In response to:

Changing Psychiatry’s Mind from the January 14, 2021 issue

To the Editors:

In Gavin Francis’s thoughtful account of two books on the history of psychiatry [“Changing Psychiatry’s Mind,” NYR, January 14], I was surprised to find a brief discussion of the 1973 study by David Rosenhan, the Stanford psychologist, that accused psychiatrists of being unable to tell the difference between sanity and mental illness. Francis claims that Rosenhan had produced “an experiment of stunning elegance,” although he concedes that it “has had its detractors.” But that concession seems hardly sufficient in view of the evidence provided by Susannah Cahalan in her book The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness (2019); she shows that Rosenhan fabricated his evidence and that his conclusions were and are hopelessly unreliable. While it’s true that Rosenhan’s paper made a big splash and prompted sharp reactions within the profession of psychiatry, it should no longer be cited as evidence of the inability of doctors to distinguish mental health from madness.

H.C. Erik Midelfort
Professor of History Emeritus
University of Virginia
Charlottesville, Virginia

Gavin Francis replies:

I thank H.C. Erik Midelfort for raising questions over the Rosenhan study, which has, as I wrote, its detractors and remains controversial. Of the many who have criticized it since its publication I particularly enjoy Robert L. Spitzer’s riposte in the Journal of Abnormal Psychology (1975): “Just as his pseudopatients were diagnosed at discharge as ‘schizophrenia in remission,’ so a careful examination of this study’s methods, results, and conclusion leads to a diagnosis of ‘logic in remission.’” Susannah Cahalan’s book of 2019 is the latest to attack Rosenhan personally and professionally, but in reviewing Anne Harrington’s Mind Fixers, not Cahalan’s book, I thought it worthwhile to bring in the former’s assessment of Rosenhan, for what it might illuminate about psychiatry as practiced in the United States in the late 1960s and early 1970s.

Cahalan acknowledges that Rosenhan’s intervention was significant. Though criticism and media attention have tended to focus on the first part of the study (that Rosenhan was able to feign mental illness to get himself admitted), to my mind that is its least interesting aspect. Far more interesting was the witnessed abuse of psychiatric inpatients when staff thought they were unobserved (“Staff are credible witnesses. Patients are not”), the lack of engagement between patients and clinicians who were higher up in the hospital hierarchy (“Those with the most power have the least to do with patients”), and finally the average nineteen days it took from the cessation of professed “symptoms” to being allowed home. I understand Professor Midelfort’s perspective, and am sorry that he felt there was insufficient focus on Rosenhan’s detractors, but would argue that the study remains significant—no account of psychiatry as practiced in the 1970s would be complete without acknowledging it.