Impossible to Distinguish the Sane From Insane

One of the most important criticisms of psychiatric diagnosis is the Rosenhan experiment, which was an experiment orchestrated by David Rosenhan in 1973.  In these experiments, completely sane people faked hallucinations in order to gain access to mental hospitals in an attempt to show that “psychiatrists cannot reliably tell the difference between people who are sane and those who are insane.”

In the study, the fake patients, three women and five men, kept written records on how 12 different hospitals in 5 different states were generally operated and also how they were personally treated.

The experiments began by each of the fake students making appointments at the hospitals and describing voices and words that they heard in their heads.  They provided “a false name and job, but all other details they gave were true including general ups and downs of life, relationships, events of life history and so on.”

After being admitted to the hospital, they acted exactly as they would in the outside world, participating in activities and regularly talking to patients and hospital staff in a friendly, jovial manner.  They also immediately told the staff that they felt fine, and no longer heard voices or felt the slightest bit depressed.

The sane patients were in the hospitals for 7 to 52 days, with an average of 19 days of admittance.  Their objective: to be declared sane and get out of the hospitals by their own devices.  This is where things get interesting.

First, none of the patients were detected by the doctors or staff at the hospitals as being normal or sane, while many of the clinically insane patients spotted their sanity immediately.  In fact, 35 out of 118 patients publicly voiced thier suspicions regarding the fake patients.

Second, normal behavior was viewed as symptoms of their illness.  Writing notes on the staff (which they did openly as the staff took no interest in the subject matter of the writing) was considered ‘writing behavior,’ and showing up early for meals was labeled as “oral-acquisitive syndrome,” rather than simple boredom.

Here are the results of the staff’s behavior toward the fake patients:

Response Percentage making contact with patient
Psychiatrists Nurses
Moves on with head averted 71 88
Makes eye contact 23 10
Pauses and chats 2 4
Stops and talks 4 0.5

Next up, the researchers flipped the study on its head and lied to hospital staff, telling them that one or more sane patients would be admitted to the hospital.  The staff was to rate each patient on a 10-point scale as to the likelihood of them being a fake patient.
The results:

Number of patients judged 193
Number of patients confidently judged as pseudo patients by at least one staff member 41
Number of patients suspected by one psychiatrist 23
Number of patients suspected by one psychiatrist AND one other staff member 19

The psychiatrists at these hospitals failed miserably at recognizing insanity, as well as sanity.

Rosenhan notes that the “experience of hospitalization for the pseudo patients was one of depersonalisation and powerlessness. Powerlessness and depersonalisation were evident in the ways in which the patients were deprived of many human rights such as freedom of movement and privacy.  Medical records were open to all staff members regardless of status or therapeutic relationship with the patient and personal hygiene was monitored and many of the toilets did not have doors.  Some of the ward orderlies would be brutal to patients in full view of other patients but would stop as soon as another staff member approached.”

Anyone that has ever taken a look at the DSM knows what a joke modern day psychology and generalized labeling has become.  According to the DSM, everyone is clinically insane and requires very similar if not identical treatment.  As Rosenhan urged so long ago, “instead of labelling a person as insane we should focus on the individual’s specific problems and behaviours.”

We could also strip society of senseless laws and restrictions that halt progress and use something that has been proven to work.  Time tested, and safe, what could be better?

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