Antipsychiatry & the Rosenhan Study
Szasz, Laing, Goffman and the 1973 “pseudopatient” experiment that shook psychiatric diagnosis — the critique, its lasting reforms, and what later reporting revealed about the study itself
In 1973 the journal Science published a study with a title that became a headline: "On Being Sane in Insane Places." Its author, Stanford psychologist David Rosenhan, reported that eight healthy volunteers had gained admission to psychiatric hospitals simply by claiming to hear a voice say "empty," "hollow," and "thud" — and that once labeled, none could convince the staff they were well. The study landed in the middle of a decade-long assault on the legitimacy of psychiatry itself, led by thinkers who argued that mental illness was a myth, that diagnosis was a form of social control, and that the hospital did more harm than the illness. This chapter examines the antipsychiatry movement and the Rosenhan study together: the critique, the reforms it helped produce (including a more rigorous DSM), and the remarkable revelations, decades later, that cast doubt on how much of Rosenhan's famous experiment actually happened.
The context: psychiatry at its most confident, and most vulnerable
By the 1960s American psychiatry was dominated by psychoanalysis and housed in vast, overcrowded state hospitals (see Moral Treatment & the Asylum Era). Diagnosis was notoriously unreliable — studies showed psychiatrists in different countries, or even the same country, applying labels like "schizophrenia" in wildly inconsistent ways. Treatment could be coercive and included lobotomy and unmodified electroconvulsive therapy. Involuntary commitment was easy to impose and hard to challenge. Into this vulnerable field came a set of critics who questioned not just its methods but its foundations.
The critics
Thomas Szasz — "the myth of mental illness"
Szasz, himself a psychiatrist, argued in The Myth of Mental Illness (1961) that "disease" properly refers to bodily pathology, and that mental "illnesses" are really problems in living — moral, social, and existential struggles mislabeled as medical conditions. His sharpest concern was coercion: he saw involuntary commitment and the insanity defense as abuses in which the state used a medical vocabulary to control people who had broken no law. Szasz was a fierce civil libertarian who opposed forced psychiatry but defended voluntary contractual therapy between consenting adults.
R.D. Laing — madness as meaning
The Scottish psychiatrist R.D. Laing, in The Divided Self (1960) and later work, argued that psychotic experience was not meaningless neural noise but an intelligible, even potentially transformative, response to an intolerable social and family situation. He experimented with non-coercive therapeutic communities (such as Kingsley Hall) where "madness" could be lived through rather than suppressed. Laing romanticized psychosis in ways most clinicians reject, but he insisted on listening to the content of what patients said — a corrective to purely custodial care.
Erving Goffman — the "total institution"
The sociologist Erving Goffman's Asylums (1961), based on fieldwork in a large state hospital, described the psychiatric institution as a "total institution" that, like a prison or a barracks, stripped inmates of their prior identity through a "mortification of the self" and produced much of the passive, institutionalized behavior that staff then attributed to the illness itself. Goffman was not strictly an antipsychiatrist, but his analysis gave the movement its most durable empirical concept.
Michel Foucault and the broader current
The French philosopher Michel Foucault, in Madness and Civilization, framed the confinement of the mad as an exercise of social power and reason's need to define its opposite. Together with Franco Basaglia's reform movement in Italy — which led to the 1978 law (Law 180) closing the country's psychiatric hospitals — these thinkers made "antipsychiatry" an international intellectual and political current, not just a clinical dispute.
The Rosenhan study
Into this ferment came the study that gave the critique its most memorable evidence. In "On Being Sane in Insane Places," Rosenhan described two experiments.
Experiment 1: the pseudopatients
Eight healthy "pseudopatients," Rosenhan among them, presented at twelve hospitals reporting a single symptom — a voice saying "empty," "hollow," "thud" — and otherwise behaved normally and gave truthful life histories. All were admitted, most with a diagnosis of schizophrenia. Once inside, they stopped feigning any symptom, yet the label colored everything: normal behavior (note-taking, boredom) was reinterpreted as pathology. They were held an average of 19 days and discharged with schizophrenia "in remission." Interestingly, real patients often spotted the fakes even when staff did not.
Experiment 2: the reverse test
Rosenhan reported that a teaching hospital, told he would send pseudopatients over some weeks, subsequently rated a large fraction of its genuine incoming patients as suspected fakes — though Rosenhan had sent none. The apparent conclusion: psychiatric diagnosis could not reliably distinguish the sane from the insane in either direction.
Rosenhan's stated moral was that psychiatric diagnosis lived "in the minds of the observers" rather than in the patients, and that the hospital environment itself was "countertherapeutic." The study was widely publicized, taught for decades, and became one of the most cited indictments of psychiatric diagnosis ever published.
The reforms it helped drive: DSM-III and reliable diagnosis
Whatever its flaws, the Rosenhan study crystallized a real and embarrassing problem: psychiatric diagnosis was unreliable. The field's response was consequential. Robert Spitzer — one of Rosenhan's sharpest critics — led the development of DSM-III (1980), which replaced vague, theory-laden definitions with explicit, operationalized diagnostic criteria and decision rules designed to make diagnosis reproducible across clinicians. DSM-III was a paradigm shift toward a descriptive, criteria-based nosology, and the drive for diagnostic reliability that produced it was fueled in part by exactly the kind of criticism Rosenhan's study embodied. In that sense antipsychiatry, for all its hostility, helped push psychiatry toward greater rigor.
The movement's civil-liberties strand had parallel effects in law. The same era produced the landmark cases that made commitment harder and slower — Lessard, O'Connor, Addington — and helped drive deinstitutionalization. Szasz's insistence on the liberty stakes of involuntary treatment echoes through modern debates about coercion, capacity, and outpatient commitment.
The reckoning: did the Rosenhan study happen as described?
For decades the study stood as fact. Then, in The Great Pretender (2019), journalist Susannah Cahalan — who set out to celebrate Rosenhan — instead uncovered serious problems. She could locate only a couple of the eight pseudopatients. One she found, Harry Lando, had actually reported a positive experience of his hospitalization; his data had apparently been excluded because it did not fit the thesis. Rosenhan's own medical record from his admission suggested he had described far more severe and alarming symptoms than the innocuous "thud" the paper claimed. Cahalan found no persuasive evidence that some of the other pseudopatients existed at all, and the crucial second experiment was thinly documented. Her investigation raised the real possibility that one of psychiatry's most influential studies was, in significant part, exaggerated or fabricated.
What this history teaches
The antipsychiatry movement was wrong in its strongest claims — severe mental illnesses are real, disabling, and often treatable, and denying that has cost lives. But it was right that diagnosis had been unreliable, that institutions could harm, and that psychiatric authority could be turned to coercive ends. The mature position is neither the movement's nihilism nor a defensive dismissal of it: it is to hold the reality of mental illness together with humility about diagnostic limits, vigilance about coercion, and respect for the meaning of what patients say. Those are the movement's lasting, useful legacies — and the Rosenhan saga adds one more: that even a landmark study deserves scrutiny.
For the ethical abuses that gave the critique some of its force, see Research-Ethics Abuses; for the institutions under attack, see Moral Treatment & the Asylum Era; for the outcome, see Deinstitutionalization.
References & further reading
Rosenhan DL. "On Being Sane in Insane Places." Science 1973;179:250–258. · Szasz T. The Myth of Mental Illness (1961). · Laing RD. The Divided Self (1960). · Goffman E. Asylums (1961). · Foucault M. Madness and Civilization. · Cahalan S. The Great Pretender (2019). · Spitzer RL. Critiques of Rosenhan and the development of DSM-III. · Scull A. Madness in Civilization.