rosenhan-1973-on-being-sane-in-insane-places

On Being Sane in Insane Places
Author(s): D. L. Rosenhan
Source: Science, New Series, Vol. 179, No. 4070 (Jan. 19, 1973), pp. 250-258
Published by: American Association for the Advancement of Science
Stable URL: http://www.jstor.org/stable/1735662 .
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The Geographical Distribution of Animals A. P. Platt and L. P. Brower, Evolu- the effects of gene flow. This is because the
(Wiley, New York, 1957); B. Rensch, Evolu- tion 22, 699 (1968); 0. Halkka and E. effective gene selection on males in sex-linked
tion Above the Species Level (Methuen, Mikkola, Hereditas 54, 140 (1965); B. C. loci makes the net selection stronger, com-
London, 1959); V. Grant, The Origin of Clarke, in Evolution and Environment, E. T. pared to autosomal loci, for the population
Adaptations (Columbia Univ. Press, New Drake, Ed. (Yale Univ. Press, New Haven, as a whole. See C. C. Li, Population Genetics
1968), p. 351; B. C. Clarke and J. J. Murray, (Univ. of Chicago Press, Chicago, 1955) for
York, 1963). in Ecological Genetics and Evolution, R. a good discussion of sex-linkage and selection.
5. S. Wright, Genetics 16, 97 (1931). Greed, Ed. (Blackwells, Oxford, 1971), p. 30. The equilibrium configurations are not sig-
6. , ibid. 28, 114 (1943); ibid. 31, 39 51; J. A. Bishop and P. S. Harper, Heredity nificantly altered if the emigrants from the
25, 449 (1969); J. A. Bishop, J. Anim. Ecol. end demes do not return, unless the number
(1946); Evolution and the Genetics of Popu- 41, 209 (1972); G. Hewitt and F. M. Brown, of demes (d) is very small (J. A. Endler,
lations, vol. 2, The Theory of Gene Fre- Heredity 25, 365 (1970); G. Hewitt and C.
quencies (Univ. of Chicago Press, Chicago, Ruscoe, J. Anim. Ecol. 40, 753 (1971); unpublished data).
1969); F. J. Rohlf and G. D. Schnell, Amer. H. Wolda, ibid. 38, 623 (1969); F. B. Living- 31. See, for example, the models of B. C.
Natur. 105, 295 (1971). stone, Amer. J. Phys. Anthropol. 31, 1 (1969).
7. J. B. S. Haldane, J. Genet. 48, 277 (1948). 22. C. P. Haskins, E. F. Haskins, J. J. A. Clarke [Amer. Natur. 100, 389 (1966)] and
8. R. A. Fisher, Biometrics 6, 353 (1950); M. McLaughlan, R. E. Hewitt, in Vertebrate those in (14).
Kimura, Annu. Rep. Nat. Inst. Genet. Speciation, W. F. Blair, Ed. (Univ. of Texas 32. This model incorporates Clarke's model of
Mishima-City, Japan 9, 84 (1958). Press, Austin, 1961), p. 320. frequency-dependence; see B. C. Clarke,
9. M. Kimura and G. H. Weiss, Genetics 49, 23. A. J. Bateman, Heredity 1, 234, 303 (1947); Evolution 18, 364 (1964).
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Genet. Res. 18, 125 (1971). Bot. 38, 511 (1951); M. R. Roberts and H. for Biological, Agricultural, and Medical Re-
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1228 (1969). personal communication; K. P. Lamb, E. R. R. Sokal and F. J. Rohlf, Biometry
11. For example, J. Maynard-Smith, Amer. Natur. Hassan, D. P. Scoter, Ecology 52, 178 (1971). (Freeman, San Francisco, 1969).
100, 637 (1966). For localized distribution and problem of 34. See, for example, C. G. Johnson, Migration
12. J. M. Thoday, Nature 181, 1124 (1958); -- establishment see also: W. F. Blair, Ann. and Dispersal of Insects by Flight (Methuen,
and T. B. Boam, Heredity 13, 204 (1959); E. N.Y. Acad. Sci. 44, 179 (1943); Evolution 4, London, 1969); J. Antonovics, Amer. Sci. 59,
Millicent and J. M. Thoday, Ibid. 16, 219 253 (1950); L. R. Dice, Amer. Natur. 74, 289 593 (1971).
(1961); J. M. Thoday and J. B. Gibson, Amer. (1940); P. Labine, Evolution 20, 580 (1966); 35. E. C. Pielou, An Introduction to Mathematical
Natur. 105, 86 (1971). H. Lewis, ibid. 7, 1 (1953); W. Z. Lidicker, Ecology (Wiley-Interscience, New York, 1969).
13. F. A. Streams and D. Pimentel, ibid. 95, 201 personal communication; J. T. Marshall, Jr., 36. W. F. Blair, Contrib. Lab. Vertebrate Biol.
(1961); Th. Dobzhansky and B. Spassky, Proc. Condor 50, 193, 233 (1948); R. K. Sealander, Univ. Mich. No. 36, 1 (1947).
Roy. Soc. London Ser. B. 168, 27 (1967); Amer. Zool. 10, 53 (1970); P. Voipio, Ann. 37. P. A. Parsons, Genetica 33, 184 (1963).
Zool. Fenn. 15, 1 (1952); P. K. Anderson, 38. G. Hewitt and B. John, Chromosoma 21,
, J. Sved, ibid. 173, 191 (1969); Th. Science 145, 177 (1964). 140 (1967); Evolution 24, 169 (1970); G.
Dobzhansky, H. Levene, B. Spassky, ibid. 180, 24. N. W. Timofeeff-Ressovsky, in The New Hewitt, personal communication; H. Wolda,
21 (1972). Systematics, J. S. Huxley, Ed. (Oxford Univ. J. Anim. Ecol. 38, 305, 623 (1969).
14. M. Slatkin, thesis, Harvard University (1971). Press, Oxford, 1940), p. 73. 39. L. R. Dice, Contrib. Lab. Vertebrate Genet.
15. S. K. Jain and A. D. Bradshaw, Heredity 25. The null point is the position at which Univ. Mich. No. 8 (1939), p. 1; ibid. No. 15
21, 407 (1966). selection changes over from favoring one (1941), p. 1.
16. Parapatric divergence is divergence between type to favoring another. 40. I. C. J. Galbraith, Bull. Brit. Mus. Natur.
adjacent but genetically continuous popula- 26. J. A. Endler, in preparation. Hist. Zool. 4, 133 (1956).
tions. See H. M. Smith, Syst. Zool. 14, 57 27. L. M. Cook, Coefficients of Natural Selection 41. I am grateful to the National Science Founda-
(1965); ibid. 18, 254 (1969); M. J. D. White, (Hutchinson Univ. Library, Biological Sci- tion for a graduate fellowship in support
R. E. Blackith, R. M. Blackith, J. Cheney, ences No. 153, London, 1971); F. B. Living- of this study. I thank Prof. Alan Robertson
Aust. J. Zool. 15, 263 (1967); M. J. D. White, stone, Amer. J. Phys. Anthropol. 31, 1 (1969). and the Institute of Animal Genetics, Uni-
Science 159, 1065 (1968); K. H. L. Key, 28. W. C. Allee, A. E. Emerson, 0. Park, T. versity of Edinburgh, for the Drosophila, and
Syst. Zool. 17, 14 (1968). Park, K. P. Schmidt, Principles of Animal for kindly providing me with fresh medium
17. J. S. Huxley, Nature 142, 219 (1938); Bijdr. Ecology (Saunders, Philadelphia, 1949); H. C. throughout the study. Criticism of the manu-
Dierk. Leiden 27, 491 (1939). Andrewartha and L. C. Birch, The Distribu- script by Professors John Bonner and Jane
18. F. B. Sumner, Bibliogr. Genet. 9, 1 (1932). tion and Abundance of Animals (Univ. of Potter, Dr. Philip Ashmole, Peter Tuft, Dr.
19. F. Salomonsen, Dan. Biol. Medd. 22, 1 Chicago Press, Chicago, 1954); G. L. Clarke, David Noakes, Dr. John Godfrey, Dr. Caryl
Elements of Ecology (Wiley, New York, P. Haskins, and M. C. Bathgate was very
(1955). 1954); R. Geiger, The Climate Near the welcome. In particular, I thank my supervisor,
20. E. B. Ford, Biol. Rev. Cambridge Phil. Soc. Ground (translation, Harvard Univ. Press, Professor Bryan C. Clarke, for help and criti-
cism throughout this study. Any errors or
20, 73 (1945). Cambridge, 1966). omissions are entirely my own. I thank the
21. Examples of morph-ratio clines include: 29. Results for autosomal and sex-linked systems Edinburgh Regional Computing Center and
the Edinburgh University Zoology Department
H. B. D. Kettlewell and R. J. Berry, Heredity do not differ for the models to be discussed, for generous computer time allowances. I will
16, 403 (1961); ibid. 24, 1 (1969); H. B. D. except that, for a given amount of selection, supply the specially written IMiP language
Kettlewell, R. J. Berry, C. J. Cadbury, the sex-linked system is loss sensitive to
G. C. Phillips, Ibid., p. 15; H. N. Southern, program upon request.
J. Zool. London Ser. A 138, 455 (1966);
A. J. Cain and J. D. Currey, Phil. Trans.
Roy. Soc. London Ser. B. 246, 1 (1962);

On Being Sane in Insane Places What is viewed as normal in one cul-
ture may be seen as quite aberrant in
D. L. Rosenhan another. Thus, notions of normality and
abnormality may not be quite as accu-
If sanity and insanity exist, how shall tradicted by equally eminent psychia- rate as people believe they are.
we know them? trists for the prosecution on the matter
To raise questions regarding normal-
The question is neither capricious nor of the defendant's sanity. More gen- ity and abnormality is in no way to
itself insane. However much we may erally, there are a great deal of conflict- question the fact that some behaviors
be personally convinced that we can ing data on the reliability, utility, and are deviant or odd. Murder is deviant.
tell the normal from the abnormal, the meaning of such terms as "sanity," "in- So, too, are hallucinations. Nor does
evidence is simply not compelling. It is sanity," "mental illness," and "schizo- raising such questions deny the exis-
commonplace, for example, to read phrenia" (1). Finally, as early as 1934, tence of the personal anguish that is
about murder trials wherein eminent Benedict suggested that normality and often associated with "mental illness."
abnormality are not universal (2).
psychiatrists for the defense are con- Anxiety and depression exist. Psycho-
logical suffering exists. But normality
250 and abnormality, sanity and insanity,
and the diagnoses that flow from them

The author is professor of psychology and law
at Stanford University, Stanford, California 94305.
Portions of these data were presented to collo-
quiums of the psychology departments at the
University of California at Berkeley and at Santa
Barbara; University of Arizona, Tucson; and
Harvard University, Cambridge, Massachusetts.

SCIENCE, VOL. 179

may be less substantivethan many be- This article describessuch an experi- old and shabby, some were quite new.
lieve them to be. ment. Eight sane people gained secret Some were research-oriented, others

At its heart, the question of whether admissionto 12 differenthospitals (6). not. Some had good staff-patientratios,
the sane can be distinguishedfrom the Their diagnostic experiences constitute others were quite understaffed. Only
insane (and whetherdegreesof insanity the data of the first part of this article; one was a strictly private hospital. All
can be distinguishedfrom each other) the remainderis devoted to a descrip- of the others were supportedby state
is a simple matter: do the salient char- tion of their experiences in psychiatric or federal funds or, in one instance,by
acteristicsthat lead to diagnoses reside institutions.Too few psychiatristsand universityfunds.
in the patientsthemselvesor in the en- psychologists, even those who have After calling the hospital for an ap-
vironments and contexts in which ob- worked in such hospitals, know what pointment,the pseudopatientarrivedat
servers find them? From Bleuler, the experience is like. They rarely talk the admissions office complaining that
throughKretchmer,throughthe formu- about it with former patients, perhaps he had been hearingvoices. Asked what
latorsof the recentlyrevisedDiagnostic because they distrustinformationcom- the voices said, he replied that they
and Statistical Manual of the American ing from the previously insane. Those were often unclear, but as far as he
Psychiatric Association, the belief has who have worked in psychiatrichospi- could tell they said "empty,""hollow,"
been strong that patientspresentsymp- tals are likely to have adaptedso thor- and "thud."The voices were unfamiliar
toms, that those symptomscan be cate- oughly to the settings that they are and were of the same sex as the pseudo-
gorized, and, implicitly, that the sane insensitiveto the impact of that expe- patient. The choice of these symptoms
are distinguishable from the insane. rience. And while there have been oc- was occasioned by their apparentsim-
More recently, however, this belief has casional reports of researchers who ilarity to existential symptoms. Such
been questioned.Based in part on theo- submittedthemselvesto psychiatrichos- symptoms are alleged to arise from
retical and anthropologicalconsidera- pitalization(7), these researchershave painful concerns about the perceived
tions, but also on philosophical,legal, commonlyremainedin the hospitalsfor meaninglessnessof one's life. It is as
and therapeutic ones, the view has short periods of time, often with the if the hallucinatingperson were saying,
grown that psychologicalcategorization knowledge of the hospital staff. It is "My life is empty and hollow." The
of mental illness is useless at best and difficult to know the extent to which choice of these symptomswas also de-
downright harmful, misleading, and they were treated like patients or like termined by the absence of a single
pejorative at worst. Psychiatric diag- researchcolleagues. Nevertheless,their report of existential psychoses in the
noses, in this view, are in the minds of reports about the inside of the psychi- literature.
the observers and are not valid sum- atric hospital have been valuable. This Beyond alleging the symptoms and
maries of characteristicsdisplayed by article extends those efforts.
falsifying name, vocation, and employ-
the observed (3-5).
ment, no further alterationsof person,
Gains can be made in decidingwhich
history, or circumstances were made.
of these is more nearly accurate by Pseudopatientsand Their Settings
getting normal people (that is, people The significant events of the pseudo-

patient'slife history were presented as
who do not have, and have never suf- The eight pseudopatients were a they had actually occurred. Relation-
fered, symptoms of serious psychiatric varied group. One was a psychology ships with parents and siblings, with
disorders) admittedto psychiatrichos- graduate student in his 20's. The re- spouse and children, with people at
pitals and then determining whether maining seven were older and "estab- work and in school, consistentwith the
they were discoveredto be sane and, if lished." Among them were three psy- aforementioned exceptions, were de-
so, how. If the sanity of such pseudo- chologists,a pediatrician,a psychiatrist, scribedas they were or had been. Frus-
patients were always detected, there a painter, and a housewife. Three trations and upsets were described
would be prima facie evidence that a pseudopatientswere women, five were along with joys and satisfactions.These
sane individual can be distinguished men. All of them employed pseudo- facts are important to remember. If
from the insane context in which he is nyms, lest their alleged diagnoses em- anything,they strongly biased the sub-
found. Normality (and presumablyab- barrassthem later. Those who were in sequent results in favor of detecting
normality) is distinct enough that it mental health professions alleged an- sanity, since none of their histories or
can be recognized wherever it occurs, other occupation in order to avoid the currentbehaviorswere seriouslypatho-
for it is carried within the person. If, special attentions that might be ac- logical in any way.
on the other hand, the sanity of the corded by staff, as a matterof courtesy Immediately upon admission to the
pseudopatientswere never discovered, or caution, to ailing colleagues (8). psychiatric ward, the pseudopatient
serious difficultieswould arise for those With the exceptionof myself (I was the ceased simulatingany symptomsof ab-
who support traditionalmodes of psy- firstpseudopatientand my presencewas normality. In some cases, there was a
chiatricdiagnosis.Given that the hospi- knownto the hospitaladministratorand brief period of mild nervousness and
tal staff was not incompetent,that the chief psychologistand, so far as I can anxiety, since none of the pseudopa-
pseudopatient had been behaving as tell, to them alone), the presence of tients reallybelievedthat they would be
sanely as he had been outside of the pseudopatientsand the natureof the re- admittedso easily. Indeed, their shared
hospital, and that it had never been search programwas not known to the fear was that they would be immedi-
previously suggested that he belonged hospitalstaffs (9).
ately exposed as frauds and greatly
in a psychiatric hospital, such an un- The settingswere similarlyvaried.In embarrassed.Moreover, many of them
likely outcome would supportthe view order to generalizethe findings,admis- had never visited a psychiatric ward;
that psychiatric diagnosis betrays little sion into a variety of hospitals was even those who had, nevertheless had
about the patient but much about the sought. The 12 hospitalsin the sample some genuine fears about what might
environmentin which an observerfinds were located in five differentstates on happen to them. Their nervousness,
him. the East and West coasts. Some were then, was quite appropriateto the nov-

19 JANUARY 1973 251

elty of the hospital setting, and it abated labeled schizophrenic, the pseudopatient them personal, legal, and social stigmas
was stuck with that label. If the pseudo- (12). It was therefore important to see
rapidly. patient was to be discharged, he must whether the tendency toward diagnosing
Apart from that short-lived nervous- naturally be "in remission"; but he was the sane insane could be reversed. The
not sane, nor, in the institution's view,
ness, the pseudopatient behaved on the had he ever been sane. following experiment was arranged at
ward as he "normally" behaved. The a research and teaching hospital whose
pseudopatient spoke to patients and The uniform failure to recognize san- staff had heard these findings but
staff as he might ordinarily. Because ity cannot be attributed to the quality doubted that such an error could occur
there is uncommonly little to do on a of the hospitals, for, although there in their hospital. The staff was informed
psychiatric ward, he attempted to en- were considerable variations among that at some time during the following
gage others in conversation. When them, several are considered excellent. 3 months, one or more pseudopatients
asked by staff how he was feeling, he would attempt to be admitted into the
indicated that he was fine, that he no Nor can it be alleged that there was psychiatric hospital. Each staff member
longer experienced symptoms. He re- simply not enough time to observe the was asked to rate each patient who pre-
sponded to instructions from attendants, pseudopatients. Length of hospitaliza- sented himself at admissions or on the
to calls for medication (which was not tion ranged from 7 to 52 days, with an ward according to the likelihood that
swallowed), and to dining-hall instruc- average of 19 days. The pseudopatients the patient was a pseudopatient. A 10-
tions. Beyond such activities as were were not, in fact, carefully observed, point scale was used, with a 1 and 2
available to him on the admissions reflecting high confidence that the pa-
but this failure clearly speaks more to tient was a pseudopatient.
ward, he spent his time writing down
his observations about the ward, its traditions within psychiatric hospitals Judgments were obtained on 193 pa-
patients, and the staff. Initially these than to lack of opportunity. tients who were admitted for psychi-
notes were written "secretly," but as it atric treatment. All staff who had had
soon became clear that no one much Finally, it cannot be said that the
failure to recognize the pseudopatients' sustained contact with or primary re-
cared, they were subsequently written sanity was due to the fact that they sponsibility for the patient-attendants,
on standard tablets of paper in such were not behaving sanely. While there nurses, psychiatrists, physicians, and
public places as the dayroom. No secret was clearly some tension present in all psychologists-were asked to make
was made of these activities. of them, their daily visitors could detect judgments. Forty-one patients were al-
no serious behavioral consequences- leged, with high confidence, to be
The pseudopatient, very much as a nor, indeed, could other patients. It was pseudopatients by at least one member
true psychiatric patient, entered a hos- quite common for the patients to "de- of the staff. Twenty-three were consid-
pital with no foreknowledge of when tect" the pseudopatients' sanity. During ered suspect by at least one psychiatrist.
he would be discharged. Each was told the first three hospitalizations, when Nineteen were suspected by one psychi-
that he would have to get out by his accurate counts were kept, 35 of a total atrist and one other staff member.
own devices, essentially by convincing of 118 patients on the admissions ward
the staff that he was sane. The psycho- voiced their suspicions, some vigorously. Actually, no genuine pseudopatient (at
logical stresses associated with hospital- "You're not crazy. You're a journalist, least from my group) presented himself
ization were considerable, and all but or a professor [referring to the con- during this period.
one of the pseudopatients desired to be tinual note-taking]. You're checking up
discharged almost immediately after on the hospital." While most of the The experiment is instructive. It indi-
being admitted. They were, therefore, patients were reassured by the pseudo- cates that the tendency to designate
motivated not only to behave sanely, patient's insistence that he had been sane people as insane can be reversed
but to be paragons of cooperation. That sick before he came in but was fine when the stakes (in this case, prestige
their behavior was in no way disruptive and diagnostic acumen) are high. But
is confirmed by nursing reports, which now, some continued to believe that what can be said of the 19 people who
have been obtained on most of the were suspected of being "sane" by one
the pseudopatient was sane throughout psychiatrist and another staff member?
patients. These reports uniformly indi- his hospitalization (11). The fact that Were these people truly "sane," or was
cate that the patients were "friendly," the patients often recognized normality it rather the case that in the course of
"cooperative," and "exhibited no ab- when staff did not raises important
normal indications." avoiding the type 2 error the staff
questions. tended to make more errors of the first
The Normal Are Not Detectably Sane Failure to detect sanity during the
sort-calling the crazy "sane"? There is
Despite their public "show" of sanity, course of hospitalization may be due no way of knowing. But one thing is
the pseudopatients were never detected. to the fact that physicians operate with certain: any diagnostic process that
Admitted, except in one case, with a a strong bias toward what statisticians lends itself so readily to massive errors
diagnosis of schizophrenia (10), each call the type 2 error (5). This is to of this sort cannot be a very reliable
was discharged with a diagnosis of say that physicians are more inclined one.
schizophrenia "in remission." The label to call a healthy person sick (a false
"in remission" should in no way be positive, type 2) than a sick person The Stickiness of
dismissed as a formality, for at no time healthy (a false negative, type 1). The
during any hospitalization had any reasons for this are not hard to find: Psychodiagnostic Labels
question been raised about any pseudo-
patient's simulation. Nor are there any it is clearly more dangerous to mis- Beyond the tendency to call the
indications in the hospital records that diagnose illness than health. Better to healthy sick-a tendency that accounts
the pseudopatient's status was suspect. err on the side of caution, to suspect better for diagnostic behavior on admis-
Rather, the evidence is strong that, once illness even among the healthy. sion than it does for such behavior after

252 But what holds for medicine does a lengthy period of exposure-the data
speak to the massive role of labeling in
not hold equally well for psychiatry.
Medical illnesses, while unfortunate, are SCIENCE, VOL. 179
not commonly pejorative. Psychiatric
diagnoses, on the contrary, carry with

psychiatric assessment. Having once ences, with no markedly deleterious ment on one of the pseudopatients who
been labeled schizophrenic, there is
nothing the pseudopatient can do to consequences. Observe, however, how was never questioned about his writing.
overcome the tag. The tag profoundly
colors others' perceptions of him and such a history was translated in the Given that the patient is in the hospital,
his behavior.
psychopathological context, this from he must be psychologically disturbed.
From one viewpoint, these data are
hardly surprising, for it has long been the case summary prepared after the And given that he is disturbed, continu-
known that elements are given meaning
by the context in which they occur. patient was discharged. ous writing must be a behavioral mani-
Gestalt psychology made this point
vigorously, and Asch (13) demon- This white 39-year-old male . . . mani- festation of that disturbance, perhaps a
strated that there are "central" person- fests a long history of considerable ambiv- subset of the compulsive behaviors that
ality traits (such as "warm" versus alence in close relationships,which begins are sometimes correlated with schizo-
"cold") which are so powerful that they in early childhood. A warm relationship
markedly color the meaning of other with his mother cools during his adoles- phrenia.
information in forming an impression cence. A distant relationship to his father
of a given personality (14). "Insane," is described as becoming very intense. One tacit characteristic of psychiatric
Affective stability is absent. His attempts diagnosis is that it locates the sources
"schizophrenic," "manic-depressive," to control emotionality with his wife and
and "crazy" are probably among the children are punctuated by angry out- of aberration within the individual and
most powerful of such central traits. bursts and, in the case of the children,
Once a person is designated abnormal, spankings. And while he says that he has only rarely within the complex of stim-
all of his other behaviors and character- several good friends, one senses consider- uli that surrounds him. Consequently,
able ambivalence embedded in those rela- behaviors that are stimulated by the
istics are colored by that label. Indeed, tionships also .... environment are commonly misattrib-
that label is so powerful that many of uted to the patient's disorder. For ex-
the pseudopatients' normal behaviors The facts of the case were uninten- ample, one kindly nurse found a
were overlooked entirely or profoundly
misinterpreted. Some examples may tionally distorted by the staff to achieve pseudopatient pacing the long hospital
clarify this issue. consistency with a popular theory of corridors. "Nervous, Mr. X?" she asked.
the dynamics of a schizophrenic reac-
Earlier I indicated that there were tion (15). Nothing of an ambivalent "No, bored," he said.
nature had been described in relations
no changes in the pseudopatient's per- The notes kept by pseudopatients are
sonal history and current status beyond with parents, spouse, or friends. To the full of patient behaviors that were mis-
those of name, employment, and, where extent that ambivalence could be in-
necessary, vocation. Otherwise, a veridi- interpreted by well-intentioned staff.
cal description of personal history and ferred, it was probably not greater than Often enough, a patient would go "ber-
circumstances was offered. Those cir- is found in all human relationships. It serk" because he had, wittingly or un-
is true the pseudopatient's relationships wittingly, been mistreated by, say, an
cumstances were not psychotic. How with his parents changed over time, but attendant. A nurse coming upon the
were they made consonant with the in the ordinary context that would scene would rarely inquire even cursor-
diagnosis of psychosis? Or were those hardly be remarkable-indeed, it might ily into the environmental stimuli of
diagnoses modified in such a way as to very well be expected. Clearly, the the patient's behavior. Rather, she as-
bring them into accord with the cir- meaning ascribed to his verbalizations sumed that his upset derived from his
cumstances of the pseudopatient's life, pathology, not from his present inter-
as described by him? actions with other staff members. Oc-

As far as I can determine, diagnoses (that is, ambivalence, affective instabil- casionally, the staff might assume that
were in no way affected by the relative
health of the circumstances of a pseudo- ity) was determined by the diagnosis: the patient's family (especially when
patient's life. Rather, the reverse oc- schizophrenia. An entirely different they had recently visited) or other pa-
curred: the perception of his cir- meaning would have been ascribed if tients had stimulated the outburst. But
cumstances was shaped entirely by the
diagnosis. A clear example of such it were known that the man was never were the staff found to assume
translation is found in the case of a
"normal." that one of themselves or the structure
pseudopatient who had had a close re-
lationship with his mother but was All pseudopatients took extensive of the hospital had anything to do with
rather remote from his father during notes publicly. Under ordinary circum- a patient's behavior. One psychiatrist
stances, such behavior would have pointed to a group of patients who were
his early childhool. During adolescence
and beyond, however, his father be- raised questions in the minds of ob- sitting outside the cafeteria entrance
came a close friend, while his relation-
ship with his mother cooled. His present servers, as, in fact, it did among pa- half an hour before lunchtime. To a
relationship with his wife was charac-
teristically close and warm. Apart from tients. Indeed, it seemed so certain that group of young residents he indicated
occasional angry exchanges, friction the notes would elicit suspicion that that such behavior was characteristic
was minimal. The children had rarely
been spanked. Surely there is nothing elaborate precautions were taken to re- of the oral-acquisitive nature of the
especially pathological about such a move them from the ward each day. syndrome. It seemed not to occur to
history. Indeed, many readers may see
a similar pattern in their own experi- But the precautions proved needless. him that there were very few things to
The closest any staff member came to anticipate in a psychiatric hospital be-
19 JANUARY 1973 questioning these notes occurred when sides eating.

one pseudopatient asked his physician A psychiatric label has a life and an

what kind of medication he was receiv- influence of its own. Once the impres-
sion has been formed that the patient is
ing and began to write down the re-
sponse. "You needn't write it," he was schizophrenic, the expectation is that
told gently. "If you have trouble re- he will continue to be schizophrenic.
membering, just ask me again." When a sufficient amount of time has

If no questions were asked of the passed, during which the patient has

pseudopatients, how was their writing done nothing bizarre, he is considered

interpreted? Nursing records for three to be in remission and available for dis-

patients indicate that the writing was charge. But the label endures beyond
seen as an aspect of their pathological discharge, with the unconfirmed expec-
tation that he will behave as a schizo-
behavior. "Patient engages in writing

behavior" was the daily nursing com- phrenic again. Such labels, conferred

253

by mental health professionals, are as The Experience of keep to themselves, almost as if the dis-
influential on the patient as they are on order that afflicts their charges is some-
his relatives and friends, and it should Psychiatric Hospitalization how catching.
not surprise anyone that the diagnosis
acts on all of them as a self-fulfilling The term "mental illness" is of re- So much is patient-staff segregation
prophecy. Eventually, the patient him- the rule that, for four public hospitals
self accepts the diagnosis, with all of cent origin. It was coined by people in which an attempt was made to mea-
its surplus meanings and expectations, who were humane in their inclinations sure the degree to which staff and pa-
and behaves accordingly (5). tients mingle, it was necessary to use
and who wanted very much to raise the "time out of the staff cage" as the
The inferences to be made from station of (and the public's sympathies operational measure. While it was not
toward) the psychologically disturbed the case that all time spent out of the
these matters are quite simple. Much from that of witches and "crazies" to cage was spent mingling with patients
as Zigler and Phillips have demon- (attendants, for example, would occa-
strated that there is enormous overlap one that was akin to the physically ill. sionally emerge to watch television in
in the symptoms presented by patients And they were at least partially success- the dayroom), it was the only way in
who have been variously diagnosed ful, for the treatment of the mentally which one could gather reliable data
(16), so there is enormous overlap in ill has improved considerably over the on time for measuring.
the behaviors of the sane and the in- years. But while treatment has im-
proved, it is doubtful that people really The average amount of time spent
sane. The sane are not "sane" all of regard the mentally ill in the same way by attendants outside of the cage was
that they view the physically ill. A 11.3 percent (range, 3 to 52 percent).
the time. We lose our tempers "for no broken leg is something one recovers This figure does not represent only
good reason." We are occasionally de- from, but mental illness allegedly en- time spent mingling with patients, but
pressed or anxious, again for no good dures forever (18). A broken leg does also includes time spent on such chores
reason. And we may find it difficult to not threaten the observer, but a crazy as folding laundry, supervising patients
get along with one or another person- schizophrenic? There is by now a host while they shave, directing ward clean-
again for no reason that we can specify. of evidence that attitudes toward the up, and sending patients to off-ward
Similarly, the insane are not always in- activities. It was the relatively rare at-
sane. Indeed, it was the impression of mentally ill are characterized by fear, tendant who spent time talking with
the pseudopatients while living with hostility, aloofness, suspicion, and dread patients or playing games with them. It
them that they were sane for long pe- (19). The mentally ill are society's proved impossible to obtain a "percent
riods of time-that the bizarre behav- mingling time" for nurses, since the
lepers. amount of time they spent out of the
iors upon which their diagnoses were That such attitudes infect the general cage was too brief. Rather, we counted
allegedly predicated constituted only a instances of emergence from the cage.
small fraction of their total behavior. population is perhaps not surprising, On the average, daytime nurses emerged
only upsetting. But that they affect the from the cage 11.5 times per shift,
If it makes no sense to label ourselves including instances when they left the
professionals-attendants, nurses, phy- ward entirely (range, 4 to 39 times).
permanently depressed on the basis of sicians, psychologists, and social work- Late afternoon and night nurses were
an occasional depression, then it takes ers-who treat and deal with the men- even less available, emerging on the
better evidence than is presently avail- average 9.4 times per shift (range, 4 to
able to label all patients insane or tally ill is more disconcerting, both 41 times). Data on early morning
schizophrenic on the basis of bizarre because such attitudes are self-evidently nurses, who arrived usually after mid-
behaviors or cognitions. It seems more pernicious and because they are unwit- night and departed at 8 a.m., are not
useful, as Mischel (17) has pointed ting. Most mental health professionals available because patients were asleep
out, to limit our discussions to behav- would insist that they are sympathetic during most of this period.
toward the mentally ill, that they are
iors, the stimuli that provoke them, and neither avoidant nor hostile. But it is Physicians, especially psychiatrists,
their correlates. were even less available. They were
more likely that an exquisite ambiv- rarely seen on the wards. Quite com-
It is not known why powerful impres- alence characterizes their relations with monly, they would be seen only when
sions of personality traits, such as they arrived and departed, with the re-
"crazy" or "insane," arise. Conceivably, psychiatric patients, such that their maining time being spent in their offices
when the origins of and stimuli that avowed impulses are only part of their or in the cage. On the average, physi-
give rise to a behavior are remote or entire attitude. Negative attitudes are cians emerged on the ward 6.7 times
unknown, or when the behavior strikes there too and can easily be detected. per day (range, 1 to 17 times). It
Such attitudes should not surprise us. proved difficult to make an accurate
us as immutable, trait labels regarding They are the natural offspring of the estimate in this regard, since physicians
the behaver arise. When, on the other labels patients wear and the places in often maintained hours that allowed
which they are found.
hand, the origins and stimuli are known them to come and go at different times.
and available, discourse is limited to Consider the structure of the typical The hierarchical organization of the
the behavior itself. Thus, I may hallu- psychiatric hospital. Staff and patients
cinate because I am sleeping, or I may are strictly segregated. Staff have their psychiatric hospital has been com-
hallucinate because I have ingested a own living space, including their dining mented on before (20), but the latent
peculiar drug. These are termed sleep- facilities, bathrooms, and assembly
induced hallucinations, or dreams, and places. The glassed quarters that con- meaning of that kind of organization is
tain the professional staff, which the worth noting again. Those with the
drug-induced hallucinations, respective- pseudopatients came to call "the cage,"
ly. But when the stimuli to my hallu- sit out on every dayroom. The staff SCIENCE, VOL. 179
cinations are unknown, that is called emerge primarily for caretaking pur-
craziness, or schizophrenia-as if that poses-to give medication, to conduct a
inference were somehow as illuminating therapy or group meeting, to instruct or
reprimand a patient. Otherwise, staff
as the others.

254

Table 1. Self-initiated contact by pseudopatients with psychiatrists and nurses and attendants, compared to contact with other groups.

PsychiaPtrsiycchhioastpritcals University campus University medical center
-_____________ ((nnoonnmmeeddiciacla)l) Physicians

Contact (2) Fa(p(33s)y)lchiatrist""Look((4i4n))g for a ((55))

(1) Nurses "Looking for No ad(6di)tional

()Psychiatrs aNurses an internist" comment

Pasttyecnadaattnetnsdants

Responses 71 88 00 00
Moves on, head averted (%)
Makes eye contact (%) 23 10 0 11 00
Pauses and chats (%)
Stops and talks (%) 2 2 0 11 0 10
4 0.5 100 78 100 90
Mean number of questions
answered (out of 6) ** 6 3.8 4.8 4.5
13 47 14 18 15 10
Respondents (No.) 185 1283 14 18 15 10
Attempts (No.)

* Not applicable.

most power have least to do with pa- ritated. In examining these data, re- school: ". .. to the medical school?").
tients, and those with the least power member that the behavior of the 5) "Is it difficult to get in?"
are most involved with them. Recall, 6) "Is there financial aid?"
pseudopatients was neither bizarre nor
however, that the acquisition of role- Without exception, as can be seen in
appropriate behaviors occurs mainly disruptive. One could indeed engage in Table 1 (column 3), all of the questions
good conversation with them. were answered. No matter how rushed
through the observation of others, with
The data for these experiments are they were, all respondents not only
the most powerful having the most in- shown in Table 1, separately for physi- maintained eye contact, but stopped to
fluence. Consequently, it is understand- cians (column 1) and for nurses and talk. Indeed, many of the respondents
able that attendants not only spend attendants (column 2). Minor differ- went out of their way to direct or take
more time with patients than do any the questioner to the office she was
other members of the staff-that is re- ences between these four institutions seeking, to try to locate "Fish Annex,"
or to discuss with her the possibilities
quired by their station in the hierarchy were overwhelmed by the degree to of being admitted to the university.
-but also, insofar as they learn from which staff avoided continuing contacts
their superiors' behavior, spend as little that patients had initiated. By far, their Similar data, also shown in Table 1
time with patients as they can. Attend- most common response consisted of (columns 4, 5, and 6), were obtained
ants are seen mainly in the cage, which either a brief response to the question, in the hospital. Here too, the young
is where the models, the action, and offered while they were "on the move" lady came prepared with six questions.
the power are. and with head averted, or no response After the first question, however, she
at all. remarked to 18 of her respondents
I turn now to a different set of (column 4), "I'm looking for a psy-
The encounter frequently took the chiatrist," and to 15 others (column
studies, these dealing with staff re- following bizarre form: (pseudopatient) 5), "I'm looking for an internist." Ten
sponse to patient-initiated contact. It "Pardon me, Dr. X. Could you tell me other respondents received no inserted
has long been known that the amount when I am eligible for grounds priv- comment (column 6). The general de-
of time a person spends with you can ileges?" (physician) "Good morning, gree of cooperative responses is con-
be an index of your significance to him. Dave. How are you today?" (Moves off siderably higher for these university
If he initiates and maintains eye con- without waiting for a response.) groups than it was for pseudopatients
tact, there is reason to believe that he in psychiatric hospitals. Even so, differ-
It is instructive to compare these ences are apparent within the medical
is considering your requests and needs. data with data recently obtained at school setting. Once having indicated
If he pauses to chat or actually stops Stanford University. It has been alleged that she was looking for a psychiatrist,
and talks, there is added reason to infer that large and eminent universities are the degree of cooperation elicited was
less than when she sought an internist.
that he is individuating you. In four characterized by faculty who are so
hospitals, the pseudopatient approached busy that they have no time for stu- Powerlessness and Depersonalization
the staff member with a request which dents. For this comparison, a young
took the following form: "Pardon me, lady approached individual faculty mem- Eye contact and verbal contact re-
Mr. [or Dr. or Mrs.] X, could you tell bers who seemed to be walking pur- flect concern and individuation; their
me when I will be eligible for grounds posefully to some meeting or teaching absence, avoidance and depersonaliza-
privileges?" (or " . . . when I will be engagement and asked them the fol- tion. The data I have presented do not
do justice to the rich daily encounters
presented at the staff meeting?" or ". . . lowing six questions. that grew up around matters of deper-
when I am likely to be discharged?"). 1) "Pardon me, could you direct me sonalization and avoidance. I have rec-
While the content of the question varied ords of patients who were beaten by
according to the appropriateness of the to Encina Hall?" (at the medical staff for the sin of having initiated ver-
target and the pseudopatient's (appar- school: ". . . to the Clinical Research
ent) current needs the form was al- 255
Center?").
ways a courteous and relevant request
for information. Care was taken never 2) "Do you know where Fish Annex
to approach a particular member of the
staff more than once a day, lest the is?" (there is no Fish Annex at Stan-
staff member become suspicious or ir-
ford).
19 JANUARY 1973
3) "Do you teach here?"
4) "How does one apply for admis-
sion to the college?" (at the medical

bal contact. During my own experience, down. Abusive behavior, on the other psychotherapy with other patients-all
for example, one patient was beaten in of this as a way of becoming a person
the presence of other patients for hav- hand, terminated quite abruptly when in an impersonal environment.
ing approached an attendant and told other staff members were known to be
him, "I like you." Occasionally, punish- The Sources of Depersonalization
ment meted out to patients for misde- coming. Staff are credible witnesses.
meanors seemed so excessive that it What are the origins of depersonali-
Patients are not. zation? I have already mentioned two.
could not be justified by the most radi- First are attitudes held by all of us
cal interpretations of psychiatric canon. A nurse unbuttoned her uniform to toward the mentally ill-including those
Nevertheless, they appeared to go un- who treat them-attitudes character-
questioned. Tempers were often short. adjust her brassiere in the presence of
A patient who had not heard a call for an entire ward of viewing men. One did ized by fear, distrust, and horrible ex-
medication would be roundly excori- not have the sense that she was being pectations on the one hand, and benev-
ated, and the morning attendants would olent intentions on the other. Our
often wake patients with, "Come on, seductive. Rather, she didn't notice us.
you m-----f-----s, out of bed!" ambivalence leads, in this instance as
A group of staff persons might point to in others, to avoidance.
Neither anecdotal nor "hard" data a patient in the dayroom and discuss
him animatedly, as if he were not there. Second, and not entirely separate,
can convey the overwhelming sense of the hierarchical structure of the psy-
powerlessness which invades the indi- One illuminating instance of deper- chiatric hospital facilitates depersonali-
vidual as he is continually exposed to sonalization and invisibility occurred zation. Those who are at the top have
the depersonalization of the psychiatric least to do with patients, and their be-
hospital. It hardly matters which psy- with regard to medications. All told, havior inspires the rest of the staff.
chiatric hospital-the excellent public the pseudopatients were administered Average daily contact with psychia-
ones and the very plush private hospital nearly 2100 pills, including Elavil, trists, psychologists, residents, and
were better than the rural and shabby Stelazine, Compazine, and Thorazine, physicians combined ranged from 3.9
ones in this regard, but, again, the to name but a few. (That such a variety to 25.1 minutes, with an overall mean
features that psychiatric hospitals had of 6.8 (six pseudopatients over a total
in common overwhelmed by far their of medications should have been ad- of 129 days of hospitalization). In-
apparent differences. cluded in this average are time spent
ministered to patients presenting identi- in the admissions interview, ward meet-
Powerlessness was evident every- cal symptoms is itself worthy of note.) ings in the presence of a senior staff
where. The patient is deprived of many Only two were swallowed. The rest member, group and individual psycho-
of his legal rights by dint of his psy- were either pocketed or deposited in therapy contacts, case presentation con-
chiatric commitment (21). He is shorn the toilet. The pseudopatients were not ferences, and discharge meetings.
alone in this. Although I have no pre- Clearly, patients do not spend much
of credibility by virtue of his psychiatric time in interpersonal contact with doc-
label. His freedom of movement is re- cise records on how many patients toral staff. And doctoral staff serve as

stricted. He cannot initiate contact with rejected their medications, the pseudo- models for nurses and attendants.
patients frequently found the medica-
the staff, but may only respond to such tions of other patients in the toilet There are probably other sources.
overtures as they make. Personal pri- before they deposited their own. As Psychiatric installations are presently in
vacy is minimal. Patient quarters and long as they were cooperative, their serious financial straits. Staff shortages
possessions can be entered and ex- behavior and the pseudopatients' own are pervasive, staff time at a premium.
amined by any staff member, for what- in this matter, as in other important Something has to give, and that some-
ever reason. His personal history and thing is patient contact. Yet, while
anguish is available to any staff member matters, went unnoticed throughout. financial stresses are realities, too much
(often including the "grey lady" and Reactions to such depersonalization can be made of them. I have the im-
"candy striper" volunteer) who chooses
to read his folder, regardless of their among pseudopatients were intense. Al- pression that the psychological forces
therapeutic relationship to him. His per- though they had come to the hospital that result in depersonalization are
sonal hygiene and waste evacuation are as participant observers and were fully much stronger than the fiscal ones and
often monitored. The water closets may aware that they did not "belong," they that the addition of more staff would
have no doors. nevertheless found themselves caught
not correspondingly improve patient
At times, depersonalization reached up in and fighting the process of de- care in this regard. The incidence of
such proportions that pseudopatients personalization. Some examples: a grad- staff meetings and the enormous
had the sense that they were invisible, uate student in psychology asked his amount of record-keeping on patients,
or at least unworthy of account. Upon wife to bring his textbooks to the hos- for example, have not been as sub-
being admitted, I and other pseudo- pital so he could "catch up on his stantially reduced as has patient con-
patients took the initial physical exami- homework"-this despite the elaborate tact. Priorities exist, even during hard
nations in a semipublic room, where precautions taken to conceal his profes- times. Patient contact is not a signifi-
staff members went about their own sional association. The same student, cant priority in the traditional psychia-
tric hospital, and fiscal pressures do not
business as if we were not there. who had trained for quite some time account for this. Avoidance and de-
to get into the hospital, and who had
On the ward, attendants delivered looked forward to the experience, "re- personalization may.
verbal and occasionally serious physical membered" some drag races that he Heavy reliance upon psychotropic
abuse to patients in the presence of had wanted to see on the weekend and
other observing patients, some of whom SCIENCE. VOL. 179
(the pseudopatients) were writing it all insisted that he be discharged by that

256 time. Another pseudopatient attempted
a romance with a nurse. Subsequently,
he informed the staff that he was ap-

plying for admission to graduate school
in psychology and was very likely to be
admitted, since a graduate professor
was one of his regular hospital visitors.
The same person began to engage in

medication tacitly contributes to deper- same consequences it does in medical textual stimuli that often promote them.
sonalization by convincing staff that diagnosis. A diagnosis of cancer that At issue here is a matter of magnitude.
treatment is indeed being conducted has been found to be in error is cause And, as I have shown, the magnitude
and that further patient contact may of distortion is exceedingly high in the
not be necessary. Even here, however, for celebration. But psychiatric diag- extreme context that is a psychiatric
caution needs to be exercised in under- noses are rarely found to be in error.
The label sticks, a mark of inadequacy hospital.)
standing the role of psychotropic drugs. forever. The second matter that might prove
If patients were powerful rather than
powerless, if they were viewed as inter- Finally, how many patients might be promising speaks to the need to in-
esting individuals rather than diagnostic "sane" outside the psychiatric hospital crease the sensitivity of mental health
entities, if they were socially significant but seem insane in it-not because workers and researchers to the Catch
rather than social lepers,. if their an-
guish truly and wholly compelled our craziness resides in them, as it were, 22 position of psychiatric patients.
sympathies and concerns, would we but because they are responding to a Simply reading materials in this area
not seek contact with them, despite the bizarre setting, one that may be unique will be of help to some such workers
availability of medications? Perhaps for to institutions which harbor nether and researchers. For others, directly
the pleasure of it all?
people? Goffman (4) calls the process experiencing the impact of psychiatric
The Consequences of Labeling of socialization to such institutions hospitalization will be of enormous use.
Clearly, further research into the social
and Depersonalization "mortification"-an apt metaphor that
includes the processes of depersonali- psychology of such total institutions
Whenever the ratio of what is known zation that have been described here. will both facilitate treatment and
to what needs to be known approaches
zero, we tend to invent "knowledge" And while it is impossible to know deepen understanding.
and assume that we understand more whether the pseudopatients' responses I and the other pseudopatients in the
to these processes are characteristic of
than we actually do. We seem unable all inmates-they were, after all, not psychiatric setting had distinctly nega-
to acknowledge that we simply don't real patients-it is difficult to believe tive reactions. We do not pretend to
know. The needs for diagnosis and that these processes of socialization to describe the subjective experiences of
remediation of behavioral and emo- a psychiatric hospital provide useful true patients. Theirs may be different
attitudes or habits of response for liv- from ours, particularly with the pas-
tional problems are enormous. But ing in the "real world." sage of time and the necessary process
rather than acknowledge that we are of adaptation to one's environment. But
just embarking on understanding, we Summary and Conclusions we can and do speak to the relatively
continue to label patients "schizo- more objective indices of treatment
phrenic," "manic-depressive," and "in- It is clear that we cannot distinguish within the hospital. It could be a mis-
sane," as if in those words we had the sane from the insane in psychiatric take, and a very unfortunate one, to
captured the essence of understanding. hospitals. The hospital itself imposes a consider that what happened to us de-
The facts of the matter are that we special environment in which the mean- rived from malice or stupidity on the
ings of behavior can easily be misunder- part of the staff. Quite the contrary,
have known for a long time that diag- stood. The consequences to patients our overwhelming impression of them
noses are often not useful or reliable, hospitalized in such an environment- was of people who really cared, who
but we have nevertheless continued to the powerlessness, depersonalization, were committed and who were uncom-
segregation, mortification, and self-
use them. We now know that we can- labeling-seem undoubtedly counter- monly intelligent. Where they failed,
therapeutic. as they sometimes did painfully, it
not distinguish insanity from sanity. It would be more accurate to attribute
is depressing to consider how that in- I do not, even now, understand this
formation will be used. problem well enough to perceive solu- those failures to the environment in
tions. But two matters seem to have
Not merely depressing, but frighten- some promise. The first concerns the which they, too, found themselves than
ing. How many people, one wonders, proliferation of community mental to personal callousness. Their percep-
are sane but not recognized as such in health facilities, of crisis intervention tions and behavior were controlled by
our psychiatric institutions? How many centers, of the human potential move- the situation, rather than being moti-
have been needlessly stripped of their ment, and of behavior therapies that, vated by a malicious disposition. In a
privileges of citizenship, from the right for all of their own problems, tend to more benign environment, one that was
to vote and drive to that of handling avoid psychiatric labels, to focus on less attached to global diagnosis, their
their own accounts? How many have specific problems and behaviors, and to behaviors and judgments might have
feigned insanity in order to avoid the retain the individual in a relatively non- been more benign and effective.
criminal consequences of their behav- pejorative environment. Clearly, to the
ior, and, conversely, how many would extent that we refrain from sending the References and Notes
rather stand trial than live interminably distressed to insane places, our impres-
in a psychiatric hospital-but are sions of them are less likely to be dis- 1. P. Ash, J. Abnorm. Soc. Psychol. 44, 272
wrongly thought to be mentally ill? torted. (The risk of distorted percep- (1949); A. T. Beck, Amer. J. Psychiat. 119,
How many have been stigmatized by tions, it seems to me, is always present, 210 (1962); A. T. Boisen, Psychiatry 2, 233
well-intentioned, but nevertheless erro- since we are much more sensitive to an (1938); N. Kreitman, J. Ment. Sci. 107, 876
neous, diagnoses? On the last point, individual's behaviors and verbaliza- (1961); N. Kreitman, P. Sainsbury, J. Morrisey,
recall again that a "type 2 error" in tions than we are to the subtle con- J. Towers, J, Scrivener, ibid., p. 887; H. O.
psychiatric diagnosis does not have the Schmitt and C. P. Fonda, J. Abnorm. Soc.
Psychol. 52, 262 (1956); W. Seeman, J. Nerv.
19 JANUARY 1973 Ment. Dis. 118, 541 (1953). For an analysis
of these artifacts and summaries of the dis-
putes, see J. Zubin, Annu. Rev. Psychol. 18,
373 (1967); L. Phillips and J. G.
ibid. 22, 447 (1971). Draguns,

2. R. Benedict, J. Gen. Psychol. 10, 59 (1934).
3. See in this regard H. Becker, Outsiders:

Studies in the Sociology of Deviance (Free
Press, New York, 1963); B. M. Braginsky,

257

D. D. Braginsky, K. Ring, Methods of state law to the contrary notwithstanding. I H. E. Freeman and 0. G. Simmons, The
Madness: The Mental Hospital as a Last was not sensitive to these difficulties at the Mental Patient Comes Home (Wiley, New
Resort (Holt, Rinehart & Winston, New York, 1963); W J. Johannsen, Ment. Hygiene
York, 1969); G. M. Crocetti and P. V. outset of the project, nor to the personal and 53, 218 (1969); A. S. Linsky, Soc. Psychiat. 5,
Lemkau, Amer. Sociol. Rev. 30, 577 (1965); situational emergencies that can arise, but 166 (1970).
E. Goffman, Behavior in Public Places (Free
later a writ of habeas corpus was prepared 13. S. E. Asch, J. Abnorm. Soc. Psychol. 41, 258
Press, New York, 1964); R. D. Laing, The. for each of the entering pseudopatients and (1946); Social Psychology (Prentice-Hall, New
Divided Self: A Study of Sanity and Madness an attorney was kept "on call" during every
(Quadrangle, Chicago, 1960); D. L. Phillips, hospitalization. I am grateful to John Kaplan York, 1952).
Amer. Sociol. Rev. 28, 963 (1963); T. R. and Robert Bartels for legal advice and
Sarbin, Psychol. Today 6, 18 (1972); E. Schur, 14. See also I. N. Mensh and J. Wishner, J.
Amer. I. Sociol. 75, 309 (1969); T. Szasz, assistance in these matters. Personality 16, 188 (1947); J. Wishner,
Law, Liberty and Psychiatry (Macmillan, Psychol. Rev. 67, 96 (1960); J. S. Bruner and
New York, 1963); The Myth of Mental Illness: 9. However distasteful such concealment is, it R. Tagiuri, in Handbook of Social Psychology,
Foundations of a Theory of Mental Illness was a necessary first step to examining these G. Lindzey, Ed. (Addison-Wesley, Cambridge,
Mass., 1954), vol. 2, pp. 634-654; J. S. Bruner,
(Hoeber Harper, New York, 1963). For a questions. Without concealment, there would D. Shapiro, R. Tagiuri, in Person Perception
critique of some of these views, see W. R. have been no way to know how valid these and Interpersonal Behavior, R. Tagiuri and
Gove, Amer. Sociol. Rev. 35, 873 (1970). L. Petrullo, Eds. (Stanford Univ. Press, Stan-
4. E. Goffman, Asylums (Doubleday, Garden experiences were; nor was there any way of
knowing whether whatever detections oc- ford, Calif., 1958), pp. 277-288.
City, N.Y., 1961). 15. For an example of a similar self-fulfilling
curred were a tribute to the diagnostic
5. T. J. Scheff, Being Mentally Ill: A Sociologi- acumen of the staff or to the hospital's prophecy, in this instance dealing with the
cal Theory (Aldine, Chicago, 1966). rumor network. Obviously, since my con- "central" trait of intelligence, see R. Rosen-
cerns are general ones that cut across indi- thal and L. Jacobson, Pygmalion in the
6. Data from a ninth pseudopatient are not vidual hospitals and staffs, I have respected Classroom (Holt, Rinehart & Winston, New
their anonymity and have eliminated clues York, 1968).
incorporated in this report because, although that might lead to their identification.
16. E. Zigler and L. Phillips, J. Abnorm. Soc.
his sanity went undetected, he falsified aspects 10. Interestingly, of the 12 admissions, 11 were Psychol. 63, 69 (1961). See also R. K.
of his personal history, including his marital diagnosed as schizophrenic and one, with the Freudenberg and J. P. Robertson, A.M.A.
identical symptomatology, as manic-depressive Arch. Neurol. Psychiatr. 76, 14 (1956).
status and parental relationships. His experi- psychosis. This diagnosis has a more favorable
mental behaviors therefore were not identical prognosis, and it was given by the only 17. W. Mischel, Personality and Assessment
private hospital in our sample. On the rela- (Wiley, New York, 1968).
to those of the other pseudopatients. tions between social class and psychiatric
7. A. Barry, Bellevue Is a State of Mind (Har- diagnosis, see A. deB. Hollingshead and 18. The most recent and unfortunate instance of
F. C. Redlich, Social Class and Mental Illness: this tenet is that of Senator Thomas Eagleton.
court Brace Jovanovich, New York, 1971); A Community Study (Wiley, New York,
I. Belknap, Human Problems of a State Mental 1958). 19. T. R. Sarbin and J. C. Mancuso, J. Clin.
Hospital (McGraw-Hill, New York, 1956); Consult. Psychol. 35, 159 (1970); T. R. Sarbin,
W. Caudill, F. C. Redlich, H. R. Gilmore, 11. It is possible, of course, that patients have ibid. 31, 447 (1967); J. C. Nunnally, Jr.,
E. B. Brody, Amer. J. Orthopsychiat. 22, 314 Popular Conceptions of Mental Health (Holt,
(1952); A. R. Goldmnan, R. H. Bohr, T. A. qui'te broad latitudes in diagnosis and there- Rinehart & Winston, New York, 1961).
Steinberg, Prof. Psychol. 1, 427 (1970); un- fore are inclined to call many people sane, even
authored, Roche Report 1 (No. 13), 8 those whose behavior is patently aberrant. 20. A. H. Stanton and M. S. Schwartz, The
However, although we have no hard data on Mental Hospital: A Study of Institutional
(1971). this matter, it was our distinot impression that Participation in Psychiatric Illness and Treat-
this was not the case. In many instances, ment (Basic, New York, 1954).
8. Beyond the personal difficulties that the patients not only singled us out for attention,
pseudopatient is likely to experience in the but came to imitate our behaviors and styles. 21. D. B. Wexler and S. E. Scoville, Ariz. Law
hospital, there are legal and social ones that, Rev. 13, 1 (1971).
combined, require considerable attention be- 12. J. Cumming and E. Cumming, Community
fore entry. For example, once admitted to a Ment. Health 1, 135 (1965); A. Farina and 22. I thank W. Mischel, E. Ome, and M. S.
K. Ring, J. Abnorm. Psychol. 70, 47 (1965); Rosenhan for comments on an earlier draft
psychiatric institution, it is difficult, if not
of this manuscript.
impossible, to be discharged on short notice,

NEWS AND COMMENT strumental in arousing the association's
interest in the herbicide issue several
AAAS Council Meeting: Vietnam
Resolutions; B7 y/ laws Voted years ago.
During a brief debate, the resolution
In an unprecedented expression of ship of the AAAS to elect it. The
political sentiment, the governing coun- AAAS thereby completed what former was modified slightly at the suggestion
cil of AAAS adopted a strongly worded chairman of the board Mina Rees and of Lewis M. Branscomb, the former
resolution in its business meeting of 30 head of the National Bureau of Stan-
December condemning the United chief executive officer William Bevan dards and now the IBM Corporation's
States' continued involvement in the chief scientist. Branscomb urged that
called "a major step toward becoming two critical references to U.S. military
Vietnam war and the application of a genuine membership organization." activity in Thailand be deleted, on the
American science and technology to grounds that the American presence
the "wanton destruction of man and The council's antiwar resolution was there was not analogous to U.S. involve-
ment in Vietnam. The council con-
environment." the first in which the AAAS has taken sented, and the midified resolution car-
The council passed a second war- ried by a vote of 80 to 41 with a large
an unqualified stand in opposition to but uncertain number of abstentions,
related resolution urging Congress to U.S. military involvement in Vietnam. including those of Glenn Seaborg, the
support a major study, by the Na- Past councils have limited themselves former chairman of the Atomic Energy
tional Academy of Sciences, of the Commission, and others seated at the
war's impact on the people and the to expressions of "concern," particular- dais. Only about 170 of the council's
environment of Indochina. At the same ly about the adverse effects of defoli- approximately 530 members were pres-
time, the council in effect voted its ants. ent.
own termination by approving a new
and much-discussed set of bylaws that This year's bluntly phrased resolution The full text of the resolution is as
will drastically reduce the size of the was introduced as an "emergency mo- follows:
council and allow the general member- tion" by seven council delegates, includ-
ing Everett Mendelsohn, a Harvard The Council of the AAAS condemns
258 historian of science and a AAAS vice the United States' continued participation
president, and E. W. Pfeiffer, a Univer- in the war in Vietnam, heightened in
sity of Montana zoologist who was in- the post-election bombing escalation.

As scientists we cannot remain silent

SCIENCE, VOL. 179