On Being Sane in Insane Places

“Pseudopatient” is the term Rosenhan uses to describe the individuals who pretended to have a mental illness for the purpose of his study. The concept of the pseudopatient—that is, the assumption that certain people are “really” mentally healthy—is central to the experiment, as it serves to test the legitimacy of psychiatric diagnoses and the hospital environment’s response to mental illness. Rosenhan argues that the pseudopatients’ persistent misdiagnosis exposes the flaws and biases in psychiatric practices and The Unreliability of Psychiatric Diagnoses.

“Sanity” is a loosely defined term; in popular parlance, it refers to the state of being mentally healthy, but it has no clinical definition. This ambiguity takes on added significance in light of Rosenhan’s study, which questions the ability of psychiatric institutions to differentiate between “sanity” and “insanity” and highlights the power dynamics at play in such designations.

Schizophrenia is a chronic and severe mental health condition involving psychosis—i.e., confusion regarding what is real and what is not. Common symptoms include hallucinations, delusions, and changes in socialization and emotion. Schizophrenia is a significant term in the study, as it is the diagnosis given to nearly all the pseudopatients despite the feigned nature of their symptoms and their subsequent “normal” behavior. This highlights the longevity of psychiatric labels, including potentially incorrect ones. As a particularly stigmatizing condition (and one with a relatively poor prognosis), schizophrenia also reminds readers of how such a label can lead to a distorted view of the individual who receives it.

A self-fulfilling prophecy is a psychological phenomenon where a person’s belief or expectation influences their behavior in such a way that it causes the belief or expectation to come true. Rosenhan references self-fulfilling prophecies when discussing how a false belief about mental disorder can leads to its own reality: “Eventually, the patient himself accepts the diagnosis, with all of its surplus meanings and expectations, and behaves accordingly” (254). Similarly, the diagnosis of schizophrenia becomes a self-fulfilling prophecy for hospital staff in Rosenhan’s study, as their expectations lead them to find evidence of the illness regardless of its actual presence.

In the context of social behavior and attitudes, stigma refers to a mark of disgrace attached to a person, often due to a particular characteristic, quality, or condition. It involves negative stereotypes and prejudicial attitudes that separate a person or group from society or societal norms. Rosenhan’s study explores stigma in depth as it examines the negative consequences of psychiatric labels on individuals. The term encourages examination of the social and personal implications of mental health diagnoses, including societal discrimination and the internalization of negative stereotypes, which can have profound effects on an individual’s life and self-perception.