Back to the madness

A new series of the excellent BBC Radio 4 Mind Changers series has just started with a fantastic edition on the Rosenhan experiment – a study that sent seismic waves of controversy through 1970s psychiatry.

Titled ‘On being sane in insane places’ when published in a 1972 edition of Science, the experiment reported on how Rosenhan and his associates had presented to psychiatric hospitals faking a single psychiatric symptom – a hallucinated voice.

All of the pseudopatients were admitted to hospital and diagnosed with mental illness. They then stopped faking only to find that their normal behaviour was pathologised as a sign of a disturbed mind.

Later, when word got out and the hospitals were accused of being ‘bad apples’, Rosenhan promised to send more fake patients but, in reality sent none. The hospitals subsequently branded 41 real patients as fakes.

The Mind Changers programme throws much fresh light on this study by examining never-before-seen documents from Rosenhan’s own archive.

While the study has often been framed as an attack on psychiatric diagnosis, according to Rosenhan, it was never intended to be. He started out wanting to conduct an anthropological study of psychiatric wards.

There’s an interesting bit where the hospital admission notes are read out concerning Rosenhan’s admission to hospital under a fake name:

Admission note 6th February 1969

The patient, David Lurie, is a 39 year-old married father of two… Three to four months ago he started hearing noises, then voices, recently he has been able to discern that the voices say “It’s empty, nothing inside, it’s hollow, it makes an empty noise.”

Compare this with the description from the original text of the study:

After calling the hospital for an appointment, the pseudopatient arrived at the admissions office complaining that he had been hearing voices. Asked what the voices said, he replied that they were often unclear, but as far as he could tell they said ‚Äúempty,‚Äù ‚Äúhollow,‚Äù and ‚Äúthud.‚Äù…

The choice of these symptoms was occasioned by their apparent similarity to existential symptoms. Such symptoms are alleged to arise from painful concerns about the perceived meaninglessness of one’s life. It is as if the hallucinating person were saying, “My life is empty and hollow.”

I’m intrigued that while the paper suggests that the pseudopatients were told to report single word hallucinations, the medical records suggest whole sentences were heard.

I wonder whether the pseudopatients were tempted to embellish their single words or whether the psychiatrists genuinely did weave narratives around the sparse information presented to them.

Either way, as many people have countered, the study is not in itself a very good critique of psychiatric diagnosis. If I go to my doctor and say I’m distressed by hallucinated voices, this is a legitimate symptom of mental illness as far as the doctor is concerned.

However, as psychologist Richard Bentall notes in the programme, much more damning is the fact that once seen as patients, almost everything the fakers did was interpreted as abnormal or pathological in some way.

The fact that diagnosis or clinical opinion is swayed by personal, cultural or professional beliefs is now a well established research finding and this part of Rosenhan’s study remains as relevant today as it was in the 1970s.

Link to crap BBC Radio 4 page with audio archive (via @researchdigest)
Link to full text of Rosenhan’s study.

4 thoughts on “Back to the madness”

  1. This is the real ambivalence of the whole endevour of psychiatry.
    To me psychiatry is the pinnacle of all medical sciences but because practitioners deal with the most complex organ (the brain and its maladies)and ussually other colleagues from the rest of specialities treat psychiatry as the poor sister of medicine, is very difficult for psychiatry to develop fully and gain respect.
    They claim psychiatry has not found biological markers of mental illness and relies on subjective behavioural measures of symptoms etc.

  2. There is a paralel between this research and a current scandal in Sweden at the moment. A student at the swedish academy of arts. She faked a psychosis with homocidal tendencis (she tried to jump of a bridge in Stockholm). The event has sparked a fierce debate concerning what art is and how far it can go to mirror society. The student is now facing charges. One can wonder what or if there is a difference between this art student and the researcher?

  3. “not in itself a very good critique”
    Yeah? What about the second half, where no patients are sent?
    Yet “fake” patients are found where none exist?
    I think that IS a good critique.

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