Can we tell who has a ‘mental illness’ or not? That was the question raised in a famous psychology experiment in 1969. It showed how poorly the experts can tell. Read part of my speech below, given at a public speaking club. Most of the content of the speech was taken from information you can find on YouTube by searching “David Rosenham experiment” and related videos.
Extract from my speech, entitled, “The Pseudo Patient Study”
Imagine yourself as David Rosenhan, a psychologist in 1969, sitting around with friends saying, “I have an idea for an experiment. I will get 8 volunteers to join me, and each go to a different psychiatric hospital and say we are hearing a voice, which says a single word, Thud, or Empty, or Dull. We’ll say it in a way that convinces them that it is real and a concern, and see if you get admitted. After you get admitted, say that it has stopped and see what happens?”
So he and his volunteers went ahead and did this. Other friends were concerned but he said, “I’ll be all right; I can get out as soon as I want to.” He did not realise he would be in there nearly 2 months. All the pseudo patients were admitted; one was diagnosed with Bipolar Disorder and the rest with Schizophrenia. They were all prescribed antipsychotic medication.
After admission, the pseudo patients acted normally and told staff they had not experienced any more auditory hallucinations. Instead staff believed all patients exhibited symptoms of ongoing mental illness.
When they did tell staff why they were there, they were not believed. The pseudo patients openly kept notes on the staff’s behaviour but this was just seen as odd. They were kept in from 8 – 52 days; the average was 19 days. Their instructions were to get out without outside help. Eventually they realised to get out they had to agree with the doctors they were ill, but they were getting better; and they promised to continue taking their medication after release. All were released as being in remission; none were judged as sane.
Of the 8 pseudo patients, one was a psychiatrist, another was a paediatrician, 3 were psychologists, and Rosenhan said none had any psychiatric condition.
One moral of this story is never volunteer for a psychology experiment!
More importantly, this was pointing out that psychiatry is not very good at judging people – since they expect to see mental illness, they see it everywhere. They are loath to regard people as normal, a thought I have occasionally in clinical meetings I attend.
After Rosenhan reported his experiment, one psychiatric hospital boasted he could not do that with them; they could spot phony patients. So with their agreement he arranged over a 3 month period to send pseudo patients there to see if they were better at detecting them. He asked them to rate how certain they were. Of 193 patients, they considered 41 as imposters, and a further 42 as suspects. He then revealed he had sent none! This time they were identifying a large number of regular patients as imposters.
The American Psychiatric Association was embarrassed and publicly angry. They worked to tighten their criteria so they could differentiate between those with real problems and others. At least that is what they would have you believe. Are they any better at telling normal from abnormal?
Last year (2010) on Australian TV there was a BBC show, “How Mad Are You?” They gathered 5 people who had a psychiatric diagnosis, and 5 with none; then they got them to do some tasks (5 minute stand-up comedy to the group; and cleaning out a cow-shed) and asked the panel of 3 mental health experts to observe them. They identified 2 patients correctly, gave another an incorrect diagnosis, and incorrectly diagnosed 2 people who had no diagnosis. [My speech continued but is not relevant to this article.]
It is tricky to use psychiatric labels – they are not that objective really. They amount to deciding how strange or different is abnormal. In this age of Ethics committees and financial restraints, David Rosenhan’s experiment will never be repeated. The BBC program is the closest that will be devised. My impression however, is that many patients still experience the need to admit they have a mental illness, and must promise they will continue with their medications in order to be discharged from hospital.
From the perspective of constructivism this is a gross error. It is elevating one belief system (that of the professional) above another (the client’s) on the basis that one group has more power than another. There is the presumption of objective reality and the professionals are right. Rosenhan’s experiment cautions us on the danger in such thinking.
(Go to Summary & Conclusion, essay 10.)