01/23/2024
On Being Sane In Insane Places
David L. Rosenhan*
How do we know precisely what constitutes “normality” or mental illness? Conventional wisdom suggests
that specially trained professionals have the ability to make reasonably accurate diagnoses. In this
research, however, David Rosenhan provides evidence to challenge this assumption. What is -- or is not -
- “normal” may have much to do with the labels that are applied to people in particular settings.
If sanity and insanity exist, how shall we know them?
The question is neither capricious nor itself insane. However much we may be personally
convinced that we can tell the normal from the abnormal, the evidence is simply not compelling. It is
commonplace, for example, to read about murder trials wherein eminent psychiatrists for the defense are
contradicted by equally eminent psychiatrists for the prosecution on the matter of the defendant’s sanity.
More generally, there are a great deal of conflicting data on the reliability, utility, and meaning of such
terms as “sanity,” “insanity,” “mental illness,” and “schizophrenia.” Finally, as early as 1934, {Ruth}
Benedict suggested that normality and abnormality are not universal.[1] What is viewed as normal in one
culture may be seen as quite aberrant in another. Thus, notions of normality and abnormality may not be
quite as accurate as people believe they are.
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. Nor does raising such
questions deny the existence of the personal anguish that is often associated with “mental illness.” Anxiety
and depression exist. Psychological suffering exists. But normality and abnormality, sanity and insanity,
and the diagnoses that flow from them may be less substantive than many believe them to be.
At its heart, the question of whether the sane can be distinguished from the insane (and whether
degrees of insanity can be distinguished from each other) is a simple matter: Do the salient characteristics
that lead to diagnoses reside in the patients themselves or in the environments and contexts in which
observers find them? From Bleuler, through Kretchmer, through the formulators of the recently revised
Diagnostic and Statistical Manual of the American Psychiatric Association, the belief has been strong that
patients present symptoms, that those symptoms can be categorized, and, implicitly, that the sane are
distinguishable from the insane. More recently, however, this belief has been questioned. Based in part on
theoretical and anthropological considerations, but also on philosophical, legal, and therapeutic ones, 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
observers and are not valid summaries of characteristics displayed by the observed.
