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P. Ash,J. Abnorm. Soc. Psychol. 44, 272 (1949); A. T. Beck,Amer. J. Psychiat. 119, 210 (1962); A. T. Boisen,Psychiatry 2, 233 (1938); N. Kreitman,J. Ment. Sci. 107, 876 (1961); N. Kreitman, P. Sainsbury, J. Morrisey, J. Towers, J. Scrivener,ibid., p. 887; H. O. Schmitt and C. P. Fonda,J. Abnorm. Soc. Psychol. 52, 262 (1956); W. Seeman,J. Nerv. Ment. Dis. 118, 541 (1953). For an analysis of these artifacts and summaries of the disputes, see J. Zubin,Annu. Rev. Psychol. 18, 373 (1967); L. Phillips and J. G. Draguns,ibid. 22, 447 (1971).
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See in this regard H. Becker,Outsiders: Studies in the Sociology of Deviance (Free Press, New York, 1963); B. M. Braginsky, D. D. Braginsky, K. Ring,Methods of Madness: The Mental Hospital as a Last Resort (Holt, Rinehart & Winston, New York, 1969); G. M. Crocetti and P. V. Lemkau,Amer. Sociol. Rev. 30, 577 (1965); E. Goffman,Behaviour in Public Places (Free Press, New York, 1965); R. D. Laing,The Divided Self: A Study of Sanity and Madness (Quadrangel, Chicago, 1960); D. L. Phillips,Amer. Sociol. Rev. 28, 963 (1963); T. R. Sarbin,Psychol. Today 6, 18 (1972); E. Schur,Amer. J. Sociol. 75, 309 (1969); T. Szasz,Law, Liberty and Psychiatry (Macmillan, New York, 1963);The Myth of Mental Illness: Foundations of a Theory of Mental Illness (Hoeber Harper, New York, 1963). For a critique of some of these views, see W. R. Gove,Amer. Sociol. Rev. 35, 873 (1970).
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Data from a ninth pseudopatient are not incorporated in this report because, although his sanity went undetected, he falsified aspects of his personal history, including his marital status and parental relationships. His experimental behaviors therefore were not identical to those of the other pseudopatients.
A. Barry,Bellevue Is a State of Mind (HarcourtBrace Jovanovich, New York, 1971; I. Belknap,Human Problems of a State Mental Hospital (McGraw Hill, New York, 1956); W. Caudill, F. C. Redlich, H. R. Gilmore, E. B. Brody,Amer. J. Orthopsychiat. 22, 314 (1952); A. R. Goldman, R. H. Bohr, T. A. Steinberg,Prof. Psychol. 2, 427 (1970); unauthored,Roche Report 1 (No. 13), 8 (1971).
Beyond the personal difficulties that the pseudopatient is likely to experience in the hospital, there are legal and social ones that, combined, require considerable attention before entry. For example, once admitted to a psychiatric institution, it is difficult, if not impossible, to be discharged on short notice, state law to the contrary not with standing. I was not sensitive to these difficulties at the outset of the project, nor to the personal and situational emergencies that can arise, but later a writ of habeas corpus was prepared for each of the entering pseudopatients and an attorney was kept “on call” during every hospitalization. I am grateful to John Kaplan and Robert Bartels for legal advice and assistance in these matters.
However distasteful such concealment is, it was a necessary first step to examining these questions. Without concealment, there would have been no way to know how valid these experiences were; nor was there any way of knowing whether whatever detections occurred were a tribute to the diagnostic acumen of the staff or to the hospital's rumor network. Obviously, since my concerns are general ones that cut across individual hospitals and staff, I have respected their anonymity and have eliminated clues that might lead to their identification.
Interestingly, of the 12 admissions, 11 were diagnosed as schizophrenic and one, with the identical symptomatology, as manic-depressive psychosis. This diagnosis has a more favorable prognosis, and it was given by the only private hospital in our sample. On the relations between social class and psychiatric diagnosis, see A. deB. Hollingshead and F. C. Redlich,Social Glass and Mental Illness: A Community Study (Wiley, New York, 1958).
It is possible, of course, that patients have quite broad latitudes in diagnosis and therefore are inclined to call many people sane, even those whose behavior is patently aberrant. However, although we have no hard data on this matter, it was our distinct impression that this was not the case. In many instances, patients not only singled us out for attention, but came to imitate our behaviors and styles.
J. Cumming and E. Cumming,Community Ment. Health 1, 135 (1965); A. Farina and K. Ring,J. Abnorm. Psychol. 70, 47 (1965); H. E. Freeman and O. G. Simmons,The Mental Patient Comes Home, (Wiley, New York, 1963); W. J. Johannsen,Ment. Hygiene 53, 218 (1969); A. S. Linsky,S. Psychiat. 6, 166 (1970).
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For an example of a similar self-fulfilling prophecy, in this instance dealing with the “central” trait of intelligence, see R. Rosenthal and L. Jacobson,Pygmalion in the Classroom (Holt, Rinehart & Winston, New York, 1968).
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The most recent and unfortunate instance of this tenet is that of Senator Thomas Eagleton.
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D. B. Wexler and S. E. Scoville,Ariz. Law Rev. 13, 1 (1971).
I thank W. Mischel, E. Orne, and M. S. Rosenhan for comments on an earlier draft of this manuscript.
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Reprinted by permission of the author andScience magazine from Vol. 179, pp. 250–258, January 19, 1973. Copyright 1973 by the American Association for the Advancement of Science.
Portions of these data were presented to colloquiums of the psychology departments at the University of California at Berkeley and at Santa Barbara; University of Arizona, Tucson; and Harvard University, Cambridge, Massachusetts.
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Rosenhan, D.L. On being sane in insane places. Clin Soc Work J 2, 237–256 (1974). https://doi.org/10.1007/BF01785781
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DOI: https://doi.org/10.1007/BF01785781