On Being Sane in Insane Places

“On Being Sane in Insane Places” centers on the unreliability of psychiatric diagnosis. The 1970s were marked by an emerging skepticism toward the unquestioned authority of medical professionals and a burgeoning awareness of the rights of mental health patients. David L. Rosenhan’s study dovetails with these societal trends, probing the trustworthiness of psychiatric diagnoses and the consequences of their unreliability.

In fact, Rosenhan’s experiment was only possible because of that unreliability. By reporting auditory hallucinations, Rosenhan and his colleagues successfully gained admission to psychiatric hospitals. Rosenhan implies that even at this stage, confronted with the pseudopatients’ outright falsehoods, the system might have detected their status as mentally healthy: The pseudopatients reported hearing words that communicated a sense of existential purposelessness, and these words were chosen in part by the “absence of a single report of existential psychoses in the literature” (251). This already raises doubts about the diagnostic process, which ought to have flagged the pseudopatients’ reports as unusual, even on its own terms. That it did not points to the malleability of purportedly objective diagnostic criteria, as does the fact that one of the pseudopatients received a diagnosis of “manic-depression” (bipolar disorder) rather than