Being Sane In Insane Places

Being Sane in Insane Places

If sanity and insanity exist, how shall we know
them?
The question is neither capricious nor itself
insane. However much we may be personally
convinced that we can tell the normal from the
abnormal, the evidence is simply not compelling. It is commonplace, for example, to read
about murder trials wherein eminent psychiatrists for the defense are contradictedby equally
eminent psychiatrists for the prosecution on the
matter of the defendant's sanity. More generally, there are a great deal of conflicting data on
the reliability, utility, and meaning of such terms
as "sanity," "insanity," "mental illness," and
"schizophrenia"
Finally, as early as 1934,
Benedict suggested that normality and abnormality are not universal
What is viewed as
normalin one culture may be seen as quite aberrant in another. Thus, notions of normality and
abnormality may not be quite as accurate as people believe they are.
To raise questions regarding normality and abnormality is in no way to question the fact that
some behaviors are deviant or odd. Murder is
deviant. So, too, are hallucinations. Nor does
raising such questions deny the existence of thepersonal anguish that is often associated with
"mental
Anxiety and depression exist.
Psychological suffering exists. But normality
and abnormality, sanity and insanity, and the
diagnoses that flow from them may be less substantive than many believe them to be.
At its heart, the question of whether the sane
can be distinguished from the insane (and
whether degrees of insanity can bedistinguished
from each other) is a simple matter: do the salient characteristics that lead to diagnoses reside
in the patients themselves or in the environments and contexts in which observers find
them? . . . [T]he belief has been strong that patients present symptoms, that those symptoms
can be categorized, and,
that the sane
are distinguishable from the insane. More recently, however, this beliefhas been questioned. . . . [T]he view has grown that psychological categorization of mental illness is useless
at best and downright harmful, misleading, and
pejorative at worst. Psychiatric diagnoses, in

D. L. ROSENHAN

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
ismore nearly accurate by getting normal people
(that people who do not
and have never
suffered, symptoms of serious psychiatric disorders) admitted to psychiatric hospitals and then
determining whether they were discovered to
be sane and, if so, how. If the sanity of such
pseudopatients were always detected, there
would be prima facie evidence that a sane individual can be distinguished fromthe insane context in which he is found.
If, on the other
hand, 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
staff was not incompetent, that the pseudopatient had been behaving as sanely as he had been
outside of the hospital, and that it had never
beenpreviously 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.
This article describes such an experiment.
Eight sane people gained secret admission to 12
hospitals
Their diagnostic
riences constitute the data of the firstpart of
this article; the remainder is devoted to a description of their experiences in psychiatric institutions. . . .
Pseudopatients and Their Settings
The eight pseudopatients were a varied group.
One was a psychology graduate student in his
The remaining seven were older and "esAmong them were three psychologists, a pediatrician, a psychiatrist, a painter,
and a housewife. Three...