Being Sane In Insane Places

Being Sane in Insane Places

D. L. ROSENHAN

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 arecontradicted by 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 asnormal in 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 be distinguished fromeach 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 belief has beenquestioned. . . . [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

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 nearly accurate by getting normalpeople (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 from the insane context in which he is found. If, onthe 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 been previously suggested that he belonged in a psychiatrichospital, 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 first part of this article; the remainder is devoted to a description oftheir 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 pseudopatients were women, five were men. All of them employed pseudonyms,...