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Psychology · 7 February 2011 ·

What's insane anyways?

It’s already hard to define insanity, but it’s even harder to define what’s sane. What is considered to be sane behaviour in one condition might be considered completely insane in another, but even this depends on the context. If you see an old man crouching crouching and quacking through his garden, it is likely to think that this man must have lost his mind. But when you know that this man was the famous ethologist Konrad Lorenz, trying to imprint a group of ducklings hidden in the grass, you would interpret the actions quite differently (Watzlawick et al., 1967, p. 20). Thus, sanity has a lot to do with the intentions we are trying to attribute to another’s mind: If we can follow them, they are sane, otherwise not.

In other cases, it very much depends on the cultural context. Thus, hearing voices in Western Societies is not accepted and people who do, face stigma in the society. However, there is an exception to this: If your voices have a religious background and are based on a shared belief system such as Christianity, then you are much more likely to get away with it. The point as such is not, that Christianity is just about hearing voices, but about the same action having a different interpretation depending on the cultural context. A definition of sanity can only work within a frame of reference, and no individual can be considered insane without considering the context.

But sometimes this can be extremely difficult, particularly with people who have already been diagnosed with a mental problem. Quickly, this diagnosis can become a prism through which all sorts of behaviour can appear far from lucidity.

A recent incident in Germany exemplifies this classic problem: Due to a series of blows of fate, such as the loss of work, Karl G., a 48-year old system administrator, developed a severe depression and asked for treatment. He was soon hospitalized. In the psychiatric ward his general concern about data protection was interpreted very differently. In the ward, he refused to have a photo taken since the use and purpose of such a photo was not explained to him. He also refused to have photos of his taken by other inmates, demanding that they should get permission before taking photos and uploading them to social networks. In similar instances, concern was expressed about the security of patient data on the clinic’s computers.

Given the social stigma associated to a stay in a psychiatric institution, a strong concern about data protection in the clinical setting is actually not unreasonable, and given that G. was working in the IT industry, one can expect a reasonable sensitivity towards the issue. And whilst there are people who openly speak about their experiences with mental illness, others might don’t want to bring it up. It is important to understand that this is a matter of one’s own personal choice and not someone else’s. However, G.‘s concern, when looked at through the psychiatrist’s prism, was quickly translated into a diagnosis of paranoia, that began to supersede the initial diagnosis of depression. In the interviews, his concern was interpreted as a general distrust and were brought up repeatedly. He objected, and argued he wasn’t paranoid but simply concerned about the handling of his personal data. This in turn was taken as further evidence of his pathological paranoia. The diagnosis was now circular, and the only way for G. to overcome it was by agreeing that he was indeed paranoid, which he obviously refused.

The case bears a frightening resemblance to the Rosenhan experiment, a classical study conducted in 1973. David L. Rosenhan sent out a group of colleques, friends and students, all with no previous history of mental illness, to feign brief auditory hallucinations, so that they were assigned to a mental hospital. As soon as they arrived, they were instructed to act totally normal and take notes of their hospital stay. They expected to be sent home soon, and were worried their real identity would soon be revealed, but they were wrong. The wards happily accommodated them and took no suspicion whatsoever. In fact, they interpreted almost everything the pseudopatients did as part of their underlying mental problem, whether it they were taking notes or waiting for lunch — everything confirmed that there was something wrong. Ironically it wasn’t the staff that suspected them of being imposters: Some of their inmates raised suspicion as to their status and a few even accused them of being journalists. Rosenhan writes: “The fact that the patients often recognized normality when staff did not raises important questions.”

Some of the “insane” behaviour found in their inmates can be attributed to the surroundings the patients found themselves in. The boredom due to the lack of activity, the overinterpretation of behaviour in staff. Paul Watzlawick stresses the importance of context in attributing normality, or what I have called “intentionality” earlier. In a psychiatric ward, it is easy to be insane, for the sheer reason that it will be interpreted this way:

Often enough, a patient would go “berserk” because he had, wittingly or unwittingly, been mistreated by, say, an attendant. A nurse coming upon the scene would rarely inquire even cursorily into the environmental stimuli of the patient’s behavior. Rather, she assumed that his upset derived from his pathology, not from his present interactions with other staff members. (Rosenhan, 1973)

The study had an enormous impact on the field and was widely debated. Rosenhan was asked to repeat the experiment and send out another group of pseudopatients. In the follow-up study, out of 193 patients who were to be admitted for psychiatric treatment, 41 were considered to be imposters whilst another 42 were at least suspected. But Rosenhan didn’t send a single one.

All these cases illustrate how hard it is to practically define insanity, yet alone sanity. We can infer the importance of context and of intentionality, they play important roles in our judgement of our fellow people. As illustrated, the same behaviour can have entirely different interpretations depending on intentions and contexts, ranging from absolutely brilliant to utterly crazy. But often, we may simply fail to take the context into account, sometimes because we are preoccupied with an existing interpretation, other times it’s just our plain ignorance. There are lessons to be learnt, not just for the way psychiatric wards are run, but also on a far more individual level, how we interact with the people around us, how we interpret their behaviour and how fast we are in discarding the sanity of their decisions and life choices.

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