The Insane Experiment

The following is an article from Uncle John's Giant 10th Anniversary Bathroom Reader.

BRI member Ben Brand sent us this information about a couple of experiments conducted by a Stanford professor a few years ago. The results are a little scary -but frankly, they're not that surprising, are they?

EXPERIMENT #1

Researchers: Dr. David Rosenhan, a professor psychology and law at Stanford University. He was assisted by eight people, carefully chosen because they were "apparently sane in every measurable aspect, with no record of past mental problems": three psychologists, a psychiatrist, a pediatrician, an artist, a housewife, and a psychology graduate student.

Who They Studied: The people who run America's mental institutions.

* Using pseudonyms, the researchers presented themselves at 12 different mental institutions around the U.S. as patients "worried about their mental health." They were admitted and diagnosed as insane. According to Ron Perlman in the San Francisco Chronicle, "All told the same tale of trouble: they had been hearing voices which seemed to be saying 'empty' or 'hollow' or 'thud.' This was the only symptom they presented, and the pseudopatients were scrupulously truthful about all other aspects of their lives during interviews and therapy sessions."

* Perlman adds, "As soon as they were admitted to the hospitals, they stopped simulating any symptoms at all, and whenever they were asked they all said they felt fine and that their brief hallucinations were gone. They were cooperative a patients and behaved completely normally. The only symptom they might then have shown was a little nervousness about the possibility of being found out."

* They remained in the institutions for as long as 52 days, getting regular treatment.

* The eight "mental patients" scrupulously kept a written record of both their treatment and the things that happened around them in the mental wards. At first they did it furtively, hiding their notes so that the staff wouldn't find them. But gradually they realized that the staff didn't care, and never even bothered to ask what they were writing. "One nurse," writes Perlman, "noticing that a pseudopatient was taking regular notes, saw it as a symptom of a crazy compulsion. 'Patient engages in writing behavior,' she wrote portentously on his chart day after day."

What They Learned: "We cannot distinguish the sane from the insane in psychiatric hospitals," Rosenhan reported. Moreover, he added, "it's the hospitals themselves that might be 'insane,' rather than the patients confined there."

Some of the evidence:

* Of the eight experimenters, seven were diagnosed as schizophrenics; one was diagnosed as "a victim of manic-depressive psychosis."

* And when they were released, they were described as "improved," or "in remission," but no doctors listed any of them as "cured."

* The staff at the institutions never suspected the eight experimenters weren't crazy ...but the real patients did.

* Perlman writes, "Many of the real patients challenged them. 'You're not crazy,' they insisted. 'You're a journalist or a professor. You're checking up on the hospital.'" Rosenhan's wry comment on the subject: "The fact that the patients often recognized normality when staff did not raises important questions."

EXPERIMENT #2

At one of the hospital included in the experiment, administrators doubted Rosehan's results. It was, they insisted, impossible for professionals to make such egregious mistakes. So Rosenhan suggested a new experiment that would prove either the hospital or his own findings right.

Researchers: Rosenhan, and an undetermined number of "pseudopatients."

Who They Studied: The hospital staff. Rosenhan told the hospital that his new assistants would pull the same stunt they'd tried before, and challenged hospital officials to detect them.

What They Learned: Rosenhan's original findings could well have been correct.

Some of the evidence:

* "The hospital staffs took extra pains diagnosing the next 193 patients admitted for psychiatric treatment," Perlman writes, "and sure enough, 41 new patients were determined by at least one staff member to be a "pseudopatient" -a sane person posing as insane. Twenty-three patients were judged to be sane by at least one psychiatrist."

* Actually, not a single one of the 193 were sent there by Rosenhan.

* That didn't mean they were really insane, of course -Rosenhan offered no conclusions about them. He merely pointed out that as soon as doctors and their staff expected to find sane people among the patients, they did.

* His conclusion: "Any diagnostic process that lends itself so readily to massive errors of this sort cannot be a very reliable one."

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Reprinted with permission from Uncle John's Giant 10th Anniversary Bathroom Reader, which comes packed with 504 pages of great stories.

Since 1988, the Bathroom Reader Institute had published a series of popular books containing irresistible bits of trivia and obscure yet fascinating facts.

If you like Neatorama, you'll love the Bathroom Reader Institute's books - check 'em out!

Playing Devils Advocate

Although I'm sure this article was written to send a light-hearted message, I cringe at the anticipated popular responses that it's readers may have. I anticipate such a response to be a negative one towards the field of psychology, mental health diagnostics, and mental health services in general. Thus, I want to play devil's advocate in response to such. (NOTE: I am not arguing against the basic message that points at the power of suggestion and the role that expectations play in the development of one's perceptions. I agree that there is still a problem with over-diagnosis of certain mental disorders, although I believe the reasoning for that calls for an in depth discussion and should be saved for another day.)

The first passage that I take issue with is the following: “As soon as they were admitted to the hospitals, they stopped simulating any symptoms at all, and whenever they were asked they all said they felt fine and that their brief hallucinations were gone. They were cooperative a patients and behaved completely normally. The only symptom they might then have shown was a little nervousness about the possibility of being found out.” Just because they felt fine and reported to the staff that they felt fine, does not mean that they would or even should be immediately discharged. It’s probably not that uncommon for people who have actually experienced auditory hallucinations to report to others that they are fine if 1.) the voices they hear are not bothersome to them, 2.) they are being treated with antipsychotic medications that are in fact mitigating such symptoms, or 3.) they have learned that when they report being “fine” that they are left alone and not bothered with further questioning, medications, or other procedures that they may find disruptive or unpleasant. In other words, what do you expect that the staff would say? “Oh, okay, so you feel okay and don’t hear voices anymore?? Great! Let’s discharge you into society immediately with no diagnostic information that notes a history of abnormal psychological experiences (i.e. hearing voices)!” Just something to consider.

A second passage I’d like to comment on is the following: “And when they were released, they were described as “improved,” or “in remission,” but no doctors listed any of them as ‘cured.’” While I understand that they should not have been diagnosed in the first place, I wish to point out that once someone is diagnosed and treated for a disorder like schizophrenia, it is highly unlikely that it would ever be noted as being “cured”. Such expectations are unrealistic since that language (i.e. being “cured”) would not be used in a mental health setting even if the symptoms have mitigated or are under control as a result of treatment.

Another statement that I have trouble with (among the many) is: “They were admitted and diagnosed as insane.” I question and challenge this statement vehemently because there is no such diagnosis of “insane” in the DSM-IV. So, it is possible that either 1.) the published study was not using DSM/common language used in the professional field, 2.) the study was conducted many years ago at a time when the DSM was not used or the term insane was used in the DSM, 3.) the writers who wrote this article (that I am replying to) did not properly report the research findings. I think the point here is to emphasize that we all must be critical thinkers and consumers of the things we read. Especially when the statements or messages that the author wishes to make have so many implications. In this case, the implications or messages being conveyed are reinforcing the stigma associated with mental health services, diagnoses, and the profession at large. I am not arguing that the field is perfect, nor am I attempting to argue against the actual research findings (because without reading the research article itself, there is no way to critically assess its validity, generalizability, implications, limitations, etc.). I am merely trying to highlight the importance of thinking critically about statistics, data, and general “findings” that are reported in the media in general. For example, if this research was conducted nearly 40 years ago, we need to be open-minded to the likelihood that research, mental diagnoses, diagnostic measures/assessments, and mental health care services have changed (a lot) since then. It makes for an interesting read and something to think about but I would encourage fellow readers to be sure to be educated consumers of such information before spreading the ‘news’.

On a final note, I think it’s important to highlight that there are in fact that there are people who malinger. Malingering is hard to catch sometimes. Fortunately, there are assessments used today to help determine one’s likelihood of feigning mental illness. One thing that this article certainly highlights is the value of proper psychological evaluation by a psychologist using a battery of assessment tools.