1. Who’s Crazy Here, Anyway?
Julia Tomasson

2. Background David L. Rosenhan (1973) “Being sane in insane places”
Can we really distinguish between healthy and abnormal?
What are the consequences of the mistakes?
Is it the patients or the situations they are found in?
Professionals should be able to determine with criteria
‘Pseudopatients’ should be found healthy

3. Methods
8 subjects (including Rosenhan, 3 women, 5 men, 12 psychological hospitals, 5 states on east and west coasts)
Each made an appointment and complained of hearing voices
“empty,” “hollow,” “thud”
Otherwise completely healthy
All but one were diagnosed and admitted with schizophrenia
In the hospital
No symptoms, behaved normally

4. Results 7 - 52 days, average of 19 days before released None suspected
All released as “schizophrenia in remission”
35/118 real patients voiced suspicions
Contact between patients and staff was minimal and bizarre
Severe depersonalization, but no lack of medicine
Never really communicated effectively
Not considered real people!

5. Conclusion
In the hospital setting healthy subjects cannot be distinguished from mentally ill people.
“If they are here, they must be crazy!”
Diagnostic labels become persona
Tend to add psychological implications to normal things
Doctor interpretations of past depend on diagnosis

6. Significance Hospital environments, counter - therapeutic?
Danger in diagnostic labels
Self- concerning
With new antipsychotic medicines, less people are being confined to mental hospitals
Use labels carefully and with respect to power demands

7. Criticism Criticism Who would lie to get into a mental institute?
Questioned if mistakes like these could happen in THEIR hospital
During the next 3 months one or more pseudo patients would be sent
Rate each submission on a 10 point scale of likeliness to be a pseudo patient
193 admissions: 41 considered with high confidence to be the pseudo patient, 23 suspected, 19 identified
…No pseudo patients actually sent

8. Recent Applications Szasz (1993) Brighton and Chesterman (2001)
mental illness cannot be diagnosed simply if one person (health professional) does not understand the other (patient)
Brighton and Chesterman (2001)
Faking of a mental illness can be a “get out of jail free card” for criminals
Wahl (1999)
Stigma against psychological disorders in our society
Boisvert and Faust (1999)
Scenarios of an employee who behaves violently toward their boss
If the employee was pre-diagnosed as schizophrenic, subjects were more likely to blame the employee
With no evidence of mental illness, subjects most often blamed environmental stress