On being sane in insane places (1973) [pdf](weber.edu)
weber.edu
On being sane in insane places (1973) [pdf]
https://www.weber.edu/wsuimages/psychology/FacultySites/Horvat/OnBeingSaneInInsanePlaces.PDF
57 comments
Thanks for sharing, will read these.
https://spectator.com/article/how-a-fraudulent-experiment-se... Goes over things pretty well - the experiment seems to have been almost completely fraudulent with fabricated or heavily cherry-picked data.
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)
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)
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.
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.
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.
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.
I thought about defining it up front but decided to move it to the second paragraph.
I would say it's worth talking to a doctor about how you feel. There are many things that can help. If you are in the USA, if is likely that they will use the PHQ-9 form, so consider looking at that questionaire to see how it aligns with your mood. medcalc is a common site that many of the residents at my institution use for these questionaires and other various scoring systems.
I would say it's worth talking to a doctor about how you feel. There are many things that can help. If you are in the USA, if is likely that they will use the PHQ-9 form, so consider looking at that questionaire to see how it aligns with your mood. medcalc is a common site that many of the residents at my institution use for these questionaires and other various scoring systems.
Is "energy capsules" a euphemism for amphetamines?
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.
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.
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.
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.
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.
I wonder what's the false negative rate for these checklists.
This study was a fraud: https://doi.org/10.1177/0957154x221150878
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).
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.
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.
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.
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.
I'm not sure it's even uncertainty. Authority carries a bigger stick, and things like witch hunts and burning of heretics and rebel peasants, have deselected independence of mind over the centuries. Society has an unconscious memory of what used to happen when people disagreed. And still does in some places.
People today worship the white lab coat and the military/police uniform in the same way their ancestors honoured witch doctors/shamans and the tribe's warriors. They assume the former groups will dish out good advice and the latter will protect them. The general public experiences this in hospitals and schools, with psychiatric hospitals being the most extreme version of hierarchy. I've mentioned that I currently have two friends who are stuck in a mental hospital, and I have told both of them that they need to be respectful of staff if they want to get out sooner. The woman seems to have had her day passes revoked, and been placed on a more secure ward, after being cheeky to staff. Maybe the staff were awful but she isn't in much of a position to negotiate — she's been in there for nine months. (I've heard rumours of one of the other patients being sexually assaulted by staff, but thanks to the nature of these places I don't know whether it is fantasy or a real crime, since the supposed victim is doped up to the eyeballs much of the time and would not remember it properly.)
People today worship the white lab coat and the military/police uniform in the same way their ancestors honoured witch doctors/shamans and the tribe's warriors. They assume the former groups will dish out good advice and the latter will protect them. The general public experiences this in hospitals and schools, with psychiatric hospitals being the most extreme version of hierarchy. I've mentioned that I currently have two friends who are stuck in a mental hospital, and I have told both of them that they need to be respectful of staff if they want to get out sooner. The woman seems to have had her day passes revoked, and been placed on a more secure ward, after being cheeky to staff. Maybe the staff were awful but she isn't in much of a position to negotiate — she's been in there for nine months. (I've heard rumours of one of the other patients being sexually assaulted by staff, but thanks to the nature of these places I don't know whether it is fantasy or a real crime, since the supposed victim is doped up to the eyeballs much of the time and would not remember it properly.)
[deleted]
This is one of those "important research with unbelievably flawed methods" sort of situations. Psych research before IRBs was crazy.
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.
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.
To explain this for anyone else like me who hadn't heard the term.
https://en.wikipedia.org/wiki/Open_access_citation_advantage
Full Text On the Net = FUTON.
https://en.wikipedia.org/wiki/Open_access_citation_advantage
Full Text On the Net = FUTON.
This experiment is now widely debated, the author may have made up or exaggerated details.
Reminds me of: Man’s Search for Meaning (1946) https://en.wikipedia.org/wiki/Man%27s_Search_for_Meaning
Was rereading that last year. Recommend it to anyone who hasn't.
"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 ; )
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 ; )
Hello from a wildcat alumnus class 2006, never thought I would see a weber state link in HN top 20.
lol, that's the first pdf link i could find of this article.
This is from the seventies. I wonder if things would be different fifty years later.
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.
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
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
> 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 by 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?
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 by 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?
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.
> 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.
Sorry for replying so late, I only just checked the thread.
"I was mislabeled but not locked up" is misleading because hospitalization was phased out decades ago (https://en.wikipedia.org/wiki/Deinstitutionalisation). The reason she didn't get "locked up" is because treatments changed, not because she was assessed correctly (she was not). Psychotic patients don't get "locked up" by default anymore—they get medicated, which is what happened in her case as well.
It's a red herring to emphasize an obsolete practice that was phased out long ago. "I was mislabeled but not locked up" says no more than "I was mislabeled but not put in an insulin coma". A more accurate statement would be "I was misdiagnosed and treated for mental illness". Written that way, it's clearer that this is not a refutation of Rosenhan at all, and looks more like a replication.
I don't know if the book is actually this misleading because I haven't read it. I'm just making an out-of-context response to the out-of-context bits of information I've gleaned here.
"I was mislabeled but not locked up" is misleading because hospitalization was phased out decades ago (https://en.wikipedia.org/wiki/Deinstitutionalisation). The reason she didn't get "locked up" is because treatments changed, not because she was assessed correctly (she was not). Psychotic patients don't get "locked up" by default anymore—they get medicated, which is what happened in her case as well.
It's a red herring to emphasize an obsolete practice that was phased out long ago. "I was mislabeled but not locked up" says no more than "I was mislabeled but not put in an insulin coma". A more accurate statement would be "I was misdiagnosed and treated for mental illness". Written that way, it's clearer that this is not a refutation of Rosenhan at all, and looks more like a replication.
I don't know if the book is actually this misleading because I haven't read it. I'm just making an out-of-context response to the out-of-context bits of information I've gleaned here.
Mental healthcare does care about dishonest patients in some cases, mainly where it's an avenue for drug-seeking. But no-one's trying to get ahold of anti-psychotics for recreational purposes.
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.
This isn't really the same situation.
That one is a case of mistaken identity, but the same process, same players, and same system.
The fact that we're hearing about it means that the process worked, doesn't it?
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
>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
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).
I don’t think you are thinking rationally about the issue. Medical mistakes are significant events, and $75 in gift cards, much less than minimum wage, fixes very little except the consciences of the “mental health providers”.
No
easy solution is to not put yourself in that situation
Grifters gonna grift.
No reason to talk about yet another failure in social sciences
https://spectator.com/article/how-a-fraudulent-experiment-se...
https://spectator.com/article/how-a-fraudulent-experiment-se...
[flagged]
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.)
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.)
[deleted]
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