Psychiatric Diagnoses Only Exist in the Mind of the Psychiatrist - the Rosenhan Experiment (n)
✳ Joseph S R de Saram (JSRDS)
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The ‘Rosenhan experiment’ is a well known experiment examining the validity of psychiatric diagnosis. It was published in 1975 by David Rosenhan in a paper entitled
‘On being sane in insane places’
The study consisted of two parts. The first involved ‘pseudopatients’ – who, as part of the study, briefly reported auditory hallucinations in order to gain admission to psychiatric hospitals across the United States.
After admission, the pseudopatients no longer reported hallucinations and behaved as they ‘normally’ would.
Despite this many were confined as inpatients for substantial periods of time and all were discharged with the diagnosis of a psychiatric disorder.
For the second part of the experiment staff at a teaching hospital, whose staff had learned of Rosenhan’s above results, were informed that one or more pseudopatients would attempt to be admitted to their hospital over an ensuing three month period.
Many patients were subsequently identified as likely pseudopatients but in fact no pseudopatient had been sent.
‘On being sane…’ also examines, though the experience of the pseudopatients, the patient experience of psychiatric inpatient wards. This part of the paper is discussed often only in passing.
Rosenhan’s conclusion was stark:
A psychiatric diagnosis is more a function of the situation in which the observer finds a patient and reveals little about a patient themselves.
“It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals“
[MEANING THAT IF THE PSYCHIATRIST IS SPEAKING TO ME IN A PSYCHIATRIC FACILITY, IT SOMEHOW CONFIRMS THAT I HAVE BEEN LABELLED CORRECTLY AND THEY MERELY ALIGN THEIR DIAGNOSIS WITH THAT OF THE LABEL.]
Despite being over forty years old the Rosenhan experiment remains well known and is often cited. Accounts of the experiment are widespread on the internet, but critiques are rarer and many people accept the study’s conclusions at face value.
This was an audacious experiment and the subsequent paper had an extremely good title, but was Rosenhan justified in his conclusion? Anthony Clare, amongst others, wrote that Rosenhan was ‘theorising in the absence of sufficient data’.
[A GREATER AMOUNT OF DATA WOULD PROBABLY NOT CHANGE THE CONCLUSION]
But if Rosenhan was correct then his experiment remains extremely important; as if diagnoses are in ‘the mind of the observer’ and do not reflect a quality inherent a patient, they are of little use.
[I DO NOT LIKE SHITLANKANStm AND THEY DO NOT LIKE ME. HOWEVER PUT ME INTO A SITUATION IN WHICH A SHITLANKANtm CAN EFFECT POWER AND CONTROL OVER ME, THEN THEY WILL SAY WHATEVER THEY LIKE BECAUSE THEY ENJOY THE NARCISSISTIC SUPPLY AND GET AWAY WITH IT BECAUSE OF THEIR GROUPTHINK.]
If you wish to read the original paper it can be found here. Spitzer’s 1975 critique is available here (for a fee). Davis’s critique here. Clare’s ‘Psychiatry in dissent’ is available in preview here.
Circumstances of Diagnosis and the Detecting of Sanity
I refer to this excellent article, and I have referred to certain paragraphs:-
The Rosenhan experiment examined
The ‘Rosenhan experiment’ is a well known experiment examining the validity of psychiatric diagnosis. It was published in 1975 by David Rosenhan in a paper entitled ‘On being sane in insane places’ The study consisted of two parts. The first involved...
In the experiment eight pseudopatients presented at psychiatric hospitals complaining of hearing a voice. Asked what the voices said, they replied that the voices were often unclear, but as far as they could tell, said “empty,” “hollow,” and “thud.” Beyond alleging this symptom, and falsifying their names and vocations, no other falsehoods were told. Upon admission to the ward the pseudopatients are reported to have ceased to claim symptoms and behaved as they ‘normally’ would.
Length of hospitalization was an average of 19 days during which time no pseudopatients were identified as fraudulent. All pseudopatients except one (diagnosed with bipolar disorder) were discharged with a diagnosis of ‘schizophrenia in remission’.
In light of this Rosenhan regards there to have been ‘uniform failure to recognise sanity’.
Rosenhan refused to identify the hospitals used on the grounds of his concern for confidentiality. This is laudable in some respects, but it makes it impossible for anyone at the hospitals in question to corroborate or refute this account of how the pseudopatients acted or were perceived.
It is a difficulty that Rosenhan seeks to answer whether patients can be identified as ‘sane’ or ‘insane’, whilst psychiatrists, whose practice he wishes to scrutinize
do not make such distinctions in their practice but instead aim to identify and treat what they view as psychiatric disorders.
This objection aside, and working within this terminology, in his 1975 critique Spitzer identifies three possible meanings for ‘detecting of sanity’.
Recognition, when he is first seen, that the pseudopatient is feigning insanity as he attempts to gain admission to the hospital. This would be detecting sanity in a sane person simulating insanity.
[THE SHITLANKANtm PSYCHIATRIST FAILED TO EXPLORE THE ULTERIOR MOTIVE OF EDWARD DE SARAM AND/OR THE PARTIES CLAIMING I HAD A MENTAL PROBLEM.]
Recognition, after having observed him acting normally during his hospitalization, that the pseudopatient was initially feigning insanity. This would be detecting that the currently sane person never was insane.
[THE SHITLANKANtm PSYCHIATRISTS REFUSED TO CONSIDER THAT THE SYMPTOMS THAT WERE MERRILY FALSIFIED AND/OR INDUCED BY EDWARD DE SARAM, HAD SIGNIFICANT DEFICIENCIES IN THEIR VALIDITY AND/OR VERACITY.]
Recognition, during hospitalization, that the pseudopatient, though initially appearing to be ‘insane’ was no longer showing signs of psychiatric disturbance.
[THE SHITLANKANtm PSYCHIATRISTS COULD CLEARLY SEE THAT THERE WERE NO PSYCHIATRIC PROBLEMS, BUT [DELIBERATELY] FAILED TO CHANGE THEIR ERRONEOUS VIEW POINT. THIS BEHAVIOUR ACTUALLY FITS THE DSM-5 DEFINITION OF A DELUSION:-
“Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence.”
“the belief is held despite clear or reasonable contradictory evidence regarding its veracity.”
Only the first two involve identifying a pseudopatient as a fraud and Spitzer feels that it is these that Rosenhan implies are all that are relevant to the central research question. He disagrees, writing that when the third definition of detecting of sanity is considered Rosenhan’s conclusions cannot be sustained.
This assertion hinges on Rosenhan’s report that all the pseudopatients were diagnosed as being ‘in remission’, that is recognised as being, currently, without signs of mental disorder or ‘sane’. By this view the data as reported by Rosenhan contradicts Rosenhan’s own conclusion. Spitzer also writes that ‘schizophrenia in remission’ was a diagnosis rarely used by psychiatrists at the time of the experiment, and as such this indicates that the diagnoses given were a function of the patients’ behaviours and not simply of the environment in which they were made.
Should a psychiatrist be able to able to detect that a patient is a fraud? That is, should a psychiatrist be able to detect that, after observing a patient acting normally, that they were initially feigning insanity?
[THE SHITLANKANtm PSYCHIATRISTS SIMPLY IGNORED THE FACTS BECAUSE THE WHOLE PSYCHIATRIC FRAUD WAS TO DISCREDIT ME AND DESTROY EVIDENCE OF CELLULAR INTERCEPTION AND OTHER EVIDETIARY MATERIAL.]
Rosenhan reports that this possibility was considered by the pseudopatients’ fellow patients but by no clinical staff:
“It was quite common for the patients to “detect” the pseudopatient’s sanity. During the first three hospitalizations, when accurate counts were kept, 35 of a total of 118 patients on the admissions ward voiced their suspicions, some vigorously. “You’re not crazy. You’re a journalist, or a professor (referring to the continual note-taking). You’re checking up on the hospital.” …. The fact that the patients often recognized normality when staff did not raises important questions.”
Rosenhan reports that the psychiatrists did not spend much time with the pseudopatients. Other patients of course had ample time to formulate their own theories. Whilst the medical staff’s lack of engagement with the pseudopatients is regrettable, it does point towards poor clinical skills rather than an indictment of psychiatric classification. Clare again:
“Rosenhan and those many critics of psychiatry who have greeted his paper with enthusiasm seem in fact to be saying that, since the doctors did not appear to have the faintest idea as to what constitutes the operational concept of ‘schizophrenia’ and yet applied it with haste to people showing virtually no signs or symptoms whatsoever, the whole diagnostic approach should be scrapped!”
Rosenhan later wrote that he considered the patients apparent insight over that of the psychiatrists as due to the ‘experimenter effect’ or ‘expectation bias’.
The professionals expected to see a patient with a mental illness, so they looked for reasons to believe it, and eventually they convinced themselves that the pseudopatients were actually suffering from schizophrenia.
[THE SHITLANKANtm PSYCHIATRISTS WERE SO DELUDED BY THE CONVINCING LIES OF EDWARD DE SARAM AND OTHERS, THAT THEY BOUGHT INTO THE ‘STORY’ AND CONTINUED TO APPLY IT WITHOUT BOTHERING TO CHANGE THEIR ASSESSMENT WHEN EXAMINING ME DIRECTLY, DESPITE IS BEING PATENTLY OBVIOUS.]
People do sometimes simulate mental illness for their own ends and this is a genuine diagnostic problem.
Munchausen Syndrome by Proxy MSbP
In MSbP, an individual — usually a parent or caregiver— causes or fabricates symptoms in a child. The adult deliberately misleads others (particularly...
It is a situation not unique to psychiatry and how easily a disorder psychiatric or otherwise can be feigned tells us little about the worth of the psychiatric classification system. Kety has something to say on this.
“If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood, the behavior of the staff would be quite predictable. If they labeled and treated me as having a bleeding peptic ulcer, I doubt that I could argue convincingly that medical science does not know how to diagnose that condition”
[THE PSYCHIATRIC FRAUD IS DEMONSTRATED BECAUSE NO ERROR COULD HAVE BEEN REMOTELY POSSIBLE GIVEN MY RESPONSES AND BEHAVIOUR IN THE PSYCHIATRIC FACILITY. ALL THAT HAPPENED WAS THIRD PARTIES [MELBOURNE FRAUDSTERS INCLUDED] WITH AN AGENDA FABRICATED THEIR DESIRED POSITION AND GOT PSYCHIATRISTS TO ‘MAKE IT OFFICIAL’.]
Clare makes a similar point using the example that the signs and symptoms of diabetes exist independently of whether they are correctly elicited or not.
Rosenhan does consider in his paper that that a mental illness is a life sentence:
“A broken leg is something one recovers from, but mental illness allegedly endures forever”
If a disorder was known to be always chronic and unremitting, it would illogical not to question the original diagnosis if the patient was later found to be asymptomatic and it is at this that Rosenhan is presumably driving.
If the pseudopatients ‘recovered’ from an incurable illness whilst under the gaze of their psychiatrists and this did not alter the diagnosis then this would be an example, just as Rosenhan says, of the hospital environment influencing diagnostic decision making.
[EXACTLY – THE SHITLANKANStm MERELY USED FRAUDULENT MEDICAL REPORTS THAT EDWARD DE SARAM HAD FABRICATED FOR A DTI MATTER FROM 2001 ONWARDS AND IGNORED THE COPIOUS INFORMATION IN THE PRESENT COMING FROM ME DIRECTLY. IN FACT THEY MERELY USED THOSE AS A ‘ROADMAP TO TORTURE’.]
Conditions on the ward
Rosenhan’s description of the depersonalising effect of a long stay on the wards is also powerful. Despite their commitment to the experiment in which they are taking part, their wish to resist the powerlessness they experience leads several of them to jeopardise the study.
“ The patient is deprived of many of his legal rights by dint of his psychiatric commitment. He is shorn of credibility by virtue of his psychiatric label. His freedom of movement is restricted. He cannot initiate contact with the staff, but may only respond to such overtures as they make. Personal privacy is minimal. Patient quarters and possessions can be entered and examined by any staff member, for whatever reason. His personal history and anguish is available to any staff member (often including the “grey lady” and “candy striper” volunteer) who chooses to read his folder, regardless of their therapeutic relationship to him. His personal hygiene and waste evacuation are often monitored. The water closets have no doors.”
Attendants were reported to deliver verbal and occasional physical abuse to patients, something that can in no way be justified.
[I WAS CONTINUALLY SPOKEN TO IN AN EXTREMELY CONDESCENDING MANNER.]
Validity of diagnosis
There are two issues here. Where the psychiatrists who met his pseudopatients wrong to make a diagnosis of schizophrenia within the DSM II diagnostic framework? And are psychiatric diagnoses of use or should they be replaced by an alternative?
The ease with which the pseudopatients gained admission on the basis of what are reported to be mild symptoms was remarked upon by Anthony Clare in Psychiatry in Dissent.
“ It is a matter of some interest that a solitary complaint of a hallucinatory voice in the absence of any other unusual experience or personal discomfort should actually persuade certain American hospitals to open their doors. Such is the current demand for a psychiatric bed within the National Health Service and the prevailing emphasis on treating patients outside hospitals and in the community that the average admitting doctor in Britain is likely to find himself under strict instructions to avoid admitting any patient who can see, speak, and do all of these things without bothering himself or others to an significant extent. On suspects that, in Britain, Professor Rosenhan might well be advised to go home like a good man, get a decent night’s rest and come back again in the morning.”
And many people have been critical of the way the pseudopatients were diagnosed with schizophrenia on the basis of hallucinations – a single symptom and not even essential for the diagnosis. Anthony Clare again:
“…the doctors did not appear to have the faintest idea as to what constitutes the operational concept of ‘schizophrenia’ and yet applied it with haste to people showing virtually no signs or symptoms whatsoever…”
The poor diagnostic skills and apparent lack of curiosity of the psychiatrists that the pseudopatients met is not an indictment of the classification per se, rather its application.
Amongst others Richard Bentall has made a career out of pointing out that psychiatric diagnosis is neither particularly valid nor reliable.
In contrast to psychiatric disorders, the diagnosing of physical medical conditions is often portrayed as being solid and dependable.
“It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals. The hospital itself imposes a special environment in which the meaning of behavior can easily be misunderstood. The consequences to patients hospitalized in such an environment – the powerlessness, depersonalization, segregation, mortification, and self-labeling – seem undoubtedly counter-therapeutic.”
I will be referring to this article “Psychiatric Diagnoses Only Exist in the Mind of the Psychiatrist – the Rosenhan Experiment” during forthcoming articles in relation to forensic analysis of the statements that I made in the Psychiatric Facility to confirm the underlying basis of the Psychiatric Fraud was Cellular Interception and Spoliation of Evidence.
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Joseph S R de Saram (JSRDS)