MSL NOTES ON READING #19: ON BEING SANE IN INSANE PLACES
ProfessorMalcolm Mac Kinnon
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MSL – READING 19: ON BEING SANE IN INSANE PLACES BY: DAVID
L. ROSENHAN (p. 197 – 207)
-Deviance is the recognized violation of social norms.
-Whether a person is labelled deviant depends on how others perceive, define, and respond to
that person’s behaviour
-Even if we are personally convinced that we can tell the normal from the abnormal, the
evidence for that is not compelling.
•There is a great deal of conflicting data on the reliability, utility, and meaning of such
terms as sanity, insanity, mental illness, and schizophrenia.
•Benedict suggested that normality and abnormality are not universal.
What is viewed as normal in one culture may be seen as quite abnormal in
-Some behaviours (i.e., murder or hallucinations) are deviant or odd.
-With “mental illness” comes the existence of personal anguish (e.g., anxiety, depression,
psychological suffering, etc).
-Normality and abnormality, sanity and insanity, and the diagnoses that flow from them may
be less substantive than many believe them to be.
-The belief has been strong that patients present symptoms, that those symptoms can be
categorized, and, implicitly that the sane are distinguishable from the insane.
•Most recently, however, this belief has been questioned.
Based in part on theoretical and anthropological considerations, but also on
philosophical, legal, and therapeutic ones, the view has grown that
psychological categorization of mental illness is useless at best and downright
harmful, misleading, and pejorative (judgmental) at worst.
oPsychiatric diagnoses, in this view, are in the minds of the observers
and are not valid in summaries of characteristics displayed by the
-In studying whether a patient admitted to a hospital is determined to be sane and how such a
diagnosis is made, gains can be made getting “normal” people (people without history or
symptoms of serious psychiatric disorders) admitted to psychiatric hospitals.
•If the sanity of such pseudopatients were ALWAYS DETECTED, there would be
prima facie evidence that a sane individual can be distinguished from the insane
context in which he is found.
•Normality (and presumably abnormality) is distinct enough that it can be recognized
wherever it occurs, for it is carried within a person.
•If the sanity of the pseudopatients were NEVER DISCOVERED, serious difficulties
would arise for those who support traditional modes of psychiatric diagnosis.
•Given that the hospital was not incompetent, that the pseudopatient had been
behaving as sanely as he had been outside the hospital, and that it had never been
previously suggested that he belonged in a psychiatric hospital, such an unlikely
outcome would support the view that psychiatric diagnosis betrays little about the
patient but much about the environment in which an observer finds him.
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-This article describes such an experiment.
•Eight sane people gained secret admission to twelve different hospitals.
•Too few psychiatrists and psychologists, even those who have worked in such
hospitals, know what the experience is like.
They rarely talk about it with former patients, perhaps because they distrust
information coming from the previously insane.
Those who have worked in psychiatric hospitals are likely to have adapted so
thoroughly to the settings that they are insensitive to the impact of that
Pseudopatients and Their Settings
-The eight pseudopatients were a varied group.
•One was a psychology graduate student in his 20s.
•The remaining seven were older and “established.”
Among them were three psychologists, a paediatrician, a psychiatrist, a
painter, and a housewife.
•Three pseudopatients were women and five were men.
•All of them employed pseudonyms, lest their alleged diagnoses embarrass them later.
•Those who were in mental health professions alleged another occupation in order to
avoid the special attentions that might be accorded by staff, as a matter of courtesy or
caution, to ailing colleagues.
-The presence of pseudopatients and the nature of the research program were not known to the
-The settings were similarly varied.
•In order to generalize the findings, admission into a variety of hospitals was sought.
•The 12 hospitals in the sample were located in five different states on the East and
Some were old and shabby.
Some were quite new.
Some were research-oriented, others not.
Some had good staff-patient ratios, others were quite understaffed.
Only one was a strictly private hospital.
All of the others were supported by state or federal funds or, in one instance
by university funds.
-After calling the hospital for an appointment, the pseudopatient arrived at the admissions
office complaining that he had been hearing voices.
•The voices were reported to be unclear but a few words that were heard were “empty,”
“hollow,” and “thud.”
•The voices were unfamiliar but of the same sex as the pseudopatient.
-Beyond alleging the symptoms and falsifying name, vocation, and employment, no further
alterations of person, history, or circumstances were made.
•The significant events of the pseudopatient’s life history were presented as they had
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