What is mental illness today? How is the diagnosis made and what is the likelihood of medical error? Is it true that cliches, not reason, rule the ball in insane asylums? How easy is it to deceive modern psychiatry? We turn to the experiment of the American psychologist David Rosenhan and compare the results of the study with the realities of today.
In 1973, David Rosenhan conducted an experiment, the outcome of which unexpectedly called into question the existence of the entire institution of psychiatry. The psychologist wondered how accurately psychiatrists can distinguish mentally ill from "normal" people. Without speculating, Rosenhan persuaded eight friends to sacrifice several months of their lives. All participants in the experiment went to eight different mental hospitals located in five US states. The hospitals differed from each other in status: some of the "patients" visited government institutions with "average" conditions, others ended up in private clinics, where they could enjoy relative luxury.
According to the conditions of the experiment, each of the participants independently arrived at the hospital, was seen by a psychiatrist and complained of only one specific syndrome - the word "splash" that sounded in his head. "Splash" was the only "symptom" of the disease. The rest of the men behaved adequately, spoke only the truth about themselves, did not hide any facts of their biography. Despite this, they were all hospitalized, each received a heavy diagnosis - schizophrenia or depressive-manic psychosis. Interestingly, after hospitalization, the participants contacted the medical staff and claimed that they felt better, that their voice had disappeared, and that they were ready to return home. However, none of them were discharged ahead of schedule. In addition, all "patients" received medication (the participants in the experiment did not swallow the medication). At the same time today,more than 40 years later, science can not provide accurate data on the nature of the action of most psychotropic drugs.
The results of the experiment, published in the journal Science, caused a scandal in the scientific community. Rosenhan was criticized and, above all, from psychiatrists. Many of them believed that the experiment was set up incorrectly. And the author of the classification of mental disorders DSM-II.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a US nomenclature for mental disorders.
Robert Spitzer stated:
In response, Rosenhan conducted another unplanned experiment, because outraged specialists at one of the clinics told Rosenhan that they would never confuse healthy and unhealthy people. They invited him to re-conduct a similar study, referring any number of "pseudo-patients" to their hospital. Rosenhan agreed. Three months later, the management of the institution reported that 41 healthy people were identified. At the same time, Rosenhan did not send anyone to the clinic.
The experiment that broke the status of psychiatry provoked more than just public debate. The aforementioned Robert Spitzer set about creating a new DSM-III classification, excluding any ephemeral statements. Now, since 1980, diagnoses have been based on a specific list of symptoms, the frequency and duration of their manifestation. Spitzer himself argued that the revised DSM was "a defense of the medical model as applied to psychiatry."
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Years later, psychologist, journalist and writer Loreen Slater, who became interested in Rosenhan's experiment, decided to repeat it. The woman chose a clinic with an excellent reputation and went to see a psychiatrist. After the first conversation, during which she complained about the word "splash", the doctor revealed signs of psychosis in her and prescribed an antipsychotic drug.
After Slater visited eight more clinics, met with doctors and repeated the legend. In most cases, the woman was diagnosed with depression with elements of psychosis. It is important that, in the DSM classification, depression is "in the category of severe diseases accompanied by severe motor and intellectual disorders." During the experiment, Slater received prescriptions for 25 antipsychotic drugs and 60 antidepressants. At the same time, the conversation with the doctor never lasted more than 12.5 minutes.
Slater was quick to share her experience with Robert Spitzer, who gave up after long resistance to Rosenhan's idea. He reported:
Nevertheless, the results of two similar experiments were somewhat different. During the study, Rosenhan noted that patients in psychiatric hospitals were not only treated unprofessionally, but also not humanly. He recorded that patients were beaten and ignored. According to him, once a nurse came into a crowded ward, unbuttoned her blouse and straightened her bra. It was obvious that she did not perceive her patients as full-fledged personalities: they did not exist for her.
During Slater's experiment, the staff treated her more than tactfully. In addition, she was never offered hospitalization, as they would have done about 40 years ago.
Psychiatrists today rely on DSM-V guidelines ⓘ
Latest official version of the Diagnostic and Statistical Manual of Mental Disorders
published in 2013. But despite constant innovations and improvements, today psychiatric treatment still remains far from ideal. Of course, it cannot be denied that many psychiatrists are distinguished specialists and literally save their patients. However, against the general background, such examples are rather an exception.
Rosenhan believed that in the clinic, the urge to identify pathology determined the diagnosis. Slater, in turn, believes that diagnosis today is based on a zeal to prescribe drugs. At the same time, it is known that most drugs only stop the symptoms of diseases, and it is still unclear exactly how many medicines, even those most often recommended by doctors, work. Slater writes:
There is no doubt that the clinic is different. However, in the investigations and reports of Russian journalists, descriptions of "Rosenhan's time psychiatry" are often found. For example, journalist Marina Koval got a job as a nurse in one of the provincial psychiatric clinics in 2013. Then she published a report in which she reported on the monstrous conditions in which patients were forced to live. Koval came to the conclusion that gross violation of sanitary standards, beatings, threats, smoking of medical staff in wards, theft of patients' belongings, etc. is a simple consequence of the fact that mentally ill people are not perceived as full-fledged individuals. In addition, the patients took psychotropic drugs that relieved the symptoms and at the same time made him very docile and comfortable for the medical staff. Some patients have complained about the side effects of the drugs:some fainted, others lost their memory, and still others gained weight rapidly. At the same time, the examination by a psychiatrist took five minutes at best. Koval notes that there are many outwardly absolutely normal people in modern psychiatric clinics. A simple nervous breakdown could have brought them to the hospital. However, as in the case of Rosenhan, after the diagnosis and registration of the medical record, the question of "normality" did not bother anyone.the question of "normality" did not bother anyone.the question of "normality" did not bother anyone.
Of course, psychiatry as an institution cannot be discredited by devaluing the many innovations that make many people receive timely and effective care. However, Rosenhan's experiment and subsequent research have challenged many of the principles of modern psychiatry.