Mental Illness

On Being Sane in Insane Places

Can you tell if someone is insane?  Maybe, maybe not.  On the other hand, can you tell if someone is sane.   Are these questions the same?

Let’s be more specific.  Can you identify a insane person while walking around your neighborhood?  On the other hand, could you identify a sane person in a psychiatric facility?  According to an article by David L. Rosenhan, the answer to the latter is no.

Rosenhan’s allowed for 8 sane people to gain secret admission to 12 different hospitals.  These people included a graduate student, psychologists, a pediatrician, a psychiatrist, a painter, and a housewife.

Further details of this experiment can be found below.

  • Setting: “The 12 hospitals in the sample were located in five different states on the East and West coasts.  Some were old and shabby, some were quite new.  Some had good staff-patient ratios, others were quite understaffed.  Only one was a strict private hospital.  All of the others were supported by state or federal funds or, in one instance, by university funds.”
  • Gaining Admission: “The pseudopatient arrived at the admissions office complaining that he had been hearing voices.  Asked what the voices said, he replied that they were often unclear, but as far as he could tell they said ’empty,’  ‘hollow,’ and ‘thud.’…Beyond alleging the symptoms and falsifying name, vocation, and employment, no further alterations of person, history, or circumstances were made.  The significant events of the pseudopatient’s life history were presented as they had actually occurred.”
  • Admission:  “Immediately upon admission to the psychiatric ward, the pseudopatient ceased simulating any symptoms of abnormality.  In some cases, there was a brief period of mild nervousness and anxiety, since none of the pseudopatients really believed that they would be admitted so easily…The pseudopatient, very much as a true psychiatric patient, entered a hospital with no foreknowledge of when he would be discharged.  Each was told that he would have to get out by his own devices, essentially by convincing the staff that he was sane.”
  • Failure to Detect Sanity: Despite their public ‘show’ of sanity, the pseudopatients were never detected.  Admitted, except in one case, with a diagnosis of schizophrenia, each was discharged with a diagnosis of schizophrenia ‘in remission…the evidence is strong that, once labeled schizophrenic, the pseudopatient was stuck with that label.  If the pseudopatient was to be discharged, he must naturally be ‘in remission’; but he was not sane, nor, in the institution’s view, had he ever been sane.’…It was quite common for the patients to ‘detect’ the pseudopatient’s sanity. During the first three hospitalizations, when accurate counts were kept, 35 of a total of 118 patients on the admissions ward voiced their suspicions, some vigorously.  ‘You’re not crazy. You’re a journalist, or a professor (referring to the continual note-taking).  You’re checking up on the hospital.’ …The fact that the patients often recognized normality when staff did not raises important questions.”
  • Inappropriate Insanity Classifications.  “The notes kept by pseudopatients are full of patient behaviors that were misinterpreted by well-intentioned staff.  Often enough, a patient would go ‘berserk’ because he had, wittingly or unwittingly, been mistreated by, say, an attendant.  A nurse coming upon the scene would rarely inquire even cursorily into the environmental stimuli of the patient’s behavior.  Rather, she assumed that his upset derived from his pathology, not from his present interactions with other staff  members…One psychiatrist pointed to a group of patients who were sitting outside the cafeteria entrance half an hour before lunchtime.  To a group of young residents he indicated that such behavior was characteristic of the oral-acquisitive nature of the syndrome.  It seemed not to occur to him that there were very few things to anticipate in a psychiatric hospital besides eating.”
  • Conclusion: “It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals.


  • David L. Rosenhan. Being Sane in Insane Places. Science 19 January 1973: Vol. 179 no. 4070 pp. 250-258, DOI: 10.1126/science.179.4070.250

1 Comment

  1. Teachers in psychiatry should be teaching this important study by Dr. David
    Rosenhan to medical students.I being a retired psychiatrist can in no
    uncertain terms testify that we have not made much progress in psychiatirc
    diagnoses. Look at the New DSM Five with all kinds of spectrum disorders
    a kind of coded catalogue.we have no more knowldge of the etiology of these
    conditions. When God created heaven and earth there was no DSM. Then DSM 1 created 100 psychitric diagnoses DSM 11 200 diagnoses DSM111
    300 diagnoses and DSM 1V 400 diagnoses Let God bless American
    Psychiatric Association

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