On Being Sane and Insane Places - D.L. Rosenhan
If sanity and insanity exist how shall we know them?
There are a great deal of conflicting data on the reliability, utility, and meaning of such terms as
sanity insanity mental illness and schizophrenia.
What may be viewed as normal in one culture may not be normal in another so the notions of
normality and abnormality are not as accurate
o Some behaviors are deviant or odd. Murders are deviant and so are hallucinations, and
there is a personal anguish that is associated with mental illness. Anxiety and depression
exist and psychological suffering that exists
o However sanity and insanity; normality and abnormality and the diagnoses that flow from
them may be less substantial
Do the salient characteristics that lead to diagnoses reside in the patients themselves or in the
environments and contexts in which observer find them?
o From the DSM the belief has been strong that patients present symptoms and those
symptoms can be categorized and the sane can be distinguished from the insane
o Psychological categorization of mental illnesses is useless at best and downright harmful,
misleading, and pejorative at worst.
Psychiatric diagnoses in this view are in the minds of the observers and are not
valid summaries of characteristics displayed by the observed
Gains can be made in deciding which of these is more accurate by getting normal people (that is
people who do not have and have never suffered, symptoms of serious psychiatric disorders)
admitted to hospitals and then determining whether they were discovered to be sane and if so
o Normality (and presumably abnormality) is distinct enough that it can be recognized
wherever it occurs for it is carried within a person
o If on the other hand the sanity of the pseudopatients were not discovered serious
difficulties would arise for early psychiatric diagnosis
Eight sane people gained secret admission to 12 different hospitals
o Too few psychiatrist and psychologists even those who have worked in such hospitals
know what the experience is like and rarely talk about it with former patients because the
distrust information coming from the insane.
o Those in psychiatric hospitals are likely to have adapted so thoroughly to the settings that
they are insensitive to the impact of that experience
o The eight pseudopatients were a varied group. One was a psychology graduate student in
his twenties. The remaining seven were older and established. Among them were three
psychologists a pediatrician, a psychiatrist, a painter, and a housewife. Three
pseudopatients were women five were men. All of them employed pseudonyms lest their
alleged diagnoses embarrass them later
o Asked what the voices said he replied that they were often unclear but as far as he could
tell they said empty hollow and thud.
o Such symptoms are alleged to arise from painful concerns about the perceived
meaninglessness of one’s life. It is as if the hallucinating person were saying ‘My life is empty and hollow’. The choice of these symptoms was also determined by the absence of
a single report of existential psychoses
o No future alterations of person, history, or circumstances were made other than alleging
symptoms, employment and name.
Relationships with parents and siblings with spouse and children with people at
work and in school consistent with the aforementioned exceptions were described
Frustrations and upsets were described along with joys and satisfactions
Brief period of nervousness and anxiety since admission was easy but apart from
that spoke normally and behaved normally
The pseudopatients very much as a true psychiatric patient entered a hospital
with no foreknowledge of when he would be discharged
Despite their public show of sanity the pseudopatients were never detected
Could be due to the quality of hospitals
Daily visitors could detect no serious behavioral consequences nor
indeed could other patients
Common for the patients to detect the pseudopatients sanity
Failure to detect sanity during the course of hospitalization may be due to the fact that physicians
operate with a strong bias toward what statisticians call the type 2 error.’ This