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.
In the experiment, Rosenhan and several other “pseudo patients” intentionally tried to get themselves admitted to mental hospitals in several states, feigning schizophrenia. They were easily admitted, and once inside they stopped exhibiting any abnormal behaviors. Rosenhan’s idea was that normality would be so distinct and easy to detect that surely the subjects would be released nearly immediately. To his surprise, behaviors that are traditionally considered normal were interpreted by hospital staff as being part of the pseudo patients’ pseudo condition. For instance, each participant was asked to keep a notebook or journal to record their experiences. In the real world, one may be inclined to ask one of the subjects what they were writing about if they witnessed the subject constantly scribbling away in a notebook. But in the hospitals, no nurse or staff member ever commented on the pseudo patients’ note-taking, assuming that it was a nervous habit associated with schizophrenia. In fact, several real patients in the hospital grew suspicious of the imposters, and tried to bring it to the attention of the nurses. But these claims were always overlooked, since they were coming from someone labeled as “insane”.
Rosenhan theorizes that there are several causes for these kinds of reactions. One, he says, is the tendency of the psychiatric community to “err on the side of caution”, making more false-positives of mental disorders out of fear of making a false-negative. This has some serious implications and makes us wonder how many people admitted to these institutions are actually sane and have simply been misdiagnosed. Rosenhan also suggests that the label associated with being schizophrenic causes the hospital staff to make misguided assumptions about the patients’ behavior through no fault of their own. When someone is seen as mentally ill, everything they do may be interpreted as symptomatic of their disorder. Another example of this was found when a doctor observed several pseudo patients waiting outside the door of the cafeteria a half hour before lunch, and proceeded to tell someone else that this was part of the “oral-acquisitive nature” of the syndrome. In another experiment, when hospital staff was told that pseudo patients would be attempting to get themselves admitted in the next month, the staff identified many people who they suspected may have been posing as mentally ill. Secretly, no pseudo patients had even walked through the clinic doors!
Everyone experiences some minor bouts of sleeplessness, depression, anxiety, or elation, but none of those are criteria to call us insane. He talks about the way that the label sticks with a person even after they are released, and that if the patient in his mind truly believes that there is something wrong with him it is likely that upon release he will revert back to his old behaviors. These experiments illustrate how tricky diagnosing a mental illness can be, if one even exists in the individual.