On being sane in insane places

The 1973 experiment by David Rosenhan - 'on being sane in insane places'12 - has been widely reported. But it bears repetition. Rosenhan arranged for eight ordinary people from conventional backgrounds to go to hospitals in the USA and tell unsuspecting psychiatrists that they had heard disembodied voices saying 'empty', 'hollow' or 'thud'. Apart from reporting this experience (which is, of course, a conventional criterion for the diagnosis of schizophrenia), the eight undercover researchers were told to reply to all questions honestly.

All eight of them were admitted to hospital, the majority of them with a diagnosis of schizophrenia. Once they were admitted, each

'pseudopatient' behaved normally. But the fact that they had been admitted to hospital and given a psychiatric diagnosis appeared to change the way they were regarded by the staff. Staff saw one pseudopatient pacing the corridors - they were bored - and suggested that they were experiencing 'anxiety' when seen. One pseudopatient was seen to be writing - in fact, writing notes of their experiences - which was recorded as 'patient engages in writing behaviour'. The scientific or medicalised language ('writing behaviour') subtly indicates that something odd is going on. Rosenhan reports that it was only the other patients in the hospital who realised that there was something odd going on; one challenged a researcher, saying: 'you're not crazy, you're a journalist or a professor. You're checking up on the hospital.'

Sadly, the treatment that the pseudopatients received in hospital was deeply worrying. Once in hospital, the undercover researchers reported that they no longer heard any voices. And indeed, after an average of 19 days (with a range of 7 to 52), the staff agreed that they were now well enough to be discharged - all were discharged with a diagnosis of schizophrenia in remission. But, by then, the pseudopatients had been prescribed a total of 2100 pills. We should be careful not to read too much into Rosenhan's research. It was conducted in 1973 and things have undoubtedly changed. But we should note that staff members only spent 11% of their time interacting with patients in Rosenhan's study,

and that comments like 'Come on, you mother f---s, get out of bed'

were reported as common. We should contrast this with the stories we are told about residential mental health units today, some of which I have included in this book.

Many people argue that it's possible to read a little too much into Rosenhan's study. For me, however, this study is important. For example, I think that, within the logic of the 'disease model' of psychiatric diagnosis, the psychiatrists apparently duped by Rosenhan's pseudopatients had reasonable grounds for making their diagnostic decisions - and subsequent decisions to admit to hospital and prescribe medication. In the standard diagnostic manuals, hearing voices - experiencing auditory hallucinations - is a symptom of 'schizophrenia'. And the disease model dictates to psychiatrists that 'schizophrenia' warrants hospital treatment and medication. Within this (flawed) system, diagnosis, classification, hospitalisation and prescription are justified. My point is that I don't believe the 'disease model' is appropriate, and so the diagnostic and treatment decisions that follow are equally flawed.

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