Who’s Crazy Here, Anyway?
Julia Tomasson
Background
• David L. Rosenhan (1973)
• “Being sane in insane places”
• Can we really distinguish between healthy and
abnormal?
• What are the consequences of the mistakes?
• Is it the patients or the situations they are found
in?
• Professionals should be able to determine with
criteria
• ‘Pseudopatients’ should be found healthy
Methods
• 8 subjects (including Rosenhan, 3 women, 5 men, 12
psychological hospitals, 5 states on east and west
coasts)
• Each made an appointment and complained of hearing
voices
– “empty,” “hollow,” “thud”
• Otherwise completely healthy
• All but one were diagnosed and admitted with
schizophrenia
• In the hospital
– No symptoms, behaved normally
Results
•
•
•
•
•
7 - 52 days, average of 19 days before released
None suspected
All released as “schizophrenia in remission”
35/118 real patients voiced suspicions
Contact between patients and staff was minimal
and bizarre
– Severe depersonalization, but no lack of medicine
– Never really communicated effectively
– Not considered real people!
Conclusion
• In the hospital setting healthy subjects cannot
be distinguished from mentally ill people.
• “If they are here, they must be crazy!”
• Diagnostic labels become persona
• Tend to add psychological implications to
normal things
• Doctor interpretations of past depend on
diagnosis
Significance
•
•
•
•
Hospital environments, counter - therapeutic?
Danger in diagnostic labels
Self- concerning
With new antipsychotic medicines, less people
are being confined to mental hospitals
• Use labels carefully and with respect to power
demands
Criticism
• Criticism
• Who would lie to get into a mental institute?
• Questioned if mistakes like these could happen in
THEIR hospital
– During the next 3 months one or more pseudo
patients would be sent
– Rate each submission on a 10 point scale of likeliness
to be a pseudo patient
– 193 admissions: 41 considered with high confidence
to be the pseudo patient, 23 suspected, 19 identified
– …No pseudo patients actually sent
Recent Applications
• Szasz (1993)
– mental illness cannot be diagnosed simply if one person (health
professional) does not understand the other (patient)
• Brighton and Chesterman (2001)
– Faking of a mental illness can be a “get out of jail free card” for
criminals
• Wahl (1999)
– Stigma against psychological disorders in our society
• Boisvert and Faust (1999)
– Scenarios of an employee who behaves violently toward their boss
• If the employee was pre-diagnosed as schizophrenic, subjects were more likely
to blame the employee
• With no evidence of mental illness, subjects most often blamed environmental
stress