On Being Sane in Insane Places
How do you separate insane from sane?
- 1934, Benedict suggested normality and abnormality are not universal
- Belief has been strong that patients present symptoms, those symptoms can be
categorized and implicitly, the sane are distinguishable from the insane
- Psychiatric diagnoses, in this view, are in the minds of observers and are not
valid summaries of characteristics displayed by the observed
- You place a sane person in a psychiatric hospital, and observe. If he is found
sane, if so how. If the pseudopatients were always detected, there would be
evidence that a sane individual can be spotted from the insane context in which
he is found.
- If pseudopatient not detected, outcome would support the view that psychiatric
diagnosis betrays little about the patient but much about the environment in
which an observer finds him.
- 8 sane people admited to 12 different hospitals
the same sex, but unfamiliar voice. (such symptoms are alleged to arise from
- Falsified only name, vocation and employment and nothing else.
- Patient was nervous, but conversed with staff and other patients, observing
everything and writing in a journal.
- Patients do not know when he would be discharged. Only way out is convincing
they are sane. (friendly, cooperative, exhibited no abnormal indications)
- Noone detected the pseudopatients but other patients raised suspicion.
- Due to the fact that physicians operate with a strong bias toward Type 2 error.
- Physicians more inclined to call healthy person sick (false positive, type 2) than a
sick person healthy (type 1).
- More dangerous to misdiagnose illness than health but what holds for medicine
does not hold equally for psychiatry
- Staff member were to rate 193 patients according to the likelihood that the
patient was a pseudopatient.
- No pseudopatient appeared in that period of time
- Experiment indicated tendency to designate sane people as insane can be
resverse when stakes are high.
- Diagnoses were in no way affected by relative health of circumstances of
Ç}]v[o](XZZUZ]}v}(his circumstances was shaped
entirely by diagnosis.
- Eg. one pseudopatient was close to his mom but remote from his dad. When he
- Facts of the case unintentionally distorted by staff to achieve consisteny with a
- Behaviours stimulated by the environment are commonly misattributed to
nurse assumes he is nervous
- Patient behavoiurs were misinterpreted by well-intentioned staff.
- Often, a patient goes beserk because of mistreatment by staff, a nurse coming to
with other staff.
- Never would the staff found to assume that another staff or the hospital had
anything to do.
- There is patient-staff segregation.
- Study where pseudopatients self-initiated contact with staff. Staff avoided
contact while university students did not.
- Patients are powerless and depersonalized. As if not there, treated bad, stripped
of legal rights. Treated badly