Marc Wilson: are psychiatrists easy to fool?

by The Listener / 13 June, 2013
A 70s experiment led to claims that dodgy shrinks are really just improv artists without a clue.
David Rosenhan: his research caused a furore. Photo/Getty Images

If I told you I’m hearing voices – they’re a little fuzzy, but I think they’re saying “empty”, “hollow” and “thud” – what would you do?

Laugh uncertainly, maybe? As it happens, I don’t hear voices (my wife complains I don’t hear her when she is talking to me); I’m just messing with you.

Let’s imagine I say the same thing to a person on the admissions desk of a psychiatric institution. What then? Hopefully, a detailed psychological examination would follow, and after I admit I’m not actually hearing voices, I should rightly be told to shove off and stop wasting valuable time.

I wouldn’t do such a thing, but David Rosenhan did back in the early 1970s. Under his guidance, eight pseudopatients were told to call psychiatric institutions to report exactly the experience I’ve just described. Aside from “hearing” those three words, the pseudopatients were told to behave normally, respond truthfully to questions and accurately provide any information requested.

The pseudopatients were admitted to the wards, all but one with a diagnosis of schizophrenia (a diagnosis characterised by experiencing hallucinations and delusional thoughts), before sitting back and waiting for release. After admission, they were told to “stop” hearing the voices, to follow instructions (but avoid shucking back the meds) and to make detailed notes about their experience.

This obvious notetaking blew the pseudo-patients’ cover, however. At least with their fellow patients. Around a third accused the planted patients of masquerading as unwell. “You’re not crazy. You’re a journalist or a professor … checking up on the hospital,” Rosenhan quotes.

The staff, on the other hand, saw this quite differently: “Patient engages in writing behaviour,” noted one nurse in the daily log. Potted patients recording the medication they were receiving were told not to worry about writing it down because staff would be happy to remind them.

So, are they still there, waiting for someone to work out they were faking it? On average, Rosenhan’s confederates were committed for 19 days (one for almost two months) before being released as a result of “schizophrenia in remission”. Not “made it all up, not really hearing things at all”.

When Rosenhan published this research, there was a furore. “Being sane in insane places” was jumped on as evidence that those dodgy shrinks are really just improv artists without a clue. Rosenhan reports that one hospital challenged the researchers to try it again, and subsequently kept detailed records of all suspect patients for a three-month period, proudly identifying more than 40 planted patients. You can guess the punchline – Rosenhan hadn’t sent anyone.

It’s an awesome story, and a very real warning not to take things for granted, but does it show that a psychiatric diagnosis is just a convenient truth?

If you think about it, it’s not quite as clear cut as that. For a start, those who work in psychiatric institutions don’t expect people to rock up and make up stuff to try to get in. Dr Robert Spitzer (who admittedly probably had a vested interest in this as a driver behind the third edition of the Diagnostic and Statistical Manual, which is used for psychiatric diagnosis) argued that professionals had done their job exactly as we would want them to – identifying a potential reason for the experiences of the pseudopatients before identifying when the “symptoms” were no longer present.

Spitzer also notes that “schizophrenia in remission” was an extremely unusual discharge, showing that professionals knew the pseudopatients were clearly different from “normal” patients.

You won’t be surprised at what I think (though I’m not “that kind” of psychologist). My view is that psychological diagnoses are important tools for helping people. They provide something that helps people experiencing difficulties (and those who support them) to understand what they’re going through, they guide appropriate therapy and, yes, medication in some cases, and they get people state support to do so.
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