In 1973, D. L. Rosenhan published a groundbreaking psychiatric study in January 19 issue of Science magazine. The article exposed a serious shortcoming in the psychiatric hospitals at the time, and therefore it became very controversial. Dr. Rosenhan, a professor of psychology and law at Stanford University, designed the study to try to answer the title question: \u201cIf sanity and insanity exist, how shall we know them?\u201d<\/p>\n
The now famous (some offended or embarrassed psychiatrists preferred to call it \u201cinfamous\u201d) experiment that was carried out involved 12 different psychiatric hospitals and 8 different people, mostly professionals (including the author). Each of the eight were totally and certifiably sane \u201cpseudo-patients\u201d.<\/p>\n
Each one secretly gained admission to one or two different mental hospitals by falsely complaining to a psychiatrist that they had been hearing voices over the past few weeks. The \u201cvoices\u201d in each case were saying only the three words \u201cempty,\u201d \u201chollow,\u201d and \u201cthud.\u201d No visual hallucinations or other psychological abnormalities were relayed to the examining psychiatrist. Except for the fake \u201cchief complaint\u201d, the intake histories relayed by the patients were entirely truthful. Each \u201cpatient\u201d was immediately admitted, much to the surprise of most of the pseudo-patients.<\/p>\n
All but one of the admitted \u201cpatients\u201d were given a diagnosis of \u201cschizophrenia\u201d. The other one was labeled \u201cmanic-depressive\u201d. When they were discharged, the eleven had discharge diagnoses of \u201cschizophrenia, in remission,\u201d despite the fact that absolutely no psychotic or manic behaviors had been observed during their stays.<\/p>\n
After admission, each pseudo-patient acted totally sane, each emphasizing that the voices had disappeared. When given the chance, each also asked about when they could be discharged. Those questions were largely ignored by staff.<\/p>\n
Despite the fact that each one acted totally normally throughout, their hospital stays averaged 19 days, ranging from 7 to 52 days.<\/p>\n
The pseudo-patients engaged in all the normal ward activities except for the fact that they never swallowed the variety of antipsychotic pills that had been prescribed for them. The only obvious difference between the behaviors of the experimental group and the regular patients was that each of them took notes during their hospitalizations. On several occasions, a staff member wrote in the patient\u2019s chart: \u201cthe patient engages in note-taking behavior\u201d. Otherwise none of the staff seemed interested in any of the patient\u2019s behaviors.<\/p>\n
Although the pseudo-patients planned to secretly smuggle out their daily notes, they eventually stopped trying to hide the fact that they were recording their impressions of their stays, and they soon stopped the smuggling operations – with no consequences.<\/p>\n
The average daily contact with the therapeutic staff was only 6.8 minutes per day (mean 3.9 \u2013 25.1 minutes) and that included admissions interviews, ward meetings, group and individual psychotherapy contacts, case conferences and discharge meetings.<\/p>\n
The group observed that attendants only came outside the \u201ccage\u201d 11.5 times per 8-hour shift but usually only interacted minimally with the patients when doing so. The staff psychiatrists rarely interacted meaningfully with any patient. If any interaction occurred, it was usually rather patronizing.<\/p>\n
None of the professional therapeutic staff ever suspected that any of the 12 were pseudo- patients, whereas many of the \u201creal\u201d patients knew for certain that they were faking. These patients (who were probably actually taking their meds) often said things like: \u201cYou\u2019re not crazy. You\u2019re a journalist or a professor. You\u2019re checking up on the hospital.\u201d The staff never tumbled to the subterfuge. The only people who recognized normality were those who themselves had been labeled \u201cinsane\u201d.<\/p>\n
Upon the publication of the Rosenhan paper, there arose an enormous uproar from the psychiatric community about the \u201cethics\u201d of performing such a study. Rosenhan was attacked viciously by those who had been fooled or had themselves hastily jumped to erroneous psychiatric diagnoses in the past.<\/p>\n
Because of the controversy, Rosenhan announced that there was to be done a follow-up study in a certain research and teaching hospital whose staff had heard about the first study but doubted that such errors could occur in their own hospital. The staff was led to believe that sometime in the next 3 months there would be one or more pseudo-patients attempting to be admitted. However, by design, no pseudo-patients actually attempted admission.<\/p>\n
Among the total of 193 patients that were admitted for psychiatric treatment during the 3-month period, 41 genuine patients (20 % of the total) were suspected, with high confidence, of being pseudo-patients by at least one member of the staff. 23 of the 41 were suspected of being fake patients by a psychiatrist, and 19 were suspected by both a psychiatrist and one other staff member. On the bright side, their heightened vigilance saved 41 normal people from receiving a diagnosis of permanent mental illness and the prescribing of brain-altering drugs.<\/p>\n
Among the conclusions the reader can draw from these two experiments are these important and quite logical ones:<\/p>\n
It is a known fact that hallucinations can occur in up to 10% of normal people. Vivid flashbacks in patients with PTSD (posttraumatic stress disorder) have, in the past, been commonly and tragically misdiagnosed as \u201challucinations\u201d and therefore that unfortunate patient can be permanently labeled (and then drugged) as a permanent \u201cparanoid schizophrenic\u201d rather than as a patient with PTSD having temporary \u201cflashbacks\u201d (a common error in pre-1990s VA hospitals in combat-traumatized war veterans).<\/p>\n
Hallucinations can normally occur during certain phases of sleep, half-waking states, sleep deprivation, or from drug effects \u2013 either because of neurotoxic\/psychotoxic effects from brain-altering, psycho-stimulating prescription (or illicit) drugs or from withdrawal from sedating antipsychotic drugs. It is not uncommon for Ritalin, cocaine, Adderall or speed to cause (drug-induced) psychotic episodes.<\/p>\n
It is well known that drug-induced mania (and thus a false diagnosis of bipolar disorder \u201cof unknown etiology\u201d) can occur from even standard doses of most psycho-stimulating antidepressant drugs, especially the SSRIs (\u201cselective\u201d serotonin reuptake inhibitors) or during withdrawal from \u201cminor\u201d tranquilizer drugs such as the Valium-type benzodiazepines or \u201cmajor tranquilizers\u201d such as antipsychotic drugs like Thorazine, Haldol, Risperdal, Zyprexa, Abilify, Seroquel, Geodon, etc.<\/p>\n
One well-done showed that a significant percentage of patients admitted from one psychiatric hospital emergency room were ultimately discharged with a diagnosis SSRI drug-induced mania and not \u201cbipolar disorder of unknown etiology\u201d. The cause of those ER visits was not a mental disorder but rather a drug-induced neurological disorder that was self-limited and best treated by stopping the offending drug.<\/p>\n
Rosenhan rightly points out: \u201cHow many people\u2026are sane but not recognized as such in our psychiatric institutions? How many have been needlessly stripped of their privileges of citizenship, from the right to vote and drive or of handling their own accounts? How many have feigned insanity in order to avoid the consequences of their behavior and, conversely, how many would rather stand trial for a crime than live interminable in a psychiatric hospital because they were wrongly thought to be mentally ill? How many have been stigmatized by well-intentioned, but nevertheless erroneous, diagnoses?\u201d (Ed note: recall the end result of Jack Nicholson\u2019s character in \u201cOne Flew Over the Cuckoo\u2019s Nest\u201d),<\/p>\n
To those concerns, I would add, how many patients have suffered the brain-disabling and neurotoxic and neurodegenerative consequences of dangerous, dependency-inducing, and very powerful psychiatric drugs, that if used long enough can easily produce dementia as well as deadly withdrawal effects when stopped?<\/p>\n
Rosenhan\u2019s study has significant implications for our society today, and perhaps more so, for in 1973 there was only Elavil, Stelazine, Compazine, Thorazine and a few other psychiatric drugs to be concerned about. Eventually these drugs were discovered to be brain-damaging substances, and we can now justifiably say of them: \u201cgood riddance\u201d.<\/p>\n
However, today there are scores and scores of \u201csecond and third generation\u201d, \u201cnovel\u201d or \u201catypical\u201d drugs that were never tested for long-term safety or efficacy before they were granted marketing approval by the FDA. Many of them are commonly used in hugely expensive cocktail combinations which likewise were never tested for long-term safety or efficacy in the animal lab, much less thoroughly tested in human studies.<\/p>\n
All of these psychiatric drugs are bio-accumulative substances that are known to be hazardous to the planetary and human environments (essentially HazMat substances). They need to be handled with extreme care \u2013 unless, apparently, they are prescribed by a licensed healthcare worker for indefinite periods of time and to be swallowed by obedient patients with unknown liver detoxification capabilities who might be taking other prescription drugs with unknown drug-drug interactions. The irony of that reality should give us all pause.<\/p>\n
Below are some choice quotes from Rosenhan\u2019s original article which was titled \u201cOn Being Sane In Insane Places\u201d. (Science magazine 1973, Vol. 179 p. 250 \u2013 258)<\/p>\n
\u201cIt is commonplace, for example, to read about murder trials wherein eminent psychiatrists for the defense are contradicted by equally eminent psychiatrists for the prosecution on the matter of the defendant\u2019s sanity. <\/em><\/strong><\/p>\n \u201cPsychological suffering exists\u2026but do the salient characteristics that lead to diagnoses reside in the patients themselves or in the environments and contexts in which observers find them?\u00a0\u2026Psychiatric diagnosis betrays little about the patient but much about the environment in which an observer finds him.\u00a0<\/em><\/strong><\/p>\n \u201cThe view has grown that psychological categorization of mental illness is useless at best and downright harmful, misleading, and pejorative at worst.\u00a0<\/em><\/strong><\/p>\n \u201cDespite their public \u2018show\u2019 of sanity, the pseudopatients were never detected, and\u00a0\u00a0 each was discharged with a diagnosis of schizophrenia \u2018in remission.\u2019\u00a0<\/em><\/strong><\/p>\n \u201cOnce labeled schizophrenic, the pseudo-patient was stuck with that label.\u00a0\u00a0If the pseudo-patient was to be discharged, he must naturally be \u2018in remission\u2019; but he was not sane, nor, in the institution\u2019s view, had he ever been sane.<\/em><\/strong><\/p>\n \u201cIt was quite common for fellow patients to \u2018detect\u2019 the pseudo-patient\u2019s sanity.\u00a0 The fact that the patients often recognized normality when staff did not raises important questions.<\/em><\/strong><\/p>\n \u201cPhysicians are more inclined to call a healthy person sick (a false positive) than a sick person healthy (a false negative).\u00a0\u00a0The reasons for this are not hard to find:\u00a0\u00a0it is clearly more dangerous to misdiagnose illness than health.\u00a0Better to err on the side of caution, to suspect illness even among the healthy.<\/em><\/strong><\/p>\n \u201c\u2019Patient engaged in writing behavior\u2019 was the daily nursing comment on one of the pseudo-patients who was never questioned about his writing.\u00a0\u00a0Given that the patient is in the hospital, he must be psychologically disturbed.\u00a0\u00a0And given that he is disturbed, continuous writing must be a behavioral manifestation of that disturbance, perhaps a subset of the compulsive behaviors that are sometimes correlated with schizophrenia.\u00a0<\/em><\/strong><\/p>\n \u201cOne 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.\u00a0\u00a0 <\/em><\/strong><\/p>\n \u201cOften enough, a patient would go \u2018berserk\u2019 because he had, wittingly or unwittingly, been mistreated by, say, an attendant.\u00a0<\/em><\/strong><\/p>\n \u201cNever were the staff found to assume that one of themselves or the structure of the hospital had anything to do with a patient\u2019s behavior.\u00a0\u00a0<\/em><\/strong><\/p>\n \u201cA psychiatric label has a life and an influence of its own. 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.\u00a0\u00a0Eventually, the patient himself accepts the diagnosis, with all of its surplus meanings and expectations and behaves accordingly.<\/em><\/strong><\/p>\n \u201cThere is enormous overlap in the behaviors of the sane and the insane.\u00a0\u00a0The sane are not \u2018sane\u2019 all of the time.\u00a0\u00a0 Similarly, the insane are not always insane.\u00a0\u00a0 It makes no sense to label (<\/em><\/strong>anyone as) permanently depressed on the basis of an occasional depression\u2026 <\/em><\/strong><\/p>\n \u201cI may hallucinate because I am sleeping, or I may hallucinate because I have ingested a peculiar drug.\u00a0\u00a0These are termed sleep-induced hallucinations (or dreams) and drug-induced hallucinations, respectively.\u00a0\u00a0But when the stimuli to my hallucinations are unknown, that is called craziness, or schizophrenia.<\/em><\/strong><\/p>\n \u201cThe average amount of time spent by attendants outside of the cage was 11.3 percent (range, 3 to 52 percent).\u00a0 It was the relatively rare attendant who spent time talking with patients\u2026<\/em><\/strong><\/p>\n \u201cThose with the most power have the least to do with patients, and those with the least power are the most involved with them.\u00a0\u00a0<\/em><\/strong><\/p>\n \u201cNeither anecdotal nor \u2018hard\u2019 data can convey the overwhelming sense of powerlessness which invades the individual as he is continually exposed to the depersonalization of the psychiatric hospital.\u00a0\u00a0<\/em><\/strong><\/p>\n \u201cHeavy reliance upon psychotropic medication tacitly contributes to depersonalization by convincing staff that treatment is indeed being conducted and that further patient contact may not be necessary.\u00a0\u00a0<\/em><\/strong><\/p>\n \u201c<\/em><\/strong>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.\u00a0\u00a0<\/em><\/strong><\/p>\n \u201cFinally, how many patients might be \u2018sane\u2019 outside the psychiatric hospital but seem insane in it\u2026<\/em><\/strong><\/p>\n \u00a0\u201cIt is clear that we cannot distinguish the sane from the insane in psychiatric hospitals.\u201d<\/em><\/strong><\/p>\n __________________________________<\/p>\n Dr. Gary Kohls practiced holistic mental health care until his retirement a few years ago. Most of the patients that came asking for his help exhibited a variety of drug-induced, brain-altering, neurological and physical disabilities as well as drug dependencies from the multitude of drugs they had been taking. Dr. Kohls reminds people that they should not try to stop their prescription psychotropic drugs without the help of a physician knowledgeable about basic brain neuroscience, brain nutrition and the intricacies of drug withdrawal syndromes.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":" The now famous (some offended or embarrassed psychiatrists preferred to call it \u201cinfamous\u201d) experiment that was carried out involved 12 different psychiatric hospitals and 8 different people, mostly professionals (including the author). Each of the eight were totally and certifiably sane \u201cpseudo-patients\u201d.<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[52],"tags":[],"class_list":["post-58426","post","type-post","status-publish","format-standard","hentry","category-health"],"_links":{"self":[{"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/posts\/58426","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/comments?post=58426"}],"version-history":[{"count":0,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/posts\/58426\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/media?parent=58426"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/categories?post=58426"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/tags?post=58426"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}