Sanity and insanity: definitions and distinctions

¶ … Sane

Sanity and insanity

"on being sane in insane places:"

Challenges to the convention definitions of what constitutes sanity and insanity

David L. Rosenhan's 1973 study "On being sane in insane places" was designed to question the seemingly secure divide within our culture between sanity and insanity. To illustrate the subjective nature of insanity, Rosenhan arranged for eight pseudopatients representing relatively broad demographic groups to claim they heard voices. After being committed, they comported themselves as normal within their respective insane asylums. The patients were instructed to get out using their own devices, and all tried to behave as sanely as possible, and to be cooperative and accommodating. None were detected as posers and all were discharged with a diagnosis of schizophrenia in remission. The assumption that the patients were insane colored the perceptions of the staff.

Interestingly, the hospital patients immediately detected that the pseudopatients were sane, and said the pseudopatients were journalists or some other type of person checking up on the hospital. The fact that the actual patients detected a distinct difference between themselves and others, however, raises a question: clearly, there did seem to be some difference between the persons who had engineered their place in the asylum vs. those who had not. But what this difference was, precisely, no staff member could detect. None of the staff diagnosed the pseudopatients, reflecting what Rosenhan calls a 'Type 2' bias -- amongst medical professionals, it is far more common to assume that a sane person is insane or a healthy person is sick than vice versa. Patient outbursts were attributed to insanity, not to legitimate grievances and patients who wrote down information were said to be engaging 'writing behavior' rather than in a meaningful activity. Boredom likewise was pathologized, even though there was little to do on the ward. The label of 'insanity' is such a powerful one; it overwhelms all other characteristics of the person.

Patients experienced a sense of 'depersonalization' based upon their lack of power on the ward. Doctors and nurses often acted as if they were not there and ignored their concerns. This depersonalization can contribute to the frustrations that are often deemed to be a 'natural' part of the supposedly insane person's condition. Treated as a non-person, and subjected to the stressors of incarceration such as boredom, they began to exhibit more and more symptoms. This further underlines the notion of the fine line between sanity and insanity.

The hospital creates a context where sanity and insanity cannot be distinguished, and therefore, Rosenhan implies, little effective treatment seems feasible of the supposedly insane under these conditions. If the difference between pathological and normal behavior cannot be distinguished, based upon the assumptions of the staff, how can they know in a meaningful way when a person should be released, when someone is a danger to himself or others, or when the patient's grievances are legitimate vs. illegitimate against staff members?