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