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Article Review "on Being Sane in Insane Places" by David Rosenhan

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In his essay, On Being Sane in Insane Places, D. L

Rosenhan discusses a series of experiments that he participated in involving psychiatric institutions and the effect of misdiagnoses of psychological disorders on the patients admitted to the hospitals. Rosenhan’s research shows us that the labels associated with mental illness (particularly schizophrenia) have a significant impact on the way patients are treated.

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To raise questions regarding normality and abnormality is in no way to question the fact that some behaviors are deviant or odd. Murder is deviant. So, too, are hallucinations. Nor does raising such questions deny the existence of the personal anguish that is often associated with "mental illness." Anxiety and depression exist. Psychological suffering exists. But normality and abnormality, sanity and insanity, and the diagnoses that flow from them may be less substantive than many believe them to be

At its heart, the question of whether the sane can be distinguished from the insane (and whether degrees of insanity can be distinguished from each other) is a simple matter: do the salient characteristics that lead to diagnoses reside in the patients themselves or in the environments and contexts in which observers find them? From Bleuler, through Kretchmer, through the formulators of the recently revised Diagnostic and Statistical Manual of the American Psychiatric Association, the belief has been strong that patients present symptoms, that those symptoms can be categorized, and, implicitly, that the sane are distinguishable from the insane. More recently, however, this belief has been questioned. Based in part on theoretical and anthropological considerations, but also on philosophical, legal, and therapeutic ones, the view has grown that psychological categorization of mental illness is useless at best and downright harmful, misleading, and pejorative at worst.

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David Rosenhan sought to challenge common psychiatric diagnoses, using a controlled experiment to test whether the sane can be distinguished from the insane—wanting to shed light on a problem of type 2 error and misdiagnosis that often has serious social and psychological consequences (1973). The experiment placed eight “pseudopatients,” or normal, clinically sane individuals, in various mental hospitals throughout the country under the pretense that they had heard voices (and once admitted, ceased displaying any symptoms). The reactions and diagnoses of these pseudopatients were used to verify misdiagnoses, and Rosenhan ultimately concluded that psychiatric professionals have a bias for diagnosing the sane as “insane,” and use this determination to interpret behavior as a product of that diagnostic label. This paper will review this theory and experiment using the evaluation criteria set out by Akers and Sellers (2012), in order to determine its validity in a methodological, scientific fashion (p. 1-15)

While Rosenhan points out from the very beginning that the concepts “sane” and “insane” are problematic—due to cultural differences and interpretations—he nonetheless adheres to a simplified understanding of deviant and non-deviant behavior. In this way, the terms “sane” and “insane” do not necessarily have to be defined—as they can be measured in perceived sanity or insanity, through diagnosis. In this way, the experiment is turned to perceived illness as compared to whether the behaviors associated to that illness are acted out. He claims that normality (and therefore abnormality) “is distinct enough that it can be recognized wherever it occurs” (p. 236).

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In either case, some pseudopatients were nervous about lying to the admitting doctor, but apart from any signs of that the alleged hallucinations were the sole reason for admitting them. Each pseudopatient gave a false name and job, but they otherwise gave true details about their lives—its ups and downs, their relationships, and their life histories.

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Akers, R. L., & Sellers, C. S. (2012) Criminological theories: introduction, evaluation, and application (Sixth ed.). USA: Oxford University Press.

Rosenhan, D. L. (1973). On Being Sane in Insane Places. Science, 179, 235-242.

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