On being sane in insane places (1973) [pdf]
61 points
7 hours ago
| 13 comments
| weber.edu
| HN
ggreer
5 hours ago
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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

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dbgrman
3 hours ago
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Thanks for sharing, will read these.
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dang
3 hours ago
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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)

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ossicones
7 hours ago
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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.
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dillydogg
6 hours ago
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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.

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post_break
3 hours ago
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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.
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RodgerTheGreat
6 hours ago
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Is "energy capsules" a euphemism for amphetamines?
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dillydogg
5 hours ago
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I was taught that it was more a memory device for recognizing major depressive disorder as a state of sadness and low energy. The treatment, I presume was still SSRIs first line.
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throwway120385
2 hours ago
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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.

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hickelpickle
23 minutes ago
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Related but unrelated, but we had issue with breastfeeding and the only help that was valid was being informed to go to WIC as they could provide guidance. All medical adjacent people treated it like it was a lack of effort, when it was breaking her down and making her feel worthless. I think the WIC people helped more just in their lack of judgement made it less stressful, or it was just timing.

Our child also got stuck in the canal during birth and there was a good 30 seconds where the midwife from the hospital was trying to encourage to doctor who was to step in to let here keep trying, my kid came out white and took the longest 30-60 seconds to take their first breath. Never experienced so much dunning-kurger all at once. I had read a few week before that about medical professionals talking about how ominous a quiet birth it and was just zoned out as that was exactly what happened and I could sense all the tension. Then people from children services start demanding umbilical cord because my fiance had failed for MJ on her first prenatal vist, she quit smoking as soon as we knew and never failed a test after wards. But it all felt like an extreme lack of compassion. Then I was ostracised because I didnt want to cut the cord while I just thought my kid was dead and these social workers are trying to insert themselves in the process and its all chaos for no reason. The only good thing was a nurse pretty much told them to fuck off and wait in a nice but check yourself kinda way.

But multiple times people cared about their own ego, or their perceived power than actually attempt to do a compassionate job.

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dbgrman
3 hours ago
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I wonder what's the false negative rate for these checklists.
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ameliaquining
5 hours ago
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nephihaha
1 hour ago
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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).
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dbgrman
7 hours ago
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An experiment where they sent normal people to mental institutes to see if professionals would be able to identify them.
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lostlogin
6 hours ago
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And interestingly, how often the patients in the ward could spot these normal people while the medical staff did not.
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12_throw_away
5 hours ago
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This is one of those "important research with unbelievably flawed methods" sort of situations. Psych research before IRBs was crazy.
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TZubiri
5 hours ago
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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.

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wumms
4 hours ago
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Reminds me of: Man’s Search for Meaning (1946) https://en.wikipedia.org/wiki/Man%27s_Search_for_Meaning
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nephihaha
2 hours ago
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Was rereading that last year. Recommend it to anyone who hasn't.
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cm2012
5 hours ago
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This experiment is now widely debated, the author may have made up or exaggerated details.
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nibles_and_bits
3 hours ago
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Hello from a wildcat alumnus class 2006, never thought I would see a weber state link in HN top 20.
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dbgrman
3 hours ago
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lol, that's the first pdf link i could find of this article.
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tines
7 hours ago
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This is from the seventies. I wonder if things would be different fifty years later.
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dbgrman
3 hours ago
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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.
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clort
4 hours ago
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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.

https://en.wikipedia.org/wiki/Opening_Skinner%27s_Box

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blast
3 hours ago
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> 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?

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hamdingers
2 hours ago
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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.

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nephihaha
1 hour ago
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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.
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EtienneDeLyon
7 hours ago
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tines
6 hours ago
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This isn't really the same situation.
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cwmoore
6 hours ago
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That one is a case of mistaken identity, but the same process, same players, and same system.
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tines
5 hours ago
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The fact that we're hearing about it means that the process worked, doesn't it?
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cheeseomlit
4 hours ago
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Yeah, after he was forcibly injected with drugs against his will.

>Mr. Wright said the hospital later apologized to him and gave him a $50 gift card for a restaurant. The crisis center also apologized and gave him a $25 Walmart gift card.

That alone would be enough to drive me clinically insane

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tines
4 hours ago
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Sure, that was the first responders on the scene. The question isn’t about whether mistakes are made, it’s that once they’re made, will they be recognized and fixed? The commenters article doesn’t show what they claim (if not proving the opposite).
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nephihaha
2 hours ago
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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.

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jordwest
8 minutes ago
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I think it comes down to a fear of uncertainty. It's comfortable to believe in authority.

Authority provides the illusion of a sense of control, predictability, certainty and orderliness, and it's like we gravitate toward that even when it leads to bad outcomes for us.

For most of us the fear of being out of control seems to be greater than the fear of being controlled.

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TacticalCoder
1 hour ago
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"The normal are not detectably sane"

I remember reading an essay explaining that patients not sharing the political beliefs of the physician running the asylum are more likely to be classified as mentally ill. A mental asylum paid by state money is usually going to be in the hand of physicians who never see anything wrong with the state (not biting the hand that feeds you and all that): so when for example a libertarian arrives, he's much more likely to be classified as mentally ill than if a socialist arrives.

So it's all arbitrary and, moreover, you better put the odds on your side by trying to determine what are the physicians' political beliefs and pretend you have the same ; )

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sddfgvdsvsdfas
5 hours ago
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[flagged]
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dang
3 hours ago
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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.)

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