Sanity/Insanity: The Rosenhan Experiment

bowling alley and so he went nuts. He took his bowling shoes off, he started throwing bowling balls at people, and fortunately no one was killed, but several people were seriously injured. And now this man is standing trial for his bowling ball rampage. And at trial, the man's attorney attempts to mount a defense based on the insanity plea, the claim that the accused did commit the acts in question, but is not responsible for his actions because his mental

state prevents him from understanding them. Uh. And then the prosecution brings out an expert witness who is a highly respected and very confident sounding forensic psychiatrist who testifies that he has interviewed the defendant and found that the defendant shows all the normal signs of a person in perfect

command of his actions. But then the defense brings forth another highly respected and confident sounding forensic psychiatrist who testifies exactly the opposite, that the defendant symptoms are consistent with those of a person who is disconnected from reality and cannot tell right from wrong. If you have no psychiatric expertise yourself, how are you supposed to tell which one

of these expert witnesses is correct. This is the problem that one encounters with a number of these trials, right, because it ultimately comes down to a who can either who can make the better case for insanity or insanity, or if they both kind of make equally pressing cases, then it comes down to something as simple as a as a character judgment on the part on your part of the accused. Yeah, now, I might say that it's possibly true that this scenario I've come up with it's

kind of contrived. It might be worth saying that apparently less than one percent of defendants in US cases plead insanity, and then for those that do enter such a plea, the rates of success are low, so pleading insanity typically doesn't get you very far in the US legal system. But the example does raise a few questions about how we deal with concepts of mental uh, let's say, mental normality and mental abnormality, as as the lay public understands them.

Throughout this episode, we're gonna be using the words sane and insane to give a sense of the way that they're used in the milieu of the experiment we're going to talk ab out in this episode. But every time you hear those words, you should imagine that we're putting some huge, big finger quotes around them, because, as we discussed at the end, these are probably not the most useful terms or concepts for describing or helping people in the real world, but they still are salient concepts too

many people. Like if you take the average person and ask them if they think the difference between sane and insane is a real, actual thing and they can tell the difference, they'll say, yeah, right, yeah, I mean, we we encountered this all the time, right The just the basic idea that I'm here on this side of the wall, and then there are people inside the hospital, there are people receiving care, there are people that are incarcerated. That's the insane side of the wall, and there's a bearer

between us. It's kind of a Sneeches and star Belt. He'd sneeches approach to mental health. You can easily divide everybody into one of two categories. Either those that have it all thegether and are seeing everything straight and have an acceptable understanding of reality, and in those who do not. Yeah, And so today we want to talk about a landmark experiment in the history of psychology, one that's been written about and talked about a lot for years, often celebrated.

It's highly cited, and it concerns the question of how do we know precisely what constitutes normality or mental illness? And if there is a difference between sanity and insanity, can anybody tell the difference? Even professionals, Yeah, especially professionals that because this uh, I mean, that's what this whole experiment hinges on is is how do our professionals, how do our mental health professionals judge uh and and evaluate

individuals that are entering the system. Yeah. So the experiment in question was carried out by the Stanford professor and psychologist David Rosenhan, who lived from nineteen twenty nine to two thousand twelve, And I found this in an obituary of him, that his education path seemed to be interestingly varied.

So he got a BA in mathematics in nineteen fifty one from Yeshiva College, and then and then a master's in economics, and then a PhD in psychology from Colombia, and then he went on to sort of branch into two different fields and work on unifying concepts between them. So he's a professor of law and of psychology. And according to his Stanford obituary which I read, he he was sort of known for applying psychology to legal practices

like jury selection and jury consultation. And he held various honors during his lifetime, like being the head of the A p A and and stuff like that. So he was very respected psychologist and jurist, one might say. But in nineteen seventy three, rosen Hand published in the journal Science a piece that was old on being sane in insane places. And it begins with this question that we talked about a minute ago. If sanity and insanity exist,

how shall we know them? That's what he says. Yeah, He presents this quite nicely, and as we were discussing prior to to the recording session here, the whole paper is just so well written. It's so accessible to uh to, to the average leader, to the average reader, it's not it's not you know, lost in a bunch of psycho babble. Yeah, you can find this paper online and I do highly recommend reading it as it is. It is not just clear and very interesting, it's a great piece of writing.

But so Rosenhan opens by pointing out the same thing we did at the beginning of our podcast. He says that it's common in murder trials where the defendant sanity is under dispute, for perfectly respectable psychiatrists to testify in direct contradiction of one another about the mental state of

the accused. And I actually went and read a couple of articles about what happens when somebody tries to enter an insanity polae in court, like how can the the experts try to figure out whether they are faking it or not? And there are various methods they have, But one of the things that struck me about the way that forensic psychiatrists go about trying to evaluate the mental state of a person accused of a crime is they're trying to see if the person fits a known diagnosis.

So they're trying to say, here the known symptoms of schizophrenia or here the known symptoms of x known state of psychosis as described in the literature, and can the defendant match the description that I have here? And if they just present sort of like an odd collection of symptoms,

it's generally ruled that they're probably faking right there. They're they're just putting together things that seem to them like they qualify as crazy, right, And one of the big ones that often shows up is someone will be they'll be trying to defend the accused by saying that they are insane, and then the prosecution will point out something something in their actions that is clearly premeditated and uh, thus uh disputing any idea that this was just a

spontaneous manifestation. Oh yeah. There are often very various features of the crime itself that make it clear that the person was in a fairly lucid state when they committed that, like if they try to destroy evidence and you know, do smart, clear thinking ways of avoiding responsibility for the crime. But anyway to investigate this question. If sanity and insanity exist,

how shall we know them? David Rosenhan staged an experiment that's one of the most interesting I've ever come across in the history of psychology, and it was essentially an under cover sting operation to determine what it takes to convince a mental health facility that a person is insane, and then what it takes to convince them that that same person is sane. Indeed, so this took place between nine seventy two, So they're there as we'll discuss, uh,

their various locations that are employee. Here you have eight same people and they're gained a secret admission to twelve different hospitals. So we're talking three women, five men, um one of the psychology graduate student in his twenties. The remaining seven were older and quote unquote established. So among them you have three psychologists, a pediatrician, a psychiatrist, a painter, and a housewife. And uh oh, and then also rosen himself.

Rosenhan himself is involved here to Yeah, he was one of the mental health professionals, and the mental health professionals gave false professions in their biographies. They were describing themselves to the these mental hospitals basically for fear of being treated differently than other patients. And that makes sense to me, because if if you want to know how the hospital treats, you know, the average person who walks up, you don't

want to say hi, I'm a psychiatrist. I know, they might sort of be on their guard when they're dealing with you. And likewise, they went in under false names as you might expect. Yes, Rosenhan himself was one of the patients, um though he was not a fully clandestined one as the other one as the other people were. He Rosenhan himself was the first of these pseudo patients as they're called, and his presence was quote known to the hospital administration and the chief psychologist and so far

as he says, I can tell to them alone. So he was known, but nobody else was known, and he was only known to a couple of people at the hospital and nobody else there. Yeah, there has I mean, obviously you would have to have some sort of arrangement employ here. You can't just They couldn't have carried out this experiment by just doing cold blind calls on various institutions, right, but no nobody else was known to anybody, which just him. And so the eight patients that they went to twelve

different hospitals. So obviously some of them were admitted more than once, and they went to twelve different hospitals in the sample, and they were trying to cover a broad range of the different kinds of mental facilities that you could go to. So they were in five different states on the east and west coast, and the hospitals were a varying condition. Some were old and shabby, as they said,

and some were newer. They had different levels of funding, different patients to staff ratios, and only one of the twelve hospitals was a private hospital and that made an interesting difference in how the diagnoses were treated. Later. But how did the so called pseudo patients get admission to the hospital. It was a pretty simple trick, and they

all did exactly the same thing. Yeah, they all show up and uh claim that they are hearing voices, that they're experiencing auditory hallucinations, Yes, which of course is is is often a key symptom of schizophrenia, right, And so when they were asked about what the voices said, the participant would say that the voice was an unfamiliar voice of the same sex as the pseudo patient and that they were generally difficult to understand, but that they had

said the words quote, empty, hollow, and thud, and I was like, wow, what an interesting combination of words. What would a psychiatrist make of that? But Rosenhunt explains that these words were chosen because they sort of went both ways, and number one, they formed an easy association with concepts of existential anxiety, like you could imagine somebody having thoughts like my life is empty. I'm so you know, existence is so hollow? Should I kill myself and land on

the floor with a thud? But they never said any of that explicitly, just empty, hollow and thud. Those were the only words, empty hollow, that that would be a great name for like a nineties goth act. Oh yeah, yeah, yeah, I love it. That's a that's a tattoo already on somebody. But anyway, they also picked these because this type of psychosis described in these terms did not match any in the medical literature at the time. So this didn't match

an existing diagnosis that could be found. Okay, so it's a little more abstract than just it was less on the nose. If someone is showing up and saying, oh, well, I have this symptom, the symptom in this system, and they go, oh, those symptoms are exactly what I have on the paper here. More, it leaves the uh, the individual making the diagnosis, room for at least the illusion of discovery. R So, as you would expect, the people who showed up at the hospitals faking these symptoms were

immediately detected and sent home. Oh no, wait, that's not the case. In fact, all twelve times they were admitted to the hospitals, with eleven out of the twelve times they were diagnosed with schizophrenia, and then interestingly, one out of the twelve times they were diagnosed with manic depressive psychosis, which Rosenhan. Rosenhan points out that the manic depressive psychosis had at the least of the time a more favorable prognosis than schizophrenia, so that this was a condition that

you were more likely to recover from. Things looked better for you had a better outlook, and for whatever reason, this one different diagnosis. The better diagnosis took place at the one private hospital in the study, but note that it's not necessarily a more accurate diagnosis because these people were all faking and all said the same thing. It's just the diagnosis that tended to turn out better for

the patient. Okay, So this is adding possibly an interesting layer of class bias into what they found these hospitals behave like. So they were admitted, they were put into these hospitals, and then what did they do. Did they continue to pretend that, oh, I'm hearing these voices that at step, of course, is to sort of straighten up and said and uh and resume their normal behavior, claim that their symptoms are completely gone. But it's important to

note they're not coming clean either. They're not saying actually surprised. This is all part of a study, right, They're just saying, oh, I feel fine now, I'm not experiencing those auditory hallucinations that I was talking about earlier. Right. They immediately resumed normal behavior, claim their symptoms were entirely gone and they were on their best behavior. So they were very good patients. Uh, at least they tried to be, and they self reported

that they were good patients. They were described by the nursing reports kept at the facilities as quote friendly, cooperative, and exhibited no abnormal indications. So according to the reports, they didn't do anything weird or disruptive. Uh that they seemed perfectly well behaved and normal. But nobody caught on. Well maybe not nobody. None of the people who should have caught on caught on. The the hospital staff uh

and psychologist, psychiatrists, the attendants, the nurses. Nobody caught onto the fact that these people were faking, but some of the other patients did. In fact, that was fairly common. So during the course of the of three different hospitalization records, participants recorded that out of a hundred and eighteen fellow patients on the admissions ward, thirty five of them quote

voiced their suspicions somewhat 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. So the other patients were detecting what was going on with these people, but the hospital staff was not. Huh, that's fascinating. So how did the staff respond. They forced the studio pay since first of all, to admit to having a mental illness and made him agree to take antipsychotic drugs as a

condition of their release. So there they said, Okay, you're doing better. You're you're not having you're not experiencing these auditory hallucinations anymore. UM, to sign this and then agree to this a particular drug treatment, and you can go on your way. Okay. So how long did that take? Was that just like two or three days before they did that? Between let's see whether the length of the

hospital stays or between seven and fifty two days. So an average day of nine average day of nineteen days. So this one overnight, Yeah, a week confined to the hospital was the shortest. Somebody was in there for fifty two days. In fact, that might have been rosen Hunt himself. I'm not sure, but there was a point where he said, I didn't know how long I was going to be in there, but I thought it would be a few days.

I didn't expect it to be two months. Um. But yeah, an average day of nineteen days in the hospital with no symptoms whatsoever while they're there, and then a note on all of those anti psychotic drugs that they were required to take as a condition of their release. Um. The report says that the pseudo patients were administered more

than two thousand pills. It was like pills over the course of this including the drugs uh, I don't even know if I'm not familiar with these, elavil, stella, zine, composine, thorazine, I know those, uh, to name a few of them. And then Rosenhan points out in this note that quote such a variety of medications should have been administered to

patients presenting identical symptoms is itself worthy of note? It kind of makes you wonder about the extent to which, at least at the time, some of the drugs prescribed for psychological diagnoses were I don't know, perhaps somewhat arbitrary, but anyway, that they didn't take the pills, so only two pills over the course of the entire experiment were swallowed.

The rest they pocketed deposited in the toilet. And then they also said that they noticed some of the real patients doing the same thing, because I mean, and they had to actually consume two of them in order to set the precedent that they were taking them. Because that's because that's a common reaction to being administered all these pills, right that you can start start refusing to take them or secret them away. Yeah, well, at least they for

whoever took those two pills, I guess. I mean the fact that they could get away with not taking the pills for so long, I mean almost nobody took the pills and then they didn't get caught. I think that's interesting also key to the experiment, of course, that they're not taking all these pills and then because then you would have to factor in, well to what effect is this massive drug intake affecting their behavior and therefore, uh,

their reception by the staff. Right, So you had all these diagnoses, you had these schizophrenia diagnosis, but then people they reported their symptoms were gone and eventually were released, though sometimes after a kind of a long stay in the hospital that I that I know in many cases was not pleasant for these people. Yeah, and they were all diagnosed with schizophrenia quote in remission before their release.

And this is a really key point because Rosenhn is careful to point out the distinction between in remission and sane It's suggesting sort of the categorization of schizophrenia in remission retains a level of categorical stigma that's associated with the fact that the patient is still considered fundamentally an insane person. They're just not showing symptoms right now. Like, once you have been deemed insane, it almost seems as

if the hospital will not consider you sane again. Yeah, it's it's it's as if it's affected your sort of baseline sanity score, and it's it's forever going to be a little lower, no matter what your particular manifestation level is going to be. Yeah, though then again, I mean even that might be more progressive than what was actually displayed in practice in the hospital, because I don't know, it seems kind of cruel to think of sanity on a like sliding scale of numbers, like a like a

D one role. But what we have here doesn't even seem like the sliding scale. You're just either in the club or you're not. You're in the normal sane person club, or you are outside that club and you don't get

to get in. You either have the star or you don't. Now, I do want to mention as well that that in in the paper, Rosenhan also comments on the conditions that that they encountered, then he himself encountered a part of Yeah, just talking about like the language that was used, the attitude that was used against the patients, as well as just the feeling of powerlessness that that that he felt

inside these institutions. And uh and therefore the ramifications that that that those conditions would have upon any individual that's placed in their care, especially someone who might have some level of of actual mental illness. But one of the main takeaways of this, at least the first half of this experiment, and we'll get to the very interesting second half in a moment um, is what they called called

the uniform failure to recognize sanity. And Rosenhan points out on the paper that that shouldn't be attributed to these just being like bad hospitals, because they went for a whole range of them. They went from you know, they went to some shabby hospitals, but then also to some very nice hospitals, and it just seemed like, you know, once you were there and you presented a few symptoms,

they said, okay, yes you are insane. You know, given all of this, I can imagine if I was running a hospital at the time of rosen Hans's experiment, I would I would respond with, well, you know what that could ever happened. Here, it never happened. Here's one thing for these other institutions to fail to to to see through this scheme and to properly diagnose these pseudo patients. But you try that mess with me, buddy, and I'm going to spot your pseudo patients and kick them right

out the door. Give me your best shot. And in fact, there was there was one hospital that did exactly that. There was a hospital administration that took issue with rosen Hans findings and they put a challenge to him. They were like, okay, okay, hold on a second, you send us your pseudo patients and we will rout them out. And what did Rosahn do? He agreed, he so he said, I'll send you send them, I'll send them on beyond

your guard. And so they were on their guard. In the following weeks, out of one new patients that the staff identified, forty one as potential pseudo patients, with twenty three receiving suspicion from at least one psychiatrist and nineteen of these receiving suspicion from one psychiatrist and one other staff member. So they were and they they upped their security. They were ready for it, and they were pointing out pseudo patients left and right, calling out of the woodwork.

Uh so how many did rosen Han actually send zero? He sent nobody right. So this is an interesting because now we have two different types of classical errors that are being attributed to a psychiatric diagnosis in these hospitals. We have the type two error, which is the false positive. You have somebody who comes in, uh, fakes a very simple simple symptom, resumes normal behavior and is not detected as a sane person. So that's a that's a false

positive identification of mental illness. Then in the second half we've got tons of false negatives. People showing up with actual complaints saying I have a mental illness, I need help, and the hospital saying you faker. It's like a game of Werewolf where you don't have an individual with the werewolf roll. Uh do, you just end up making accusations left and right. Okay, So what conclusions can we draw

from this experiment? Now? Remember, as we said, this was back in nineteen seventy three, published in seventy three, took place between sixty nine and seventy two, So, uh, it's not a direct common terry on the current day. Yeah, so this was back then, and we can at least hope that things are to some extent largely informed by this study better today, but at least back then. The takeaways where that the diagnostic process for distinguishing sanity and

insanity is not reliable. It has shown massive errors, just complete failure to identify correctly people's mental state going both ways, the type one error and the type two error. Uh. The other takeaway that I sort of get from this is that sane and insane do not seem to be helpful designations to begin with, but rather the sort of arbitrary and likely harmful ones. They might be a completely

artificial distinction. Now, that doesn't mean that mental illness isn't real and that you can't experience, you know, true suffering and symptoms from afflictions that affect the mind and the psyche. These are definitely real things, and that's acknowledged by rosen Han in the study. But it's more that these catch all categories that fundamentally designate a person as sane or insane just don't make sense and they don't really work.

So I think the study provides a powerful example of white might be best to find different ways of talking about mental illness. Thus some you know, saying like Ted has a mental illness rather than Ted is a mentally ill person. Yeah, and this is very much an issue still today, just in our attempts to try and talk about mental illness and deal with it. And of course this has been in the news a lot recently, uh, in response to the gun violence in America. Totally, I

know what you mean. Whenever there's another mass shooting in America, one of the narratives that pops up in the media is whether or not we need to do something in quotes, do something about mental illness to stop things like this from happening. Now. I think there probably are a lot of ways we could improve how we treat and care

for people with mental illnesses. But I think sometimes I worry that a subset of the people advocating this narrative of do something about mental illness are less focused on specific ways we could improve treatment and more focused on, in a kind of vague and general way, just increasing stigma even more, which is unfounded. I mean, most people who have a mental illness of one kind or another are not dangerous and do not commit acts of violence.

But it's just this idea that you know that having a mental illness makes you sort of a tainted person, you're just automatically suspect. And that's certainly a major theme in rosen Hans's experiment. Yes, absolutely that. The third main takeaway that I wanted to introduce was, and I wanted to quote rosen Hans's own words because I can't put it any better. Quote. Having once been labeled schizophrenic, there is nothing the pseudo patient can do to overcome the tag.

The tag profoundly colors others perceptions of him and his behavior unquote. So instead of observing a person's behaviors to determine mental illness, the observers use the diagnosis of mental illness to interpret the behaviors. So the context seems to rule how observations of behavior are interpreted. Sitting in a coffee shop writing in a journal is considered by most

people normal behavior. Sitting in a mental institution with a diagnosis of schizophrenia writing in a journal is considered pathological writing behavior. The behavior is the same, but they're using the diagnosis to to interpret the meaning of what the person's actions are, and the same thing is reported by Rosen Han in some of the therapy sessions and the notes that were taken on those. So a person can talk about the relationships in their life and say, um,

you know, my wife and I rarely argue. Every now and then we get angry with one another, but most of the time we have a very loving relationship. Okay, so that sounds perfectly normal. But if you're trying to look at this with a kind of with an eye for instability and and you know, problems in one's personal life, you can just latch onto the part where you said, well, every now and then we get angry and argue, and say, you know has issues with angry arguments at home, and

that becomes a part of this psychological diagnosis. I mean, everybody gets angry with people that they love every now and then. It happened, it's totally normal. Now to just to put this in a certain uh in the framework of the time and sort of in the timeline of

American um psychiatric care, I found this pretty helpful. So, according to American psychiatrist Alan Francis, who was a chair on the task force that created the American Psychiatric Association's Diagnostic and Statistics Manual four or the d s M four UM in war Uh. He said that the predominant post war, post World War two model and psychiatry was psychoanalytic with an extremely confident focus on treatment. So it's out there, we can treat it, and we can treat

it well. That was kind of according to Francis, that was we know what we're doing here. Step back, Yeah, let the professionals handle it. The institutions can handle it. But then of course came rosen Han's experiment, and along with some other revelations, it really took the wind out of everyone's sales, right, exposing the unreliability of psychiatric diagnosis. And I can imagine if you worked in the field of psychiatry or psychology at the time, this would come

as a huge blow to you. Yeah. Indeed. Uh. In his book Saving Normal and Insiders Revolt against Out of Controlled Psychiatric Diagnosis ds M five, Big Pharma and the Medicalization of Ordinary Life, Francis writes that before d s M three, which very much previous edition, yeah, but but still comes after rosen Hans experiments UM, he said that psychiatry was quote pure art forms, something brilliant, sometimes brilliant usually idiosyncratic and always chaotic. Yeah, I mean, I have

heard this charge before. H And I don't want to make judgments against psychiatry or psychology. I mean, I don't have any relevant expertise that can let me stand in judgment of them. But I've definitely heard people make the accusation than in some ways, especially historically, psychology is more of an art than a science. I could see where

one could make a case for that. Yeah. And then of course another feature of it is that seemingly, at this time at least, there is a lot that it seems to grow out of an expert's intuitions, you know, like that you can't it's difficult to do very accurate, unbiased quantitative measurements of a person's psychological state. So you I mean, I guess you can derive sort of standard batteries like of of question errors and and psychological tests. But still in the field, I think you're going to

have a lot of intuition coming into play. You're having an expert who knows something about the field, has read the medical literature, knows what the standard diagnoses and the descriptions of them are, and then sort of looks at what he or she sees and gets a feeling or

intuition about what's going on here. Then then again, I think you could probably also say sometimes medical doctors, you know, somatic illness doctors, would do the same thing, say, you know, I'm just kind of looking at your symptoms and getting a feel for the fact that you've probably just have some virus infect viral infection of the upper respiratory system. Well, you know, that actually leads me to one of the big criticisms that was leveled against rosen Hans experiment at

the time, um and uh. And one of the individuals doing this was the Columbia psychiatrist and DASM three chair Robert Spitzer, And that is that psychiatric diagnosis relies on the patient honestly reporting what they feel, and rosen Hans experiment would seem to bend, if not break that right because each pseudo patient story is a lie. And and let's not forget that a healthy person can still enter a hospital emergency room complain of non existent pain and

received treatment. That might be a useful criticism, But then again, I think a lot of the point of rosen Han's experiment was about the hospital not catching on over time, So I can maybe understand the original admission to the hospital, especially if the hospital is strapped for time, they can't spend a lot of time with the patient. Um, but they didn't have complex, fake psychological personas that were designed cleverly to trick the psychologist. They just said empty, hollow thud,

heard a voice said it. That's it. They get in and then they completely all symptoms went away, normal behavior, and then they couldn't get out for a long time. Yeah. And and to your point, they're judging the individual who is no longer claiming to have any kind of auditory hallucinations. They are diagnosing them as something other than saying yes absolutely and again playing on that that really problematic distinction,

the overall categorical distinction between sane and insane. But I think this is a really strong indication that it is not good for us to use these categories of sane person and insane person. Just a fact I want to mention is that according to the U s National Institute of Mental Health in there were an estimated forty three point eight million adults aged eighteen or older in the

United States with any mental illness. So that's just any mental illness of all the kinds recognized in the past year, and this represented eighteen point five of all US adults. So there's a huge chunk of people in any given country. But we have the stats here for the United States that at any given time will experience a mental illness. But this doesn't mean they've always had it. It doesn't mean they always will have it. It doesn't mean they're

a bad or suspect person for having it. I mean, we don't think that about people who have illnesses of the body. We don't label somebody who has a somatic body illness as a sick person who from thereafter is known as a person who has been sick. Yeah. I mean it's like we end up treating the human mind as this fixed state that is not susceptible to change and influence. Yeah, it's almost as if we're importing a

kind of magical thinking. They're too, Like the having a mental illness is in a very unfair way treated like being in a state of sin or being in uh, having some kind of magical taint to you that makes people afraid of you. This is a thing that was described in the part of the report where rosen Han talks about the conditions inside the hospital, which is a very also a very salient part of the report and

another great reason you should read it. But one of the things he talks about is the lack of contact between the staff and the patients, like that there's just really very little interaction, and that sometimes it's as if people who don't claim to suffer from a mental illness were afraid that they could catch it by being near or interacting with the people who did have a mental illness. There was like a like an aversion that drove them away.

And this was partially explaining the lack of interaction between the staff and the patients. Yeah, and I can definitely imagine an unwillingness to have to look at and think about this thing that we UH often have an inability to to talk about and to to even quantify in a in a meaningful sense. There was one last paragraph I wanted to read from rosen Hans studied because I just found it absolutely fascinating. I wonder what you thought

about this, Robert, but let me read it first. The quote is conceivably when the origins of and stimuli that give rise to a behavior are remote or unknown or when the behavior strikes us as immutable, trait labels regarding the behavior arise the trait labels like insane that we were talking about. When, on the other hand, the origins and stimuli are known and available, discourse is limited to

the behavior itself. Thus, I may hallucinate because I am sleeping, or I may hallucinate because I have ingested a peculiar drug. These are termed sleep induced hallucinations or dreams or drug induced hallucinations, respectively. But when the stimuli to my hallucinations are unknown, that is called craziness or schizophrenia. As if

that inference were somehow as illuminating as the others. I thought that was absolutely fascinating because it almost uh tracks this this problem we have in dealing with mental illness as a function of our lack of understanding. Like, like, we think we're very advanced or much more advanced than we used to be in fields like psychiatry and psychology because we're I guess we're a lot better than we used to be. I mean, we no longer think people

have demons in them. Uh, we understand that that there are conditions that can affect the mind, that can cause people suffering and distress or cause people abnormal behavior, and that there are hopefully physical or or at least like you know, talk based ways of treating those and helping get people get relief and and fix the problem that's affecting them. But we're still very imprecise with psychology, aren't we.

I mean, it's not like in many ways of treating body illnesses where we've come up with extremely just laser targeted ways of fixing the problems that arise. If you get a broken bone, you know, you can get a surgery or a splint put on. You know, there there are ways of fixing it that we're pretty sure are gonna work and aren't gonna have too many weird side effects. And you can do the same thing with say antibiotics or other you know, drug treatments that we have for

body illnesses. And there is just a fundamental lack of precision and lack of technological advancement we have in treating

illnesses that affect the mind. Yeah, and it it definitely reminds me of content that looked at in the past, just talking about like what is in the same way we're talking about what is saying and what is insane, um and and as flawed as those categories are, But then you know what is what is an actual experience of reality versus a skewed experience of reality, especially when you start thinking of any human perception of reality is

essentially flawed. It's imperfect, it's based, it's it's not it's not one for one, you know, So, so how do you start There is no objective Yeah, there is no objective reality. All reality is a subjective reality, and the individual on the other side of the glass, their experience of of subjective reality is just different. So then how do you treat it? How do you quantify it? Uh?

You end up falling back on these false terms. Yeah, absolutely, And I think that point Rosenhan makes uh still largely applies today. Even though we may have come somewhere since since the nineteen seventies, we still are at this place where the fact that we don't understand the origins of of of somebody's problem makes us treat it with less compassion than we should. And so, if there's one takeaway from today's episode, try to ditch the concepts of sane

and insane. And I know they're deeply ground into us, but I say, do your best to chuck them out. I mean, when you encounter somebody who has a mental illness and has symptoms, think about what can be done to help the person's symptoms or there or alleviate the problems in their direct experience, rather than saying, this is

an insane person. Yeah, or even if you just go back your daily life, it's so easy to fall into the mindset of just walking down the street and going that person saying that one's that one's insane, that one's crazy, that one's crazy, that one maybe a little crazy, that one's sane. Uh. But but again that's just falling upon this this this this false dichotomy of a mental experience. Yeah. So anyway, I think that's a very fascinating paper, but

really highly recommended. You can find it online. There are copies you can find you can read the whole text for will make sure to link to it as well on the landing page for this episode. So fantastic in the in the history of psychology and science, and really in the history of human empathy. I think. Yeah. All right, So in the meantime, check us out at stuff to Blow your mind dot com. That's where you'll find all the episodes, various videos, blog post links out to social

media accounts like Twitter and Facebook. Will Blow the Mind on both of those and I tumbling. We're stuff to blow your mind. And if you want to write us and let us know your feet back about today's episode or what you thought about the topic of the categories of sanity and insanity and how we diagnose them, you can email us at will the Mind at how stuff works dot com for more on this and thousands of other topics. Is it how stuff works dot com. Remember