Surrealpolitik

Surrealpolitik: On Being Sane In Insane Places

Author: D.L. Rosenhan

Washington DC: American Association for the Advancement of Science

Quick Summary

Describes the results of an experiment in which sane people were secretly admitted to mental hospitals for the purpose of seeing whether the psychiatrists could tell they were sane. The result can be summarized by one of the article's subheadings: "The normal are not detectably sane."

Quotes

There are 11 quotes currently associated with this book.

However much we may be personally convinced that we can tell the normal from the abnormal, the evidence is simply not compelling. (page 250)
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To raise questions regarding normality and abnormality is in no way to question the fact that some behaviors are deviant or odd. Murder is deviant. So, too, are hallucinations...But normality and abnormality, sanity and insanity, and the diagnoses that flow from them may be less substantive than many believe them to be. (page 250)
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[T]he belief has been strong that patients present symptoms, that those symptoms can be categorized, and, implicitly, that the sane can be distinguished from the insane. More recently, however...the view has grown that psychological categorization of mental illness is useless at best, and downright harmful, misleading, and pejorative at worst. Psychiatric diagnoses, in this view, are in the minds of the observers and are not valid summaries of characteristics displayed by the observed. (page 251)
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Despite their public "show" of sanity, the pseudopatients were never detected. Admitted, except in one case, with a diagnosis of schizophrenia, each was discharged with a diagnosis of schizophrenia "in remission."...If the pseudopatient was to be discharged, he must naturally be "in remission"; but he was not sane, nor, in the institution's view, had he ever been sane. (page 252)
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[I]t cannot be said that the failure to recognize the pseudopatients' sanity was due to the fact that they were not behaving sanely...It was quite common for the patients to "detect" the pseudopatients' sanity..."You're not crazy. You're a journalist, or a professor...You're checking up on the hospital." (page 252)
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All pseudopatients took extensive notes publicly...Nursing records for three patients indicate that the writing was seen as an aspect of their pathological behavior. "Patient engages in writing behavior" was the daily nursing comment on one of the pseudopatients who was never questioned about his writing. Given that the patient is in the hospital, he must be psychologically disturbed. And given that he is disturbed, continuous writing must be a behavioral manifestation of that disturbance... (page 253)
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One tacit characteristic of psychiatric diagnosis is that it locates the sources of aberration within the individual and only rarely within the complex of stimuli that surrounds him. Consequently, behaviors that are stimulated by the environment are commonly misattributed to the patient's disorder. For example, one kindly nurse found a pseudopatient pacing the long hospital corridors. "Nervous, Mr. X?" she asked. "No, bored," he said. (page 253)
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Occasionally, the staff might assume that the patient's family...or other patients had stimulated [an] outburst. But never were the staff found to assume that one of themselves or the structure of the hospital had anything to do with a patient's behavior. One psychiatrist pointed to a group of patients who were sitting outside the cafeteria entrance half an hour before lunchtime. To a group of young residents he indicated that such behavior was characteristic of the oral-acquisitive nature of the syndrome. It seemed not to occur to him that there were very few things to anticipate in a psychiatric hospital besides eating. (page 253)
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Whenever the ratio of what is known to what needs to be known approaches zero, we tend to invent "knowledge" and assume that we understand more than we actually do. We seem unable to acknowledge that we simply don't know...[W]e continue to label patents "schizophrenic," "manic-depressive," and "insane," as if in those words we had captured the essence of understanding. The facts of the matter are that we have known for a long time that diagnoses are often not useful or reliable, but we have nevertheless continued to use them. We now know that we cannot distinguish insanity from sanity. (page 257)
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[H]ow many patients might be "sane" outside the psychiatric hospital but seem insane in it -- not because craziness resides in them, as it were, but because they are responding to a bizarre setting, one that may be unique to institutions which harbor nether people? Goffman calls the process of socialization to such institutions "mortification" -- an apt metaphor that includes the processes of depersonalization that have been described here. (page 257)
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[Staff] perceptions and behavior were controlled by the situation, rather than being motivated by a malicious disposition. In a more benign environment, one that was less attached to global diagnosis, their behaviors and judgments might have been more benign and effective. (page 257)
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