Rosenhan choked down breakfast and returned to the drafty dayroom, where he fell back into uneasy slumber. He woke for lunch—“pink gloppy,” a white sauce with pale-pink things floating in it—prompting a diatribe in his notes from a man who prided himself (thanks to a mother who was an awful cook) on his ability to choke down just about anything. “The accounting department has obviously taken over the kitchen… Cook better, serve better foods, damn it and the ‘proper balanced diet problem’ will disappear!” This is all contained in his private writings; none of it was communicated aloud.
Rosenhan began to warm up to the patients, many of whom he initially expressed a “nameless terror” of. “Distance permits us to control the terror, to keep it from awareness—away!” he wrote. But as a patient, he could maintain only a fingernail hold on that distance. He asked around about grounds privileges, which led to the inevitable question, How do you get out? A patient named Bill summed it up: “You got to talk to the doc. Not in his office but on the floor. Ask him how he is. Make him feel good.”
Make the doctor feel good? Who was running the asylum here? “Drs. exist to be conned,” he wrote. He could hardly believe the level of manipulation that being a patient required, and how far one would go to avoid interacting with the system. Another patient, also named David, gave an example of how to play the game: “I might want to kill myself but I won’t tell the psychiatrist, he’d keep me here,” he said. “This way when I get out I can do what I want to.” And yet another patient, Paul, who had been diagnosed with schizophrenia and had been in and out for years, had a similar perspective: “You’ve got to cooperate if you want to get out. Just cooperate. Don’t assert your will.”
Sunday 2/9/69
1:45 pm
I am depressed, sort of ready to cry. One tear jerking moment and I’d be flooding. Given my commitment to “being normal” on the ward, I can’t account for my blues in terms of role enactment.
Later in the dayroom, after returning to the dining hall for dinner, he ran into the hostile Mr. Harris.
“Have you got a moment, Mr. Harris?” Rosenhan asked.
“Didn’t I tell you to get away and quit bothering me?” Harris said.
Rosenhan watched himself flee from the interaction and “in doing so behaved like a patient.” David Rosenhan, the professor, would never have allowed anyone—anyone!—to speak to him like that, but David Lurie, the patient, hung his head in shame. He went to the bathroom to splash water on his face and caught his image in the mirror. This time he didn’t see just a haggard patient. He saw a middle-aged man in slacks and white button-down shirt (wrinkled, yes). The realization shook him out of his stupor: He looked like a professor, an academic, an intellectual. In much the same way that the judge had recognized Nellie Bly’s ladylike demeanor, no beaten-up old Clarks or moth-eaten shirts could sufficiently mask Rosenhan’s status. Harris, Rosenhan realized, must have mistaken him for a psychiatrist, and the intimate conversation emerged from Harris’s desire to impress Rosenhan, whom he considered higher up in the pecking order. The illusion dissolved when the nurses broke the news. The look on Harris’s face—total embarrassment—returned to Rosenhan and he felt vindicated. He thought I was sane. But the relief was fleeting.
Rosenhan begged for a phone call to check up on his family, but the nurses wouldn’t budge: He didn’t yet have phone privileges. These were doled out in stages—first phone, then grounds, then day passes, and finally night passes until you were stepped down to one of the open Osmond-style buildings or released. Rosenhan still needed to prove that he could use the phone responsibly. “I then had the fantasy of kicking the door, trying to break it down.” He imagined swaggering into their darkened cage. “You think I’m a real patient! I’m not. I’m sane. I faked my way into the hospital for a study I’m doing. In fact, I’m not David Lurie, I’m David Rosenhan, professor of psychology!”
But the fantasy always ended the same way, much as it did when Bly had tried in vain to convince doctors of her sanity: with the nurse asking, “Do you often think you’re ‘David Rosenhan’?”
DAY FIVE
Nurses’ Note: 2/10/69 Patient quite cooperative. Patient had visitors this PM. No complaints at this time.
Rosenhan was in a foul mood when he woke up on the fifth day to an attendant berating a patient for using the shower too long. “The blood rises,” he wrote. When he stumbled to the bathroom and discovered that the door’s handles had been unscrewed the night before, destroying even the illusion of privacy, “the blood rises further.” In the cafeteria on pancake day (which sounds far better than it was), Rosenhan asked the lunch ladies for some syrup. They directed him to an attendant who was eating by himself in the back of the room with the one maple syrup container.
Rosenhan asked the aide to pass him the syrup.
“There is none,” the attendant responded. “You’ve got to use jelly.” Rosenhan stared as the aide poured a river of the brown liquid onto his already syrup-logged pancakes.
Rosenhan was so angry he nearly blurted out: “Are we supposed to be blind?” But he stopped himself, recognizing in time that anger, however justified, is here considered sick, disturbed.
And he wanted out. The words of one patient stayed with him: “Don’t tell them you’re well. They won’t believe you. Tell them you’re still sick, but getting better. That’s called insight, and they’ll discharge you.”
Back in the dayroom, he continued writing.
“What are you writing?” a fellow patient asked.
“A book.”
“Why do you write so much?”
It wasn’t the first time one of his peers noticed his constant writing. Another patient had asked him if he was penning an article about the place. Others had asked outright: “Are you an undercover journalist?” One psychiatrist seemed to have caught on, at one point commenting, “What are you doing, Mr. Lurie? Writing an exposé of us?” When Rosenhan asked him to repeat his question, the doctor waved it off. It was just a joke. Of course David Lurie wasn’t writing an exposé. That would be crazy.
In the dayroom, Rosenhan witnessed a scene between Harrison, an attendant who had greeted Rosenhan with a razor his first morning in, and Tommy, an eighteen-year-old diagnosed with schizophrenia.
“I like you Mr. Harrison.”
“Get over here.”
Harrison pushes Tommy into his room. “Where is your bed?”
“Please don’t. I didn’t do anything.”
Harrison tosses Tommy onto the floor and pins him down, knee on arm and stomach. Tommy cries out and fights back. [Harrison] is now openly angry, throws Tommy onto his bed, reaches under and appears to grab his balls.
A nurse interrupted the assault. She threatened to lock Tommy in solitary.
Tommy later struck a patient in the face, and this time the nurse did not hesitate to send him into an isolation room. He kicked and screamed and thrashed and yelled with such violence that it took two attendants and a nurse to push him inside. Rosenhan watched Tommy through the glass opening at the top door:
He began to break the walls, first with the bed and then with his bare hands. No one stopped him as he screamed and cried, his hands and even his face and arms bleeding from the torn plaster. No one administered a calming sedative. Rather, nurse, attendants, and patients watched through the little window that opened onto the isolation room, crowding each other for the pleasure of watching a nether person tear himself into bloody exhaustion.
DAY SIX
Nurses’ Note: 2/11/69 Quiet and cooperative with no known complaints. Spends a lot of time in dayroom watching TV and writing
It must have been a nurse who led Rosenhan to the ward’s conference room. Did he lose his composure once he saw the ten or so pairs of eyes—some of them no doubt strangers—narrowing to take him in? Certainly there were his two psychiatrists, Dr. Bartlett and Dr. Browning, and the ward’s head nurse, but there must have been unfamiliar faces, too, like the chief of male services, the clinical dir
ector, and a social worker or two, all there to make an assessment.
These did not always go smoothly and respectfully. In a case conference in 1967, a patient admitted that he suffered from syphilis and one of the doctors asked him if he had sores on his penis. The man shook his head, but the doctor ordered him to drop his pants in front of the entire room. No one questioned the doctor or thought about what effect this might have on a person who was already psychologically fragile. The psychiatrist was king.
This was a new case conference—typically people on the ward had several. But Rosenhan didn’t want another meeting. He wanted out. He took the advice that the other patients had given—convince them with a narrative they would understand. He would say that he had hit rock bottom and Haverford Hospital had helped him climb out of it. Rosenhan explained that prior to his hospitalization, he had secured an interview with an advertising agency in Philadelphia. It was a big opportunity. It was time to leave.
The staff dismissed Rosenhan from the conference room so that they could discuss his case. They changed his diagnosis again, now to “acute paranoid schizophrenia, in partial remission,” and granted him a day pass to attend the interview. They also recommended that his commitment run out, meaning that he would soon be free to leave. But they insisted that it was important for him to continue outpatient psychotherapy.
DAY SEVEN
Meanwhile, the hospital decided that Rosenhan was now healthy enough to walk the property unaccompanied, and gave him grounds privileges (“in record time!” he wrote). He could join in ward activities, go on walks, and use the phone. Privileges allowed him access to the gym—where he “couldn’t tell many of the patients from the staff,” he wrote. That hollow dread he felt in the presence of “the other,” the patient, was gone.
After gym, he joined the chattel outside the cafeteria waiting for the doors to open, pacing back and forth to pass the time.
“Nerves?” Faust, an attendant, asked.
“Bored, nothing to do.”
Rosenhan’s behaviors were self-fulfilling prophecies: He was crazy so he paced; he paced because he was crazy. Though there were many reasons for the pacing—sheer boredom, for one—the diagnosis shaded every interaction, every movement, and even every footstep.
Later that morning he overheard a conversation in the bathroom. One of the attendants was shaving a patient, who winced from the cold water and the feeling of the dull blade against his neck.
“Look, this may be cold, but it’s the best we could do,” the attendant said.
Rosenhan laughed. This is the best you could do?
DAY EIGHT
Nurses’ Note: 2/13/69 8:30pm—Patient returns from temp visit. [Stated he had a nice time.]
The hospital released Rosenhan on a temporary visit to attend his “interview”—but I imagine he spent the day with Mollie and his children. No writing exists for this day in his notes or in his book.
DAY NINE
Nurses’ Note: 2/14/69 Patient is being discharged. custody of wife.
8:35am
It’s not so easy to leave.
Did he literally mean it wasn’t so easy to get out or did he mean it was hard for him to summon the psychological distance necessary to move on? It’s unclear. In his final notes on the ward, Rosenhan waxed poetic about the patients and his new friendships (whether this was authentic, exaggerated, or a function of the relief of leaving is hard to say): “Feel like I’m leaving friends behind. One develops a camaraderie of the afflicted, the cursed, and one’s good fortunes feel like misfortunes.”
By midday, Rosenhan’s notes took on a more desperate tone. The doctor who was supposed to facilitate his discharge was late and there was a chance he would not arrive in time for Rosenhan to be released before the start of the weekend, at which point he’d be trapped there for another three mornings. Rosenhan smoked and smoked and smoked, trying to keep his nerves in check for fear that any sign of unease or aggression might lead to a renewed commitment.
And then, as if in a movie, Dr. Myron Kaplan arrived at zero hour. After finding Rosenhan competent to drive and “handle money,” Dr. Kaplan released him to the care of his wife, out into the wintry world beyond the hospital. Dr. Kaplan recommended that he seek outpatient and “chemotherapy treatment” (a now outdated term for psychopharmacological medicine), leaving Rosenhan with a diagnosis, a prescription, and little else.
You will notice that the doctor did not say Lurie was cured—no one was “cured” of a mental illness—but instead that he was in remission, much as cancer is during the beginning stages of recovery. The sickness could always relapse, and the threat of reoccurrence would remain with you like a sweat stain you couldn’t quite scrub out.
Around the time of Rosenhan’s first admission, researchers were studying the stigma of mental illness diagnoses. Stigma—in ancient Greece the word referred to a mark placed on slaves as a sign of their diminished status—created a sort of self-fulfilling prophecy that came externally (from the world around you) and internally (from your own feelings of shame). As Rosenhan wrote in his paper: “A psychiatric label has a life and an influence of its own. Once the impression has been formed that the patient is schizophrenic, the expectation is that he will continue to be schizophrenic… The label endures beyond discharge, with the unconfirmed expectation that he will behave as a schizophrenic again.”
This touches not only the patient but also the people around him. Study after study—from Rosenhan’s time to today—has confirmed that people hold mostly negative views about people with serious mental illness. They are often viewed as more violent, dangerous, and untrustworthy. Three years after Rosenhan’s stay at Haverford, in 1972, Tom Eagleton, a US senator running for vice president, lost his spot on the Democratic ticket when the public learned of his prior psychiatric hospitalizations for depression. With the Cold War raging, the question became: Do you really want this guy even near “the button”? It didn’t matter that these hospitalizations had happened years earlier and that he had, by all estimations, recovered—once labeled, he, and others like him, would always be sick and would never be fully capable again.
I wish I knew how sweet the homecoming was for Rosenhan and his family. I wish I could interview Mollie and hear her perspective. I wish I could see what he looked like, hear how he sounded. Was he tired? Were his clothes rumpled? Did he look like a different man? If I could, I would crack open their heads and pluck out the memories. Did he think of his brother during his hospitalization? Did he reframe some of his own behaviors in light of his new diagnosis? Did it frighten him to realize how easy it was to wear the garb of a so-called schizophrenic? Did his days on the ward touch on some paranoia, some part of him that felt unworthy? How many truths had his doctors chanced upon on the way to a gross misjudgment?
His research assistant Bea Patterson told me that Rosenhan seemed “quite shook” when he returned. “You could tell he felt whatever had happened to him [in the hospital] affected him deeply,” she said. “He was quieter, more reserved.” His abnormal psychology seminar students, some of whom I have interviewed, told me that when he returned from the hospital his mood had darkened. He seemed humbled. One student recalled that he looked distressed, worn out, somewhat older than before. The students begged to hear more, but he refused to discuss it. One thing was clear: They were not going to continue the experiment. It was over. Done.
The story could have ended here, an upsetting episode in the life of a professor who took on a difficult and painful role to protect his students. The study could so easily have remained a what-if—his notes would have likely been lost, his diary filed away, the experience reduced to an interesting footnote in Rosenhan’s life. But it didn’t.
Instead, sometime between the end of “David Lurie’s” hospitalization in February 1969 and the first finished draft of his article “On Being Sane in Insane Places” in 1972, this single experience morphed from a teaching experiment into something much larger, as seven other volunteers joined
—even though Rosenhan had declared that it was too dangerous—what would eventually become the study. They willingly subjected themselves to the same indignities Rosenhan had just survived, and in the process cemented Rosenhan’s legacy in the history of psychiatry.
For as traumatizing as his days there had been, Rosenhan must have understood the value of his insight into life on the ward, and the importance of getting the “normal” world to finally pay attention. He needed them to listen in a way they hadn’t listened to Nellie Bly, to Dorothea Dix, to Ken Kesey, or to any of the brave others who had gone before him. In order to bring attention to the state-sponsored travesties going on around them, he’d need more—more data, more hospitals, and more people to go undercover. He had to create an account that could not be dismissed. It needed to be solid, quantifiable. It needed to be scientific.
PART THREE
People ask, How did you get in there? What they really want to know is if they are likely to end up in there as well. I can’t answer the real question. All I can tell them is, It’s easy.
—Susanna Kaysen, Girl, Interrupted
11
GETTING IN
There is no question that “David Lurie” was, in fact, Rosenhan himself. But what about the others? They were not his Swarthmore abnormal psychology students, who had inspired the study. Who were they, then, and how did he find them? Why had they so selflessly decided to help Rosenhan in his quest to bring light to these dark corners? How would I find them now?
The Great Pretender Page 11