Have you ever been in a confrontation with someone where they ended with calling you a lunatic, crazy, or insane? It does not feel too great. But at least you know you are sane, and to everyone else around you, you seem “normal.” Can you walk down the street and visibly see a difference between a sane and insane person? There are some people however that are permanently labelled as “abnormal” or “insane.” These people are diagnosed as “mentally ill” and are forever stigmatized and in some cases, dehumanized because of such labeling. Is it easy to distinguish the sane from the insane, or is it in fact the environment and contexts in which observers find these people? David L. Rosenhan formulated an experiment to investigate if psychiatrists could identify the difference between people who are mentally ill and those who are not. According to Rosenhan, “there are a great deal of conflicting data on the reliability, utility, and meaning of such terms as “sanity,” “insanity”… normality and abnormality are not universal” (Rosenhan, 1973, pg.310). Rosenhan formed a group of 8 people who attempt to gain admission to 12 different hospitals across the United States.
The psuedopatients each claimed of having textbook symptoms of schizophrenia. Once admitted, the psuedopatients each described their histories truthfully, and “they strongly biased the subsequent results favor of detecting sanity” (pg.313). Each psuedopatient “ceased simulating any symptoms of abnormality” (pg.313). Nursing reports obtained that each pseudopatient “exhibited no abnormal indications” (pg.313). The average length of hospitalization was 19 days, and upon discharge, each psuedopatient had a case summary written. All of the summaries were “unintentionally distorted by the staff to achieve consistency with a popular theory of the dynamics of schizophrenic reaction” (pg.316). Each psuedopatient upon discharge was reported as in remission, not cured, which perpetuates the negative label. These ascribed labels are permanent, and puts the diagnosed person at a disadvantage forever. People diagnosed as mentally ill are treated differently, in most cases they are treated as if their thoughts and opinions cannot be trusted or taken seriously. This is not fair, nor is it accurate. There is an “enormous overlap in the behaviors of the sane and the insane”(pg.318). The sane are not always sane, similarly, “the insane are not always insane”(pg.318).
While reading this article, I was reminded about the homeless, and that many people assume that just because they are homeless, they are likely to have a mental illness. Now I see why many people assume this; the reason is the environment and contexts that civilians see these homeless people in. It is possible that some of these people are mentally ill, but it is more likely that they are in their position because of other reasons. From a sociological perspective, this experiment highlights the conflict perspective. In class, we have discussed how power is the core of all social relationships, all social systems feature a superordinate group and a subordinate group. In mental institutions, as well as in the public, conflict perspective is conveyed via sane people discriminating the allegedly insane people. Psychiatrists, nurses, and even civilians are above the mentally ill, because they are “sane” while the “insane” are incapable of having valid opinions. Power is scarce, and everyone wants some of it, and unfortunately this permanent label is debilitating for the person who is marked with it, leaving them with little hope of upward mobility in our society.
Rosenhan, David L, (1973). On Being Sane in Insane Places. 310-321
The second Rosenhan experiment
Hospitals that learned of the results of the first Rosenhan experiment (part 1 of the summary) described in "On Being Sane in Insane Places" could not believe that such errors can systematically occur. Rosenhan therefore devised a second experiment in which the local staff was notified in advance that within the upcoming three months a fake patient will try to get himself committed to their institute. All personal were requested to rate patients according to the chances that they are the fake patient. Reports were filled on 193 patients: 41 were rated a highly likely to be fake by at least one staff member, 23 were suspected by at least one psychiatrist and 19 were suspected by one psychiatrist and one staff member. In actual fact, no fake patients were ever committed to any of the hospitals as part of Rosenhan's study.
The second Rosenhan experiment proves that the tendency for over-diagnosis can be reversed. Since 19 patients were suspected to be sane by a psychiatrist and a staff member, the credibility of diagnosis is undermined.
Rosenhan's study and psychiatric labeling
What the Rosenhan experiments shows is that once a person is labeled as deviant, all his actions will be labeled accordingly. The power of this labeling is so powerful that perfectly normal behaviors were ignored, misinterpreted or even coerced to fit the original diagnosis. Personal facts were distorted by professionals in order to fit in with schizophrenia. Even sadness or outbursts by the fake patients that were the result of being committed were misunderstood as being related to schizophrenia. Rosenhan's study also painted a very harsh image regarding the treatment of mental patients that are dehumanized by the staff that disregard their rights and treat them harshly.
Rosenahn concludes "On Being Sane in Insane Places" in wondering how many sane people are labeled and committed as mental patients. He claims that psychiatric labeling can have a life of its own with risk of becoming a self fulfilling prophecy in which even the person himself accepts the diagnosis and begins to act accordingly.