Posted: Jul 14, 2007 6:20 pm
The basic premise of the experiment was to get a number of ordinary people and have them attempt to gain admission into a psychiatric hospital. The idea here obviously being that the psychiatrists should reliably be able to tell that these people were not really mentally ill.
12 different hospitals in the United States were chosen as the places to try and gain entry to. The hospitals were a mixture of old, new, research, teaching, government funded and privately owned - but all with a good, solid reputation.
Each of the pseudo-patients was told to phone up one of the hospitals and arrange a meeting with one of the psychiatrists there. They were instructed that the only symptom they should complain of was that of hearing a voice. These auditory hallucinations would be of the same sex as the patient and what they heard would be indistinct although all would say they could make out the words 'hollow', 'dull' and 'thud'. Other than this the patients were to behave exactly as they normally would and to be honest with any questions they were asked.
Every single one was admitted with a diagnosis of schizophrenia, except one who was diagnosed with manic-depression.
The pseudo-patients were instructed that should they gain entry into the hospital they were to stop showing any symptoms immediately and behave exactly as normal. Just as in the case when a patient gets committed for real, they had no idea when they would be released; it was up to them to get out - basically by proving to the doctors that they were fine. On the ward they were to be the models of cooperativeness and politeness and were to be totally asymptomatic. Each patient was to write down in a note-book the way that they were treated by the staff and other patients, as well as details of their medication and general ward life.
During this time the patient was allowed to see 'visitors', and these friends or family members were asked to note if they saw any changes in manner, behaviour or thought in the people they knew. All of the patients were eventually discharged with a diagnosis of 'schizophrenia/manic-depression in remission'. The length of stay was between 7 and 52 days - with an average of 19.
One day a pseudo-patient was walking up and down the corridors, a nurse stopped and asked if he was nervous, he replied that no, he was just bored and decided to stretch his legs. The next day his medication was upped to control this 'compulsive behaviour.'
Indeed one of the most surprising aspects of the experiment was that all the pseudo-patients were suspected of being fake by the other patients on their ward! Despite the pseudo-patients assertions that they had been sick but were now feeling a bit better, many of the other patients claimed that 'You're not crazy. You're a journalist, or a professor. You're checking up on the hospital.'
Another factor noted in most of the real patients was that there would be occasions were one would become upset, or even 'go berserk'. In such cases the doctors and staff would always assume the cause of this to be the patient's disorder, or sometimes a visit from a family member or friend; it was never thought that the upset might stem from the situation within the hospital - despite the fact that the patients often stated that that was in fact the reason. All behaviour was viewed within the model of the diagnostic label already attached.
The idea that mental illness was something 'for life' and could not really be cured, bur rather just go into remission or be controlled with medication was almost ubiquitous amongst the staff and doctors at the hospitals.
This lack of personal contact as well as the fact that patients had many of their legal rights taken away due to their diagnosis and were restricted in their activities and interactions contributed to an overwhelming feeling of powerlessness and depersonalization. These feelings, along with the label, seemed to remain even if the patients were discharged. All of which is incredibly counter-therapeutic.
For this part of the experiment, several other hospitals were chosen and the doctors and staff were shown the results of the previous study. Without exception they all insisted that this could never happen at their hospital and that the results must be false. They were then told that during the next three months there would be some more of these pseudo-patients coming to their hospitals to try and gain entry. During this period all doctors and staff should keep a note of the new patients and record which, if any, they thought were faking it.
This, however, was all part of a further act. Rosenhan was not in fact sending any pseudo-patients to their hospitals. However during that time, 41 of the 193 patients who were admitted at the various hospitals were 'confidently judged to be pseudo-patients' by the doctors and staff.
The normal are not detectibly sane
"Any diagnostic process which lends itself so readily to massive errors of this sort cannot be a very reliable one."
Rather than confessing that we don't know, or are just embarking on understanding, we continue to label patients as schizophrenic etc., as if in those words we had captured the essence of understanding. But we have known for a long time that diagnoses are often not useful or reliable, and that we cannot distinguish insanity from sanity. How many people have been needlessly stripped of their privileges of citizenship, right to vote and drive and handle their own accounts? How many have feigned insanity in order to avoid the criminal consequences of their behaviour and, conversely, how many would rather stand trail than live intermittently in a psychiatric hospital, but are wrongly thought to be mentally ill.
Finally, how many patients might be 'sane' outside the psychiatric hospital, but seem insane in it; not because craziness resides in them, but because they're responding to a bizarre setting?"
If mental health professionals cannot distinguish between the mentally ill and the healthy, the question of whether they can distinguish between different types of mental illness seems premature and, perhaps, even pointless.