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On Being Sane in Insane Places
D. L. Rosenhan
Science
, New Series, Vol. 179, No. 4070. (Jan. 19, 1973), pp. 250-258.
Stable URL:http://links.jstor.org/sici?sici=0036-8075%2819730119%293%3A179%3A4070%3C250%3AOBSIIP%3E2.0.CO%3B2-Z
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The Geographical Distribution of Animals
(Wiley, New York, 1957); B. Rensch,
Evolu-tion Above the Species Level
(Methuen.London, 1959); V. Grant,
The Origin ofAdaptations
(Columbia Univ. Press, NewYork. 1963).
5.
S. Wright.
Genetics
16, 97 (1931).6.
----,
ibid.
28, 114 (1943);
ibid.
31, 39(1946);
Evolution and the Genetics of Popu-lations,
vol. 2,
The Theory of Gene Fre.quencies
(Univ. of Chicago Press, Chicago.1969);
F.
J. Rohlf and G. D. Schnell,
Atrler.Natur.
105. 295 (1971).7. J.
B.
S. Haldane.
I.
Genet.
48,
277 (1948).8. R. A. Fisher,
Biomerrics
6, 353 (1950);
M.
Kimura,
Annu. Rep. Not. Inst. Genet.Mishima-City, Japan
9. 84 (1958).9. M. Kimura and G. H. Weiss,
Genetics
49,561 (1964);
M.
Kimura and
T.
Maruyama,
Genet. Res.
18, 125 (1971).10.
P.
R. Ehrlich and P. H. Raven,
Science
165,1228 (1969).11. For example, J. Maynard-Smith,
Amer. Natur.
100. 637 (1966).12. J.
M.
Thoday,
Nature
181, 1124 (1958);
-
nd
T.
B. Boam,
Heredity
13, 204 (1959);
E.
M~llicent and J. M. Thoday,
lbid.
16, 219(1961);
J.
M. Thoday and J. B. Gibson.
Amer.Natur.
105, 86 (1971).13.
F.
A. Streams and D. Pimentel,
ibid.
95, 201(1961); Th. Dobzhansky and B. Spassky,
Proc.Roy. Soc. London Ser.
B.
168,
27 (1967);
-
J. Sved.
ibid.
173, 191 (1969);
Ih.
Dobzhansky, H. Levene, B. Spassky,
ibid.
180,21 (1972).14. M. Slatkin, thesis, Harvard University (1971).15. S. K. Jain and
A.
D.
Bradshaw,
Herediry
21, 407 (1966).16. Parapatric divergence is divergence betweenadjacent but genetically continuous popula-tions. See
H.
M. Smith,
Syst. Zool.
11, 57(1965);
ibld.
18, 254 (1969); M.
J.
D. White,R. E. Blackith, R.
M.
Blackith, J. Cheney,
Aust. J. 2001.
15, 263 (1967); M.
J.
D.
White,
Science
159. 1065 (1968);
K.
H. L. Key,
Syst. 2001.
17, 14 (1968).17. J. S. Huxley,
Nature
142, 219 (1938);
Biidr.Dierk. Leiden
27, 491 (1939).18.
F.
B. Sumner,
Bihliogr. Genet.
9,
1 (1932).19.
F.
Salomonsen,
Dan. Biol. Medd.
9,
1(1955).20. E. B. Ford.
Biol. Rev. Cambridge Phil. Soc.
20, 73 (1945).21. Examples of morph-ratio clines include:H.
B.
D. Kettlewell and
R.
J.
Berry,
Heredity
16,
403 (1961);
ibld.
24,
1 (1969); H.
B.
D.
Kettlewell,
R.
J. Berry. C. J. Cadbury,G. C. Phillips,
ibid..
p.
IS; H. N. Southern,
J. Zoof. London Ser. A
138, 455 (1966):A. J. Cain and
J.
D.
Currey.
Phil. Trans.Roy. Soc. London Ser.
B.
246, 1 (1962);
A.
P.
Platt and
L.
P.
Brower,
Evolu-tion
22,
699 (1968);
0.
Halkka and
E.
Mikkola.
Hereditas
U,
140 (1965); B. C.Clarke, in
Evolution and Environment,
E. T.Drake, Ed. (Yale Univ. Press, New Haven,1968). p. 351; B. C. Clarke and J. J. Murray,in
Ecological Genetics and Evolution,
R.Greed,
Ed.
(Blackwells, Oxford, 1971). p.51; J. A. Bishop and P. S. Harper.
Hrrrdrty
25, 449 (1969); J. A. Bishop,
J. Anim. Ecol.
41. 209 (1972); G. Hewitt and F. M. Brown,
Heredity
25,
365 (1970); G. Hewin and
C.
Ruscoe,
J. Anim. Ecol.
40,
753
(1971);H. Wolda,
ibid.
38, 623 (1969); F. B. Living-stone.
Amer. J. Phys. Anthropol.
31. 1 (1969).22. C. P. Haskins. E. F. Haskins, J.
.I.
A.
McLaughlan,
K.
E. Hew~tt, in
VertebrateSpeciation,
W.
F.
Blair, Ed. (Univ. of TexasPress, Austin, 1961). p. 320.23. A. J. Bateman,
Heredity
1.
234, 303 (1947);
ibid.
4, 353 (1950); R.
N.
Colweil.
Amer.
J.
Bor.
38, 511 (1951);
M.
R. Roberts and
H.
Lewis,
Evolution
9,445(1955); C. P. Haskins,personal wmmunication;
K.
P. Lamb,
E.
Hassan,
D.
P. Swter,
Ecology
52, 178 (1971).For localized distribution and problem ofestablishment see also: W. F. Blair,
Ann.N.Y. Acad. Sci.
44,
179 (1943);
Evolution
4,
253 (1950); L.
R.
Dice,
Amer. Natur.
74. 289(1940); P. Lahine,
Evolution
20, 580 (1966);H. Lewis,
ibid.
7, 1 (1953): W.
Z.
Lidicker,personal communication;
J.
T.
Marshall, Jr.,
Condor
50, 193, 233 (1948);
R.
K. Sealander,
Amer. Zool.
10, 53 (1970); P. Voipio,
Ann.Zool. Fenn.
15, 1 (1952);
P.
K. Anderson,
Science
la, 177 (1964).24. N. W. Timofeeff-Ressovsky, in
The NewSystematics,
J.
S. Huxley, Ed. (Oxford Univ.Press, Oxford, 1940), p. 73.25. The null point
is
the position at whichselection changes over from favoring onetype to favoring another.26. J.
A.
Endler, in preparation.27. L.
M.
Cook,
Coeficients of Natural SeiPlection
(Hutchinson Univ. Library. Biological Sci-ences No. 153, London, 1971):
F.
B.
Living-stone.
Amer.
I.
Phys. Anthropol.
31, 1 (196%.28. W.
C.
Allee, A. E. Emerson,
0.
Park,
T.
Park,
K.
P.
Schmidt.
Principles
of
AnimalEcology
(Saunders, Philadelphia, 1949):
H.
C.Andrewartha and L. C. Blrch,
The Distribu-tion and Abundance of Animals
(Univ.
of
Chicago Press, Chicago, 1954); G. L. Clarke,
Elements
of
Ecology
(Wiley, New York,1954);
R.
Geiger,
The Climate Near theGround
(translation, Harvard Univ. Press,Cambridge. 1966).29. Results for autosomal and sex-linked systemsdo not differ for the models to
be
discussed.except that. for a given amount of selection,the sex-linked system is
lass
sensitive
to
On Being Sane
in
Insane Places
If sanity and insanity exist, how shallwe know them?The question is neither capricious noritself insane. However much we maybe personally convinced that we cantell the normal from the abnormal, theevidence is simply not compelling. It iscommonplace, for example, to readabout murder trials wherein eminentpsychiatrists for the defense are con-
D.
L.
Rosenhantradicted by equally eminent psychia-trists for the prosecution on the matterof the defendant's sanity. More gen-erally, there are a great deal of conflict-ing data on the reliability, utility, andmeaning of such terms as "sanity," "in-sanity," "mental illness," and "schizo-phrenia"
(I).
Finally, as early as
1934,
Benedict suggested that normality andabnormality are not universal
(2).
the effects of gene flow.
This
is
because
the
effective gene selection on males in sex-linkedloci makes the
net
selection stronger, wm-pared to autosornal loci, for the population
as
a whole. See C.
C.
Li,
Population Genetics
(Univ. of Chicago Press. Chicago, 1955) fara good discussion of sex-linkage and selection.30. The equilibrium wnfigurations are not dg-nificantly altered if the emigrants from theend demes do not return, unless the numberof drmes
(4
is very small (J. A. Endler,unpublished data).31. See, for example, the models of B. C.Clarke
[Amer. Natur.
100,
389 (1966)l andthose in
(14).
32. This model incorporates Clarke's model offrequency-dependence: see B. C. Clarke,
Evoiution
111364 (1964).33.
R.
A. Fisher and
F.
Yates,
Statistical Tublesfor Biological, Asricultural, and Medical Re-search
(Oliver
&
Boyd, Edinburgh, 1948);R.
K.
Sokal and F. J. Rohlf,
Biometry
(Freeman, San Francisco, 1969).34. See, for example, C. G. Johnson,
Migrationund Dispersd of Insects by Fli~ht
Methuen,
I
ondon, 1969); J. Antonovics,
Arner. Sci.
59,593 (1971).35.
E.
C. Pielou,
An Introdrrction to MathematicalEcotom
(Wiley-Interscience, New York, 1969).36.
W.
F.
Blair,
Contrib. Lab. Vertebrate Biol.Univ. Mich.
No. 36. 1 (1947).37. P. A. Parsons,
Genetica
33, 184 (1963).38. G. Hewitt and
8.
John.
Chromosoma
21,
140 (1967);
Evolution
24. 169 (1970); G.Hewin. personal communication:
H.
Wolda,
I.
Anrm. Ecol.
38, 305, 623 (1969).39.
L.
R. Dice,
Contrib.
Lnh.
Vertebrate Genet.Unlv. Mich.
No.
8
(1939). p. 1;
ibid.
No. 15(1941). p. I.
40.
I.
C.
1.
Galbraith,
Bull. Brit.
Mus.
Natur.Hist. Zwl.
4,
133 (1956).41.
I
am
grateful to the Natmnal Science Founda-tion for a graduate fellowship
in
supportof this study.
I
thank Prof. Alan Robensonand the Institute of Animal Genetics, Uni-versity of Edinburgh, for the
Dmsophila,
andfor hndly providmg me with fresh mediumthroughout the study. Criticism of the manu-script by Professors John Bower and JanePotter, Dr. Philip Ashmole, Peter Tuft. Dr.David Noakes, Dr. John Godfrey, Dr. CarylP. Haskins, and
M.
C. Bathgate was verywelcome. In particular.
I
thank my supervisor,Professor Bryan C. Clarke, for help and criti-cism throughout this study. Any errors oromissions are entirely my own.
I
thank theEdinburgh Regional Computing Center andthe Edinburgh University Zoology Departmentfor generous computer time allowances.
I
willsupply the spec~ally written IMIP languageprogram upon request.
What is viewed as normal in one cul-ture may be seen as quite aberrant inanother. Thus, notions of normality andabnormality may not be quite as accu-rate as people believe they are.To raise questions regarding normal-ity and abnormality is in no way toquestion the fact that some behaviorsare deviant or odd. Murder is deviant.So, too, are hallucinations. Nor doesraising such questions deny the exis-tence of the personal anguish that isoften associated with "mental illness."Anxiety and depression exist. Psycho-logical suffering exists. But normalityand abnormality, sanity and insanity,and the diagnoses that flow from them
The author is professor of psychology and lawat Stanford University, Stanford. California 94305.Portions
of
these data were presented to wllo-quiums of the psychology departments at theUniversity of Cahfomia at Berkeley and at SantaBarbara: University of Arizona, Tucson: andHarvard University, Cambridge, Massachusetts.
SCIF.NCE,
VOL.
179
may be less substantive than many be-lieve them to be.At its heart, the question of whetherthe sane can be distinguished from theinsane (and whether degrees of insanitycan be distinguished from each other)is a simple matter: do the salient char-acteristics that lead to diagnoses residein the patients themselves or in the en-vironments and contexts in which ob-servers find them? From Bleuler,through Kretchmer, through the formu-lators of the recently revised
Diagnosticand Statistical Manual
of the AmericanPsychiatric Association, the belief hasbeen strong that patients present symp-toms, that those symptoms can be categorized, and, implicitly, that the saneare distinguishable from the insane.More recently, however, this belief hasbeen questioned. Based in part on theo-retical and anthropological considera-tions, but also on philosophical, legal,and therapeutic ones, the view hasgrown that psychological categorizationof mental illness is useless at best anddownright harmful, misleading, andpejorative at worst. Psychiatric diag-noses, in this view, are in the minds ofthe observers and are not valid sum-maries of characteristics displayed bythe observed
(3-5).
Gains can be made in deciding whichof these is more nearly accurate bygetting normal people (that is, peoplewho do not have, and have never suf-fered, symptoms of serious psychiatricdisorders) admitted to psychiatric hos-pitals and then determining whetherthey were discovered to be sane and, ifso, how. If the sanity of such pseudo-patients were always detected, therewould be prima facie evidence that asane individual can be distinguishedfrom the insane context in which he isfound. Normality (and presumably ab-normality) is distinct enough that itcan be recognized wherever it occurs,for it is carried within the person. If,on the other hand, the sanity of thepseudopatients were never discovered,serious difficulties would arise for thosewho support traditional modes of psy-chiatric diagnosis. Given that the hospi-tal staff was not incompetent, that thepseudopatient had been behaving assanely
as
he had been outside of thehospital, and that it had never beenpreviously suggested that he belongedin a psychiatric hospital, such an un-likely outcome would support the viewthat psychiatric diagnosis betrays littleabout the patient but much about theenvironment in which an observer findshim.This article describes such an experi-ment. Eight sane people gained secretadmission to 12 different hospitals
(6).
Their diagnostic experiences constitutethe data of the first part of this article;the remainder is devoted to a descrip-tion of their experiences in psychiatricinstitutions. Too few psychiatrists andpsychologists, even those who haveworked in such hospitals, know whatthe experience is like. They rarely talkabout it with former patients, perhapsbecause they distrust information com-ing from the previously insane. Thosewho have worked in psychiatric hospi-tals are likely to have adapted so thor-oughly to the settings that they areinsensitive to the impact of that expe-rience. And while there have been oc-casional reports of researchers whosubmitted themselves to psychiatric hos-pitalization
(7),
these researchers havecommonly remained in the hospitals forshort periods of time, often with theknowledge of the hospital staff. It isdifficult to know the extent to whichthey were treated like patients or likeresearch colleagues. Nevertheless, theirreports about the inside of the psychi-atric hospital have been valuable. Thisarticle extends those efforts.
Pseudopatients and
Their
Settings
The eight pseudopatients were avaried group. One was a psychologygraduate student in his 20's. The re-maining seven were older and "estab-lished." Among them were three psy-chologists, a pediatrician, a psychiatrist,a painter, and a housewife. Threepseudopatients were women, five weremen. All of them employed pseudo-nyms, lest their alleged diagnoses em-barrass them later. Those who were
in
mental health professions alleged an-other occupation in order to avoid thespecial attentions that might be ac-corded by staff, as a matter of courtesyor caution, to ailing colleagues
(8).
With the exception of myself (I was thefirst pseudopatient and my presence wasknown to the hospital administrator andchief psychologist and, so far as I cantell, to them alone), the presence ofpseudopatients and the nature of the re-search program was not known to thehospital staffs
(9).
The settings were similarly varied. Inorder to generalize the findings, admis-sion into a variety of hospitals wassought. The
12
hospitals in the samplewere located in five different states onthe East and West coasts. Some wereold and shabby, some were quite new.Some were research-oriented, othersnot. Some had good staff-patient ratios,others were quite understaffed. Onlyone was a strictly private hospital. Allof the others were supported by stateor federal funds or, in one instance, byuniversity funds.After calling the hospital for an ap-pointment, the pseudopatient arrived atthe admissions office complaining thathe had been hearing voices. Asked whatthe voices said, he replied that theywere often unclear, but as far as hecould tell they said "empty," "hollow,"and "thud." The voices were unfamiliarand were of the same sex
as
the pseudo-patient. The choice of these symptomswas occasioned by their apparent sim-ilarity to existential symptoms. Suchsymptoms are alleged to arise frompainful concerns about the perceivedmeaninglessness of one's life. It is as
if
the hallucinating person were saying,"My life
is
empty and hollow." Thechoice of these symptoms was also de-termined by the
absence
of
a
singlereport of existential psychoses in theliterature.Beyond alleging the symptoms andfalsifying name, vocation, and employ-ment, no further alterations of person,history, or circumstances were made.The significant events of the pseudo-patient's life history were presented asthey had actually occurred. Relation-ships with parents and siblings, withspouse and children, with people atwork and in school, consistent with theaforementioned exceptions, were de-scribed as they were or had been. Frus-trations and upsets were describedalong with joys and satisfactions. Thesefacts are important to remember. Ifanything, they strongly biased the sub-sequent results in favor of detectingsanity, since none of their histories orcurrent behaviors were seriously patho-logical in any way.Immediately upon admission to thepsychiatric ward, the pseudopatientceased simulating
any
symptoms of ab-normality. In some cases, there was abrief period of mild nervousness andanxiety, since none of the pseudopa-tients really believed that they would beadmitted so easily. Indeed, their sharedfear was that they would be immedi-ately exposed as frauds and greatlyembarrassed. Moreover, many of themhad never visited a psychiatric ward;even those who had, nevertheless hadsome genuine fears about what mighthappen to them. Their nervousness,then, was quite appropriate to the nov-
19
JANUARY
1973
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