Rosenhan（罗森汉恩）实验——当正常人装成精神病人进入精神病院

Type I error & Type II error
第一类错误和第二类错误

In statistics, a Type I error is a false positive conclusion, while a Type II error is a false negative conclusion.

Example: You decide to get tested for COVID-19 based on mild symptoms. There are two errors that could potentially occur:

Type I error (false positive): the test result says you have coronavirus, but you actually don’t.

Type II error (false negative): the test result says you don’t have coronavirus, but you actually do.

在统计学中，第一类错误，是指假阳性结论；第二类错误，是指假阴性结论。

例子：

第一类错误（假阳性）：测试结果说你感染了新冠，但你实际上并没有；

第二类错误（假阴性）：漏网之鱼；测试结果说你没感染新冠，实际上你感染了。

What does it mean to be sane? How reliably can even medical professionals distinguish the sane from the insane?

“精神正常”的定义是什么？医疗专业人员在对精神正常和不正常的诊断上，又有多可靠？

Psychologist Dr. David Rosenhan of Stanford University had long been interested in these age-old questions and, in 1969, devised a unique experiment to put them to the test.

斯坦福大学心理学家 David Rosenhan 对这一由来已久的问题一直很感兴趣，1969年，他设计了一个实验，对此进行了测试。

Rosenhan and seven other perfectly sane subjects went undercover inside various psychiatric hospitals from 1969-1972 and acted insane in order to see if the doctors there could tell that they were faking. The doctors could not.

Rosenhan 和其他七位绝对精神正常的人从1969至1972年期间，假装精神病人，进入了多家不同精神病医院，故意做出精神不正常表现，目的是看这些医生们是否可以看出来他们在假装。但这些医生却并未识别出来。

How The Rosenhan Experiment Was Carried Out
具体开展过程

The Rosenhan experiment’s eight sane subjects went inside 12 different psychiatric hospitals, all but one state- or federally-run, spread across five U.S. states. These pseudopatients consisted of three women and five men, including Rosenhan himself, whose occupations ranged from actual psychologist to painter.

这一实验的八名参与者分别佯装精神病人，进入了分别处于美国五个州的12个不同的精神病医院。除了一家之外，其他都是州立或联邦医院。这些假患者中包括3位女性和五位男性，其中就包括Rosenhan本人。这些参与者的职业包括真正心理学家，画家等。

The participants assumed false names and professions and were instructed to set up appointments at the hospitals and claim that they had been hearing strange voices muttering words like “empty” and “hollow” (these words were meant to evoke an existential crisis, as in, “my life is empty and hollow”). On the basis of these appointments, every single pseudopatient was admitted to the hospital that they contacted.

他们用的是假名字和假职业，被要求去这些医院看医生，并声称自己听到低声呢喃“空洞”和“空虚”（并透露出这些词激发了生存危机感，比如“我的人生空洞空虚”。）的奇怪声音。在就诊之后，每一位假患者都被收入了他们所联系的那家医院。

According to the landmark 1973 report that Rosenhan published about his experiment, On Being Sane in Insane Places, “none of the pseudopatients really believed that they would be admitted so easily.”

在Rosenhan1973年基于这次实验所发布的标志性的报告《On Being Sane in Insane Places》中，他写道，“这些假患者谁也没料到自己能这么容易被医院收治”。

Not only was every pseudopatient admitted, but all except one received a diagnosis of schizophrenia (the other diagnosis was “manic-depressive psychosis”). All they had done was feign auditory hallucinations. They exhibited no other symptoms and invented no false details about their lives aside from their names and professions. Yet they were diagnosed with serious psychological disorders.

不仅每位假患者都被收治，而且除其中一位之外，其他所有人都收到了精神分裂症的诊断结果（另一个人的诊断是癫狂-抑郁神经症）。这些假患者唯一做的，就是假装幻听。他们没表现出其他症状，除了他们名字和职业外，也没有伪造他们生活的其他方面细节。但他们都被诊断出了严重的心理障碍。

Once checked into the hospitals and diagnosed, the pseudopatients were on their own. None knew when the doctors would deem them fit for release — or find out that they were faking first.

在他们被收治入院和被诊断后，就没人管他们了。没有人知道什么时候可以被医生认为可以出院，或者什么时候会识破他们在造假。

The Disturbing Results
引人不安的结果

At the start of the experiment, the patients’ biggest concern was that they would “be immediately exposed as frauds and greatly embarrassed,” according to Rosenhan. But as it turned out, there was no need to worry on this account.

There was a “uniform failure to recognize sanity” in any of the pseudopatients, Rosenhan wrote, and not one of them was ever found out by the hospital staff. The pseudopatients showed no new symptoms and even reported that the strange voices had gone away, yet the doctors and staff continued to believe that their diagnoses were correct.

按照 Rosenhan所说，在这实验开始之前，这些假患者的最大担忧是“立马被揭露是骗子，颜面尽失”。但后来却发现这类担忧完全没必要。

Rosenhan写道，在任一位假患者中，都无一例外没有发现他们精神正常，医院职员自始至终都没有识别出来。这些假患者没有表现出任何新的症状，甚至即使患者报告说那一奇怪的声音已经消失了，这些医生和员工们继续坚信自己的诊断是正确的。。

In fact, hospital staff would observe totally normal behavior on the part of the pseudopatients and characterize it as abnormal. For instance, Rosenhan instructed the pseudopatients to take notes on their experiences. And one nurse who observed this note-taking wrote in a daily report that the “patient engages in writing behavior.”

实际上，医院职员会将假患者的完全正常行为归类为不正常。比如，Rosenhanz 让这些假患者记笔记。一位护士观察到了这种记笔记的行为，在一次日常报告中，她写道：患者表现出书写行为。

As Rosenhan saw it, doctors and staff would assume that their diagnosis was correct and work backward from there, reframing everything they observed so that it would be in harmony with that diagnosis:

“Given that the patient is in the hospital, he must be psychologically disturbed. And given that he is a disturbed, continuous writing must be a behavioral manifestation of that disturbance, perhaps a subset of the compulsive behaviors that are sometimes correlated with schizophrenia.”

在Rosenhan看来，医生和医院其他职员会先假设他们的诊断是正确的，然后再反推，从这一诊断结果的视角去诠释他们所观察到的行为，从而让观察结果与诊断结果相一致。

“由于患者在医院接受治疗，因此他们肯定心理不正常。由于他不正常，那么持续的书写行为就肯定是这种不正常心理在行为上的表现，可能是有时与精神分裂症相关联的一种亚型强迫行为。‘

Likewise, one of the pseudopatients was a man who described his home life by truthfully reporting that he had a warm relationship with his wife, with whom he fought occasionally, and children, who he spanked minimally for misbehavior. But because he was admitted to a psychiatric hospital and diagnosed with schizophrenia, his discharge report stated that “His attempts to control emotionality with his wife and children are punctuated by angry outbursts and, in the case of the children, spankings.”

同样的是，一位假患者如实报告了自己的家庭情况，他说自己和妻子关系和睦，但偶尔争吵，在孩子犯错时会轻轻打孩子屁股。但由于他被一家精神病医院收治，而且被诊断为精神分裂症，他的出院报告上就是这样写的:”他试图控制自己对妻子和孩子的情绪化态度，但这一控制过程中夹杂着对妻子的发火和打孩子屁股等行为。”

Had the man not been a patient in a psychiatric hospital, his common, mundane home life surely wouldn’t have been described in such dark tones.

“Diagnoses were in no way affected by the relative health of the circumstances of a pseudopatient’s life,” Rosenhan wrote. “Rather, the reverse occurred: The perception of his circumstances was shaped entirely by the diagnosis.”

这个人如果不是在一家精神病医院中的一位患者，那么他普通无奇的家庭生活肯定就不会被用这样阴暗的视角描述。

“诊断结果丝毫没有受到这些假患者的正常生活状态的影响，” Rosenhan写道，“恰恰相反，对他生活状态的解读视角却是由其诊断结果而决定的。”

And in addition to stubbornly sticking to their diagnoses, hospital staff would treat the pseudopatients coldly. Interactions with the staff ranged from disinterested at best to abusive at worst. Even when the pseudopatients attempted to engage with staff in a friendly, conversational manner, responses were perfunctory (when given at all).

除了固执坚持他们的诊断结果外，医院职员们还冷漠对待这些假患者。最好时候，也不过是对病人漠不关心，最坏情形中，就直接虐待了。甚至当这些假患者试图和这些职员友好交谈时，做得到的回应也往往是敷衍的（如果有的话。）

But while hospital staff treated the pseudopatients poorly and never realized they were faking, the actual patients often had no trouble detecting them. When the researchers were able to keep track, 35 out of 118 actual patients blatantly accused the pseudopatients of faking, with some outright stating, “You’re not crazy. You’re a journalist or a professor.”

但尽管这些医院员工对待这些假患者态度不好，而且也从未识破他们在假装，那些真患者们却不费吹灰之力地就识别出了他们在假装。当研究人员掌握足够资料去调查这一方面数据时，他们发现，118名真正患者中，有35名直接说他们在假装，而且一些人会直截了当地说：你没疯。你是一名记者或教授。

Nevertheless, the doctors never got wise. The pseudopatients were eventually released — stays ranged from 7 to 52 days, with an average of 19 — but all with the same diagnosis under which they’d been admitted. They were released, however, because doctors decided that their condition was “in remission.”

但那些医生们却从未知情。这些假患者最终被允许出院——住院时长从7天至52天不等，平均19天——但都带着他们入院时的诊断结果。他们虽然被允许出院，只是因为医生们判断说他们的症状在“缓退期”。

As Rosenhan wrote:

“At no time during any hospitalization had any question been raised about any pseudopatient’s simulation. Nor are there any indications in the hospital records that the pseudopatient’s status was suspect. Rather the evidence is strong that, once labeled schizophrenic, the pseudopatient was stuck with that label. If the pseudopatient was to be discharged, he must naturally be ‘in remission’; but he was not sane, nor, in the institution’s view, had he ever been sane.”

Rosenhan写道：

“在每个住院过程中，从未有人问过假患者是不是在假装。医院病历中也没有提到假患者的状态令人存疑。但有充分的证据表明，一旦被贴上精神分裂症的标签，那么这个标签就永远贴在这个患者身上了。如果这个患者被同意出院，那么他肯定就是在“缓退期”，而并不是因为他精神正常，而且，在机构看来，他从来没有精神正常过。”

The Legacy Of The Rosenhan Experiment
这一实验对后世的影响

David Rosenhan discusses what his experiment revealed

“It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals,” Rosenhan wrote at the outset of his report’s conclusion.

Rosenhan theorized that the willingness of the hospitals to admit sane people resulted from what’s known as a “Type 2” or “false positive” error, which results in a greater willingness to diagnose a healthy person as sick than a sick person as healthy. This kind of thinking is understandable to a point: failing to diagnose a sick person usually has more severe consequences than misdiagnosing a healthy one. However, the consequences of the latter can be dire.

David Rosenhan谈到了他的实验所揭露的信息。

“很明显在精神病医院中我们无法区分精神正常和不正常，” Rosenhan在他报告的结论开头这样写道。

Rosenhan认为，之所以医院愿意收治精神正常者，是因为一种被称为“第二类“或”假阳性“的（统计学）错误，这类错误会让他们更倾向于将正常人诊断有病，而非反过来。这种思维方式在一定程度上是可以理解的：和误诊一位正常人相比，漏掉一位真正有病的人往往后果更严重。但误诊正常人，其后果也可以非常可怕。

Either way, the results of the Rosenhan experiment caused a sensation. People were astonished about the unreliability of psychiatric diagnoses and the ease with which hospital staff had been duped.

However, some researchers criticized the Rosenhan experiment, stating that the pseudopatients’ dishonest reporting of their symptoms made the experiment invalid because patients’ self-reports are one of the cornerstones on which psychiatric diagnoses are built.

无论如何，这一实验结果都引起了轰动。人们被精神病学诊断结果的不可靠性和医院职员的易骗性而震惊。

但一些研究人员也批评了这一实验，认为这些假患者对自己症状的谎报，让这一实验变得无效，因为患者的病情自述是精神病学诊断的基石之一。

But other researchers have affirmed Rosenhan’s methods and results, with some even partially replicating his experiment and coming up with similar conclusions.

Of course, even Rosenhan was not the first American to bring the darker side of the mental health system to light in this way.

但也有其他研究人员肯定了Rosenhan的方法和实验结果，并且其中一些还部分复制了他的实验，并得到了相似的结论。当然，Rosenhan并非是以这种方式揭露精神医疗系统这一黑暗面的第一人。

In 1887, journalist Nellie Bly went undercover in an insane asylum and published her findings as Ten Days in a Mad-House.

Bly too concluded that many of the other patients were just as “sane” as she and had been sent to the asylum unfairly. Bly’s work resulted in a grand jury investigation that attempted to make psychiatric examinations more thorough in an attempt to make sure that less “sane” people were institutionalized.

1887年，记者 Nellie Bly潜入了一家精神病院，并出版了《疯人院10日》，书中记录了自己在这一过程中的发现。

Bly也得出结论说，其他很多病人也像她一样正常，而且是被以不公平的方式被送到这家精神病院的。Bly的这一著作也开启了一次大陪审团调查，该调查旨在让精神病检查流程变得更全面彻底，从而降低正常人被误诊收治的几率。

Almost a century later, Rosenhan showed that the mental health profession still had a long way to go in being able to reliably and consistently distinguish the sane from the insane.

After the results of the Rosenhan experiment were published, the American Psychiatric Association changed the Diagnostic and Statistical Manual of Mental Disorders. The new version of the manual, published in 1980, presented a more thorough list of symptoms for every mental illness and stated that, in order to diagnose a patient with a certain disorder, multiple symptoms had to be present as opposed to just one.

几乎一个世纪以后，Rosenhan 展示了精神医疗行业在可靠稳定诊断病患方面，依旧有很长的路要走。

在Rosenhan实验结果发布后，美国精神医学会更改了《精神障碍诊断与统计手册》。新版本出版于1980年，为每种精神疾病列出了更全面的症状列表，而且指明：要确诊一位患者患有某种障碍，必须有多种症状同时出现，不能仅凭一条症状就确诊。

These changes in the manual survive to this day, although it has yet to be conclusively determined whether it has been successful in preventing false diagnoses. Perhaps the Rosenhan experiment could be duplicated today.

手册中的这些修改延续至今，尽管尚还不能确切判断这一手册是否成功阻碍了误诊。可能Rosenhan的实验在今天依旧可以被复制。

New Research Casts Doubt
新调查引发质疑

Because the pseudopatients of the Rosenhan experiment would never be able to talk about their participation and because relatively little had been written authoritatively about the course of the study itself, it became a difficult experiment to discuss and critique — there simply wasn’t much to argue with. However, subsequent research that utilized uncovered documentation from the original experiment eventually found fault with Rosenhan’s study.

由于这一实验中的假患者永远不能谈论他们在这一实验中的参与，而且关于这一研究过程本身也并没有很多权威书面记录，因此就很难去讨论和评判——因为并没有很多可以反驳的实际内容。但后来一些研究中，研究人员找到了这一实验的文件记录，并基于此对Rosenhan的实验提出了质疑。

In her 2019 book on the Rosenhan experiment, The Great Pretender, journalist Susannah Cahalan cited unearthed primary sources like correspondence, diary entries, and excerpts from Rosenhan’s unfinished book. And such documentation, Cahalan found, actually contradicted the results that Rosenhan published on certain points.

记者 Susannah Cahalan在2019年出版的关于 Rosenhan实验的书《The Great Pretender》中，提到了所找出的早期资料，比如信件，日记，Rosenhan未完成的书中的片段等。而且她发现，这些文件实际上在一些方面于Rosenhan所出版的结果相互矛盾。

For one, Cahalan claimed that Rosenhan himself, when undercover in an institution as part of his own experiment, told doctors there that his symptoms were quite severe, which would explain why he was so quickly diagnosed. This is significant because it runs counter to Rosenhan’s report, which claimed that he told doctors of some relatively light symptoms, which is precisely what made those doctors’ diagnoses seem like such an overreaction.

例如，Cahalan说，Rosenhan在这一实验中假装患病待在医院时，他告诉医生说他的症状相当严重，这就解释了为什么他会那么快被下诊断。这一点很重要，因为它与Rosenhan的报告截然相反。因为在他的报告中，他说他告诉医生自己有一些相对轻微的症状，这也恰恰是让医生诊断看起来小题大做的原因所在。

Furthermore, when Cahalan was finally able to track down one of the pseudopatients, he summed up his experience inside an institution with one word — “positive” — a stark rebuttal of the horror shows that Rosenhan’s participants had supposedly endured. But Rosenhan allegedly ignored this data when drafting his report.

而且，当Cahalan终于找到了其中一位假患者时，他用一个词总结了自己在当时医疗机构的经历——“正面的”——这与人们所认为的Rosenhan实验参与者所遭受的遭遇形成了截然对比。但Rosenhan据说在书写其报告时，忽略了这一信息。

“Rosenhan was interested in diagnosis, and that’s fine, but you’ve got to respect and accept the data, even if the data are not supportive of your preconceptions,” said the participant in question, Harry Lando.

If such claims are accurate and the Rosenhan experiment didn’t quite prove what it purported to, who knows how the course of psychiatric care in the U.S. may have unfolded in the decades since.

“Rosenhan对诊断感兴趣，这没问题，但你需要尊重和接受事实数据，即使这些数据并不支持你的假设，”上面提到的这位参与者 Harry Lando说道。

如果上面的说法准确，Rosenhan实验并没有像它所声称的那样充分证明其结论，谁知道自那之后几十年中美国精神疾病治疗领域或许会有着怎样的走向。