Rosenhan experiment: how to get into a madhouse

US, WASHINGTON (ORDO NEWS) — It turns out very simple. It’s enough to pretend, and voilà – you are already in the hospital bed. And maybe even attached. At least this is proved by the experiment of American psychologist David Rosenhan. It also calls into question the whole system of psychiatric diagnosis.

Doctor, I hear voices

That was in 1973. Rosenhan himself and his mentally healthy colleagues (two psychologists, one undergraduate student studying psychology, a pediatrician, a psychiatrist, an artist and a housewife) decided to check the reliability of psychiatric methods, for which they tried to get into different psychiatric hospitals in the United States as patients. And they succeeded. And it’s easy. It was enough to change the information about the place of work and introduce yourself as a pseudonym (of course, not one of the pseudopatients in psychiatric hospitals had any medical records, but the true names, surnames and information about education and work, of course, would have raised doubts among doctors, as well as future problems for the experiment participants themselves). All other information about the “patients” was true. Including their natural behavior.

In addition to one, each of them informed doctors that he hears voices belonging to people of his own gender. The voices are most often illegible, but in them, according to patients, one can guess something like the words “empty”, “hollow”, “knock”. And nothing else. Such words were specially selected — in part, they contained signs of a certain existential crisis (states of anxiety and discomfort when thinking about the meaning of one’s own existence), on the other hand, there was no literature to consider these manifestations as symptoms of psychosis. The pseudo-patients complained only of voices; no other symptoms bothered them.

And the patient is healthy!

All pseudopatients were hospitalized. In this case, they were instructed to behave appropriately, to report that they did not feel discomfort and no longer heard any voices. Which they did, but no reaction from the doctors followed (although pseudopatients were described as “friendly and helpful” in hospital records). Doctors of all hospitals – there were eight clinics in all states of the USA; with different incomes: from the poor rural to the well-known in scientific circles, as well as prestigious paid hospitals – pseudopatients were in no hurry to release. At the same time, they were prescribed psychotropic drugs (which they lowered into the toilet, as, indeed, real patients).

And yet, despite the fact that they all showed the same symptoms, they were given different diagnoses. At least one – manic-depressive psychosis (the rest had “schizophrenia”). The duration of patients in hospitals ranged from 7 to 52 days (19 on average), after which they were discharged with a diagnosis of schizophrenia in remission. For David Rosenhan, this was proof that mental illness is perceived as irreversible and becomes a label for life. During all this time, none of the doctors doubted the correctness of the diagnosis made to the pseudo-patients, but real patients regularly expressed such doubts: out of 118 patients, 35 expressed suspicion that the pseudo-patients were healthy and were researchers or journalists.

Longing and loss of self

And also an unceremonious invasion of personal space. Such feelings, according to the participants in the experiment, they constantly experienced during their stay in psychiatric hospitals. Things were selectively checked, even when the patients themselves were not in place (they went to the toilet). People were treated like things, despite the fact that the hospital staff could be generally described as decent (obviously, the blame was the notorious occupational deformation).

Often, the charges were discussed in their presence (and one of the doctors told the students about a group of patients crowding in line waiting for dinner that they were experiencing symptoms of “increased oral sensuality”), some of the attendants in the absence of doctors were completely rude or even pushed patients.

Any action or statement of patients was perceived solely in the light of their diagnosis. Even the fact that one pseudo-patient made notes was interpreted by some nurse as a pathology and considered it to be a manifestation of graphomania (a pathological desire to compose works claiming to be published). Another nurse in the presence of patients unbuttoned her blouse and straightened her bra, clearly not perceiving the people in the ward as full-fledged men.

Healthy can’t be sick

The authority of psychiatry has staggered, but this was not enough for the insidious David Rosenhan. Following the first, he set up a second experiment. This time everything was exactly the opposite. Rosenhan warned the doctors of a well-known psychiatric hospital (the latter had its own educational and research base and, having read the results of the previous experiment, claimed that such things could not be repeated in their institution) that they would try to receive one or more of them within three months pseudopatients.

Of the 193 people who applied to the clinic during this period, 41 were convicted of simulations, another 42 were suspected. What a surprise the doctors were when they found out that Rosenkhan did not send a single pseudo-patient to them! The results of his experiments were published in the prestigious journal Science, where Rosenhan made a disappointing conclusion: “No diagnosis that too easily leads to significant errors of this kind can not be very reliable.” Similar results were obtained in studies of other specialists.

No healthy – there are unexplored

For example, the experiment of psychologist and journalist Lorin Slater, who, after several years, exactly repeated the actions and phrases of the pseudo-patients of Rosenhan, going to one of the psychiatric clinics (in this case, a hospital with a very good reputation was chosen). The journalist was considered crazy and prescribed a psychotropic medicine. The same thing happened in eight more clinics where Slater went to. The woman was prescribed 25 antipsychotic drugs and 60 antidepressants. Moreover, the conversation with each of the doctors, according to the journalist, lasted no more than 12.5 minutes. In fairness, it should be said that during hospitalization (which was not forced, the woman herself invited the doctors to go to the hospital), the clinic staff treated her more than humanely. Nonetheless, the question of making an incorrect diagnosis and the appointment of potent drugs has remained open. This was again confirmed by other experiments.

Take, for example, the study of the famous psychotherapist and professor at the University of Oklahoma, Maurice Temerlin, who divided 25 psychiatrists into two groups and invited them to listen to the voice of the actor. The latter portrayed a mentally healthy person, but Maurice was told to one group that this was the voice of a psychotic who looked like a neurotic (a less severe pathology compared to psychosis), and the second did not say anything at all. 60% of psychiatrists in the first group were diagnosed with talking psychosis (in most cases it was schizophrenia), in the second – control group – no one made any diagnoses.

In 1998, a similar study was conducted by other American psychologists – Loring and Powell, who distributed 290 psychiatrists a text with a clinical interview with a patient. In this first half of the doctors, they reported that the patient was black, the other that he was white. The conclusion was predictable: psychiatrists attributed “aggression, a tendency to suspicion and social danger” to a patient with black skin, despite the fact that the texts of the clinical interviews of both were completely identical.

In 2008, a similar experiment was conducted by the BBC channel (in the Horizon program). Ten people took part in it: half of them had previously been diagnosed with various mental disorders, the other half had no diagnoses. All of them were examined by three eminent psychiatrists. The task of the latter was simple – to identify people with psychiatric pathologies. Bottom line: only two out of ten were given the correct diagnosis, one was the wrong one and two healthy people were mistakenly “recorded” as “unhealthy”.

Controversy

The experiments caused fierce debate. Someone was forced to accept the unreliability of psychiatric diagnosis, someone argued. The author of the classification of mental disorders (DSM-IV) Robert Spitzer responded to criticism like this: “If I drank a liter of blood and, hiding it, with bloody vomiting came to the emergency department of any hospital, the behavior of the staff would be quite predictable. If they diagnosed me and prescribed treatment, as with a stomach ulcer, I would hardly have been able to convincingly prove the lack of medical science knowledge about the diagnosis of this disease. ” However, after the experiment of the aforementioned journalist Lorin Slater, Robert Spitzer was forced to admit: “I am disappointed. I think that doctors just don’t like to say: “I don’t know.”

The only good news is that all these experiments helped to make psychiatric hospitals literally more human. True, judging by the study of Loreen Slater, this applies so far only to Western clinics. A similar experiment in Russia in 2013 was conducted by a journalist named Marina Koval, who got a job as a nurse in one of the provincial psychiatric hospitals. And then she wrote an article in which she told everything she saw: monstrous living conditions, beatings and theft of personal belongings of the wards, threats against them, smoking of medical staff. And also the appointment of psychotropic drugs that turn patients into obedient and completely meek people. This is despite the fact that, according to Koval, in modern Russian psychiatric hospitals there are quite a few apparently healthy people who were brought there by a normal nervous breakdown.

Was there schizophrenia?

“All mental states (including disorders) are derived from that culture and from the language to which we belong,” says the famous St. Petersburg psychoanalyst Dmitry Olshansky. – Any diagnosis arises and disappears in the same way as one literary style replaces another. At the beginning of the XVI century, the roguish novel replaces the knightly novel, the diagnosis of depression replaces the melancholy. We can even strictly date the period of the existence of certain diseases: for example, hysteria lasted from 1950 BC. e. (the first mention of hysteria in the Kahun papyrus) until the 1950s e., that is, almost 4 thousand years. Today, no one is hysterical, therefore, such a disease does not exist in medical directories. The same goes for diseases such as melancholy and obsession.

All medical diagnoses are the same literary product of the era in which they exist, as well as the conditions that they describe. Therefore, it is not surprising that doctors see in a person those diseases and those disorders that are prescribed by science at the moment, they attribute to the patient what is dictated by the development of medical literature at the moment. People see only what they are ready to see. Strictly speaking, all human civilization is a product of fiction and fiction, and medicine, as part of it, is no exception. The Rosenhan experiment only proves this common truth.

The question of the “reality of psychiatric diagnoses” is as meaningless to pose as the question of the reality of the psychic world in general: “is there schizophrenia really or was it invented by doctors?”, “Is there really love or was it invented by philosophers?”, “ do we really feel or is it just a model of behavior that we have learned in the process of education? ” Psychiatry works with the same fictitious phenomena as mathematics or linguistics. And we have no reason to discriminate against all other sciences and blame her for more fiction.

How is the diagnosis

“Despite the fact that in psychiatry the diagnosis remains subjective enough and largely depends on the experience of the personal characteristics of the doctor, there are quite a few ways to verify the diagnosis,” says Ph.D. I.I. Mechnikova Olga Zadorozhnaya. – This includes various psychometric scales, structured interviews, tests and, most importantly, what all psychiatrists are guided by when making a diagnosis – the criteria for mental illness set out in the International Classification of Diseases. This, in turn, is also a kind of general arrangement, based, however, on the vast clinical material and traditions of the main schools of psychiatry.

Psychotropic drugs are currently created a lot. For the treatment of severe mental disorders, mainly antipsychotics, antidepressants, tranquilizers are used. The drugs of these groups act on receptors located on the membranes of neurons in the central nervous system. Modern drugs can quite effectively deal with the most dangerous manifestations of mental illness, but unfortunately they do not cure completely. A person with schizophrenia or manic-depressive psychosis is forced to take therapy for life. However, not all mental disorders require lifelong therapy. There are so-called borderline mental disorders, such as neurosis, as well as mental reactions caused by severe extraordinary events, shocks. Such conditions can be cured,

Hospitalization in a psychiatric hospital in our country is regulated by the Law on Psychiatric Care and Guarantees of the Rights of Citizens when Provided. According to this law, psychiatric care is provided only on a voluntary basis. Forced hospitalization of a patient in a hospital is possible only by court order. This procedure is carried out in strict accordance with the law and on time. Without a court decision, a person can spend in the hospital no more than one week. Also an extract. The average hospital stay of a patient is determined by his diagnosis and usually should not exceed two months.

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