Tuesday, September 13, 2011

When the Sane is labeled “Insane”


If you worked in a mental hospital, would you be able to tell the difference between a “normal” and an “insane” patient?

In 1973, 8 people entered into 12 mental hospitals. They reported having had a brief auditory hallucination. They stated that the voice were often unclear, but as far as they could tell it said something like “empty”, “hollow” and “thud”. If pressed, they interpreted the meaning of the voice's message as “My life is empty and hollow”.

All eight were admitted, seven of them diagnosed as schizophrenic and one as manic-depressive. But none of them had a history of mental illness! Actually, amongst them were three psychologists and one psychiatrist.

Except for lying about their auditory hallucination, names, and occupation (those who were mental health professionals alleged another occupation in order to avoid any special attention), the psaudopatients told the truth about themselves and their lives. The presence of pseudopatients and the nature of the experiment were not known to the hospital staffs.

After being admitted, the psaudopatients acted normally and said the hallucination had stopped and that they felt fine. Despite the fact that the nurses reported the patients as “friendly” and “cooperative” and said they “exhibited no abnormal indications”, none of the staff got suspicious. They consistently treated all of these normals as insane!

In one admission interview, the psychiatrist asked the pseudopatient (psychologist David Rosenhan, who led the experiment) about his relationship with his parents and wife, and inquired if he ever spanked his children. Rosenhan answered that before adolescence he got on well with his parents, but during his teen years he experienced some tension with them, that he and his wife got along well, but had occasional fights, and that he almost never spanked his kids, the exception being when he spanked his son for running across a busy street and his daughter for getting into a medicine cabinet.

The psychiatrist did not inquire into the context of these episodes! Instead, they were interpreted as reflecting his “enormous ambivalence in interpersonal relationships and a great deal of difficulty in impulse control…” It seemed like the psychiatrist had just decided that Rosenhan was disturbed, and looked into his history to find stories that would support that conclusion.

All eight psaudopatients kept detailed notes of their experiences. In one description, the staff reported that the “patient engages in writing behavior” on a list of signs of pathology. The painter pseudopatient began producing paintings of high quality, and the staff claimed to see in them manifestations of a disturbed mind. One pseudopatient, while pacing up and down the hall, was asked by a nurse, “Nervous, Mr. X?” He replied, “No, bored”. Another pseudopatient overheard a psychiatrist explaining to some interns that the line of patients queued up for lunch 30 minutes early “was characteristic of the oral-acquisitive nature of the syndrome”. Eh…could it not be that they were just bored and hungry?

But there were some who got suspicious. Guess who! Many of the real patients suspected something fishy going on right away. One of them exclaimed: “You're not crazy. You're a journalist or a professor. You're checking up on the hospital.” Who else would be sitting around a mental hospital taking copious notes?

How does the pathology belief system cause professionals to judge sane people insane? Well, given that the person is admitted to a mental hospital, does it not follow that he is in fact psychologically disturbed? And, if so, then his/her behavior must certainly be a manifestation of disturbance? If the diagnostic label is so powerful as to cause professionals to judge sane people insane, could it work in the reverse? Might insane behavior be interpreted as sane?

In a subsequent experiment, Rosenhan contacted a mental institution after they wrote him to claim that they would never fall for his ploy. Rosenhan told them that over the course of the next 3 months he would send in one or more pseudopatients, and to instruct the staff to record which patients they thought were fake.

Once again, the experiment demonstrated the power of belief to interpret the date in light of the diagnostic tool. Out of 193 patients admitted to this hospital, 41 were classified as impostors by at least one staff member, with an additional 42 classified as suspected fakes (combined, that is 43%). Actually, no pseudopatients were sent to that institution!

These experiments demonstrate our beliefs may color how we interpret data, and that we tend to seek the data that confirms what we believe. This is why even professionals may not to spot a person "being sane in insane places". It is often easy to read into paintings what you want to see in them. Most behavior can be the symptom of a variety of psychological states (is he nervous or bored?). So, will you recognize sanity when you see it?


Reference:

Shermer, M. (2011). The Believing Brain. New York: Times Books.

Rosenhan, D. L. (January, 1973). “On being sane in insane places”. Science, 179 (4070): 250-8.

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