Friday, December 11, 2015

Things That Go Thud in the Night

It was 1973 in the United States. The Vietnam War ended and the last of the soldiers came home. Richard Nixon was elected for a second term but it was not long after that the Watergate scandal came to light. Nixon swore that he was not a crook but the Senate and the House of Representatives voted overwhelmingly in favor of confirming Gerald Ford as president of the United States.  The United States launched its first space station, Skylab. Although there was a trend of deinstitutionalizing the mentally ill (moving them out of mental hospitals and back into society) more than 250,000 inpatients were admitted to mental institutions.¹


That year a pivotal paper was published in the most prestigious scientific journal in the world, Science. The article, titled "On Being Sane in Insane Places" was written by psychologist and Standford University professor Dr. David Rosenhan. This experiment cast a critical eye on the process of psychiatric evaluation and treatment.

Dr. Rosenhan and seven other mentally healthy volunteers attempted to get themselves admitted into mental institutions in order to determine if hospital staff could accurately judge the difference between the sane and the insane. The eight pseudopatients (3 women and 5 men including Rosenhan) adopted pseudonyms. Since half of the pseudopatients were mental health professionals they alleged another occupation in order to not rouse suspicion. Otherwise the pseudopatients accurately reported the details of their lives and pasts. ²

In order to avoid biases a variety of very different institutions were approached. Some were old, some were new. Some were focused on research, one was a private hospital, some were understaffed. The pseudopatients called the hospitals and scheduled an appointment. In the admissions office they reported hearing voices that said "empty", "hollow", and "thud". Every single one of the pseudopatients was admitted. Immediately after admission each patient reported a surcease of all symptoms and proceeded to act normal. The pseudopatients had two main goals at this point: to record the conditions in the hospitals and to get released. The pseudopatients were all exceedingly polite and cooperative throughout the experience which is noted in both the paper and the clinical notes from the hospital.²

At first the pseudopatients attempted to hide their note taking and act like they were not there to observe/ report on the hospital conditions. After a short time they realized they didn't need to. Their writing was considered just a symptom of their disorder.  "Having once been labeled schizophrenic, there is nothing the pseudopatient can do to overcome the tag. The tag profoundly colors others' perceptions of him and his behavior.... "Insane," "schizophrenic," "manic-depressive," and "crazy" are probably among the most powerful of such central traits. Once a person is designated abnormal, all of his other behaviors and characteristics are colored by that label. Indeed, that label is so powerful that many of the pseudopatients' normal behaviors were overlooked entirely or profoundly misinterpreted."²

In times when the pseudopatients did become upset (often due to the conditions in the hospital and the staff treatment of patients) their feelings were always viewed as symptoms of their disorder and never as having anything to do with their surroundings. "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. Consequently, behaviors that are stimulated by the environment are commonly misattributed to the patient's disorder."² Once people come to believe or know that you have a mental disorder you are dehumanized. Your reactions to events are viewed as resulting from your disorder and no longer are you allowed the expression of emotions that would usually be considered normal. The facts or events surrounded by the emotional response are discounted entirely in some cases.

"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.'"² It is so much easier to believe you are crazy when everyone is telling you that you are. It is easier to attribute your own emotions to a disorder than it is to sort them out and deal with them.

"The facts of the matter are that we have known for a long time that diagnoses are often not useful or reliable, but we have nevertheless continued to use them."² How useful are these labels really? There is so much subjectivity that goes into diagnosing mental disorders and so much that is not known about the brain. Sharing those labels with other people irrevocably alters the way people interact with you, feel about you. The earlier in a relationship you share these facts the more altered the relationship is. I am starting to entirely believe that it is not worth it at all. All of us, no matter our mental labels, are people. People who react to the world around us. People who can be irrational and happy and sad and everything in between. People who can be high energy or low energy depending on the day. Being treated like a human being with legitimate feelings is a right that should be afforded to every person regardless of label.

The pseudopatients were hospitalized from between 7 and 52(!) days with an average of 19 days.² Once labelled, it is so difficult to shake the label, as little as the facts or behaviors correspond to it.

¹ http://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html
² Rosenhan, D. L. (1973). On being sane in insane places. Science, 179(4070), 250-258.

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