PSYCHOPATHOLOGY can be s€en to normal from abnormal is not at all clear' Raiher all beharior t b e atted 4l'ttiLt" P \' hotagnl ,..,r"'"rn*,nnormdl or $ hdr might ii. ar rhe otier: illnes' ".1 menl2l l!, /ro,r,g. dr one end. drd dbrormdl indi'arrng (M€ntal illness) (Effective functioning) It is Lo ro mcnral healh protesrionals ro rr"' h'rue rhe :mp asron rhat ]t ,fo.. p.opl" \vho have nereFrudied Psr holoqlr and rrenrrng menuL rrrwirlt dnrl\/ing pnmJri\ ,oncernFd lVhne n.ta i. Lud\ aenral illne;s callcd ooc' rhi re*e' rrh. b-an.h or p.}r holog' nea'h dll oilhe rF nori'ed hJ\e ma) dbno,.tl t\,\ota|. ) H"w.'e' .s1o' oterdll' on ha locuied ,.,'.1 ai***aio r^ in rhi: bool 'o'aalbehavro beabnornal r\'rn rn Dchr\ior normal .".fr.r.n"".re ro'e inrere'red in ( onrequ"nd)' r( normaL behd\ror m4orlq ol humdn 'r,".^, rnuch about human naNre if rve only studied Lhe ",tr"' 'r"i,r* f.".* *."1a t". "., or'".y ir Lhar is dbnorlrJl Ne\e'Ihel"\' nenul illne$ i' Io .mzll per.FnLage tl'emosr ldrciririns leas ol 'rud\ inallolPr\Lhorogl { -,"'i-"r..i..r *r ien of nudie. sirh c, u, rdl hisrorr.al rnpo'tjn'e are rn' luded here lor Firi, is d.,ud! rhar h^ kePr Ihe mentdl hcal h profe(ion ulkrng Fnrered d5-nenrdl .'" iO'*^ ln rhi''tudv'ealrh' people Po'irg(tdf (ould P'rint' rhem di'Lingurh n{!hi"Lflc hosoilal' ro 'cF rl hF do'rors dnd j'onrrt abou' the hi'ton no bool o'".nj'."'e,.,u"llym"nullvill setond. ro \ig-Lnd qould (orplere \rrhour rereren'e bF Ierarch "r,J.ra ".'.r'.f*i,,r n 'ha';\^' Pga dPh"v ot he rn"ierore, a dr"cu'(ion ol hj'rheory ir rein'luded be(ause i' rhrousl, Lh. riine. of hi. daughrFr' A'c 1, freud \virh F)'pFr rmenr i5 ud\ ,r'..''" .,,r.-' i.i.i p"' no,n,t"i'. rhe' hir d'r "n rondr Tht' htlh*t^' i.,. ,i.,' a.-.^",'.i ., phenomenon:r' alled bavcd . o'r.hooarhoron in rhat leil ro a \vidFl\ held rheoN erPlarn""i*r"*r .ns J"p'"*ron ;n r.,ma.' tu d fin.rllv dn inrigLring rnd $ell-tnown i. p'eGn ed rnvol!:ng overcrotded rats and rherr re'Llrrng dn "'"-i-.'' \i2nr behavior. \hn h mr) hd\F ;mporranr imPli" on' or hum'ns I I I 'r"--ps)(bologrsts " "IrA, (al t 179' . . . a.,..-;"i.g "'}ri,r.* -ri"one i"'glry a.r"i'"i"* ,L. ,r'eatmenr reciived bv a patient 226 jr,dgm.nr about abnormal:r) which a behavior orbeha!'ior Pattern occurs' may P^i'bnce of Behadar $re all have our "crazv" moments' A Person demonstratnecessadly without exhibit abnorrnat behavior on occasion rei.n,ft. **.*..f.""tal 'llne5s For ins!!n(e )ou mighr ha\e iu'3r dosn'own bus\ alons wdlking ne$\ and as )ou are ;;,".; ' $hi]e some ';trr. "*,' tor hau a blo'k or rc' thrs behdvior' .ia"..[. -.ia"n- nor indicare menl:l illnesc unle's you began Io uUno'*rr, "o,fa "r'ur Thi' Lrircrion dan.e down tha$rdFwall on 'ay i heekl) or daily basis behavial ordi'ruPuve lormental :llne(s iequrre' rhaL ;' bi/a're anti'o' ior patlern Persisl over time' when a person's behavior ladically violares expectations Wh€n deviant .tJ".t.t, i, -"y -*t the criteria for social deviancevisuai hallucinaor auditory as such persistent, i"f,uuio, f .r.t e-. a"a rions, lt is evidence ofm€ni21illness 5lkpttL.D"h.- FrequFnrh as jnrelligenr being' we arc a$are ofour Social Detiance ""i wh.;"".la.n',"r , p.r.."" i' The line that divides diin.ulrie' and lhe tuffering rhev are 'dusing us to atraid ol cnclored sPace! rhaL he or she (annor someone finds it imPossible to form meanorhers rhev ofLen do not need a Prolessional ai eleutor, orwhen i".r"i-'.r",.'.r'ip' '',r' ir'.. ,r."y "" i' p()rhologi'r'1 pain lhi( subiFCuve disuess is an 'li.ii menral heallh Prole.,iondls use in md(ing P'v'hologrLar imporranr I is diag"osed as mentallv iU' and the diagnosis P{Lhidui'Ls. aonL,^t at ,h. Behoua, 250-258' i( lLe aJF'ron ol ho\ ro disr'nguish ben'een rrormal and dbnorm'l beha'ior role a ke\ r."al-." ,r in p1, ho)o$ The delinirion ol abnor maliq Pla\' 'n behavior liec To make this dererminalron cliniand orher psv(horheraPisb mav use one or Thi' r' d "ubje'rite iudgmenr' bur )ou know thar e)'JnPle' ,ome s.ha'lon are clear\ biTdrre in r giren "jtuarion For vou' lawn unii.," i' "-r.i"g ''*"g. abour sundrng outside wareringIainrto''rn: 50 a les' 1ou aredohg ir rn 'our pajama' during a Pou)ing rn rhe conrexL mu"r (arefulh consider . wrlo's cRAzY Rosenhan, D ' more of rhe folto$'ing criteria ride in HERE, ANYWAY? (17f,). On being sane in in$ne pta(es srience person deler mine where on lhis ( on- . diagnoses. 'ign P'\.holo.J.t:al Honditop uten a person has grear dim'ulry being rali'fied ro psyihotogicat proslems chi: is (onsidered ro be a Prvand .r'.i.n.,r n-allp. A ;**; *h' fears success' for examPle' psv' a from is suffering in life' endeavor ;'"."ri.. ,ubotug"' .uch new J,r, iiri a". chologicai handicaP . The extent to which the behaviors in question interfere with a person's abiliry to live the life thai he or she desires, and that society will accept, may be rhe mos! important facror in diagnosing psvchologlcal problems. A behavior could be bizare and persistent, but if it does not impair your ability to fun.tion in life, pathology may not be indicared. For example, suppose you hale an uncontrollable need to stand on )our bed and sing The National Anthem every night before going to sleep. This is certainly bizarre and persisient, but unless you up th€ neighbors, disturbing other household members, or are 'raking feeling terrible about it, your behavjor mal have litde effect on your general functioning and, therefore, mal not be a clinical problem. EJIect on Fun.tioning. These stmptoms and characteristics of mentai illness all involve judgnents on the patt of psychologirts, psychiatrists, and other mental health professionals. Therefore, the foregoing guidelines noN-ithstanding, two ques- rions remain: Are menral health professionals rruly able to distinguish betw€en rhe mentally ill and the m€ntally healthy? And what are the consequences of mistakes? Th€se are the questions addressed by David Rosenhan in his provocative study ofmental hospitals. THEORETICAT PROPOSITIONS Rosenhan questioned shether the characteristics tha. lead to ps,v€hological diagnoses reside in th€ patients themsehes or in lhe situatjons and contextr in n'hich the observ€rs (those irho do the diagnosing) find the palients. H€ reasoned that if the established criieria and the training mental health professionals have receiled for diagnosing mental illness are adequare. then those professionals should be able to distinguish bet\deen the jnsane and the sane. (Technically, the words sane and insane arc t€gal terms and are not usuall) used in psychological contexb. Th€y are used here because Rosenhan jncorporated them into his research.) Rosenhan proposed tha! one way to test mental health professionals' ability to correct\, categorize would be to have be normal people s€ek admittance to psychiatric facilities to see if they '\'ould discover€d to be, in realitf, psychologically healthl If these "pseudopatients" behaved in rhe hospiial as rhey$ould on the ouiride, and iftheywe.e not dis' co\,ered !o be normal, fiis lt'ould be evidence that diagnoses of t}le mental\ rll dr" rrFd "nore ro r\. (iru/ron rhan ro rhe pdtient. plained ofhearing voices that said "emPq'," "hollo1i" and "$ud " Other than rhis single sf$ptom, all subjects acled comPletely normallv and gave totally truthfui information lo lhe inFrvjewer (except that r,hey changed their names and occupations). All the subjects were admitted to the larious hosPitals, and all bu! one $as admitied wirh a diagnosisof schizalhrcnia Once inside the hospital, the Pseudopatients disPla)€d no slmp.oms whatsoever and behat€d normallv The particiPants had no idea l'hen lhey would be allowed to leave lhe hospilal. It was up to them to gain their rel€ase bl convincing the hospjtal staff that they wer€ healthy enough to be discharsed. All the subiects took notes of their exPeriences At firsl, they tried to conceal this activiry but soon it w:s clear to all that this secrecy las unn€cen sary, because nolaraAtng ,ena"o/ was seen asjust another symPtom ofth€ir illness. They alt desired to be released as soon as possible, so they behaved as model patients, cooperating with the staff and accePting all medications (which were no. s$'! lowed, burflushed down the toilet) RESULTS The length of hospital stal for the Pseudopatients ranged from 7 days to 52 days, with an average stay of 19 da)6. The key Iinding in this study was that not one of the pseudopatients $'as detected by anyone on rhe hospital stalf \vhen ihey $€re released, their mental health status rvas recorded in their ljjes as schizofhrenia in rcmissian. 'fherc were other inreresring findings and $hiie the hospital's statrofdoctors, nulses, and attendants failed to de' tect the subjects, the other Patienrs could not be so easil)' fooled ln three of the pseudopatients' hospitalizations, 35 out of 118 real paiients voiced suspicions that the subjects were not actually mentally ill. They would make com' m€nts such as, 'You're not crazyl You're a journalist or a rcpofter, You're che€king up on the hospital!" Contacts between the patienG h{hether subjects or not) and the sta.ff $'ere minimat and often bizarre one ofthe tests made by the Pseudopatients in the study was to approach Brious staffmembers and auemPt to mak€ verba1 contact by asking common, normal questions (e g., When will I be al- loNed gmunds prililegesl or Wlen am I likely ro be dischargedl) Table r summarizes the responses they received. METHOD Rosenhan recruited eight subjectr (including himsell to seFe ar pseudopatients. The eight participants (three $'omen and five men) consisted ofone graduate student. three psychologists, one pediatician, one ps,vchialrist, one painter, and one homemaker. The subjects' mission was to present th€mselves for admission to 12 psychological hospitals, in five srates on both the ea-st and west.oasts ofthe United States. A1l the pseudopati€nts followed the same instructions. They called the hospital and made an appointment. Upon arir?l at dre hospital t}tey com- TABLE 1 Responses by Doctors and Stafi RESPONSE Lloves on, head averled lo Questions Posed by Ps€udopatients PSYCHLATRISTS f,4) NURSES AND ATTENDANTS (%) 71 88 23 10 ? 2 0.5 (Frcm p 255.) tihen the pseudopatient received a response, it frequendy .ook the fol- lowhg form: Could you tell me when I am PSEUDOPATIENT: "Pardon me, Dr elisible for srounds privileges?" PSYCHIATzuST: "Good morning, -Dale How are ),ou todayi" .her mo\ed on urrhou \Jir:ng for. respon.". In contrasr lo the se!€re tack of personal contact in the hospibls studied, rhere $a! no shortage of medication. The eight pseudoPatients in fiis studt lvere given a total of2,100 Pills fiat, as mentioned, were no! ${allo\a€d. The subjects noted that mant of the real patjents also secretly disPosed of their pills doun the toilet. Another anecdote from one of rhe pseudopatients tells of a nurse who unbuttoned her unlform rc adjust her bra in front of a dalroom full of male patients. Ii was not her intention to be Provocative, according to the subject's T\, The pseudopalient had a clos€ rclationship with his mother, but Ms rather remote with his fa$er during hh early childhood. Dudng adolescence ed beyond, honever, his father became a very close friend while his relaiionship with his morher cooted. His present relationship with his wife @s chamcteristlcalll close and wam. -A.part fron occsional angry exchanges, ftcdon was ninimal. Th€ childrcn had raiely been spanked. (p.253) The director's interpretation of this rather normal and innocuous his- do, ror report, but she simpl), did nor consider the patients to be real people. DtscusstoN Rosenhan's siudy demonstrated that normal people often cannot be distinguished from the mentalry i1l in a hospital setting According to Rosenhan, this is because of lhe oveffhelming influence of the Psychiatric-hospital setting on the staffs judgmenl of the individual\ beharior. Once patients are admitted to such a faciliq,, there is a stmng tendenq for them to be !ie\'€d in Nars fiat ignore their individuali+ The auiiude created isr "lf they are here, ther must be crazy." More important, is Nhat Rosenhan refers to as the stichiness of the diagnostic lard That is, when a Patient is labeled as r.iilo1ircntc, it becomes his or her central characteristi. or Personality tmil' From the moment the label ls given and the siaffknows it, they perceive all ofthe patient's behalior as stemming from the diagnosis, thus, the lack ofconcern o. suspicion oler the pseudopatients' note taking, i{hich was perceived as.just an' other behavioral manifestation of the ps,vchological label. The hospital stafftended to ignore the siiuational pressures on Patients and saw only rhe behalior releBnt to the pathology assigned to the Patients. This was demonstraled bv the follo$ing observarion ofone of the subje€ts: Onp p., h:dtri.' potn ed .o, g,odp ol pdtie.r' 'ro trPre n _8 oubrdP 'hF , aferr k .' ,r"n . h..f,n \our berorF lun,l-r,ne. To a group of ro ,.8 rc.idPn' \' oralD.v.h-arid, he inor.".ed ,hr_ .u.h br\dq. ra" hda(rrr" ( l,qu"'u'- n""'. or ,he cndrome rve;e simp\ verl few things to do i! "l lr .eea.d no' 'o o\Lu' 'o hrn 'hrr $ere hospital besides eating (P 253) a psychiaL.ic Beyond this, the sticky diagnosiic label even colored horv a pseudopadent's ,irlorywould be inrerpreted Remembet atl the subjects gave honest accounts of theh pasts and families. Here is an example from Rosenhant research of a pseudoparientt stared hisiorli followed by its interpretation by rhe staff doctor in a report after the subject was discharged The subject's rrue histon $'as as follows: This $hn€ sg-year-old maie manifests a long history of consid€rabl€ ambi"lence in close relationships which begins in early childhood. A rdm relationship with his mother cools during his adoles.ence. A distanr relationship with his father is desc.ibed as becomingvery intense. Affective stabiliryis abs€nt. His auempis to control emorionaliry with his wife and children are punctuated by angry outbursts and, in the cde of the chjldren, spankings. And while he srys he ha several good friends, one senses considet?ble ambnalenc€ emb€dded those relationships also. (p. 253) in There l{as no indication thar any of the stafs distortions \4€re done inkntionally. They beheved in the diagnosis (in this case, schizophrenia) and interprercd a patient's history and behavior in wa)'s that $€re consist€nhsith that diagnosis. SICNIFICANCE OF FINDINCS $e mental health profession. The resulr, poinkd out tlvo crucit facton. First, it appeared that the san? could not be distinguish€d from t|]|,e insane in mental hospitat settings. As Rosenhan himself stat€d in his article, "The hospital itrelf imposes a spe€ial environment in which the meaning of behavior can be easill misunderstood. The consequences to patients hospitalized in such an environmen! . . . seem undoubredly counterthempeutic' (p. 257). Second, Rosenhan demonstrated the danger of diagnostic labels. Once a person is labeled as having a c€rtain psychological candition Guch as schizophrenia, manic'depressive illness, etc.), thar label eclipse, any and all of his or her other chamcterisrics. All behavior and personaliry characteris[cs are seen as stemming from th€ labeled disorder The wont part of rhis sort of treai,rent is that lt can become selfconfirming. That is, if a person is treated in a c€rtain way consistendy over Rosenhan s stud) shook time, he or she ma)' begin to behave thar way. Out ofRosenhan's $'ork grew greater care in diagnostrc procedures and increased a$Breness of the dangers of app\'ing labels lo patients. Additionthe decrease ally. the problems addressed bv his study began to decline 'r,ith in patients confrned to mental hospitals. This decrease in hospital poputations rras brought about by the discovery and rridespread use ofantipsychoric medications, which have the power to r€duce stlnptoms ir most patients enough for th€m to live outside a hospital and in many cas€s lead relatively normal lives. Concurrenr io this was the growth ofcommunity mental health Excerpbd vith pemissioD riom Roscnhan, D.L. (19?3), "On BeinS Sane in lnsane Plac€,," S.n fl.a I ?91250-258, Cop}1 ight 1973 Amencan Associar.io! for the Advancem€n! of Science. r rLhouu0l0LDH) facilities, crisis intervention c€nters, and beha\ior therapies that focus on spe, cific problems and behaviors and tend to avoid labels atlogeth€r. This does not imply b) any means that the mental health profession ha.q eliminated labels. Howeler largely bccause ofRosenhan's research and other research in the sam€ vein, psirhialric labels are now used carefully and trerted rvith the respect their power demands. QUESTTONS AND CRtTtCtSMS One research and leaching hospjtal whose staff had heard abolrt Roscnhan s findiDgs before fiey were published doubied rhar such mistakes in diagnosis could be macle in their hospital. To rest &is, Rosenhan informed the hospital staff thar during rhe nent t\ree monlhs one or more pseudopatients lvould tr! !o be admitted !o their psychiatric unit. Each siaff member $as asked to rate each presenting patienr on a 1o'poji]. scale as to the likelihood that he or she ras a pseudopatient. At the end of thre€ months. 193 patients had been admitted. Of those, 41 lvere considered i{ith high confidence to be pseudopatientq b\, at least on€ staff member. Twenty,three llerc suspected bv at Ieast one pslchiatrist, and 19 $€re identified ar pseudopatients by one psychiatrisr and one other staff member. Rosenhan (the tricky deril) had not scnt anrr pseudopatienls to the hospital during the three-month periodl "The expcriment is instructii'€," sntes Rosenhan. "lt indicates thar th€ rendency ro desigrate sane people as insane can be relersed when the stakes (1n this case prestige and diagnostic ability) are high. Bui one thing is certain:AnI diagnostic process rhat lends itselfso readily to massiv€ €rroN of this sorr cannot be a \,err reliable one" (p. 252). Rosenhan replicated this study several times in 12 hospitals beF\€en 1973 and 1975. Each time he found similar resl ts (see creenberg, 1981, and Rosenhan, 1975). However oiher researchers dispute ihe conclusions Rosen, han drew from lhis research. Spitzer (1976) has argued rhar while the meihods Lrsed by Rosenhan appeared to invalidate psychological diagnostic slstems, in realitv they did not. For example, it should not be difficult for pseudopatients to lie iheir way into a mental hospital, since man), such admissjons are based on !€rbal reports (and who would ever suspect someone of ,ing t.ickery to get inlo such a placet). Th€ reasoning here is that lou could walk into a medical emergenc,v room complaining of sever€ intestinal pain and yoLr mjght ger )oLrrself admjtted to the hospital with a diagnosis of gasrri t's, appendicitls, or an ulcer Even though the doctor was tricked, the diag- nostic methods Nere not in\ulid. Additionallx Spitzer has pointed our.hat although rhe pseudopatienti behaved normally once admiued to the hospital, such slmptom ladation in ps,vchiatrjc djsorders is common and does not mean rbar the staffr\'as incompetent in failing to detect the ruse. The conrro\'€rs,v oler the validiq, of psvchological diagnosis rhar began with Rosenhan's 1973 article continues. Regardless of th€ elentuat outcome, there is little question that Rosenhan's studv reDains one ofthe most influen tial in the history ofpsy.holog.r'. RECENT APPTICATIONS tilo ofmany \alidit/ of diagin challenging the As an indication of this continuing controverst, we can consider studies rhat hai€ us€d Rosenhan's research noses made b]' mental heatth professionals. One ofthese is by Thomas Szalz, a pslchiatrist who has b€en a w€lLkno n critic of the concept of m€ntat illness since the early 1970s. His contention has been that mental illnesses are not diseares and cannot be properly understood as such, but rather must be seen at pnblens in Litine that have social and €nvironmental causes. In one a.have been ticle, he males the case lhat the dazt ,alfr exhibired by some 'r'ho diagnos€d $'ith a mental illness "is not a valid reason for concluding that a peffon is insane" simply because one person (the mental health professionat) cannot comprchend the ol\er (the patieno (Szas?, 1993, p. 61). Another study building on Rosenhant 1973 article examined how, in some real life situarions, people may purposely fabricate symptoms ofmentat illness (Broughron & Chesterrnan, 2001). The case study discussed in the alt; cle involved a man accused of sexually assautting a teenage boy. $hen the perpetrator {?s e!?luat€d for psychiatric problems, he displa,ved iarious psychotic behaviors. Upon further examination, ciinicians found thar he had laked alt of his symptoms. The authors point out that tradirionally, mental healrh professionais have assumed the accumcy ofpatient statements in diagnosing psychological disorden (as they did with Rosenhan's pseudopatients). HoNeler they suggest that inv€nting symptoms "is a tundamental issue for all ps,vchiatrists, especially lwhenl . . . complicated by external socio-legal issues which could possibly sen'e as motivation for the fabrication ofpsychopathology" (p. 407). ln other words, we hale to be careful that criminals are not able to fake menbl illness as a "g€t'out-of'jail free card." How do t}l€ peopl€ themselves feel who have been given a psychiatric diagnostic labetl In a survey of more than 1300 mental health consumerc, \,'ahl, (i99S) asked about their orperiences of being discdminated against and stigmatized. The majodty of respondents reported feeling the effects of rhe stigma surrounding mental illness from \arious sources, ircluding community membells in general, family, church members, coworkers, and even mentai healrh professionals. In addition, the author reported, "The majoriry of respondents tended !o try ro conceal iheir disorders and worried a great deal thar others would find out abour their psychiatric status and treat them unfavorablv. They reporred discouragement, hurt, anger, and lowered sell este€m as a result of fieir experiences and urged public education as a means for reducing stigma" (p. 467). Perhaps psychologisl-s are making some progess on the public educaiion front about mental illness. In a study by Boisvert and Fausr (1999), sub" jects were presented vith scenarios about an employee who behaved in a violent manner toward his boss. The scenarios varied in the amount of str€ss the employee was experiencing, and in some of the scenarios the employee was descnbed as having been pr€\'ious\' diagnosed with schizoPhr€nia. The researcheN predicted rhat subjects would be more likely to attribute the P$chopatholog violence ro the employee\ personalio rrhen the schizophrenia label was attached, but r,ould lean more roward blaming ih€ environmental strcss irhen rhere was no elidence ofmental illness. Guess $'hat. They foundjusr rhe opposile. As stress increased, the subjects blamed the personaliq, of the emplotee 1"$, regadless of the presence of the schizophrenia label. Furthermore, the researchers obtained fie same results rvhether the participants r\ere real'life, practicing mental health clinicians or college students. So, it is hoped rre can take some comfort in this evidence that tolerance and understanding of mental illness is increasing. The realir/ is that, so far, diagnosing mental illnesses continues to be as much art as it is science. Chances are e $'i11 never do away (dth labelsi thel appear to be a necessary part of effective treal'nenr of ps,vchological disorders, just as names of diseases are parr of diagnosing and treating physical illnesses. So, if we are stuck with lab€1s (no pun intended),1\'e must continue to work to take the stigma, emhrrr2ssmenr. and shame our of rhem. Boislcll, C., & Fau$, D (1999). Effe.6 olihe label'\chizophrenia" on causal auribudotu otvio |lnce. Srhizophtdia BLlletin, 2i, 419-491 Broughton, N. & Cheserman, P (2001). Malingered psy.hosis Jduthat oJ F en'i Ps).hiatr!, Creenbe.g,J (l98l,Jun€4ulr) An interyiewwirh Darid Rosenhan. l",1 Mo,i,,r 4-5. L. (r 975). Th. contexh,al natu.€ of pslchiatnc diag\osn. Jatmal a.f Abnonal Pq" thakg, 81,412-152 Spitzer R. L. (1976). Nlore on pseudoscience in sci€nce and the case of the psychiatic diagnosis: A.riiique olD. L. Rosenhanl O! beingsane in insane places'and The contexrual na' ru.. ofpsr.biatic diagnosis Arhirq aIGqqai Prchia,:l, ,,4,,9410. Szasz, T (1993). Cm"y talk: Thought dnorder or psy.hiatic att g4 .er Aiish JamaL al Melli.at Rosenhan, D. PlJ&olas, 66, 6I-61 . $Iahr O. (1999). Menial health consum€rt experience of srigna S.nizaphfttuia BrllNrin, 2J(3),46t-4t8 YOU'RE GETTING DEFENSIVE AGAIN! treud, A.(1946). Internadohi The ego and ke fiechonltns oI FrpenmeDll ro -eprescrr hrs worL. as has becn done lor orher re_ searchds in rhis book. Freud's rheories grew our of carefut obsen?rions of his patients oyer d€cades ofclinical analysis. Consequently, his writings were i:ast. The rnslish rranslation or his',co ectea #rngs, *"19*:,9:".1 :n. ol th. t Th€ onpbe Pr\.holoS,.at Walh: aJ S$nund Frtud ilon, 1953 ro 1974), rotais 24 volumesl usly, only a veq' small piece of h could be discussed here. In choosing includ€ here. considerari given to rh€ porhale stood the test of r€latively unscarhed. Over the past century a deal of cdticism focused on FreDd's ideas and, in the last 40 ye eciall). his been drawn into serious question from a scientific aryued that many of his theories either cannot be tesred rifi if they are tesred, they prove to be generally unreliable. few would doubr rhe hisrori.at imporance otFreud, many of his dlYqbour the srructure of personality, rhF developmen, or person"lir. rl-I rhe D(vchosF\uai ,ogir, ,"a ;'; soLrrces of peopler psychorosicallFl& ha;e been rejected"\ most psy_ chorosis,,,od/,. Ho"e,", r,orr, rr",e ierei,ea mo,e pIi_ tive.reviess throush the y*^g[6-" rvide acceptance. ""j$erativety are weapo'ns that bne of these i, his concepr of thgffnse mechan&,These your ego uses to prorect yon yolt own setllftgated anxiety. This et€ment ry from his work has beengfted b represent F!l)d in this book. Sigmund Freud' of d€fense melknisms occurred gradualry over 30 or more y€gtf his experiences in dealil\with psychologiial prob'<Fnes or somrFtst. A^cohfseFcontained anlwhere in lb rsitl€s Prcss- In r hook abo,1r rhe ing figure would be ex It is very unlikelt that psycho varied and complex forms, $d sponsible for elevatins our inl . Alrhough \rgmu,rd Freud (d. inregrrt ro p$cholog\', hi,rory and. rnererore. rr d nece\r'-y pd'r of rh:\ book. rhe task or inctuding hi! resea,.h here aiong wirh all the ofier researchers was a difficult one. Tie reason for ttis difiicula was rhar Freud did not reach his discoveries rhrough a clearly defined.sl ienufi. merhodotogt Ir \a, nor po.srble Lo choose a sin!re vudl or temsgrew. deJense, sig/F I Sigmund Frelrd (1856-1939). exisr toda\ as it does, in spite ol its :s contributions. He rras largely r€" uman beha\.ror (espe(ial\ abion and evil spirits to this book would be incomplete. Now' you may be asking youlself, ifSigmund Freud is so important, why does this discussion focus on a book wdtten by his daughter, Anna Freud (1895-1982)? Th€ answer to that question requires a discussion .rS t.iiJ a.., i,t "ip"a" rreud's manyvolumes. rn fact* passed thatjou'on to imporrant psychoanalyst in rfiown right,ipecializreud"nacknowtedged this fact in lg3t\iusr before Anna's 9-gfF:,ll(*" book, The/]and psychologv, oDe impos' Z3E the Mechanisms of Defense, was orteinaf{pubtished in cer_ an 7,re eyreme'y large nurnber of merhod. LL me.hanisms. a5 l€ br rnF ego in rhe djs.lr.IgF ot 15 detensrvr lun&pns. Mv dauoh_ ild dnahsr. issri,ingabookabourLhcm,s F,eudh936r.Sin.;i, Freud who svnthesized her farher,s rheories .esardir& the defense into a single work, h€r book has been chosen fo. o". air"""rio" work ofSigmund Freud. THEORETICAT PROPOSITIONS In order to examine Freud,s notion ofdef€nse mechanisms, it is nec€ssan b explain briefly his rh€ory ofthe strucrure ofpersonality. r.reud proposea that personality consisrs ofthree componentsr rhe id, the ego, and the superego.