Critical Evaluation of On Being Sane in Insane Places by David Rosenhan - Coursework Example

On Being Sane in Insane Places Introduction Psychology to this day lives with the uncertain controversy as to whether the terms “mental illness” and “normality” refer to a real occurrence in the human brain. The psychological fraternity exists as a bisected body, with one side claiming than no such thing as sanity or insanity exists while the contrary segment argues that indeed there exists definite, accurate, and proven means of defining the two. The most used terminologies associated with the normal or abnormal debate include insanity, sanity, schizophrenia, and mental illness, of which, when misused lead to what psychiatrists refer to as labeling. For those opposed to the existence of either sane or insane, they regard these words as offensive to patients who check into mental health hospitals because as they generally claim, a larger percentage of those admitted to such health centres are normal, healthy people. It is for this reason that David Rosenhan wrote his article “On Being Sane in Insane Places” that provides evidence and arguments against the existence of a sane or insane state of mind. It revolves around an experiment carried out by healthy people who were secretly posted to mental hospitals to investigate what really goes on there. This article will highlight his arguments and reasoning, as such; evaluate his thoughts as to why he is against the dual status of the human mind, then give a verdict on the same. Validity of psychological diagnosis According to Rosenhan (1973;1), even in cases where the abnormality and normality perceptions are believed and accepted, they are not universal, and different people will define the terms differently. There are various reasons that may contribute to this occurrence, for instance culture and one’s upbringing which differ from region to region. The result from this is varying understanding and definitions of what sanity and insanity really is, thus creating much doubt with regards to the validity of diagnosing the condition. As Canino and Alegria (2011) adds, there is sufficient proof that one’s background [culture] determines the perception that one has towards illness, delusion content, and the meaning of any emotion that is expressed. Moreover, there is little and insufficient proof regarding the extent of “universal” definitions of diagnosing normality or abnormality. In support of this, Canino and Alegria give a practical application of the variation in culture, and how it defines the relevance of diagnosing psychiatric conditions. It states that a child in the Anglo culture would be considered disobedient if he or she openly rebels against, or simply refuses to adhere to an adult’s order. In the Thai society, a child will be considered rude if he/she shows a lack of interest or hesitation in obeying an adult’s command. This implies that achieving a universal code of diagnosing psychiatric disorders is next to impossible since different peoples will define each context differently. All these are sufficient proof that the notion of a universal, thus credible, and valid plan of conducting psychiatric diagnoses are unachievable as portrayed by DSM-IV (American Psychiatric Association, 2005). The position by DSM-IV reveals that internal dysfunction is most likely to thrive from within a person’s body, and at the same time, existing in a negative environment. Concisely, the validity of psychological diagnoses as at now is null. Harmful labels Rosenhan (1973: 16) is concerned that due to uncertainty in the diagnosing process, it is likely that healthy patients may end up being labelled as psychologically sick. Labeling, here directly relating to the Labeling Theory, which states that a behaviour will only become deviant if society labels it as that (“Labeling Theory”, n.d.). Labeling has consequences of its own; the “labelled” individuals tend to conform to their label, and in case they were accidentally labelled, then they officially assume attributes they lacked before. In the case of a pseudopatient, labeling them as schizophrenic eventually imprisons them in that cocoon, which is usually irreversible. To make matters worse, there is nothing that the patient labelled as schizophrenic can do to control the situation. Rosenhan (1973; 16) explains, once a person is designated abnormal, all of his behaviours and characteristics are coloured by that label.” What this means, and as Strong (2011) elaborates, labeling one as mentally ill destroys their relationships with their friends, family, and worse still, with themselves. This happens because once somebody perceives of themselves as crazy, then the world rejects and/or discriminates against them, they have difficulties resuming their normal lives, and what this leads to is a deformed character and ability (Schur, 1971). In most cases, the victim from then onwards exhibits traits associated with those that are mentally ill. The discussed scenarios openly point in labeling as a catalyst in deterioration of the patients’ conditions rather than a remedy. There is positive labeling, yes, but what happens most of the time is negative attribution and allocation of names of patients with regards to their [mental] conditions (Lopez, 2011). This does not make anything easier for any of them; instead, it worsens the existing condition. Labeling is a key contributor to stigmatize, and if patients are exposed to such, then the expected outcome is them, transforming into “real” patients, only worse in their conditions (Plotnik & Kouyoumdjian, 2013). Sense should dictate that a pseudopatient suffers from mental dysfunction, then how does adding to their mental overload improve them? In short, negative labeling injures rather than help in guiding their therapy. Reliability of classification On classification’s reliability, Rosenhan (1973; 14) describes it as, “… often not useful or reliable.” He has reasons for this, and adds that despite of its irrelevance, it is still in use today. It is frightening, not even depressing, that the classification systems in psychiatric centres are faulty and untrustworthy. Clamp (2012) describes an experiment carried out by nine people sent to different psychiatric hospitals to find an insight into what actually transpires at the health centre, of which the findings were shocking. One, a participant patient gave all their life experiences to a clinician who instead of jotting it down as it was narrated, twisted it to fit a pseudo-patient’s conditions. Although the patients were normal, the hospital attendants did not notice this at all. For instance, the patients were constantly taking notes, and the only note taken of this was “patients involved in writing activity.” How is their classification going to be accurate when noticing overly visible irregularities in patients fails? This might in another aspect reflect on the staff’s lack of interest, job laxity, and general detachment from what should be their highly prioritized tasks, or better still, detachment from their patients. On another note, the participants observed ignorance and abuse of rights from the hospital staff who handle the psychiatric patients. For instance, at one time the participants witnessed the abuse of a real patient by the same hospital staff that took advantage of the patients’ conditions and reversed the story (Keith, 2014). They put the blame on the patient, accusing him of causing the trouble. This collection of scary revelations leaves one wondering how the classification is relevant, effective, and most importantly reliable if the individuals concerned with the practice lead the ignorant and unethical path. Rosenhan (1973; 4) concluded that there can exist no true or accurate classification method that hospitals can use to determine sanity or insanity, rather, it is all a random process full of guess work. This is reflected in that despite the participants’ public exhibition of normality, the hospital staff did not notice it at all. This presents the famous type 2 error that points out that medical practitioner are more likely to refer to sane patients as insane than it is to refer to the insane (unhealthy) patients as healthy (“Diagnostics & Statistical”, 2014). The described experiment reveals that there is no rule adhered to in relation to the reliability of psychiatrist classifications as “Classification” (n.d.) highlights the qualities of what an effective classification should have. For a start, it should adhere to guidelines that are used in classification. Again, a classification should be so accurate that if it was done on the same individual, the results will have to be identical. In conclusion, a reliable classification should not lead one into falsifying the outcome of the diagnosis by immediately labeling patients as mentally ill or schizophrenic. Summary The above text provides a critical evaluation of the David Rosenhan’s article, “On Being Sane in Insane Places” which focuses on mental disorder detection and control. The article has three main objectives that it aims to project; one, it reveals the laxity at work by mental hospital staff. Secondly, it reveals the poor strategy used in the classification of mental disorders (Rosenhan, n.d.). On this note, we get an insight into the reality that most of the classification carried out at the hospitals is false or inaccurate. On the third and final point, one can justify Rosenhan’s conclusion that there in no one single classification of anyone as either normal or abnormal (“On Being Sane”, 2012). This is because there are not any guidelines used in the exercise, and that culture and other factors might interfere with any strategy if it was ever put in place. This means that it is impossible and a rather complex task to classify one as either normal or not since people from different regions will have varying perspectives of the same subject thus the lack of a universal identification card. In addition, we learn of labeling as a dangerous act that worsens the mental overload on pseudo-patients, thus lower their chances or rate of improvement. The derived concept of labeling is that if used correctly, it can add to a patient’s healing, but since it will be abused most of the time, it is bound to cause more harm than the damage is was meant to repair (Newman, 2004). This text provides quite convincing evidence, basing its arguments on credible scientific, and social sources to build it. For instance, it employs the findings and methodology, obtained from an experiment to show how unconcerned, inhumane, and decided that the public health system is, with regards to mental disorder patients who would in normal hospital settings require outmost staff support and care. Conclusion “On Being Sane in Insane Places” is an excellent read regarding the existence of a normal-abnormal status of the human brain. It is made so by the gradual flow of ideas which relate closely in their flow. In addition to this, the main points are enriched and supported by scientific arguments in proving their relevance. However, the book might present a bit of a challenge in case it falls into the hands of a person who is not so familiar with psychological terminologies. This is because of the incorporation of complex psychic terminologies which are not explained in the article. All in all, the article is commendable and good enough for anyone interested in peeping into a bit of psychiatric. Finally, the evidence from the article’s evaluation tells one that it is time that something was done to improve or repair the multiple errors presenting themselves in the psychiatric health institutions. It is shocking from the experiment’s results that medical officers would even abuse by physically assaulting the patients, most of whom might be kept in such hospitals when they do not deserve to. The only remedy to these issues is to invent accurate and effective means of telling between who deserves some assistance to correct a mental disorder, rather than label and lock them up in a simulated “insanity.” References American Psychiatric Association., & American Psychiatric Association. (2005). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association. Canino, G., & Alegria, M. (2011, May 31). Psychiatric Diagnosis- is it universal or relative to culture? NCBI, 49 (3), 237-250. Clamp, H. (2012). On being sane in Insane Places. The Med School Project. Retrieved on March 1 2014 from http://www.themedschoolproject.com/2012/03/on-being-sane-in-insane-places.html “Classification.” (n.d.) CCVillage. Retrieved on March 1 2014 from http://ccvillage.buffalo.edu/Abpsy/lecture2.html “Diagnostic and statistical manual of mental disorders”. (2014). Seven Counties Services, Inc. Retrieved on March 1 2014 from http://sevencounties.org/poc/view_doc.php?type=doc&id=8212&cn=18 Keith, E., R. (2014). Key study: On Being Sane in Insane Places. Integrated SocioPsychology. . Retrieved on March 1 2014 from http://www.integratedsociopsychology.net/sane_insane-place.html “Labeling Theory.” (n.d.) University of Minnesota. Retrieved on March 1 2014 from http://www.d.umn.edu/~bmork/2306/Theories/BAMlabeling.htm Lopez, J., (2011). The Encyclopedia of Positive Psychology. John Wiley & Sons. Newman, D., M. (2004). Constructing Difference: Social Deviance. Sage Pub. Retrieved on March 1 2014 from http://www.sagepub.com/newman5study/resources/rosenhan1.htm “On Being Sane in Insane Places- A Review.” (2012, January). The Psychologic Clinic. Retrieved on March 1 2014 from http://thepsychologicalclinic.wordpress.com/2012/01/15/on-being-sane-i/ Plotnik, R., & Kouyoumdjian. (2013). Introduction to Psychology. Cengage. “Rosenhan 1973: On being sane in Insane Places.” (n.d.). Horah.Co.Uk. Retrieved on March 1 2014 from http://www.holah.karoo.net/rosenhanstudy.htm Rosehan, D., L. (1973). On being sane in insane places. Schur, E., M. (1971). Labeling Deviant Behavior- Its Sociological Implications. National Criminal Justice Reference Service. Strong, R. (2011, March 3). Diagnostic labeling of the mentally ill and the resulting stigma. Examiner.com. Retrieved on March 1 2014 from http://www.examiner.com/article/diagnostic-labeling-of-the-mentally-ill-and-the-resulting-stigma Read More