Rosenhan’s “On Being Sane in Insane Places”. · published 3 September 2026
Rosenhan’s 1973 paper is credited with forcing the overhaul of psychiatric diagnosis, yet Susannah Cahalan found his own admission record describes distressing voices, copper foil pressed over his ears and signs of danger to himself — a presentation that makes his admission a reasonable clinical call rather than the diagnostic failure the paper reported, which is a problem for the evidence even though the reform it triggered was probably needed anyway.
These are the working notes, unedited. Everything the video
states as fact comes from here, and nothing else may be stated as fact.
The sections on limits and on what the finding does not show are
part of the brief, not an afterthought — see
the method.
Published by David Rosenhan in Science in 1973, and one of the most influential papers in the history of psychiatry.
What the paper claimed
Eight healthy people, Rosenhan among them, presented at twelve psychiatric hospitals saying they heard a voice saying “empty”, “hollow” and “thud”. All but one were admitted, mostly with a diagnosis of schizophrenia. Once inside they behaved entirely normally, yet no member of staff identified them as well. They stayed an average of nineteen days, and were discharged with schizophrenia “in remission” rather than as healthy. A second part reported that a hospital, told to expect fakes, flagged 41 of 193 incoming patients as suspected impostors, when Rosenhan had sent none.
Its influence was enormous. It is widely credited as a force behind the overhaul of psychiatric diagnosis that produced DSM-III in 1980, and it fed the movement away from institutional care.
The corrections. Susannah Cahalan spent years trying to verify the study for The Great Pretender (2019), and could confirm very little of it.
Rosenhan’s own medical record from the hospital he entered does not match what he published. He told the admitting doctor that the voices were distressing enough that he had put copper over his ears to block them, and gave indications of being a danger to himself. On that account, admitting him was a reasonable clinical decision rather than a diagnostic failure. The paper describes a much blander presentation.
Cahalan could identify only two of the other pseudopatients with confidence. One of them, Harry Lando, had his data left out of the paper — his experience of the hospital had been positive, which did not fit the argument. For several of the remaining participants she found no evidence that they existed.
There is no documented protocol for the follow-up study with the 41 suspected impostors.
Rosenhan took an advance for a book about the study and never delivered it.
What this does not show
The concerns the paper raised about the reliability of psychiatric diagnosis were real, and were already being argued inside psychiatry. Robert Spitzer published a detailed methodological attack in 1975, much of which stands, and he was one of the architects of the reform the study is credited with. The reform was arguably needed whether or not the study was sound. Rosenhan died in 2012 and cannot answer Cahalan’s findings, which should be said.