being sane in insane places – Rosenhan

Great deal of conflicting data on the reliability, utility, and meaning of terms such as sanity, insanity, mental illness, and schizophrenia- what is viewed as normal in one culture may not be viewed as normal in another- not questioning the fact that some behaviours are deviant or odd (murder, hallucinations)

- not denying the struggle and existence of mental illness- can sane be distinguished from insane?- do the salient characteristics that lead to diagnoses reside in the patients themselves or in the environments and contexts in which observers find them?

psychological categorization of mental illness is useless, harmful, misleading and pejorative - diagnoses are in the minds of the observers- not valid summaries of characteristics displayed by the observed

normal people (do not have and have never had symptoms of serious psychiatric disorders) admitted to psychiatric hospitals.8 sane people gained secret admission to 12 different hospitals1 was a psychology graduate student in his twenties7 were older and established- 3 psychologists - 1 pediatrician- 1 psychiatrist- 1 painter- 1 housewide3 women, 5 men

after calling hospitals for appointment, pseudo patient arrived and complained he had been hearing voices- unclear what the voices said- perhaps said empty, hollow, and thud- unfamiliar voices, same sex as pseudo patientOther details of lives were presented as the truly existed- significant events- relationships- frustrations and upsets- joys and satisfactions-

did not swallow any meds given to him, unsure when he would be discharged - told he would have to convince staff he was sane, took notes and did not hide it as it was clear no one cared.

all but one wished to be discharged immediately

all but one diagnosed with schizophrenia upon entry- discharged with schizophrenia in remission, not as sane- could not get rid of the labellength of hospitalization ranged from 7-52 days, average 19 daysquite common for other patients to detect the sanity of the pseudo patients- convinced them that they were sick upon admission, now they are fine, but some continued to believe they were sane throughout.

- more inclined to call a healthy person sick (false positive, type 2) than a sick person healthy (false negative, type 1)- more dangerous to misdiagnose illness than health- err on the side of causation

mental illnesses carry with them personal, legal, and social stigmas- dramatic impact of psychiatric misdiagnosis, versus medical misdiagnosis (less stigmatized)

193 patients - 41 alleged with high confidence to be pseudopatients by atleast one member of staff23 considered suspect by at least on psychiatrist19 suspected by one psychiatric and one other staff member

- once a person is designated abnormal, all of his other behaviors and characteristics are coloured by that label- personal histories were unintentionally distorted by staff to achieve consistency with a popular theory of the dynamics of schizophrenic raction- no questions asked about them taking notes - assumed t was a manifestation of disorder- behaviours stimulated by the environment are commonly misattributed to the patients disorder. ex. patient pacing the hallway is perceived to be nervous, when in reality they're bored- enormous overlap in the behaviors of the sane and the insane

professionals who work with the mentally ill possess some of the attitudes of the public- staff and patients are strictly segregated in psychiatric hospitals- staff do not interact with patients more than necessary those with the most power have the least to do with the patients

- recall that they are not acting bizarre, so one could carry out a normal conversation with a pseudo patient- staff avoided continuing contact with the pseudo patient- frequently, answered question by greeting pseudo patient an asking how they were doing, then leaving without waiting for a response

eye contact and verbal contact reflect concern and individuation powerlessness was evident in every hospital, both excellent and run-down- lose credibility due to psychiatric label- freedom of movement restricted- personal privacy is minimal- may not initiate conversation, only respond to staff - sometimes beaten for engaging with staff

- pseudo patients had intense reactions to the depersonalization- attempted to stand out- tried to create relationships with others

attitudes held by everyone toward the mentally ill- fear, distrust, horrible expectations- benevolent intentions- ambivalence - avoidancehierarchical structure of the psychiatric hospitalstaff shortages, financial issues,heavy reliance on medication

these labels do not capture the essence of understandingdepressing and frightening to consider how this information will be usedhow many people are sane, yet locked up?how many people have faked insanity to avoid a criminal sentence?even if the label is found to be incorrect, it sticks with the personhow does the situation and environment affect people, and perhaps make sane people appear insane?

cannot distinguish the sane from insane in psychiatric hospitalsconsequences to patients hospitalized:- powerless- depersonalization- segregation- mortification- self-labeling directly experiencing the impact of psychiatric has an enormous influence on a person's perspective - negative reactionsfailures of the institution not due to the staff but due to the environment