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Georgia Wilson
Olatunji
Abnormal Psychology
22 September 2014
Misdiagnosing Insanity
Many speculate that sanity and insanity are virtually indistinguishable in a mental
institution. Can a sane individual, influenced by life in a cold and unforgiving
environment, pass for insane in the eyes of his or her caretakers? David L. Rosenhan,
author of On Being Sane in Insane Places, explores the effects of environment,
stigmatization, and hospitalization on an individuals perceived soundness of mind by
conducting a research experiment involving a group of pseudopatients. With identities
unbeknownst to the staff and medical records free from mental illness, these
pseudopatients take up life in mental hospitals. Their experiences in the hospitals
illuminate the nature of life in an institution for the mentally ill and the effects it can have
on otherwise normal individuals.
A group of eight healthy individuals, composed of three women and five men,
assumed the role of pseudopatients. These pseudopatients were admitted into twelve
institutions by claiming to have experienced symptoms of hearing voices. They scheduled
appointments in which they divulged the details of these hallucinations, which included
hearing words such as empty, hollow, and thud (Rosenhan 2). These claims alone,
without further investigation by hospital staff, resulted in a diagnosis of schizophrenia for
eleven of the pseudopatients and a diagnosis of manic-depressive psychosis for one. They
falsified their symptoms, their names and, in some cases, their true occupations.
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Otherwise these individuals remained entirely truthful during the course of the
experiment, which ranged from 7 to 52 days, with an average of 19 days (4). During
their stays, the pseudopatients did not feign any of the symptoms they had claimed to
experience prior to admittance. In fact, aside from the stress that accompanied adjusting
to life in the hospital and overcoming fear of being exposed as a fake, none of the
pseudopatients exhibited any behavior indicative of abnormality. Nevertheless, no
hospital staff members ever identified the pseudopatients as sane individuals. According
to Rosenhan, a veridical description of personal history and circumstances was offered
to the staff of the facilities, yet due to the diagnoses of these individuals, even normal
behaviors were overlooked entirely or profoundly misinterpreted (5).
The study focuses on not only the treatment of mentally ill in these types of
institutions, but also on the effects of labels and stigmatization. The patients in these
hospitals received minimal attention from hospital staff. One aspect of this study focuses
on hospital attendants reportedly spending only 11.3% of their time on duty outside of
the cage (8). Aptly named by the pseudopatients, this glass enclosure in which only the
hospital staff resided illustrates the separation that existed between the workers and
patients. Rosenhan notes that, aside from care-taking purposesthe staff keep to
themselves, almost as if the disorder that afflicts their charges is catching (8). In addition
to neglect, the patients also experienced verbal and physical abuse from the staff.
Furthermore, the physical presence of these patients often went unnoticed by hospital
employees, as is illustrated by one of the nurses who unbuttoned her uniform to adjust
her brassier in the present of an entire ward of viewing men (10). Needless to say, life in
the institutions was far from ideal for the mentally ill, and patients did not receive proper
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attention from hospital workers. The study also addresses the effects of labels and
stigmatization on patients. Upon diagnosis, all of the pseudopatients behaviors were
explainable in terms of their mental illnesses. For example, the pseudopatients frequent
writing in journals was seen as an aspect of their pathological behavior (6). The
frequent attribution of normal behaviors to an individuals assumed illness was
characteristic of the labels given to the patients. Depersonalization was also a result of
stigma and labels in institutions, and patients often reported having the sense that they
were invisible, or at least unworthy of account (9). Depersonalization of patients is also
illustrated by the distribution of many different kinds of pills to patients and the disposal
of them that went unobserved by the staff.
Each pseudopatient was eventually discharged with a diagnosis of schizophrenia
in remission (3). The results of the study address the fact that sane individuals can
indeed go undetected in mental institutions, despite not showing any signs of abnormal
behavior. Furthermore, each pseudopatient reported feeling the effects of
depersonalization while in the hospital. Not only does the study raise concerns about
depersonalization of patients and the ethics of treatment in mental institutions, but it also
raises concerns that many individuals in mental institutions may not be justified in their
admittance. Furthermore, the study addresses the effects of the self-fulfilling prophecy,
and how Eventually, the patient himself accepts the diagnosis, with all of its surplus
meanings and expectations, and behaves accordingly (6). This reinforces the idea that
some individuals in mental institutions may be sane, but are living up to the expectations
of their misdiagnoses. If not a victim of self-fulfilling prophecy, a sane individual may
remain undetected by staff members who do not spend sufficient time evaluating the
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mental health of their patients or whose perceptions of patients are colored by labels of
the mentally ill and social stigmas that accompany them.
My personal reaction to the study is one of confusion. Life in institutions seems
ineffective in treating the mentally ill due to neglect and occasional abuse of the patients.
Professionals are unable to identify healthy pseudopatients, which implies a possibility of
sane individuals being subjected to unnecessary treatment in hospitals. Based off of these
considerations, why are mental institutions a treatment option? Unaddressed in this
article, do success stories as a result of life in an institution exist? Furthermore,
inconsistencies clearly exist in diagnosing patients, considering the one pseudopatient out
of the group that received a diagnosis of manic-depressive psychosis as opposed to
schizophrenia. Not only that, but the hospitals never observed abnormal behavior in the
pseudopatients, yet kept them in the institution for periods up to 52 days. At what point
did they decide that it was acceptable to discharge the patient? Why were patients who
received the same diagnoses and exhibited normal behavior released from the hospitals
after such varying times from 7 days after admittance to 52 days after? Can the line
between sanity and insanity, albeit a vague one, become more identifiable under the care
of a more attentive hospital staff? The study emphasizes the many flaws of life in Insane
Places, and draws attention to the seemingly arbitrary lengths of treatment time for
individuals with the same diagnoses and behavior. How, then, has this treatment not been
eradicated entirely? Considering the terrible treatment of patients, I feel that the
inhumane aspects of hospitalization far outweigh the potential success of life in a mental
institution.


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Work Cited
David L. Rosenhan, On Being Sane in Insane Place, Science, Vol. 179 (Jan. 1973),
250-258.