What We're Reading Now

The Power of Labels

9 April 2019

Geof read David Rosenhan’s article On Being Sane in Insane Places from the journal Science (Volume 179, No. 4070. January 19, 1973), pp 250-258.

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Forty-seven years ago, five men and three women checked themselves into different psychiatric hospitals along the east and west coast of the United States. The patients ranged in professions from pediatrician, painter, housewife, psychiatrist, to psychologist. All eight called the hospitals for an appointment, and during the admissions interview all eight complained of identical symptoms: hearing an unfamiliar voice in their head saying words like “empty,” “hollow,” and “thud.” Other than the reported voices there were no other pathological behaviors. All eight were immediately admitted to their respective hospital and diagnosed with schizophrenia.

However, all eight were perfectly sane. They were part of an experiment by Dr. David Rosenhan to answer the question, “If sanity and insanity exist, how shall we know them?” Are the labels we create for people based on traits and characteristics of the person, or are they our observations of the person in an environment and its contexts?

To make the experiment as real as possible, the pseudopatients (Rosenhan’s term) entered the “hospital with no foreknowledge of when he would be discharged. Each was told that he would have to get out by his own devices, essentially by convincing the staff that he was sane. They were, therefore, motivated not only to behave sanely, but to be paragons of cooperation.” Each immediately stopped reporting the symptoms of voices once admitted to the hospital. All immediately cooperated with the staff, rules, and regulations. Reports on their behavior from the study indicated the pseudopatients were "friendly," "cooperative," and "exhibited no abnormal indications." 

Among the more interesting findings is what Rosenhan describes as the “stickiness of labels.” In other words, once diagnosed, all the pseudopatients were viewed through the lens of their diagnosis regardless of behaviors. They were labelled and their labels stuck.

For example, pseudopatients were asked to take notes of their experience as part of the study. At first, they took notes discreetly to avoid suspicion.  However, over time they took notes openly. The behavior was viewed as a compulsive symptom of their diagnosis rather than simply taking notes.

“The closest any staff member came to questioning those notes occurred when one pseudopatient asked his physician what kind of medication he was receiving and began to write down the response. ‘You needn't write it,’ he was told gently. ‘If you have trouble remembering, just ask me again.’  Nursing records for three patients indicate that the writing was seen as an aspect of their pathological behavior. ‘Patient engaged in writing behavior’ was the daily nursing comment on one of the pseudopatients who was never questioned about his writing. Given that the patient is in the hospital, he must be psychologically disturbed. And given that he is disturbed, continuous writing must be behavioral manifestation of that disturbance, perhaps a subset of the compulsive behaviors that are sometimes correlated with schizophrenia.” 

In his summary of the experiment, Rosenhan said “the tag 'schizophrenic' profoundly colors others' perceptions of him and his behavior.” The label, Rosenhan said “has a life and influence of its own” and supersedes our interpretation of behaviors over most other things (even the situation). In other words, once we’ve labeled someone, we blame their behaviors on the label and not the environment.

Ironically, the actual patients of the hospitals recognized the pseudopatients as just that, sane people acting the part. “During the first three hospitalizations…35 of a total of 118 patients on the admissions ward voiced their suspicions, some 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.’”

All eight participants were eventually released under their own merits with most averaging about three weeks in the hospital. (The longest stay was 52 days.) “Each was discharged with a diagnosis of schizophrenia 'in remission.'" As Rosenhan stated, “the evidence is strong that, once labeled schizophrenic, the pseudopatient was stuck with that label. If the pseudopatient was to be discharged, he must naturally be ‘in remission’; but he was not sane, nor, in the institution's view, had he ever been sane.”

Think about the tags or labels you have for the people in your life? How often do we “tag” another with a trait or characteristic and then interpret every behavior through that tag?  In what ways might this bias us to another person’s actual disposition? How much of our perception is of the actual person, or our label of the person?  

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