Who’s Crazy?
A bizarre experiment in the United States has demonstrated that psychiatrists cannot distinguish effectively between people who are mentally disturbed and those who are sane.
According to its originators, the experiment demonstrates the fallibility of conventional psychiatric diagnosis. It also lends considerable support to the position taken by radical psychiatrists like RD Laing, who argue that diagnoses of mental disease are often no more than convenient labels designed to make life easier for doctors.
Eight perfectly normal people, by shamming symptoms of a mild kind, successfully gained admission to psychiatric wards where they remained undetected for as long as they could stand it Once admitted, their behaviour was normal in every way, but doctors and nurses continued to treat them as disturbed.
In every case but one the diagnosis was schizophrenia. Once they were labelled as mentally ill, everything the “pseudopatients” did tended to confirm the diagnosis in the eyes of the medical staff, though other patients in the hospital were much less easy to convince.
The eight pseudopatients included three psychologists, a pediatrician, a psychiatrist, a painter and a housewife. All eight assumed false names and those connected with the medical profession also invented false occupations, so as not to attract special attention from fellow-professionals. The hospitals chosen ranged from expensive private units to dingy publicly-run institutions.
To gain admission, the pseudopatients told the whole truth about their lives, their emotions and their personal relationships — all of which were within the normal range — and lied only about their names, symptoms, and in some cases their occupations. The symptoms they complained of were hearing disembodied voices saying the words “empty”, “hollow” and “thud”.
This was sufficient in every case for them to be classified as mentally ill. Once inside J they stopped pretending and behaved as normally as they could. Their stays inside varied from 7 to 52 days, with an average of 19 days.
As many as a third of the real patients inside detected that they were frauds. "You’re not crazy. You're a journalist or a professor. You’re checking up on the hospital,’’ was a typical comment from a fellow-patient.
The pseudopatients spent much of their time taking extensive notes, but even this did not apparently raise any suspicions in the doctors’ mind. "Patient engages in writing behaviour," was the daily nursing comment on one patient, but nobody troubled to ask him what he was writing.
The experiment was carried out under the supervision of Professor D. L. Rosenhan of Stanford University, himself one of the eight fake patients. Writing about the experiment in this week’s Science, he concludes: “We cannot distinguish the sane from the insane in mental hospitals ... how many people, one wonders, are sane but not recognized as such in our psychiatric institutions? ... How many have been stigmatized by well-intentioned, but nevertheless erroneous, diagnoses?”
In Professor Rosenhan’s view, the hospital itself is an environment that distorts judgment As evidence, he quotes what happened to patients who asked doctors perfectly sensible questions. They took the form: “Pardon me, Dr. X, could you tell me when I will be eligible for ground privileges?” — or some similar request, courteously presented. In almost three quarters of the cases, the psychiatrist’s response was to walk on, head averted and some were staying for more than 3 weeks. Only one doctor in 25 stopped and tried to answer the question.
But the clinching piece of evidence comes from another experiment in which a hospital was warned that pseudopatients would be presenting themselves. Faced with this threat to their professional reputation, the doctors admitting patients became much more conservative in their diagnosis. Of 193 patients presenting themselves, one doctor was firmly convinced that 41 were frauds, while another doctor suspected 23. In fact, no fake patient had arrived at all.
In the present state of knowledge, there seems little hope of more accurate diagnostics. Doctors should try to err on the side of caution, in Rosenhan’s opinion, and “refrain from sending the distressed to insane places”. That, and a more benign environment inside institutions, could help to sort out the insane from the merely confused.
| A | B | C | D | ||
|---|---|---|---|---|---|
| 1 | used real names | ||||
| 2 | invented false occupations | ||||
| 3 | were diagnosed to be suffering from schizophrenia | ||||
| 4 | told truth about their lives, emotions, personal relationships | ||||
| 5 | lied about their symptoms | ||||
| 6 | continued to behave abnormally after being admitted to hospital | ||||
| 7 | were detected by some real patients as frauds | ||||
| 8 | spent much of their time writing | ||||
| 9 | stayed in hospital for more than three weeks | ||||
| 10 | were classified as mentally ill |
AI explanationShows the answer. Tap to open.
Question Focus: Reverse meaning check - real names vs false names
Why this is correct: The passage clearly says all eight assumed false names, so none of them used real names. This is a direct statement, not an inference.
Passage Reference: The eight pseudopatients included three psychologists, a pediatrician, a psychiatrist, a painter and a housewife. All eight assumed false names and those connected with the medical profession also invented false occupations, so as not to attract special attention from fellow-professionals.
Common Mistake: Some students choose some because they think only medical professionals changed names. This is a Reverse meaning trap because the passage says all eight used false names.
Paraphrasing: Passage: 'assumed false names' = Statement: 'used real names'
Tips: When you see a negative like 'false', mentally flip it to check the opposite meaning.
Key Vocabulary:
- assumed = took on
- false = not real
Question Focus: Quantity detail - some vs all
Passage Reference: All eight assumed false names and those connected with the medical profession also invented false occupations, so as not to attract special attention from fellow-professionals.
Why this is correct: Only those connected with the medical profession invented false occupations. That means some, not all.
Common Mistake: Choosing all because it sounds logical. This is a Qualification trap - the passage limits this action to a specific group.
Paraphrasing: Passage: 'those connected with the medical profession' = Statement: 'some of the eight'
Tips: Watch for limiting phrases like 'those who' or 'only'. They usually mean 'some'.
Key Vocabulary:
- invented = made up
- profession = job
Question Focus: Exception awareness - almost all but one
Passage Reference: In every case but one the diagnosis was schizophrenia.
Why this is correct: The phrase in every case but one means not all eight. So the correct answer is some.
Common Mistake: Choosing all and missing the exception. This is a Partial truth trap.
Paraphrasing: Passage: 'every case but one' = Statement: 'not all eight'
Tips: Underline exception phrases like 'but', 'except', or 'only one'.
Key Vocabulary:
- diagnosis = medical judgment
- but one = except one
Question Focus: Direct statement - all
Passage Reference: To gain admission, the pseudopatients told the whole truth about their lives, their emotions and their personal relationships - all of which were within the normal range
Why this is correct: The passage says they told the whole truth about these areas. This applies to all eight pseudopatients.
Common Mistake: Choosing some because students expect mixed behavior. This is a Context shift trap.
Paraphrasing: Passage: 'told the whole truth' = Statement: 'told truth'
Tips: If the passage says 'the whole truth', that usually means everyone involved.
Key Vocabulary:
- whole = complete
- within the normal range = typical
Question Focus: All participants action
Passage Reference: To gain admission, the pseudopatients told the whole truth about their lives, their emotions and their personal relationships - all of which were within the normal range - and lied only about their names, symptoms, and in some cases their occupations. The symptoms they complained of were hearing disembodied voices saying the words 'empty', 'hollow' and 'thud'.
Why this is correct: The passage clearly states they lied about their symptoms to gain admission. This was done by all eight.
Common Mistake: Choosing some because of the word 'only'. This is a Misreading trap.
Paraphrasing: Passage: 'lied about their symptoms' = Statement: 'lied about their symptoms'
Tips: Words like 'only' limit what they lied about, not who lied.
Key Vocabulary:
- lied = did not tell the truth
- symptoms = signs of illness
Question Focus: Contradiction check
Passage Reference: Once admitted, their behaviour was normal in every way, but doctors and nurses continued to treat them as disturbed.
Why this is correct: The passage says their behavior was normal in every way, so none behaved abnormally.
Common Mistake: Choosing all because doctors thought they were ill. This is a Context shift trap.
Paraphrasing: Passage: 'behaviour was normal' = Statement: 'behave abnormally'
Tips: Separate what doctors believe from what actually happened.
Key Vocabulary:
- normal = usual
- abnormally = not usual
Question Focus: Unclear quantity
Passage Reference: As many as a third of the real patients inside detected that they were frauds. "You're not crazy. You're a journalist or a professor. You're checking up on the hospital,'' was a typical comment from a fellow-patient.
Why this is correct: We know some real patients detected frauds, but the passage does not say how many pseudopatients were detected. So we can't tell if it was some or all.
Common Mistake: Choosing some automatically. This is a Not Given trap about quantity.
Paraphrasing: Passage: 'a third of the real patients' = Statement: 'how many pseudopatients'
Tips: Always check whether the number refers to patients or pseudopatients.
Key Vocabulary:
- detected = noticed
- frauds = fakes
Question Focus: General behavior statement
Passage Reference: The pseudopatients spent much of their time taking extensive notes, but even this did not apparently raise any suspicions in the doctors' mind. "Patient engages in writing behaviour," was the daily nursing comment on one patient, but nobody troubled to ask him what he was writing.
Why this is correct: The passage uses the pseudopatients as a group, meaning all of them did this.
Common Mistake: Choosing some because only one example is given. This is a Partial truth trap.
Paraphrasing: Passage: 'spent much of their time taking extensive notes' = Statement: 'spent much of their time writing'
Tips: Group nouns like 'the pseudopatients' usually mean everyone in that group.
Key Vocabulary:
- extensive = a lot
- notes = written records
Question Focus: Range and variation
Passage Reference: Their stays inside varied from 7 to 52 days, with an average of 19 days.
Why this is correct: Since stays went up to 52 days, some stayed longer than three weeks, but not all.
Common Mistake: Choosing all because the average seems high. This is a Statistics trap.
Paraphrasing: Passage: '52 days' = Statement: 'more than three weeks'
Tips: Look at minimum and maximum numbers, not just averages.
Key Vocabulary:
- varied = changed
- average = typical amount
Question Focus: Outcome of admission
Passage Reference: This was sufficient in every case for them to be classified as mentally ill.
Why this is correct: The phrase in every case clearly means all eight were classified as mentally ill.
Common Mistake: Choosing some because of later doubts. This is a Time/tense trap.
Paraphrasing: Passage: 'in every case' = Statement: 'all eight'
Tips: Focus on what happened at that time, not later opinions.
Key Vocabulary:
- classified = labeled
- mentally ill = having mental illness
General Tips:
- Matching Features questions often test quantity words like some, all, or none. Read these very carefully.
- Scan for phrases like 'all', 'some', 'in every case', or 'but one'. They decide the answer.
- Do not assume numbers. If the passage does not clearly say how many, choose 'can't tell'.
- This question type does not follow passage order. Find evidence for each statement separately.
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