the study, although methodological critiques have emerged over the years since the article’s initial publication (see Bartels & Peters2017). As another example of the study’s extraordinary half-life, as recently as 1 January 2018, the Washington Post ran a wholly uncritical article summarizing Rosenhan’s findings (Morris 2018).

…The seriousness of the crisis the profession faced was immediately recognized by psychiatry’s elite. Within weeks of the article’s appearance, the Board of Trustees of the American Psychiatric Association called an emergency meeting in Atlanta on 1 February. How could they respond to ‘the rampant criticism’ that enveloped the profession, not least to the perception (or rather, the reality) that its practitioners could not reliably make diagnoses of the mental illnesses they claimed to be expert at treating (Decker2013, The Making of DSM III: A Diagnostic Manual’s Conquest of American Psychiatry: pg141–142)?…As the APA’s Board of Trustees recognized, Rosenhan’s paper, and the immense amount of publicity it had already received, had created a focal point for psychiatry’s critics, and amounted to an existential crisis for the profession. Indeed, barely a year later, a prominent member of an emerging mental health bar—lawyers who were suing psychiatry on multiple fronts—authored a long law review article dismissing psychiatrists’ claims to be experts in the diagnosis and treatment of mental illness as fraudulent and scientifically indefensible. Advised behind the scenes by Rosenhan himself, Bruce Ennis alleged that psychiatrists who weighed in on questions of sanity fared no better than a trained monkey flipping a coin (Ennis & Litwack1974).

…One of the first tasks Spitzer set himself as the task force began its work was to rebut David Rosenhan’s study. He engaged in extensive correspondence with Rosenhan, seeking to pierce the veil of secrecy and anonymity that had been a central feature of the published paper. Who were the pseudo-patients, he asked, and which hospitals had they been admitted to? Rosenhan deflected and refused to answer. ‘I am’, he wrote, ‘obliged to protect these sources.’⁴ Spitzer’s response was to write two papers attacking the methodology, the logic and the conclusions of Rosenhan’s study, one of them forming part of a symposium that he organized to rebut Rosenhan’s claims (Spitzer1975, Spitzer1976). But while Rosenhan1973’s Science paper reached an enormous audience across the scientific community and, via the mass media, an even larger lay public, Spitzer here spoke only to his professional colleagues. There is, moreover, a deep irony at play here. It was paradoxically Rosenhan’s study, and the extraordinary publicity which had accompanied its publication, that had prompted the APA to set up a task force to revise its diagnostic system. Also it decided to appoint Spitzer to direct the creation of the new DSM, which would propel him to the forefront of the profession, and make him one of the most influential psychiatrists of the second half of the twentieth century.

[on the fabrication of the paper as revealed by the major discrepancies with actual ‘patient accounts’, including Rosenhan himself, and falsified numbers]

…Despite two years of diligent effort, the only pseudo-patient Ms Cahalan was able to locate was the psychology graduate student, whose case is examined below. In the course of his extensive correspondence with Rosenhan 1974–1975_49ya, Robert Spitzer had repeatedly sought access to the pseudo-patients’ admission records, ‘with all the safeguards for preserving confidentiality of persons and institutions’. Those redacted records, he pointed out, would demonstrate whether these volunteers ‘were able to follow protocol and limit their histories to monosymptomatic illness’. ‘Many psychiatrists’, he noted, ‘doubt that the patients only complained of hallucinations. It would be good to set this issue to rest.’⁹ Although Rosenhan had earlier indicated that he would be ‘delighted to send you the admissions notes’, he never did so. Instead, he informed Spitzer that, like others, he would have to wait: ‘I have asked others who desire raw data on our observations and/or others’ observations of us to wait until I have completed analyzing for the book I am preparing [on the study].’¹⁰

In 1974, Rosenhan had indeed signed a contract with Doubleday to write a book about his study, receiving a first installment of $46,233.85^$11,000₁₉₇₄ of a promised $184,935.41^$44,000₁₉₇₄ advance. He had begun to produce a manuscript (originally to be called Odyssey into Lunacy and later re-titled Locked Up), writing more than 200 pages that survive in his files. But nowhere in this draft, or anywhere else in his files, can one find any materials bearing in any substantial way upon the identities and experiences of the supposed pseudo-patients: not their names, not their admission documents, not their own observations about what occurred at admission or during their hospitalization; not the names of the institutions to which it is claimed they sought admission. The published paper in Science included all sorts of detail about the patients’ time in the hospital, including quantitative data allegedly recording the amounts of time psychiatrists and staff spent with the patients, but there was no trace of the observations that underpinned these numbers. Rosenhan’s files, while they are wildly disorganized, are replete with other information about the study: fan letters from those who endorsed its findings, to whom he religiously replied; criticism from psychiatrists; copies of commentaries on the study; and so on. But the crucial raw materials, which should have been collected as the study was done and which formed the basis for its claims, are nowhere to be found.

…So, far from being ignored, patients were treated with respect and care. ‘The powerlessness and depersonalization of patients emphasized by Rosenhan simply did not exist in this setting. On no occasion did I observe a patient ignored by staff.’ Small wonder that, at the end of a 19-day stay, Lando reported that ‘My overall impressions of the hospital were overwhelmingly positive’ (p. 51). It is not surprising, I suggest, that Rosenhan wanted to exclude these findings from his paper. But when it suited his purpose to extract something from Lando’s notes and use it to bolster the portrait he sought to draw of mental hospitals, Rosenhan did not hesitate.

…The misconduct did not end there. In Rosenhan’s files, Ms Cahalan discovered an earlier draft of the Science paper that he had pre-circulated to the psychologist Walter Mischel for review. [Note: Mischel appears to’ve been chair of Rosenhan’s department at the time, which is probably why he got a copy even though he tells Cahalan he disliked Rosenhan & his research. Mischel was also responsible for extremely misleading attacks on personality psychology, and the infamous ‘marshmallow test’; so perhaps he bears some blame for Rosenhan as well!] This version contained 9 pseudo-patients, not 8. Harry Lando had not yet been excluded. Both papers reported what purported to be hard data about the lack of contact between staff and patients, presented in tabular form and elaborated upon in the text. The numbers were identical even after the 9^th patient was removed in the published version. On the face of it, we know that this is a statistical impossibility. In this instance, given that Lando reported hours of contact with staff on a daily basis, both sets of ‘data’ are transparently falsified.

Rosenhan’s files contained further notes on ‘Walter Abrams’. They were riddled with errors. Lando’s diagnosis was mis-recorded as paranoid schizophrenia. His hospital stay was given as 26 days (it was actually 19 days). He was not turned away for ‘3 days’ before securing admission, and the ward was not ‘full’. Finally, he was released with medical advice, not against it, and was not given the diagnosis of ‘schizophrenia in remission’. All these statements were fabrications.

…We have already documented Rosenhan’s willingness to fabricate and distort evidence, but there remains still more d—ning evidence of his chicanery. Rosenhan’s files contain his own medical records, documenting his admission to Haverford State Hospital, as well as his notes on his institutionalization. It is revealing to compare the account he provides there with what the contemporaneous records show.

…I have quoted extensively from these documents (to which I had access through the kindness of Ms Cahalan) to demonstrate just how sharply what happened in the intake examination strayed from what Rosenhan1973 represented as Lurie’s behavior in the Science paper. Far from confining himself to reporting 3 discrete aural hallucinations and otherwise behaving perfectly normally, Rosenhan gave ample evidence of deep intellectual and emotional disturbance. Besides the grimacing and twitching, and the dull, halting speech pattern, he indicated that the radio was broadcasting to him, and that he could ‘hear’ other people’s thoughts. He was depressed and frightened, and had been unable to work for months. Outpatient treatment with drugs had failed to improve matters. Visibly ‘tense and anxious’, he thought he was worthless and had contemplated ‘suicide as everyone would be better off if he was not around’. These constitute an infinitely more serious and extensive set of pathological symptoms. Had Rosenhan told the truth about his presentation of self at the hospital, no one would have been surprised that a psychiatrist would decide to admit him, or to diagnose the patient before him as he did.

In his Science paper, Rosenhan further claimed that, once admitted, the pseudo-patients, himself included, immediately stopped displaying symptoms and behaved normally. Again, the surviving medical records show that in his case this is quite false. In the days after his admission, two other psychiatrists examined him at some length. Both documented the depths of the pathology Lurie was showing.

…Indirectly, therefore, Rosenhan’s study played a major role in the complete re-orientation of American psychiatry. Very early in the 1980s, the psychoanalysis that had dominated it since World War II lost its hold over the profession, and soon withered away to almost nothing. In its place, biology and neuroscience came to rule the roost, and both profession and public came to adopt a radically different perspective on mental illness. These were momentous changes. Remarkably, I suggest, the study that greatly helped to smooth the way to their acceptance was thoroughly dishonest, a scientific scam that stood largely unchallenged for nearly a half century. It is time for it to be revealed for what it is: a successful scientific fraud.