“It is no measure of health to be well adjusted to a profoundly sick society.”—J. Krishnamurti
In July 2011, I spent a total of nine days in the San Diego County Psychiatric Hospital. Being sane in an insane place is much harder than you might think, but then again maybe you don’t think I’m sane.*
I know how the caged bird sings, she sings with resonation found only on the super slick floors that only an insane asylum can afford where she sings “Crazy“.
“How do we know precisely what constitutes “normality” or mental illness? Conventional wisdom suggests that specially trained professionals have the ability to make reasonably accurate diagnoses. What is—or is not—“normal” may have much to do with the labels that are applied to people in particular settings.”
The Rosenhan Experiment
The Rosenhan experiment was a famous experiment into the validity of psychiatric diagnosis conducted by psychologist David Rosenhan in 1973. It was published in the journal Science under the title “On Being Sane in Insane Places.” Rosenhan DL (January 1973). The study is considered an important and influential criticism of psychiatric diagnosis. Lauren Slater later revisits the experiment and publishes her findings in Opening Skinner’s Box: Great Psychological Experiments of the Twentieth Century (2004).
Rosenhan’s study was done in two parts. The first part involved the use of healthy associates or “pseudo-patients” (three women and five men) who briefly simulated auditory hallucinations in an attempt to gain admission to 12 different psychiatric hospitals in five different states in various locations in the United States. All were admitted and diagnosed with psychiatric disorders. After admission, the pseudopatients acted normally and told staff that they felt fine and had not experienced any more hallucinations.
Hospital staff failed to detect a single pseudopatient, and instead believed that all of the pseudopatients exhibited symptoms of ongoing mental illness.
Several were confined for months.
All were forced to admit to having a mental illness and agree to take antipsychotic drugs as a condition of their release.
The second part involved asking staff at a psychiatric hospital to detect non-existent “fake” patients. No real patients were sent, yet the staff falsely identified large numbers of ordinary patients as impostors.
The study concluded,
“It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals”
and also illustrated the dangers of dehumanization and labeling in psychiatric institutions. It suggested that the use of community mental health facilities which concentrated on specific problems and behaviors rather than psychiatric labels might be a solution and recommended education to make psychiatric workers more aware of the social psychology of their facilities.
Writer Ignites Firestorm With Misdiagnosis Claims
In Opening Skinner’s Box, Slater recounted the Rosenhan study and his conclusion that psychiatric diagnoses are products of social context rather than objectively verifiable scientific criteria, as well as the enormous impact that the study made on the psychiatric profession and public perception of the reliability of diagnosis.
Slater also reported the results of her own exercise in posing as a patient: At nine separate emergency rooms, Slater said she presented herself as a patient seeking treatment because of a voice she was hearing that was saying the word “thud” (one of the same words Rosenhan’s pseudo-patients claimed to hear). She further reported being prescribed 25 antipsychotics and 60 antidepressants and said that she was diagnosed“ almost every time” with psychotic depression.
“It becomes fairly clear to me that medication drives the decisions, and not the other way around,” Slater wrote. “Rosenhan’s point that diagnosis does not reside in the person seems to stand.”
Excerpted from Psychiatric News, © American Psychiatric Association, April 7, 2006, Volume 41 Number 7, Page 10
- “On Being Sane In Insane Places“. Science 179 (4070): 250–8. doi:10.1126/science.179.4070.250. PMID 4683124. Archived from the original on 2004-11-17.
- Opening Skinner’s Box: Great Psychological Experiments of the Twentieth Century. W. W. Norton. ISBN 0-393-05095-5.
*I’m diagnosed as having a hyperthymic temperament. In layman’s terms that’s being “hard wired for happiness“. I call it happy. I don’t want to be “fixed”—that is how I became “Spunky Gidget”, after all.