"On being sane in insane places"
Rosenhan's 1973 article "On being sane in insane places" talks about a study whereby “sane” individuals were pretending to be “insane” and admitted to a mental hospital or institution without the staff there knowing that they were perfectly normal individuals. In fact, they were psychiatrists.
Rosenhan’s study brings out a question of what constitutes sanity and what constitutes insanity? How do we know if a person is sane or not? What affects a person’s perception of who is sane and insane? The study shows that a person could act insane and people will believe it, depending on the kind of environment. A sane person could be perceived insane if that person is acting out as insane. The study showed that if a normal person is placed in a mental institution, the staff would view him as insane, perhaps because the environment is affecting the judgments of the staff.
A great deal can be learned about mental capacities and emotional state by simply interacting with a person. Let us take for example a mental health nurse. It is her duty to ask questions to a client throughout an examination to gather data and observe the appropriateness of emotions and ideas. Such could be acted out by an individual and trick the nurse into thinking he is insane. Such is the case that happened in Rosenhan’s study.
The study shows that oftentimes doctors play it safe and commit the type-one error. That is, there are doctors who diagnose healthy people as sick, which happens more often than the type-two error – diagnosing sick people as healthy. Diagnosing sick people as healthy is unacceptable. It is a threat to have a sick person allowed to roam freely. Depending on a person’s degree of sickness, they could be a danger to others. On the other hand, diagnosing healthy people as sick is also unacceptable. It seems so unfair to have a normal person committed to a mental institution.
The study shows that once labelled as mentally ill, people will view a person as if they are still ill, even if all symptoms have disappeared. Normal behaviours which are done by normal people become abnormal when being done by a mental patient. Take for example the one mentioned in the study. A pseudo-patient pacing up and down was asked if he was nervous, when really he was bored. A patient might go berserk, because of being mishandled by the staff, but the medical staff would blame the behaviour on a recent visit from a relative or friend.
When a practicing psychiatrist by the name of repeated the Rosenhan experiment 25 years later, she found that, by and large, things had changed for the better. Where the earlier investigators had been treated with severity, even cruelty, she found only kindness and sympathy. She was not interned by any of the eight hospitals she visited, though her case was taken seriously by everyone (2004).
Although Slater’s study showed that some things have changed in many years, there are still some things that haven’t really changed. Such is still the case at present, more than 30 years after Rosenhan’s study. The general public still seem to avoid mentally ill people. It is surprising to find, however, that medical staffs who work with mentally ill people also seem to avoid them. Medical staff spent much of their time in their own areas, where patients were not allowed.
The mental patients have been labelled and somehow the staffs in mental institutions seem to think that they should not be treated like normal people. This is even happening not only in mental institutions but in the general public. We see an individual who is acting crazy and we tend to avoid him or her, instead of offering help. People still see mental illness as some dreaded disease wherein the affected should be isolated and pitied.
Insanity is also used to plead for criminals, thereby letting them escape the death sentence for a way-too lighter one in a mental institution. Even if they aren’t really mentally insane, they try to act like one and try to convince a jury that it was a voice in their head that made them do it. It sounds crazy, yes, but some of them are just a tactic for criminals to avoid an imprisonment or even a death sentence. An available insanity plea serves the suspect’s interest in avoiding criminal conviction.
Public misunderstanding about the nature of insanity pleas is causing some sane criminals to do short time in mental hospitals, while the truly insane go in and out of the prison system. Experts fear that inadequate rehabilitation on both ends will put dangerous criminals back on the street ( 1998).
Mental health staffs are doing their best though not to commit type-one or type-two errors. The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been used as an assessment system. The DSM's multiaxial assessment system has become the primary language of communication regarding client problems, offering a way of reducing complex client-related information into a manageable form. Also, the DSM, by categorizing people's psychological problems, aims to assist researchers and theorists in comparing various treatment approaches to particular problems ( 2006).
Further, researchers may investigate underlying causal mechanisms and processes of particular diagnoses, which in turn may allow for prevention and improved control over the outcomes of psychiatric disorders. In addition, the DSM provides information about the course, prevalence, cultural, gender, and familial issues related to each diagnosis--information that may be helpful to counselors who are struggling to fully understand their clients' experiences. This understanding, in turn, may enable effective referral and/or planning of counseling, psychotherapy, and other psychiatric treatment strategies ( 2006).
The use of DSM can thus help psychiatrists and other mental professionals in identifying which are sane and which are not, as is defined in medical context. For being sane and insane is definitely relative. Each of us has his or her own perceptions on sanity and insanity. You may see an individual as sane and yet your best friend sees that same individual as insane. Whatever one’s views, one must remember that sane or not, we are all human beings and should be accorded with the same rights, treated the same and not be seen as a deadly disease.
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