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The most obvious evidence is that Hamlet himself says he is going to pretend to be mad, suggesting he is at least sane enough to be able to tell the difference between disordered and rational behavior. If Hamlet does know that Claudius and Polonius are listening, the fact that he can instantly adjust his behavior points toward the idea that he has a firm grip on reality and his own mind. Similarly, when Hamlet is sent to England, he acts skilfully and ruthlessly to escape, which suggests that even at this late stage in the play he is capable of perfectly sane behavior.

By making the audience constantly question whether Hamlet is really mad or just pretending, Hamlet asks us whether the line between reality and acting is as clear-cut as it seems. Hamlet seems to believe that acting can be as real, or realer, than real-life emotion, which raises the possibility that by pretending to be mad, Hamlet has actually caused his own mental breakdown.

Throughout the play, Hamlet struggles to determine which role he should play—thoughtful, reticent scholar, or revenge-minded, decisive heir to the throne—and by acting both parts, Hamlet explores what his true role should be. Hamlet forces us to question what the truth is: how can we tell between reality and pretense? Home Shakespeare Hamlet Is Hamlet really mad? His attempts to control emotionality with his wife and children are punctuated by angry outbursts and, in the case of the children, spankings. And while he says that he has several good friends, one senses considerable ambivalence embedded in those relationships also.

The facts of the case were unintentionally distorted by the staff to achieve consistency with a popular theory of the dynamics of a schizophrenic reaction. Nothing of an ambivalent nature had been described in relations with parents, spouse, or friends. Clearly, the meaning ascribed to his verbalizations that is, ambivalence, affective instability was determined by the diagnosis: schizophrenia. All pseudopatients took extensive notes publicly. Under ordinary circumstances, such behavior would have raised questions in the minds of observers, as, in fact, it did among patients.

Indeed, it seemed so certain that the notes would elicit suspicion that elaborate precautions were taken to remove them from the ward each day. But the precautions proved needless. 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. If no questions were asked of the pseudopatients, how was their writing interpreted?

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Nursing records for three patients indicate that the writing was seen as an aspect of their pathological behavior. 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. One tacit characteristic of psychiatric diagnosis is that it locates the sources of aberration within the individual and only rarely within the complex of stimuli that surrounds him.

For example, one kindly nurse found a pseudopatient pacing the long hospital corridors. The notes kept by pseudopatients are full of patient behaviors that were misinterpreted by well-intentioned staff.

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One psychiatrist pointed to a group of patients who were sitting outside the cafeteria entrance half an hour before lunchtime. To a group of young residents he indicated that such behavior was characteristic of the oral-acquisitive nature of the syndrome. It seemed not to occur to him that there were very few things to anticipate in a psychiatric hospital besides eating.

A psychiatric label has a life and an influence of its own. Once the impression has been formed that the patient is schizophrenic, the expectation is that he will continue to be schizophrenic. When a sufficient amount of time has passed, during which the patient has done nothing bizarre, he is considered to be in remission and available for discharge.

But the label endures beyond discharge, with the unconfirmed expectation that he will behave as a schizophrenic again. Such labels, conferred by mental health professionals, are as influential on the patient as they are on his relatives and friends, and it should not surprise anyone that the diagnosis acts on all of them as a self-fulfilling prophecy. Eventually, the patient himself accepts the diagnosis, with all of its surplus meanings and expectations, and behaves accordingly. The inferences to be made from these matters are quite simple.

Much as Zigler and Phillips have demonstrated that there is enormous overlap in the symptoms presented by patients who have been variously diagnosed, [6] so there is enormous overlap in the behaviors of the sane and the insane. And we may find it difficult to get along with one or another person — again for no reason that we can specify. Similarly, the insane are not always insane. Indeed, it was the impression of the pseudopatients while living with them that they were sane for long periods of time — that the bizarre behaviors upon which their diagnoses were allegedly predicated constituted only a small fraction of their total behavior.

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If it makes no sense to label ourselves permanently depressed on the basis of an occasional depression, then it takes better evidence than is presently available to label all patients insane or schizophrenic on the basis of bizarre behaviors or cognitions. Conceivably, when the origins of and stimuli that give rise to a behavior are remote or unknown, or when the behavior strikes us as immutable, trait labels regarding the behavior arise.

When, on the other hand, the origins and stimuli are known and available, discourse is limited to the behavior itself. Thus, I may hallucinate because I am sleeping, or I may hallucinate because I have ingested a peculiar drug.

Other examples:

These are termed sleep-induced hallucinations, or dreams, and drug-induced hallucinations, respectively. But when the stimuli to my hallucinations are unknown, that is called craziness, or schizophrenia —as if that inference were somehow as illuminating as the others. But while treatment has improved, it is doubtful that people really regard the mentally ill in the same way that they view the physically ill. A broken leg is something one recovers from, but mental illness allegedly endures forever.

A broken leg does not threaten the observer, but a crazy schizophrenic? There is by now a host of evidence that attitudes toward the mentally ill are characterized by fear, hostility, aloofness, suspicion, and dread. That such attitudes infect the general population is perhaps not surprising, only upsetting. But that they affect the professionals — attendants, nurses, physicians, psychologists and social workers — who treat and deal with the mentally ill is more disconcerting, both because such attitudes are self-evidently pernicious and because they are unwitting.

Most mental health professionals would insist that they are sympathetic toward the mentally ill, that they are neither avoidant nor hostile. But it is more likely that an exquisite ambivalence characterizes their relations with psychiatric patients, such that their avowed impulses are only part of their entire attitude.

Negative attitudes are there too and can easily be detected. Such attitudes should not surprise us.

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They are the natural offspring of the labels patients wear and the places in which they are found. Consider the structure of the typical psychiatric hospital. Staff and patients are strictly segregated. Staff have their own living space, including their dining facilities, bathrooms, and assembly places. Otherwise, staff keep to themselves, almost as if the disorder that afflicts their charges is somehow catching. While it was not the case that all time spent out of the cage was spent mingling with patients attendants, for example, would occasionally emerge to watch television in the dayroom , it was the only way in which one could gather reliable data on time for measuring.

The average amount of time spent by attendants outside of the cage was This figure does not represent only time spent mingling with patients, but also includes time spent on such chores as folding laundry, supervising patients while they shave, directing ward cleanup, and sending patients to off-ward activities.

It was the relatively rare attendant who spent time talking with patients or playing games with them. Rather, we counted instances of emergence from the cage. On the average, daytime nurses emerged from the cage Later afternoon and night nurses were even less available, emerging on the average 9. Data on early morning nurses, who arrived usually after midnight and departed at 8 a. Physicians, especially psychiatrists, were even less available.

They were rarely seen on the wards. Quite commonly, they would be seen only when they arrived and departed, with the remaining time being spend in their offices or in the cage. On the average, physicians emerged on the ward 6. It proved difficult to make an accurate estimate in this regard, since physicians often maintained hours that allowed them to come and go at different times. The hierarchical organization of the psychiatric hospital has been commented on before, but the latent meaning of that kind of organization is worth noting again. Those with the most power have the least to do with patients, and those with the least power are the most involved with them.

Recall, however, that the acquisition of role-appropriate behaviors occurs mainly through the observation of others, with the most powerful having the most influence. Attendants are seen mainly in the cage, which is where the models, the action, and the power are. I turn now to a different set of studies, these dealing with staff response to patient-initiated contact.

It has long been known that the amount of time a person spends with you can be an index of your significance to him. If he initiates and maintains eye contact, there is reason to believe that he is considering your requests and needs. If he pauses to chat or actually stops and talks, there is added reason to infer that he is individuating you.

Care was taken never to approach a particular member of the staff more than once a day, lest the staff member become suspicious or irritated. One could indeed engage in good conversation with them. Minor differences between these four institutions were overwhelmed by the degree to which staff avoided continuing contacts that patients had initiated.

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Moves off without waiting for a response. Eye contact and verbal contact reflect concern and individuation; their absence, avoidance and depersonalization. The data I have presented do not do justice to the rich daily encounters that grew up around matters of depersonalization and avoidance.