Rosenhan’s On Being Sane in Insane Places

Subject: Psychology
Type: Informative Essay
Pages: 3
Word count: 799

What is abnormal behavior? The definition to abnormal behavior is not universally acceptable as it is dependent on both individual as well as societal perspectives; how an individual or a societal grouping views certain behavior to be normal and yet another to be abnormal makes it relatively impossible to have a singular view on matters of normalcy and abnormality. For purposes of this study, only the societal perspectives will be considered. The perception of society on the abnormal is inherently dependent on its understanding of normalcy; what is considered normal helps define what is abnormal. This perspective on behavior and society implies that both concepts are fluid, as what is normal today may be unacceptable in the future. Such issues make the process of diagnosing insanity, or mental abnormality, challenging for the mental health professional. Adopting an approach that depicts adequate validity and reliability ensures breaking down these barriers and facilitating effective interventions in mental health. 

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Rosenhan conducted a study conducted a study demonstrating the unreliability of psychiatric diagnoses. Based on reports of hearing voices, 8 sane people were diagnosed with psychiatric disorders and admitted to 12 mental hospitals (Rosenhan 250). Despite exhibiting normal behavior after admission, the average length of stay for the patients in the hospitals was 19 days (Rosenhan 253). Further studies have established that there often are inconsistencies in the diagnostic process, with the agreement in diagnosis among psychiatrists being as low as 54% (Gaughwin 302). Wrongful diagnosis is harmful, not only because it may subject the individual to unnecessary treatment, but also due to the resulting social stigma. 

Current approaches to the diagnosis and treatment of mental illness require improvement to facilitate detection and intervention. A primary aspect to consider in the improvement is that there lack universal indicators of mental illness (Babb 44). Research has indicated some abnormal behaviors being culture-bound, in that only particular societies exhibit them (Gaughwin 300). Diagnosis of mental illness, therefore, should always be grounded in cultural backgrounds and societal expectations. Diagnosis must also exhibit reliability, a feature that is currently enabled by the DSM. The presence of checklists in the DSM for behaviors associated with particular illnesses ensures that the same terms apply across professionals (Babb 13). The combination of these behavioral checklists with the cultural considerations, therefore, will ensure both validity and reliability in diagnoses. 

The process of identifying mental illness and treatment has considerable barriers. Some of the hindrances include the occurrence of a range of symptoms across multiple disorders, which complicate the process of diagnosis (Babb 126). At the same time, while there is a certain degree of stigma associated with mental health problems, some societies also grant these patients preferential treatment. Therefore, the possibility of a sane person deliberately displaying the characteristics of a person with either behavioral abnormalities or mental illness is high (Gaughwin 298). These situations often include using post-traumatic stress disorder to justify crime or schizophrenia for work-related benefits. Similarly, the shifts in societal perceptions of the abnormal influence the diagnostic process and compel an equal shift in treatment approaches. 

Deliberate actions are necessary to improve the practice and overcome the barriers. Primarily, the psychiatric field requires making more efforts towards standardizing the process of diagnosis. While it is improbable that a definite set of behaviors indicates mental illness, intensive research may reduce the overlap (Babb 93). In addition, diagnosis should require adequate background checks as well as continued evaluation to ensure reliability and validity. Single-point self-reports from patients may likely be biased or fail to capture the scope of the behavior (Rosenhan 253). The latter strategy to overcoming the barriers also involves consistent care and reduction of the dehumanization reported in Rosenhan (10). Mental health care professionals should maintain a hands-on approach, noting any inconsistencies in patient behavior and documenting for either their current use or future interventions. 

The challenges in diagnosing and treating abnormal behavior or mental illness are an outcome of the lack of validity or reliability within current approaches. It is thus necessary that current approaches be improved to accommodate various aspects of the conditions that individuals suffer. Improving diagnosis requires incorporating both the observable behaviors and their societal backgrounds to generate a comprehensive patient understanding. While diagnostic validity may be challenged by the overlap in behaviors across illnesses, it is possible that consistent research and humanized care will facilitate improvement of these features for the development of future interventions.  

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  1. Babb, Katherine Onofrio. The mental health system: Dictated power and social constructionism. Southern Connecticut State University, 2014.
  2. Gaughwin, Peter. “On Being Insane in Medico-Legal Places: The Importance of Taking a Complete History in Forensic Mental Health Assessment.” Psychiatry, Psychology and Law 12.1 (2011): 298–310.
  3. Rosenhan, David. “On being sane in insane places.” Science 179.4070 (1973): 250–258.
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