We like to believe that there’s a clear line between “sane” and “insane,” that people who are one are clearly not the other. Part of the reason is the sheer social damage that a label like “crazy,” “schizophrenic,” or “mentally disturbed” can wreck on an ordinary person. Someone who is crazy is someone who shouldn’t be trusted, someone who can never be fully trusted.
But despite those connotations a couple of researchers have shown us that the line isn’t as clear as we might prefer. Particular among these researchers are David Rosenhan and Nellie Bly, both whom schemed to get themselves admitted to mental hospitals despite their- supposed- sanity.
They both lived in very different times. Bly wrote in 1887 after going undercover for the New York World while Rosenhan and his pseudopatients were admitted in the 1970’s and their work was published in Science magazine in 1973. Both researchers found to their dismay that it was a lot easier than expected to get themselves admitted, and much harder to get out.
Bly actually checked herself in to a working class boarding house and simply acted a little strange until she was taken by the matron to the police and admitted from there, a process that took a single night. Rosenhan and the other seven pseudopatients made appointments with the hospitals themselves and then complained that they had been hearing voices. These voices were unclear but the words ‘empty,’ ‘hollow,’ and ‘thud’ were distinguishable. (These words were chosen because they are they equivalent of the patient saying, “my life is empty and hollow,” and because none of those words correspond to any reports of existential psychoses in the current medical literature).
Bly was lucky that she had a newspaper to bail her out because she heard several times upon admittance that there was no way that she would be able to get out on her own.
As the doctor was about to leave the pavilion Miss Tillie Mayard discovered that she was in an insane ward. She went to Dr. Field and asked him why she had been sent there.
“Have you just found out you are in an insane asylum?” asked the doctor.
“Yes; my friends said they were sending me to a convalescent ward to be treated for nervous debility, from which I am suffering since my illness. I want to get out of this place immediately.”
“Well, you won’t get out in a hurry,” he said, with a quick laugh.
“If you know anything at all,” she responded, “you should be able to tell that I am perfectly sane. Why don’t you test me?”
“We know all we want to on that score,” said the doctor, and he left the poor girl condemned to an insane asylum, probably for life, without giving her one feeble chance to prove her sanity.
“What is this place?” I asked of the man, who had his fingers sunk into the flesh of my arm.
“Blackwell’s Island, an insane place, where you’ll never get out of.”
-Nellie Bly, Ten Days in a Mad-House.
Meanwhile the Rosenhan researchers were told that they were to try their best to get discharged themselves. It took Rosenhan himself two entire months to get discharged.
“I told friends, I told my family, ‘I can get out when I can get out. That’s all. I’ll be there for a couple of days and I’ll get out.’ Nobody knew I’d be there for two months … The only way out was to point out that they’re correct. They had said I was insane, ‘I am insane; but I am getting better.’ That was an affirmation of their view of me.”
-David Rosenhan to BBC’s The Trap
This is even more strange given that both Bly and Rosenhan (and his patients) after being admitted stopped all pretense of insanity. They both decided to act completely normally, and would be to any outside observer completely sane. In fact, also in both cases, other patients would come up to psuedopatients or Bly and act surprised that they were in the hospital despite their obvious sanity.
What is interesting is that despite the different eras there are a lot of similarities. Not necessarily in treatment of patients, as Nellie Bly’s experience was a great deal more horrific than any of the pseudopatients in the Rosenhan experiments.
But what Rosenhan explains as a sense of “powerlessness and depersonalization” also occurred in Bly’s writings and it is a bit disturbing to think this is still the case despite the intervening years. Bly’s entrance exam to the insane asylum was peppered with questions, but not directed at her. Instead the doctor and the nurse spent most of the time discussing other subjects as if she wasn’t there at all.
“He gave the nurse more attention than he did me, and asked her six questions to every one of me. Then he wrote my fate in the book before him.”
-Nellie Bly, Ten Days in a Mad-House.
Rosenhan’s psuedopatients experienced much of the same during their stays, reporting:
“A nurse unbuttoned her uniform to adjust her brassiere in the present of an entire ward of viewing men. One did not have the sense that she was being seductive. Rather, she didn’t notice us. A group of staff persons might point to a patient in the dayroom and discuss him animatedly, as if he were not there.”
-David Rosenhan, On Being Sane in Insane Places
Both Bly and Rosenhan also found that the people most in charge of the facility, the doctors, spent the least amount of time with the patients and that most of the rest of the staff spent as little time as possible with them.
Once discharged Bly’s story made a splash and she was able to correct some of the grievous wrongs that were present in Blackwell, ensuring that more money was allocated to the facilities in the state and that there was greater oversight put into place.
Rosenhan’s papers made a similar splash in the psychiatric world. He criticized not only the depersonalization of the system but also questioned the very reliability of diagnosis and labeling itself. How can we label anyone insane, he asked, if these clearly sane people were allowed to slip through the cracks.
Others argued that if a patient fakes their experience then there isn’t much that a psychiatrist can do, and that the very nature of faking their symptoms may show an underlying issue. To which Rosenhan countered that it was not so much the initial diagnosis, as much as the continued diagnosis of mental illness despite the fact that all symptoms had ceased.
In the end though, the most compelling issue of both of these stories is how quick the rest of the world was to label the participants. No one was outright cruel in their diagnosis, but they were eager to put these people into nicely bordered boxes, places where they and their strangeness could be easily contained, rather than getting to know them and what was really the issue.
Just something to think about next time you complain about the “crazies” on the bus.