On Being Sane In Insane Places Essay Definition

In his essay, On Being Sane in Insane Places, D. L. Rosenhan discusses a series of experiments that he participated in involving psychiatric institutions and the effect of misdiagnoses of psychological disorders on the patients admitted to the hospitals.  Rosenhan’s research shows us that the labels associated with mental illness (particularly schizophrenia) have a significant impact on the way patients are treated.

In the experiment, Rosenhan and several other “pseudo patients” intentionally tried to get themselves admitted to mental hospitals in several states, feigning schizophrenia.  They were easily admitted, and once inside they stopped exhibiting any abnormal behaviors.  Rosenhan’s idea was that normality would be so distinct and easy to detect that surely the subjects would be released nearly immediately.  To his surprise, behaviors that are traditionally considered normal were interpreted by hospital staff as being part of the pseudo patients’ pseudo condition.  For instance, each participant was asked to keep a notebook or journal to record their experiences.  In the real world, one may be inclined to ask one of the subjects what they were writing about if they witnessed the subject constantly scribbling away in a notebook.  But in the hospitals, no nurse or staff member ever commented on the pseudo patients’ note-taking, assuming that it was a nervous habit associated with schizophrenia.  In fact, several real patients in the hospital grew suspicious of the imposters, and tried to bring it to the attention of the nurses.  But these claims were always overlooked, since they were coming from someone labeled as “insane”.

Rosenhan theorizes that there are several causes for these kinds of reactions.  One, he says, is the tendency of the psychiatric community to “err on the side of caution”, making more false-positives of mental disorders out of fear of making a false-negative.  This has some serious implications and makes us wonder how many people admitted to these institutions are actually sane and have simply been misdiagnosed.  Rosenhan also suggests that the label associated with being schizophrenic causes the hospital staff to make misguided assumptions about the patients’ behavior through no fault of their own.  When someone is seen as mentally ill, everything they do may be interpreted as symptomatic of their disorder.  Another example of this was found when a doctor observed several pseudo patients waiting outside the door of the cafeteria a half hour before lunch, and proceeded to tell someone else that this was part of the “oral-acquisitive nature” of the syndrome.  In another experiment, when hospital staff was told that pseudo patients would be attempting to get themselves admitted in the next month, the staff identified many people who they suspected may have been posing as mentally ill. Secretly, no pseudo patients had even walked through the clinic doors!

Everyone experiences some minor bouts of sleeplessness, depression, anxiety, or elation, but none of those are criteria to call us insane.  He talks about the way that the label sticks with a person even after they are released, and that if the patient in his mind truly believes that there is something wrong with him it is likely that upon release he will revert back to his old behaviors.  These experiments illustrate how tricky diagnosing a mental illness can be, if one even exists in the individual.

D.L.Rosenhan's "On Being Sane in Insane Places", also called the "Rosenhan experiment" is a critical study regarding the validity of psychiatric diagnosis.

The background for Rosenhan's study is the question of how can we tell sanity from insanity, arguing that there are many inconsistencies regarding the credibility and applicability of concepts of mental health and psychopathology which might be cultural dependent. Rosenhan holds that at the heart of the diagnosis of insanity lies one crucial issue: do the characteristics that lead to a diagnosis come from the patient of the surrounding context? Rosenhan suspects that the approach of determining the occurrence of mental condition based of a catalog of symptoms is not as objective as thought and is highly effected by the tendencies of the person doing the diagnosis.

In order to test his hypothesis Rosenhan thought of an experiment in which normal people are committed to mental institutions in order to see how they are diagnosed. If they are declared sane then the system can be trusted. But if "fakers" will be diagnosed as suffering from mental illness this will attest to a context related bias.

The first Rosenhan experiment

Rosenhan therefore devised two experiments for his study described in "On Being Sane in Insane Places". In the first experiment of the study eight sane people committed themselves to twelve psychiatric institutes without their crew being aware. Aside from Rosenhan himself the experiment included 3 psychologists, one psychology student, a pediatrician, a psychiatrist, a painter and a homemaker. Hospitals chosen for the experiment were also varied.

In their sessions the fake patients complained of auditory hallucinations in which very unclear voices utter vague words. The name, occupation and symptoms of the patients were made up but their personal history and behavior were authentic. None of them had any past of present pathological behavior.

The fake symptoms disappeared right after the patients were admitted, although some of the cases presented mild and passing anxiety. Patients acted inside the institution as they would act outside of it, and they were obviously motivated to be declared sane in order to be discharged. Nurse reports confirm that they were friendly, cooperative and did not exhibit any abnormal behavior.

The fake patients kept (first hidden and then overt) accounts of their experience. Fake patients in the first Rosenhan experiment spent 17 to 52 days in the institutions (an average of 19 days). They all displayed normative behavior but were all but one discharged with a diagnosis of "schizophrenia in remission". None of the files indicated any doubts regarding the diagnosis. Once diagnosed, nobody thought of second guessing the initial judgment. They were not thoroughly examined but not due to lack of time. The other real patients in the institute noticed that the fake patients were normal but the staff did not and they even thought them to be a researcher or journalist. Rosenhan concluded his first experiment in "On Being Sane in Insane Places" with the assertion that doctors tend to over-diagnose in order to be on the safe side and not miss a sick person. But this tendency can cause damage when adopted by psychiatrists due to the social and legal repercussions of a mental condition.   

The second Rosenhan experiment will be discussed in part 2 of the summary of "On Being Sane in Insane Places".

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