Rosenhan revisited: the scientific credibility of Lauren Slater's pseudopatient diagnosis study

In a recent and widely publicized book, psychologist Lauren Slater reported an attempt to test David Rosenhan's hypothesis that psychiatric diagnoses are influenced primarily by situational context rather than by patients' signs and symptoms. Slater presented herself to nine psychiatric emergency rooms with the lone complaint of an isolated auditory hallucination (hearing the word "thud"). In almost all cases, she reported receiving the diagnosis of psychotic depression and prescriptions for antidepressants and antipsychotics. Slater concluded that psychiatric diagnoses are largely arbitrary and driven by a "zeal to prescribe." Our goal was to examine the scientific credibility of Slater's findings using a vignette methodology. We presented a sample of emergency room psychiatrists (N = 74) with a detailed case vignette derived from the clinical description in Slater's book, and asked them a series of questions regarding diagnosis and treatment recommendations. In sharp contrast to what Slater reported, we found that only three psychiatrists offered a diagnosis of psychotic depression. Moreover, only one third recommended medication. Our study raises questions regarding Slater's results and conclusions, and provides scant support for the claim that psychiatric diagnoses are mostly products of fashion or fad, as claimed by Slater.