On Being Sane in Insane Places

8/11/2019 On Being Sane in Insane Places

1/26

'Dr. Rosenhan personally had himself admitted as a ''mental patient'' in 1972and wrote of his findings regarding the experience.

Please note:In this piece by David Rosenhan all the footnoteshavebeen added by meand speak of my ownexperience in relation to

Rosenhan's study which is based on his similar experience...

Patricia Lefave, Labelled, Delusional Disorder, (Paranoid)

On Being Sane In Insane PlacesBy David L. Rosenhan, PhD.Stanford University

How do we know precisely what constitutes normality! or mental illness"#on$entional wisdom suggests that specially trained professionals ha$e the

a%ility to make reasona%ly accurate diagnoses. &n this research howe$er

Da$id Rosenhan pro$ides e$idence to challenge this assumption. (hat is ))or is not )) normal! may ha$e much to do with the la%els that are applied to

people in particular settings.

&f sanity and insanity exist how shall we know them"

*he +uestion is neither capricious nor itself insane. Howe$er much we may%e personally con$inced that we can tell the normal from the a%normal the

e$idence is simply not compelling. &t is commonplace for example to read

a%out murder trials wherein eminent psychiatrists for the defense arecontradicted %y e+ually eminent psychiatrists for the prosecution on the

matter of the defendant,s sanity. -ore generally there are a great deal ofconflicting data on the relia%ility utility and meaning of such terms as

sanity! insanity! mental illness! and schiophrenia.!

/inally as early as 190 Ruth3 4enedict suggested that normality and

a%normality are not uni$ersal.

(hat is $iewed as normal in one culture may %e seen as +uite a%errant in

another. *hus notions of normality and a%normality may not %e +uite as

accurate as people %elie$e they are.

*o raise +uestions regarding normality and a%normality is in no way to+uestion the fact that some %eha$iors are de$iant or odd. -urder is de$iant.

5o too are hallucinations. 6or does raising such +uestions deny the

existence of the personal anguish that is often associated with mentalillness.! nxiety and depression exist. 8sychological suffering exists. 4ut


2/26

normality and a%normality sanity and insanity and the diagnoses that flowfrom them may %e less su%stanti$e than many %elie$e them to %e.

t its heart the +uestion of whether the sane can %e distinguished from the

insane and whether degrees of insanity can %e distinguished from each

other: is a simple matter; Do the salient characteristics that lead todiagnoses reside in the patients themsel$es or in the en$ironments and

contexts in which o%ser$ers find them" /rom 4leuler through


3/26

description of their experiences in psychiatric institutions. *oo fewpsychiatrists and psychologists e$en those who ha$e worked in such

hospitals know what the experience is like. *hey rarely talk a%out it withformer patients perhaps %ecause they distrust information coming from the

pre$iously insane. *hose who ha$e worked in psychiatric hospitals are likely

to ha$e adapted so thoroughly to the settings that they are insensiti$e to theimpact of that experience. nd while there ha$e %een occasional reports of

researchers who su%mitted themsel$es to psychiatric hospitaliation theseresearchers ha$e commonly remained in the hospitals for short periods of

time often with the knowledge of the hospital staff. &t is difficult to know the

extent to which they were treated like patients or like research colleagues.6e$ertheless their reports a%out the inside of the psychiatric hospital ha$e

%een $alua%le. *his article extends those efforts.

#$% &OR'(L (R% &O# D%#%)#(BL* S(&%

Despite their pu%lic show! of sanity the pseudo patients were ne$er

detected. dmitted except in one case with a diagnosis of schiophrenia

each was discharged with a diagnosis of schiophrenia in remission.! *he

la%el in remission! should in no way %e dismissed as a formality for at no

time during any hospitaliation had any +uestion %een raised a%out any

pseudo patient,s simulation. 6or are there any indications in the hospital

records that the pseudo patient,s status was suspect. Rather the e$idence is

strong that once la%eled schiophrenic the pseudo patient was stuck with

that la%el. &f the pseudo patient was to %e discharged he must naturally %ein remission!@ %ut he was not sane nor in the institution,s $iew had he

e$er %een sane.

#he !niform fail!re to recogni+e sanity0cannot %e attri%uted to the

+uality of the hospitals for although there were considera%le $ariations

among them se$eral are considered excellent. 6or can it %e alleged that

hospitaliation ranged from 7 to A2 days with an a$erage of 19 days. *he

pseudo patients were not in fact carefully o%ser$ed %ut this failure speaks

more to traditions within psychiatric hospitals than to lack of opportunity.

/inally it cannot %e said that the failure to recognie the pseudo patients'

sanity was due to the fact that they were not %eha$ing sanely. (hile there

was clearly some tension present in all of them their daily $isitors could

3?mphasis mine 8B


4/26

detect no serious %eha$ioral conse+uencesCnor indeed could other

patients. It was !ite common for the "atients to -detect the "se!do

"atient/s sanity.During the first three hospitaliations when accurate

counts were kept 0A of a total of 11 patients on the admissions ward

$oiced their suspicions some $igorously. Eou,re not cray. Eou,re a=ournalist or a professor referring to the continual note)taking:. Eou,re

checking up on the hospital.! (hile most of the patients were reassured %y

the pseudo patient,s insistence that he had %een sick %efore he came in %ut

was fine now some continued to %elie$e that the pseudo patient was sane

throughout his hospitaliation. *he fact that the patients often recognied

normality when staff did not raises important +uestions.

/ailure to detect sanity during the course of hospitaliation may %e due to

the fact that physicians operate with a strong %ias toward what statisticianscall the *ype 2 error. *his is to say that physicians are more inclined to call a

healthy person sick a false positi$e *ype 2: than a sick person healthy a

false negati$e *ype 1:. *he reasons for this are not hard to find; it is clearly

more dangerous to misdiagnose illness than health. 4etter to err on the side

of caution to suspect illness e$en among the healthy.

4ut what holds for medicine does not hold e+ually well for psychiatry.

-edical illnesses while unfortunate are not commonly pe=orati$e.

Psychiatric diagnoses, on the contrary, carry with them "ersonal,

legal, and social stigmas. A&t was therefore important to see whether the

tendency toward diagnosing the sane insane could %e re$ersed. *he

following experiment was arranged at a research and teaching hospital

whose staff had heard these findings %ut dou%ted that such an error could

occur in theirFhospital. *he staff was informed that at some time during the

following three months one or more pseudo patients would attempt to %e

admitted into the psychiatric hospital. ?ach staff mem%er was asked to rate

each patient who presented himself at admissions or on the ward according

to the likelihood that the patient was a pseudo patient. 1G)point scale was

used with a 1 and 2 reflecting high confidence that the patient was a

pseudo patient.

4gain emphasis mine 8B

5*et for the identified patient to complain that one's life is %eing destroyed is to in$ite

further 'assessments' related to 'paranoia.'

6it always seems to %e 'other' people perhaps %ut certainly not #$%'.


5/26

udgements were o%tained on 190 patients who were admitted for

psychiatric treatment. ll staff who had had sustained contact with or

primary responsi%ility for the patient I attendants nurses psychiatrists

physicians and psychologists I were asked to make =udgments. /orty)one

patients were alleged with high confidence to %e pseudo patients %y atleast one mem%er of the staff. *wenty)three were considered suspect %y at

least one psychiatrist. 6ineteen were suspected %y one psychiatrist and one

other staff mem%er. ctually no genuine pseudo patient at least from my

group: presented himself during this period.

*he experiment is instructi$e. &t indicates that the tendency to designate

sane people as insane can %e re$ersed when the stakes in this case

prestige and diagnostic acumen: are high. B!t what can e said of the 01"eo"le who were s!s"ected of eing -sane y one "sychiatrist and

another staff memer2 3ere these "eo"le tr!ly 4sane4 or was itrather the case that in the co!rse of avoiding the #y"e 5 error the

staff tended to ma6e more errors of the first sort 7 calling the cra+y

-sane27*here is no way of knowing. 4ut one thing is certain; anydiagnostic process that lends itself too readily to massi$e errors of this sort

cannot %e a $ery relia%le one.

PS%UDOP(#I%S (&D #$%IR S%##I&8S

*he eight pseudo patients were a $aried group. Jne was a psychology

graduate student in his 2G,s. *he remaining se$en were older andesta%lished.! mong them were three psychologists a pediatrician apsychiatrist a painter and a housewife. *hree pseudo patients were women

fi$e were men. ll of them employed pseudonyms lest their alleged

diagnoses em%arrass them later.9*hose who were in mental health professions alleged another occupation in

order to a$oid the special attentions that might %e accorded %y staff as amatter of courtesy or caution to ailing colleagues.

(ith the exception myself & was the first pseudo patient and my presence

was known to the hospital administration and chief psychologist and so far

7Jr is it =ust that this happens all the time to supposedly 'real' patients who tell thepsychiatrists and staff they are 'not sick' %ut who can not %e heard %ecause of this $erypro%lem. 5aying one is not 'sick' often meaning physically is defined as one of the signs

that one ISsick meaning physically *he tautology is e$er present to =ustify all outcomesand protect the system. 8B

8I wonder if he said, "I know I could never get a psychiatric label cause I'm not sick."9Did they not understand it was just like having diabetes?


6/26

as & can tell to them alone: the presence of pseudo patients and the natureof the research program was not known to the hospital staffs.

*he settings are similarly $aried. &n order to generalie the findings

admission into a $ariety of hospitals was sought. *he 12 hospitals in the

sample were located in fi$e different states on the ?ast and (est coasts.5ome were old and sha%%y some were +uite new. 5ome had good staff)

patient ratios others were +uite understaffed. Jnly one was a strict pri$atehospital. ll of the others were supported %y state or federal funds or in one

instance %y uni$ersity funds.

fter calling the hospital for an appointment the pseudo patient arri$ed at

the admissions office complaining that he had %een hearing $oices. skedwhat the $oices said he replied that they were often unclear %ut as far as

he could tell they said empty! hollow! and thud.! *he $oices were

unfamiliar and were of the same sex as the pseudo patient. *he choice ofthese symptoms was occasioned %y their apparent similarity to existential

symptoms. 5uch symptoms are alleged to arise from painful concerns a%outthe percei$ed meaninglessness of one,s life.1G&t is as if the hallucinating

person were saying -y life is empty and hollow.! 11*he choice of thesesymptoms was also determined %y the a%sence of a single report of

existential psychoses in the literature.

4eyond alleging the symptoms and falsifying name $ocation andemployment no further alterations of person history or circumstances were

made. *he significant e$ents of the pseudo patient,s life history werepresented as they had actually occurred. Relationships with parents and

si%lings with spouse and children with people at work and in schoolconsistent with the aforementioned exceptions were descri%ed as they wereor had %een. 12/rustrations and upsets were descri%ed along with =oys and

satisfactions. *hese facts are important to remem%er. &f anything theystrongly %iased the su%se+uent results in fa$or of detecting insanity since

none of their histories or current %eha$iors were seriously pathological in

any way.

&mmediately upon admission to the psychiatric ward the pseudo patientceased simulating any symptoms of a%normality. &n some cases there was a

%rief period of mild ner$ousness and anxiety since none of the pseudopatients really %elie$ed that they would %e admitted so easily.10&ndeed theirshared fear was that they would %e immediately exposed as frauds and

greatly em%arrassed. -oreo$er many of them had ne$er $isited a

10ell, they used to be. ith bio psych it is all pretty well defined as meaningless.11!ow we are not saying anything. e are just 'seeking attentionfame.'12#veryday reality in other words.

13!one so blind as those who cannot see what's...right in front of them.


7/26

psychiatric ward@ e$en those who had ne$ertheless had some genuine fearsa%out what might happen to them. *heir ner$ousness then was +uite

appropriate to the no$elty of the hospital setting and it a%ated rapidly. 1

part from that short)li$ed ner$ousness the pseudo patient %eha$ed on the

ward as he normally! %eha$ed. *he pseudo patient spoke to patients andstaff as he might ordinarily. 4ecause there is uncommonly little to do on a

psychiatric ward he attempted to engage others in con$ersation. (henasked %y staff how he was feeling he indicated that he was fine that he no

longer experienced symptoms. He responded to instructions from

attendants to calls for medication which was not swallowed: and todining)hall instructions. 4eyond such acti$ities as were a$aila%le to him on the

admissions ward he spent his time writing down his o%ser$ations a%out theward its patients and the staff.1A&nitially these notes were written

secretly! %ut as it soon %ecame clear that no one much cared they were

su%se+uently written on standard ta%lets of paper in such pu%lic places asthe dayroom. 6o secret was made of these acti$ities.

*he pseudo patient $ery much as a true psychiatric patient entered a

hospital with no foreknowledge of when he would %e discharged. ?ach wastold that he would ha$e to get out %y his own de$ices essentially %y

con$incing the staff that he was sane. 1F*he psychological stresses

associated with hospitaliation were considera%le and all %ut one of thepseudo patients desired to %e discharged almost immediately after %eing

admitted. *hey were therefore moti$ated not only to %eha$e sanely %ut to%e paragons of cooperation. *hat their %eha$ior was in no way disrupti$e is

confirmed %y nursing reports which ha$e %een o%tained on most of thepatients. *hese reports uniformly indicate that the patients were friendly!cooperati$e! and exhi%ited no a%normal indications.!17

#$% S#I)9I&%SS O PS*)$ODI(8&OS#I) L(B%LS

4eyond the tendency to call the healthy sick I a tendency that accounts

%etter for diagnostic %eha$ior on admission than it does for such %eha$ior

after a lengthy period of exposure I the data speak to the massi$e role of

la%eling in psychiatric assessment. 1Ha$ing once %een la%eled schiophrenicthere is nothing the pseudo patient can do to o$ercome the tag. *he tag

14*hey etting the la%el placed as +uickly as possi%le seems to %e the most

important thing to the %io psychs. *he la%el gi$es the doctor control o$er the patient


8/26

profoundly colors others, perceptions of him and his %eha$ior. 19

/rom one $iewpoint these data are hardly surprising for it has long %eenknown that elements are gi$en meaning %y the context2Gin which they

occur. >estalt psychology made the point $igorously and sch

demonstrated that there are central! personality traits such as warm!$ersus cold!: which are so powerful that they markedly color the meaning

of other information in forming an impression of a gi$en personality.&nsane! schiophrenic! manic)depressi$e! and cray! are pro%a%ly

among the most powerful of such central traits. Jnce a person is designateda%normal all of his other %eha$iors and characteristics are colored %y that

la%el. 21&ndeed that la%el is so powerful that many of the pseudopatients,

normal %eha$iors were o$erlooked entirely or profoundly misinterpreted.5ome examples may clarify this issue.

?arlier & indicated that there were no changes in the pseudopatient,s

personal history and current status %eyond those of name employment

and where necessary $ocation. Jtherwise a $eridical description of

personal history and circumstances was offered. *hose circumstances were

not psychotic. How were they made consonant with the diagnosis modified in

such a way as to %ring them into accord with the circumstances of the

pseudopatient,s life as descri%ed %y him"

s far as & can determine diagnoses were in no way affected %y the relati$e

health of the circumstances of a pseudopatient,s life. Rather the re$erse

22

occurred; the perception of his circumstances was shaped entirely %y the

diagnosis.20 clear example of such translation is found in the case of a

pseudopatient who had had a close relationship with his mother %ut was

rather remote from his father during his early childhood. During adolescence

and %eyond howe$er his father %ecame a close friend while his relationship

with his mother cooled. His present relationship with his wife was

characteristically close and warm. part from occasional angry exchanges

friction was minimal. *he children had rarely %een spanked. 5urely there is

19fter & 8B: recei$ed my own la%el it was as if & had suddenly %ecome someone else. 5uddenly

e$erything & said felt or did was up for 'interpretation' %y others. *hey now see me though the filter of

their own %elief system.

20-eaning connected to context. Did you get that part J


9/26

nothing especially pathological a%out such a history. &ndeed many readers

may see a similar pattern in their own experiences with no markedly

deleterious conse+uences. J%ser$e howe$er how such a history was

translated2in the psychopathological context this from the case summary

prepared after the patient was discharged.

*his white 09)year)old male . . . manifests a long history of considera%le

am%i$alence in close relationships which %egins in early childhood. warm

relationship with his mother cools during his adolescence. distant

relationship with his father is descri%ed as %ecoming $ery intense. ffecti$e

sta%ility is a%sent. His attempts to control emotionality with his wife and

children are punctuated %y angry out%ursts and in the case of the children

spankings. nd while he says that he has se$eral good friends one senses

considera%le am%i$alence em%edded in those relationships also . . .

*he facts of the case were unintentionally distorted %y the staff to achie$econsistency with a popular theory of the dynamics of a schiophrenic

reaction. 6othing of an am%i$alent nature had %een descri%ed in relations

with parents spouse or friends.2A*o the extent that am%i$alence could %einferred it was pro%a%ly not greater than is found in all human,s

relationships. &t is true the pseudopatient,s relationships with his parentschanged o$er time %ut in the ordinary context that would hardly %e

remarka%le I indeed it might $ery well %e expected. #learly the meaning

ascri%ed to his $er%aliations that is am%i$alence affecti$e insta%ility: wasdetermined %y the diagnosis; schiophrenia. n entirely different meaning2F

would ha$e %een ascri%ed if it were known that the man was normal.!

ll pseudopatients took extensi$e notes pu%licly. Mnder ordinary

circumstances such %eha$ior would ha$e raised +uestions in the minds ofo%ser$ers as in fact it did among patients. &ndeed it seemed so certain

that the notes would elicit suspicion that ela%orate precautions were taken toremo$e them from the ward each day. 4ut the precautions pro$ed needless.

*he closest any staff mem%er came to +uestioning those notes occurred

when one pseudopatient asked his physician what kind of medication he wasrecei$ing and %egan to write down the response. Eou needn,t write it! he

was told gently. &f you ha$e trou%le remem%ering =ust ask me again.!27

24L*ranslatedL as if the o%$ious truth were a foreign language. like the 'interpretations'

generated %y the est routine as well. 8B

25and e$en if am%i$alence 3(Sthere 3$*is the focus on oneperson and not the group

as a whole and why is am%i$alence experienced in all relationships defined as 'pathological'

in some%ut not in others"

26nd #$(#is a%out meaning connected to a "remiseisn't it" >ee...where ha$e we heard

that %efore"

27(riting %eha$iours 8B


10/26

&f no +uestions were asked of the pseudopatients how was their writing

interpreted" 6ursing records for three patients indicate that the writing wasseen as an aspect of their pathological %eha$ior. 8atient engaged in writing

%eha$ior! was the daily nursing comment on one of the pseudopatients who

was ne$er +uestioned a%out his writing.2>i$en that the patient is in thehospital he must %e psychologically distur%ed. 29nd gi$en that he is

distur%ed continuous writing must %e %eha$ioral manifestation of thatdistur%ance perhaps a su%set of the compulsi$e %eha$iors that are

sometimes correlated with schiophrenia. 0G

Jne tacit characteristic of psychiatric diagnosis is that it locates the sourcesof a%erration within the indi$idual and only rarely within the complex of

stimuli that surrounds him. 01#onse+uently %eha$iors that are stimulated %ythe en$ironment are commonly misattri%uted to the patient,s disorder. 02/or

example one kindly nurse found a pseudopatient pacing the long hospital

corridors. 6er$ous -r. N"! she asked. 6o %ored! he said.

*he notes kept %y pseudopatients are full of patient %eha$iors that weremisinterpreted %y well)intentioned staff. Jften enough a patient would go

%erserk! %ecause he had wittingly or unwittingly %een mistreated %y sayan attendant. nurse coming upon the scene would rarely in+uire e$en

cursorily into the en$ironmental stimuli of the patient,s %eha$ior. Rather she

ass!med00that his upset deri$ed from his pathology not from his presentinteractions with other staff mem%ers. Jccasionally the staff might assume

that the patient,s family especially when they had recently $isited: or otherpatients had stimulated the out%urst. 4ut neverwere the staff found to

assume that one of themselves or the str!ct!re of the hos"italhadanything to do with a patient,s %eha$ior. Jne psychiatrist pointed to a groupof patients who were sitting outside the cafeteria entrance half an hour

%efore lunchtime. *o a group of young residents he indicated that such%eha$ior was characteristic of the oral)ac+uisiti$e nature of the syndrome.0&t seemed not to occur to him that there were $ery few things to anticipate

in a psychiatric hospital %esides eating.

286o one who %elie$es he or she already knows e$erything has any interest in asking or

listening. ?$erything has %een made meaningless the minute the 'patient' has %een defined

5 the patient. *he same thing occurs with know)it)alls in families. 8B29(riting is part of the attempt to sort out all the contradictions with which the patient is

%eing %om%arded %y others. ex cult mem%ers use this sorting method also. 8l

30&magine there is no such 'disease' and keep reading. &magine it is the dysfunctional con

=o% of 5J-? of those '%lameless others.

31Eoo hoo. experts..are you H?R&6> that J


11/26

psychiatric la%el has a life and an influence of its own. Jnce the impressionhas %een formed that the patient is schiophrenic the expectation is that he

will continue to %e schiophrenic. (hen a sufficient amount of time haspassed during which the patient has done nothing %iarre he is considered

to %e in remission and a$aila%le for discharge. 4utthe lael end!res

eyond discharge,with the unconfirmed expectation that he will %eha$e asa schiophrenic again. 5uch la%els conferred %y mental health professionals

are as infl!ential on the "atient as they are on his relatives andfriends,0Aand it should not surprise anyone that the diagnosis acts on all

of them as a self;f!lfilling "ro"hecy.0F?$entually the patient himself

accepts the diagnosis with all of its surplus meanings and expectations and%eha$es accordingly. 07

*he inferences to %e made from these matters are +uite simple. -uch as

Oigler and 8hillips ha$e demonstrated that there is enormous o$erlap in the

symptoms presented %y patients who ha$e %een $ariously diagnosed sothere is enormous o$erlap in the %eha$iors of the sane and the insane. *he

sane are not sane! all of the time. (e lose our tempers for no goodreason.! (e are occasionally depressed or anxious again for no good

reason.0nd we may find it difficult to get along with one or another personI again for no reason that we can specify. 5imilarly the insane are not

always insane. &ndeed it was the impression of the pseudopatients while

li$ing with them that they were sane for long periods of time I that the%iarre %eha$iors upon which their diagnoses were allegedly predicated

constituted only a small fraction of their total %eha$ior. &f it makes no senseto la%el oursel$es permanently depressed on the %asis of an occasional

depression then it takes %etter e$idence than is presently a$aila%le to la%elall patients insane or schiophrenic on the %asis of %iarre %eha$iors orcognitions. &t seems more useful as -ischel has pointed out to limit our

discussions to %eha$iors the stimuli that pro$oke them and their correlates.

&t is not known why powerful impressions of personality traits such as

cray! or insane! arise. #oncei$a%ly when the origins of and stimuli thatgi$e rise to a %eha$ior are remote or unknown or when the %eha$ior strikes

us as immuta%le trait la%els regarding the %eha$ior arise. (hen on theother hand the origins and stimuli are known and a$aila%le discourse is

35(ho are then trained to treat us 'as if.L

36*hat's right. 8roduced with non stop pressure stress and the constant in$alidation of the

self righteous.

37-ost of us do %ut not all of us and those of us who don't are su%=ected to further

'treatment' and la%elled non compliant as & was. & told my reco$ery therapist that & was

escaping this fate %y the skin of my teeth and & knew it. (e get se$eral different la%els forthis same experience which seems to depend more on (HJ we get in the psychiatric crap

shoot and not on Lsymptoms.' *hat is how su%=ecti$e the diagnoses are.

38*his is also a $alue =udgement often %ased on &Opatient input at all.


12/26

limited to to the %eha$ior itself.09*hus & may hallucinate %ecause & amsleeping or & may hallucinate %ecause & ha$e ingested a peculiar drug.

*hese are termed sleep)induced hallucinations or dreams and drug)inducedhallucinations respecti$ely. 4ut when the stimuli to my hallucinations are

unknownGthat is called crainess or schiophrenia Ias if that inference

were somehow as illuminating as the others.

#$% %


13/26

professionals would insist that they are sympathetic toward the mentally illthat they are neither a$oidant nor hostile. 4ut it is more likely that an

ex+uisite am%i$alence characterises their relations with psychiatric patientssuch that their a$owed impulses are only part of their entire attitude.A

6egati$e attitudes are there too and can easily %e detected.F5uch attitudes

should not surprise us. *hey are the natural offspring of the la%els patientswear and the places in which they are found. 7

#onsider the structure of the typical psychiatric hospital. 5taff and patients

are strictly segregated. 5taff ha$e their own li$ing space including their

dining facilities %athrooms and assem%ly places. *he glassed +uarters thatcontain the professional staff which the pseudopatients came to call the

cage! sit out on e$ery dayroom. *he staff emerge primarily for care)takingpurposes I to gi$e medication to conduct therapy or group meeting to

instruct or reprimand a patient. Jtherwise staff keep to themsel$es almost

as if the disorder that afflicts their charges is somehow catching.

5o much is patient)staff segregation the rule that for four pu%lic hospitals inwhich an attempt was made to measure the degree to which staff and

patients mingle it was necessary to use time out of the staff cage! as theoperational measure. (hile it was not the case that all time spent out of the

cage was spent mingling with patients attendants for example would

occasionally emerge to watch tele$ision in the dayroom: it was the only wayin which one could gather relia%le data on time for measuring.

*he a$erage amount of time spent %y attendants outside of the cage was

11.0 percent range 0 to A2 percent:. *his figure does not represent onlytime spent mingling with patients %ut also includes time spent on suchchores as folding laundry super$ising patients while they sha$e directing

ward cleanup and sending patients to off)ward acti$ities. &t was therelati$ely rare attendant who spent time talking with patients or playing

games with them. &t pro$ed impossi%le to o%tain a percent mingling time!

for nurses since the amount of time they spent out of the cage was too

connections. 8B

45*hat definitely speaks to my personal experience as well. 8B

46(e who see them are used to %eing silenced for %eing a%le to do so. 8B

47*hese attitudes are then taken up %y the rest of society including family and friends who

then alter their own way of percei$ing the 'patient' so that it fits in with the la%elling and

diagnostics of the 'experts.' Jn the recei$ing end of this it /??B5 like %eing pushed out of

concrete reality and into the alternate one designed %y those who either cannot or will notface the truth. 8B

48&t does a fantastic =o% of creating a 'them and us' illusion. (hile 6J faults can usually %e

found in the staff no matter how glaringly o%$ious they may %e no end to the 'faults' are

found in the patients no matter how normally they may %e speaking or acting. *his makes

the experience as surreal as it gets. 8B


14/26

%rief. Rather we counted instances of emergence from the cage. Jn thea$erage daytime nurses emerged from the cage 11.A times per shift

including instances when they left the ward entirely range to 09 times:.Bater afternoon and night nurses were e$en less a$aila%le emerging on the

a$erage 9. times per shift range to 1 times:. Data on early morning

nurses who arri$ed usually after midnight and departed at a.m. are nota$aila%le %ecause patients were asleep during most of this period.

8hysicians especially psychiatrists were e$en less a$aila%le. 9*hey were

rarely seen on the wards. Puite commonly they would %e seen only when

they arri$ed and departed with the remaining time %eing spend in theiroffices or in the cage. AGJn the a$erage physicians emerged on the ward F.7

times per day range 1 to 17 times:. &t pro$ed difficult to make an accurateestimate in this regard since physicians often maintained hours that allowed

them to come and go at different times.

*he hierarchical organiation of the psychiatric hospital has %een commented

on %efore %ut the latent meaning of that kind of organiation is worth notingagain. *hose with the most power ha$e the least to do with patients and

those with the least power are the most in$ol$ed with them. A1Recallhowe$er that the ac+uisition of role)appropriate %eha$iors occurs mainly

through the o%ser$ation of others with the most powerful ha$ing the most

influence. #onse+uently it is understanda%le that attendants not only spendmore time with patients than do any other mem%ers of the staff I that is

re+uired %y their station in the hierarchy I %ut also insofar as they learnfrom their superior,s %eha$ior spend as little time with patients as they can.

ttendants are seen mainly in the cage which is where the models theaction and the power are.A2

& turn now to a different set of studies these dealing with staff response topatient)initiated contact. &t has long %een known that the amount of time a

person spends with you can %e an index of your significance to him. &f he

49-y in hospital one %arely spoke to me though he seemed to %e en=oying himself when he

did. 8B

506urses often %latantly dysfunctional in their own relationships are $ery often the ones

who do the diagnosing %y looking for 'signs' as suggested to them %y the psychiatrists.

Ha$ing it suggested they seem to find what they are told to look for. *hey are also $erygood at closing ranks and keeping the institution's 'secrets.'8B

51& find this to %e as true today 2GG9:as it was when this was written. &t is also true that

& was one of the people who spent the most time with indi$idual patients when & was

working there as a LspecialL and was one of the people most openly scorned %y some of thestaff for my efforts. 8B

52& found 'dismissi$e' thinking and %eha$iour to represent the 'norm' among the hospital

staff from the top down. n extraordinary le$el of arrogance is %uilt into the system as a

whole and it now feeds upon itself. &t has %egun to attack it's own now whene$er a

professional dares to speak against the system itself. 8B


15/26

initiates and maintains eye contact there is reason to %elie$e that he isconsidering your re+uests and needs. &f he pauses to chat or actually stops

and talks there is added reason to infer that he is indi$iduating you. &n fourhospitals the pseudopatients approached the staff mem%er with a re+uest

which took the following form; 8ardon me -r. Qor Dr. or -rs. N could you

tell me when & will %e eligi%le for grounds pri$ileges"! or . . . when & will%e presented at the staff meeting"! or . . . when & am likely to %e

discharged"!:. (hile the content of the +uestion $aried according to theappropriateness of the target and the pseudopatient,s apparent: current

needs the form was always a courteous and rele$ant re+uest for information.

#are was taken ne$er to approach a particular mem%er of the staff morethan once a day lest the staff mem%er %ecome suspicious or irritated . . .

QRemem%er that the %eha$ior of the pseudopatients was neither %iarre nordisrupti$e. A0 Jne could indeed engage in good con$ersation with them.

. . . -inor differences %etween these four institutions were o$erwhelmed %ythe degree to which staff a$oided continuing contacts that patients had

initiated. 4y far their most common response consisted of either a %rief

response to the +uestion offered while they were on the mo$e! and with

head a$erted or no response at all. *he encounter fre+uently took the

following %iarre form; pseudopatient: 8ardon me Dr. N. #ould you tell me

when & am eligi%le for grounds pri$ileges"! physician: >ood morning

Da$e. How are you today" -o$es off without waiting for a response.: . . .

PO3%RL%SS&%SS (&D D%P%RSO&(LI=(#IO&

?ye contact and $er%al contact reflect concern and indi$iduation@ their

a%sence a$oidance and depersonaliation.A*he data & ha$e presented do

not do =ustice to the rich daily encounters that grew up around matters of

depersonaliation and a$oidance. & ha$e records of patients who were

%eaten %y staff for the sin of ha$ing initiated $er%al contact.AADuring my

535ome psychiatrists and other physicians are now %eing diagnosed using this term as

e$idence of a psychiatric illness. *he system is now closing on itself tightening the noose

tautology: around the necks of it's own mem%ers.

54*he people who were assessing and e$aluating me and others don't seem to see a

person when they look at me %ut rather an 'o%=ect.' -y protagonist's $ersion of this ise$ident in the use of the word L&tem.L (e who are forced into this kind of position

fre+uently state we feel 'in$isi%le' which is then heard as a self contained 'symptom.L

55&n any other setting this would %e seen as %latant a%use %ut not when done to us

'attention seekers' who #J-8B&6 of a%use =ust to 'seek attention.L (atch for the e$er

present tautologies in this:


16/26

own experience for example one patient was %eaten in the presence of

other patients for ha$ing approached an attendant and told him & like you.!

Jccasionally punishment meted out to patients for misdemeanors seemed

so excessi$e that it could not %e =ustified %y the most rational interpretations

of psychiatric cannon.AF6e$ertheless they appeared to go un+uestioned.

*empers were often short.A7 patient who had not heard a call for

medication would %e roundly excoriated and the morning attendants would

often wake patients with #ome on you mS S S S S f S S S S S s out of

%edK! A

6either anecdotal nor hard! data can con$ey the o$erwhelming sense of

powerlessness which in$ades the indi$idual as he is continually exposed to

the depersonaliation of the psychiatric hospital. &t hardly matters whichpsychiatric hospital A9I the excellent pu%lic ones and the $ery plush pri$ate

hospital were %etter than the rural and sha%%y ones in this regard %utagain the features that psychiatric hospitals had in common o$erwhelmed

%y far their apparent differences.

8owerlessness was e$ident e$erywhere. FG

*he patient is depri$ed of many of his legal rights %y dint of his psychiatric

commitment. He is shorn of credi%ility %y $irtue of his psychiatric la%el. F1Hisfreedom of mo$ement is restricted. He cannot initiate contact with the staff

%ut may only respond to such o$ertures as they make. F28ersonal pri$acy is

minimal. 8atient +uarters and possessions can %e entered and examined %yany staff mem%er for whate$er reason.F0His personal history and anguish is

56*he e$er present assumption is that all this is a%out the 'reason' of those not la%elled as

the 'sick' ones:. *he 'reason' is not logic@ it is group catharsis of suppressed emotion.

57Ees and if & +uestion this staff %eha$iour & am presumed to %e stupidTcray and seeing

things that are not there.

58*he patient howe$er is expected to smile and and ha$e perfect manners underscoring

the dou%le standard.

59&n$alidation %y design and %y constant pressure. Jften this is what %rought the patient

there in the first place.

60nd it still is e$ident to e$eryone except the staff. *hey are so used to doing it it feels

normal to them.

61Ees people stop hearing you or taking anything you say at face $alue =ust as they are

taught to do. Jf course they are all sure they are right to %eha$e this way too. (e are %eingtreated as less than human for our own good after all. *he psychological isolation is enough

in itself to %reak a person down. *hat is though of as 'good' too much of the time as thosewho are losing their sense of self are so much easier to reprogramme according to the

programmer's desires. Denying the humanity of the 'other' will excuse almost anything.

62-uch like sla$e owner and sla$e. Jr =ailer and prisoner.

63&f sThe complains he may well get told to stop %eing such a %a%y since the patient is not

as 'real' as the nurse who would not tolerate such treatment personally.


17/26

a$aila%le to any staff mem%er often including the grey lady! and candystriper! $olunteer: who chooses to read his folder regardless of their

therapeutic relationship to him. His personal hygiene and waste e$acuationare often monitored. *he water closets ha$e no doors.

t times depersonaliation reached such proportions that pseudopatientshad the sense that they were in$isi%leFor at least unworthy of account.

Mpon %eing admitted & and other pseudopatients took the initial physicalexaminations in a semi)pu%lic room where staff mem%ers went a%out their

own %usiness as if we were not there.FA

Jn the ward attendants deli$ered $er%al and occasionally serious physical

a%use to patients in the presence of others the pseudopatients: who werewriting it all down. FF%usi$e %eha$ior on the other hand terminated +uite

a%ruptly when other staff mem%ers were known to %e coming. 5taff are

credi%le witnesses. 8atients are not.

nurse un%uttoned her uniform to ad=ust her %rassiere in the presence of anentire ward of $iewing men. Jne did not ha$e the sense that she was %eing

seducti$e. Rather she didn,t notice us. group of staff persons might pointto a patient in the dayroom and discuss him animatedly as if he were not

there.F7

Jne illuminating instance of depersonaliation and in$isi%ility occurred with

regard to medication. ll told the pseudopatients were administered nearly21GG pills including ?la$il 5telaine #ompaine and *horaine to name

%ut a few. *hat such a $ariety of medications should ha$e %eenadministered to patients presenting identical symptoms is itself worthy ofnote.: FJnly two were swallowed. *he rest were either pocketed or

deposited in the toilet. *he pseudopatients were not alone in this. lthough &ha$e no precise records on how many patients re=ected their medications

the pseudopatients fre+uently found the medications of other patients in the

toilet %efore they deposited their own. s long as they were cooperati$etheir %eha$ior and the pseudopatients, own in this matter as in other

645ay where ha$e we heard that %efore" Jf course it may well %e 'interpreted' %y others

as literal and then mocked from a few feet away.*he 'sane' BJU? mocking as part of their

group catharsis.65it sure doesn't seem the same as 'dia%etes' to us...

66(ell it is not like anyone who actually -**?R5 is complaining though is it" &t is only

some 'whack =o%' like me.

67*hey might do it on the streets or %uses as well and so do other mem%ers of the

community at large who tend to take their cues from the 'experts' and who don't +uestiontheir leaders or this group %eha$iour.

68Ees as it suggests that what you get 'diagnosed' with and what 'medication' is for you has

more to do with (HJ you get than (H* you Lha$e.L


18/26

important matters went unnoticed throughout. F9

Reactions to such depersonaliation among pseudopatients were intense.lthough they had come to the hospital as participant o%ser$ers and were

fully aware that they did not %elong! they ne$ertheless found themsel$es

caught up in and fighting the process of depersonaliation. 7G5omeexamples; a graduate student in psychology asked his wife to %ring his

text%ooks to the hospital so he could catch up on his homework! I thisdespite the ela%orate precautions taken to conceal his professional

association. *he same student who had trained for +uite some time to get

into the hospital and who had looked forward to the experienceremem%ered! some drag races that he had wanted to see on the weekend

and insisted that he %e discharged %y that time.71 nother pseudopatientattempted a romance with a nurse. 5u%se+uently he informed the staff that

he was applying for admission to graduate school in psychology and was

$ery likely to %e admitted since a graduate professor was one of his regularhospital $isitors. *he same person %egan to engage in psychotherapy with

other patients I all of this as a way of %ecoming a person in an impersonalen$ironment.72

#$% SOUR)%S O D%P%RSO&(LI=(#IO&

(hat are the origins of depersonaliation" & ha$e already mentioned two.

/irst are attitudes held %y all of us toward the mentally ill I including those

who treat them I attitudes characteried %y fear distrust73and horri%le

expectations on the one hand7and %ene$olent intentions on the other.7A

Jur am%i$alence leads in this instance as in others to a$oidance.7F

69 4ecause it the illusions around the power and control issues that really matter in the

situation =ust like in the dysfunctional family..

70&magine trying to fight that from the position of %eing psychiatried when those you must

fight ha$e *J*B control o$er you.

71*he fear of the psychological trap he was in was starting to %e felt e$en though in H&5

case he knew he could get out with help. &magine when it is R?B and there is no escape

possi%le.72(hen 'real' patients or prisoners or a%used children do this same thing it is called

L5tockholm 5yndrome.!

73 Iwouldn't %e letting her into my apartment if & were you. ad$ice from one of my

smiling neigh%ours to another.:

74 & wouldn't %e doing this if you weren't making me do itK

75 (e're only trying to help you. Eou would think she would %e grateful...

76*he e$er popular dysfunctional 'no response at all' response...=ust ignore her. -ay%e

she will gi$e up...Lcome J6 lady...gi$e it up...L


19/26

5econd and not entirely separate the hierarchical structure of the

psychiatric hospital facilitates depersonaliation. *hose who are at the top

ha$e least to do with patients77and their %eha$ior inspires the rest of the

staff.7$erage daily contact with psychiatrists psychologists residents and

physicians com%ined ranged form 0.9 to 2A.1 minutes with an o$erall mean

of F. six pseudopatients o$er a total of 129 days of hospitaliation:.79

&ncluded in this a$erage are time spent in the admissions inter$iew ward

meetings in the presence of a senior staff mem%er group and indi$idual

psychotherapy contacts case presentation conferences and discharge

meetings. #learly patients do not spend much time in interpersonal contact

with doctoral staff. nd doctoral staff ser$e as models for nurses and

attendants.G

*here are pro%a%ly other sources. 8sychiatric installations are presently in

serious financial straits. 5taff shortages are per$asi$e and that shortenspatient contact.1Eet while financial stresses are realities too much can %e

made of them. & ha$e the impression that the psychological forces that

result in depersonaliation are much stronger than the fiscal ones and that

the addition of more staff would not correspondingly impro$e patient care in

this regard. *he incidence of staff meetings and the enormous amount of

record)keeping on patients for example ha$e not %een as su%stantially

reduced as has patient contact.28riorities exist e$en during hard times.

8atient contact is not a significant priority in the traditional psychiatric

hospital and fiscal pressures do not account for this. $oidance and

depersonaliation may.

Hea$y reliance upon psychotropic medication tacitly contri%utes to

depersonaliation %y con$incing staff that treatment is indeed %eing

conducted and that further patient contact may not %e necessary.0 ?$en

here howe$er caution needs to %e exercised in understanding the role of

psychotropic drugs. &f patients were powerful rather than powerless if they

were $iewed as interesting indi$iduals rather than diagnostic entities if they

77Eoo hoo...is my doctor e$er going to talk directly to me""

78&t's called follow the authority for appro$al..79'I&U#%SK80nd nurses and attendants look for signs and sym%ols of madness e$erywhere as they

are instructed to do.

81*hey're late. *hey're late. /or a $ery important date. 6o time to say hello good%ye

they're late they're late they're late...

82J%=ectification allows for a %etter detachment from 'them.'

83?specially if 'treatment' reduces the awareness of the identified patient and keeps her

'managea%le.'


20/26

were socially significant rather than social lepersif their anguish truly and

wholly compelled our sympathies and concerns would we not seek contact

with them despite the a$aila%ility of medications" 8erhaps for the pleasure

of it all"

(hat are the origins of depersonaliation" & ha$e already mentioned two.

/irst are attitudes held %y all of us toward the mentally ill I including those

who treat them I attitudes characteried %y fear distrustAand horri%le

expectations on the one handF and %ene$olent intentions on the other7.

Jur am%i$alence leads in this instance as in others to a$oidance .

5econd and not entirely separate the hierarchical structure of the

psychiatric hospital facilitates depersonaliation. *hose who are at the top

ha$e least to do with patients

9

and their %eha$ior inspires the rest of thestaff.9G$erage daily contact with psychiatrists psychologists residents and

physicians com%ined ranged from 0.9 to 2A.1 minutes with an o$erall mean

of F.91six pseudopatients o$er a total of 129 days of hospitaliation:.

&ncluded in this a$erage are time spent in the admissions inter$iew ward

meetings in the presence of a senior staff mem%er group and indi$idual

psychotherapy contacts case presentation conferences and discharge

meetings. #learly patients do not spend much time in interpersonal contact

with doctoral staff. nd doctoral staff ser$e as models for nurses and

attendants.92

*here are pro%a%ly other sources. 8sychiatric installations are presently inserious financial straits. 5taff shortages are per$asi$e and that shortens

patient contact. 90Eet while financial stresses are realities too much can %e

84&f they were people@ not disease processes...

85& wouldn't %e letting her into my apartment if & were you. ad$ice from one of my

smiling neigh%ours to another.:

86Eou ne$er know what one of 'them' is going to do. L*hey can turn on you in an instant for

no reason.L

87(e're only trying to help you. you would think she would %e grateful...:

.

88 *he e$er popular dysfunctional 'no response at all' response...=ust ignore her. -ay%e

she will gi$e up...Lcome J6 lady...gi$e it up...L &t is easier to achie$e 'detachment' if yousee no person there.

89Eoo hoo...is my doctor e$er going to talk directly to me""

90&t's called follow the authority for appro$al

91-&6M*?5K

92nd nurses and attendants look for signs and sym%ols of madness e$erywhere as they

are instructed to do.

93*hey're late. *hey're late. /or a $ery important date. 6o time to say hello good%ye

they're late they're late they're late...


21/26

made of them. & ha$e the impression that the psychological forces that

result in depersonaliation are much stronger than the fiscal ones and that

the addition of more staff would not correspondingly impro$e patient care in

this regard. *he incidence of staff meetings and the enormous amount of

record)keeping on patients for example ha$e not %een as su%stantially

reduced as has patient contact. 98riorities exist e$en during hard times.

8atient contact is not a significant priority in the traditional psychiatric

hospital and fiscal pressures do not account for this. $oidance and

depersonaliation may.

Hea$y reliance upon psychotropic medication tacitly contri%utes to

depersonaliation %y con$incing staff that treatment is indeed %eing

conducted and that further patient contact may not %e necessary. 9A?$en

here howe$er caution needs to %e exercised in understanding the role of

psychotropic drugs. &f patients were powerful rather than powerless if they

were $iewed as interesting indi$iduals rather than diagnostic entities if theywere socially significant rather than social lepers9Fif their anguish truly and

wholly compelled our sympathies and concerns would we not seek contact

with them despite the a$aila%ility of medications" 8erhaps for the pleasure

of it all"

#$% )O&S%>U%&)%S O L(B%LI&8 (&D

D%P%RSO&(LI=(#IO&

(hene$er the ratio of what is known to what needs to %e known approaches

ero we tend to in$ent knowledge! and assume that we understand more

than we actually do.97(e seem una%le to acknowledge that we simply don,t

know.9*he needs for diagnosis and remediation of %eha$ioral and emotional

pro%lems are enormous.994ut rather than acknowledge that we are =ust

em%arking on understanding we continue to la%el patients schiophrenic!

manic)depressi$e! and insane! as if in those words we captured the

94J%=ectification allows for a %etter detachment from 'them.'95?specially if 'treatment' reduces the awareness of the identified patient and keeps her

'managea%le.'

96&f they were people not disease processes...

97 *he danger in that is in the defensi$e attitude of the 'knowledgea%le one' especially if he

or she has too much concrete power.

98 *hat has %een my own experience with psychiatry as well.

99 *here is also an assumption that the 'patient's pro%lems exist as defined %y others and

are self contained.


22/26

essence of understanding.1GG*he facts of the matter are that we ha$e known

for a long time that diagnoses are often not useful or relia%le %ut we ha$e

ne$ertheless continued to use them.1G1(e now know that we cannot

distinguish sanity from insanity. &t is depressing to consider how that

information will %e used.

1G2

6ot merely depressing %ut frightening.1G0How many people one wondersare sane !t not recogni+ed as s!ch in our psychiatric institutions" 1GHow

many ha$e %een needlessly stripped of their pri$ileges of citienship from

the right to $ote and dri$e to that of handling their own accounts" Howmany ha$e feigned insanity in order to a$oid the criminal conse+uences of

their %eha$ior and con$ersely how many would rather stand trial than li$eintermina%ly in a psychiatric hospital I %ut are wrongly thought to %e

mentally ill" 1GAHow many ha$e %een stigmatied %y well)intentioned %ut

ne$ertheless erroneous diagnoses"1GFJn the last point recall again that a*ype 2 error! in psychiatric diagnosis does not ha$e the same

conse+uences it does in medical diagnosis. diagnosis of cancer that has%een found to %e in error is cause for cele%ration. 4ut psychiatric diagnoses

are rarely found to %e in error. 1G7*he la%el sticks a mark of inade+uacyfore$er.1G

/inally how many patients might %e sane! outside the psychiatric hospital

%ut seem insane in it I not %ecause crainess resides in them as it were

%ut %ecause they are responding to a %iarre setting1G9one that may %e

uni+ue to institutions which har%or nether people" >offman calls the processof socialiation to such institutions mortification! I an apt metaphor that

includes the processes of depersonaliation that ha$e %een descri%ed here.

nd while it is impossi%le to know whether the pseudopatients, responses to

these processes are characteristic of all inmates I they were after all not

real patients I it is difficult to %elie$e that these processes of socialiation to

100(hat they really do is reduce another person to managea%le sie and =ustify doing it.

101*he 'de$il' they know...

102&t seems to %e mostly ignored and denied

103*ell us a%out it. &t is like talking to the wall.

104& would say a lot more than most people think. -any could %e dri$en into psychosisunder pressure like a fulfilled prophecy.

105Right again on othcounts & would say

106 -y hand is raised on that one. Eou can't tell an employer that someone is cray and

without prospect of reco$ery and expect it is not going to ha$e a negati$e impact.

107 (ell no one wants to get %lamed for anything. 5o it is 'unrealistic' of me to expect an

admission or an apology is it not" *hat is what they tell me.

108 Hey..there she is...that whack =o%.!

109 *hat is putting it mildly. Don't worry she can't see us.!..ha ha ha


23/26

a psychiatric hospital pro$ide useful attitudes or ha%its of response for li$ing

in the real world.!11G

SU''(R* (&D )O&)LUSIO&S

&t is clear that we cannot distinguish the sane from the insane in psychiatric

hospitals.111*he hospital itself imposes a special en$ironment in which the

meaning of %eha$ior can easily %e misunderstood.112*he conse+uences to

patients hospitalied in such an en$ironment I the powerlessness

depersonaliation segregation mortification and self)la%eling I seem

undou%tedly counter)therapeutic.110

& do not e$en now understand this pro%lem well enough to percei$e

solutions.114ut two matters seem to ha$e some promise. *he first concerns

the proliferation of community mental health facilities of crisis inter$ention

centers11Aof the human potential mo$ement11Fand of %eha$ior therapies

that for all of their own pro%lems tend to a$oid psychiatric la%els to focus

on specific pro%lems and %eha$iors and to retain the indi$idual in a

relati$ely non)pe=orati$e en$ironment. #learly to the extent that we refrain

from sending the distressed to insane places our impressions of them are

less likely to %e distorted.117*he risk of distorted perceptions it seems to

me is always present since we are much more sensiti$e to an indi$idual,s

%eha$iors and $er%aliations than we are to the su%tle contextual stimuli11

that often promote them. t issue here is a matter of magnitude. nd as &

1108sychiatrists don't li$e in the real world. *hey li$e in their own psychiatric fantasy. -ost

of 'us' learn how to nod and agree with authority though. &f only out of self preser$ation.

111*ry to keep thinking; this is a psychiatrist saying this.

112Ees. 4ecause it is gi$en a context %y those who see themsel$es as 'o%=ecti$e o%ser$ers'

who %elie$e they already .

113nd those of us who DJ6'* accept the 'diagnosis' and la%elling get defined as 'non

compliant' as & was.

114& %elie$e a solution is to stay self focused and percei$e e$eryone on earth as ha$ing aninherently e+ual $alue as a human %eing. 6o one as eitherinferior or superior.

115*hese also define the 'patient' %efore we walk in the door. ?specially in 2G1G when %io

psych is trying to rule the world.

1168otential to DJ and %elie$e (H*" /or some it means to control others not one's self.

117-ay%e we could stop calling the world them and us!...-ay%e we could say &! a lot

more.

118& too see a %ig #J6*?N* pro%lem and little or no communication a%out much of

anything.


24/26

ha$e shown the magnitude of distortion is exceedingly high in the extreme

context that is a psychiatric hospital.119:

*he second matter that might pro$e promising speaks to the need to

increase the sensiti$ity of mental health workers and researchers to the

)atch 55 position of psychiatric patients.12G5imply reading materials in this

area will %e of help to some such workers and researchers. /or others

directly experiencing the impact of psychiatric hospitaliation will %e of

enormous use.121#learly further research into the social psychology122of

such total institutions will %oth facilitate treatment and deepen

understanding.

& and the other pseudopatients in the psychiatric setting had distinctlynegati$e reactions. (e do not pretend to descri%e the su%=ecti$e experiences

of true patients.120*heirs may %e different from ours particularly with the

passage of time and the necessary process of adaptation to one,s

en$ironment.124ut we can and do speak to the relati$ely more o%=ecti$e

indices of treatment within the hospital. &t could %e a mistake and a $ery

unfortunate one to consider that what happened to us deri$ed from malice

or stupidity on the part of the staff. Puite the contrary our o$erwhelming

impression of them was of people who really cared who were committed

and who were uncommonly intelligent.12A(here they failed as they

sometimes did painfully it would %e more accurate to attri%ute those failures

to the en$ironment in which they too found themsel$es than to personal

callousness. *heir perceptions and %eha$iors were controlled %y the

situation12Frather than %eing moti$ated %y a malicious disposition. &n a

more %enign en$ironment one that was less attached to glo%al diagnosis

119Ees the reality of the 5*// is e$ery %it as distorted as the 'patient.'

120Eou could %eat them o$er the head with it and most of them still won't get it.

121Ees nothing like 'experienced experience' is there"

1225J#&B psychology for BB mem%ers of the group. & am with you there. &t is a%outgroupthink and %eha$iour more than anything else.

123Eou are pretty close %ut add to that an original condition of extreme real distress for

wahte$er reason: and what you get is an ?N#?R4*?D condition and not 'help.'

124


25/26

their %eha$iors and =udgments might ha$e %een more %enign and effecti$e.127

& thank (. -ischel ?. Jrne and -.5. Rosenhan for comments on an earlierdraft of this manuscript.

5JMR#?; Da$id B. Rosenhan Jn 4eing 5ane in &nsane 8laces! 5cience

Uol. 179 an. 1970: 2AG)2A.

#opyright 1970 %y the merican ssociation for the d$ancement of

5cience.

Q1 R. 4enedict .>en. 8sychol. 1G 190: A9.

Q2 4eyond the personal difficulties that the pseudo patient is likely to

experience in the hospital there are legal and social ones that com%ined

re+uire considera%le attention %efore entry. /or example once admitted to apsychiatric institution it is difficult if not impossi%le to %e discharged on

short notice state law to the contrary notwithstanding. & was not sensiti$e

to these difficulties at the outset of the pro=ect nor to the personal and

situational emergencies that can arise %ut later a writ of ha%eas corpus was

prepared for each of the entering pseudo patients and an attorney was kept

on call! during e$ery hospitaliation. 12& am grateful to ohn


26/26

QA 5.?. sch . %norm. 5oc. 8sychol. 1 19F: 5ocial 8sychology

?nglewood #liffs 6/; 8renticeSHall 19A2:.

QF ?. Oigler and B. 8hillips . %norm. 5oc. 8sychol. F0 19F1: F9. 5ee also

R. offman sylums >arden #ity 6E@ Dou%leday 19F1:

Date post:	02-Jun-2018
Category:	Documents
Upload:	mariana-primova-stankova
View:	222 times
Download:	0 times

On Being Sane in Insane Places

Documents