On Being Sane in Insane Places

[joesteph]

Imagine that you're sane but in a mental institution, and you believe that your actions demonstrate your sanity--but is anybody listening to you? Observing your behavior as sane?

D.L. Rosenhan's "On Being Sane in Insane Places" (Science, 1975) is about eight sane individuals who gained admittance to twelve hospitals throughout the US, wondering if hospital personnel were going to catch that they were actually sane.

Each had an alias and arrived at different hospitals claiming to hear a voice that said, "empty," "hollow," and "thud." They were admitted as schizophrenic patients and given medication, which the pseudopatients knew to avoid actually taking.

Upon entrance to the psychiatric ward, they exhibited no behavior other than that of an ordinary person. They mingled with the real patients, discovered that if they took notes right in front of hospital staff that it was nothing they would be questioned about, and made it known when they did speak with a doctor that the symptom of the voice had vanished. Each pseudopatient had entered wondering how quickly he would be caught by the staff; instead, some actual patients asked them about the note-taking and wondered if they were there to check up on the hospital.

Their average stay was nineteen days, released from the hospital with the diagnosis of schizophrenia in remission--which is not the same as saying they were sane persons. (Thinking ahead, that someone might be inside indefinitely, attorneys cooperating with the experimenters were kept "on call" for a writ of habeas corpus.)

_____

I teach psychology as a social studies teacher on the high school level, and present the actual article to my students. They answer certain questions in writing first, then after they've done their individual work we discuss it as a class. The most important question, to me, is:

Was this study/experiment a fair one? Could those involved as pseudopatients have reasonably expected that hospital personnel would expect that a sane person would want to be admitted to a psychiatric ward to see if they would be caught?

What do you think?

[isshinryu5toforever]

I would be inclined to say that the study was unfair. Just as we were discussing the choke question previously posed. People working under certain circumstances make assumptions, not always right, based on the circumstances under which they work. If you work at a mental institution, it is highly unlikely that a completely sane person would go there on their own volition to be committed. Some people might even deem that urge to be associated some sort of mental illness. I do understand the intention behind the experiment, but I can't say it was a necessarily fair one.

[JiuJitsuNation]

I think the same could be done in pain clinics or anywhere else with the same results. The doctors do not truly know what is going on in the mind and bodies of these people. Unless of course it is something obvious or can be seen. It sounds kinda cool. How many people get to experience that!

On top of that how scary would it be to be believed insane and kept without anyone ever listening to you! I mean your crazy right? lol

[evergrey]

They could not pay me enough to do that. Being institutionalized is one of my worst nightmares.

Doctors aren't psychic. They can't really know. Okay, some mental illnesses you can test for. But many you can't, really. Not physically.

Goodness knows doctors get things wrong often enough, even when it is physical

I just noticed the date of the publication. 1975? Oh maaaaan I would argue that anyone who would willingly get themselves admitted back then really WAS insane. Do you know the kinds of things they DID back then?

[DWx]

I think I've watched too many of the "sane person gets admitted to an institution and then goes insane" films to ever be able to do that.

I don't think that study is fair really. How often are staff going to come across a patient that has been admitted because they wanted to be? They're going to accept the official diagnosis of the doctor that admitted them then just go about their job. Even if the patient is acting normal how are staff to know if the voices they hear aren't still there?

[evergrey]

Heck, I know a woman who hears voices. I knew her for years before she told me.

[Patrick]

Interesting. Speaking generall, it's dangerous if admittance to an institution is seen as some sort of factual matter of your being. Goes against the human nature of mistakes.

[Lupin1]

I have a feeling they're going to make a movie out of this study. And I would totally see it.

[Rateh]

I think that doctors should realize that just because someone has a diagnosis doesn't mean it is correct.

I used to work at a center for developmentally disabled adults. Whenever I would worked with a new person I would read their "book" which had all of their history in it, including any diagnosis's. Many of them were diagnosed with multiple mental disorders.

I had one old man, who was diagnosed with intermittent explosive disorder. The most explosive he got was stomping his foot, shaking his fist, and making the kind of threats a confused five year old would make, intermixed with a few swear words. Hardly something I would find threatening. Sometimes it was almost humorous.

The point is, I highly doubt he had intermittent explosive disorder. Just because it was written on his chart, didn't mean that he had it. People should be taken at face value. I used their charts as a general guild. If they displayed odd behaviors, then I would use their diagnosis's to figure out why, otherwise, who knows if they are true? If the people weren't displaying any behaviors that signified that they had schizophrenia, the doctors should have figured out that they didn't have it, not just assumed that they did because their chart said so.

[joesteph]

When this is presented to high school students, the majority think it's fair, expecting that the doctors and nurses should all be able to identify a sane person. We then discuss it, and while I'm careful not to say that there's a "right" answer I expect from them, in discussion I bring out what the school nurse had told me some time ago.

Admitting the person is pretty much a no-brainer. The diagnosis is standard, given the symptoms, and the expectation that medication will be given and hopefully work is something just as standard.

If a committed individual suddenly says the voices are gone, there's nothing that says the voices can't just return the next day. The person has to be monitored over a period of time, especially since medication just doesn't work that quickly. Someone who's released is someone the doctors believe is stable, who (it was thought) has shown he's taken the medication regularly, and is therefore less likely to have a relapse.

Imagine if the voices return, only to say to kill? It's safer for the person as well as society to keep him long enough to give the illness a chance (so-to-speak) to reassert itself; if it doesn't, great, but if it does, it's better that it does so in the psychiatric ward.

Incidentally, I learned over the years I've taught psychology that certain things a patient does should not be brought up unless the patient chooses to mention it, to avoid triggering a negative reaction. If the staff had leaned over to see what the pseudopatients were writing, they might have been violating instructions. What if it triggered a paranoid reaction?