GENIUS FORUMS

I just read an interesting study about eight "sane" people who got themselves admitted to psychiatric hospitals based on a single "symptom": hearing voices in their heads say words like "dull" and "thud." They were questioned about their family history and past, and did not falsify or exaggerate their memories to make themselves look "crazier." Once they were admitted to these hospitals, the "patients" acted "normally" and even told hospital staff that they no longer heard voices. They then stayed in the hospitals for weeks and wrote down careful notes about the conditions there. Their note-taking was interpreted by staff as evidence of their insanity. None of the hospital staff suspected that the pseudo-patients were fakers, but many of their fellow patients in the hospitals did and interpreted the note-taking as part of a journalistic or research project.

Rosenhan, the author of the study who was himself admitted as a "patient," concludes:

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 do not, even now, understand this problem well enough to perceive solutions. But two matters seem to have some promise. The first concerns the proliferation of community mental health facilities, of crisis intervention centers, of the human potential movement, and of behavior therapies that, for all of their own problems, tend to avoid psychiatric labels, to focus on specific problems and behaviors, and to retain the individual in a relatively non-pejorative environment. Clearly, to the extent that we refrain from sending the distressed to insane places, our impressions of them are less likely to be distorted.

Wikipedia has a summary, but I recommend reading the whole study in the link above. It is non-technical, fairly short, and pretty interesting.

Last time i was in the hospital, reading a book instead of smoking and talking to people was considered insane, and got me several extra days of being locked up (basically until I decided that I had to get out, and went outside and smoked and talked)

Weirdly, the time before that that I was in the hospital, they encouraged us to read. A volunteer organization went around the hospital giving us new books to read and we pretty much spent a few hours a day doing educational stuff or going on walks... and most of the day reading. I was released in 4 days. This hospital is in the military...

The exact same behavior - reading nonfiction books - was interpreted as normal in one situation and abnormal in another based entirely, apparently, on what the other people around you were doing.

It is a sad world we live in if the military is a saner place than the civilian place. But that would appear to be the case. It's also a really sad place when it is considered a sign of insanity that one would choose to be alone and read than smoke and gossip. (incidentally, I had quit smoking 2 years before that hospitalization - I started again because of the pressure that the nursing staff exerted for me to fit in with the crazy people and my desire to be free...)

Also, though, this sentence may not be accurate:

Given that the hospital staff was not incompetent, that the pseudopatient had been behaving as sanely as he had been out of the hospital, and that it had never been previously suggested that he belonged in a psychiatric hospital, such an unlikely outcome would support the view that psychiatric diagnosis betrays little about the patient but much about the environment in which an observer finds him.

There have been studies done (most infamously a prison one) that shows that people tend to take on the characteristics of the people they are pretending to be. As in, normal students put in prison or declared to be prison workers will behave just as prisoners and prison workers do in the real world even when arbitrarily decided.

Maybe, but in this case the pseudo-patients were pretending to be insane only for the duration of the interviews that got them admitted to the hospitals. Or were you talking about the hospital staff?

Philosophaster wrote:Maybe, but in this case the pseudo-patients were pretending to be insane only for the duration of the interviews that got them admitted to the hospitals. Or were you talking about the hospital staff?

Both.
Remember in the prison experiment, the prisoners knew they weren't guilty, and knew they were in an experiment, just as these guys knew they weren't crazy and were in an experiment. - While family members didn't notice anything different that might be either because the family members knew they were faking and were not looking for differences, or because the situation made people behave normally around family.

You don’t have to secretly omit yourself into a mental hospital to see insanity in action, just take your notebook into any shopping mall, nightclub, or any other common social gathering place.

Ryan Rudolph wrote:You don’t have to secretly omit yourself into a mental hospital to see insanity in action, just take your notebook into any shopping mall, nightclub, or any other common social gathering place.

Well, the point wasn't to see insanity in action. The point was to see whether professionals can spot insanity or sanity when presented with it. Some of the details in that article (especially the write up of the guy's history) are pretty terrifying.

Of course the definitions of sane or insane used in this article are actually "normal" and "abnormal" but the point still holds. If you try to become truly sane in an insane world, the world will look at you as if you were the insane one.

It's also instructive for it's look at "truth" - about how one man can give a perfectly normal history of his life and because of the preconceptions on the part of the nurse, it winds up looking pathological.

I agree that the experiment produced some terrifying results, but I wonder if they were really all that unexpected. Once "diagnosed" as insane in some way, it's probably fairly natural for staff to interpret behaviour as manifestations of that insanity. But the real problem is that it's actually very difficult to distinguish between normative "sane" behaviour and most insane behaviour. The line between the two is often, though obviously not always, a very fine one. It's really not that different to me being thought of as a misogynist. Once I've had that label applied to me, most people automatically tend to interpret everything I say about the feminine and women as expressive of misogyny. For the life of me I can't convince such people that I am not. It's a case of people tending to see what they have been told is there.

Basically, the standard from which we judge sanity is very poor and argubaly less than sane itself.

Dan Rowden wrote:I agree that the experiment produced some terrifying results, but I wonder if they were really all that unexpected. Once "diagnosed" as insane in some way, it's probably fairly natural for staff to interpret behaviour as manifestations of that insanity.

A friend of mine and I once got ahold of the DSM-IV and started going through it to see whether we could be interpreted as being all these different disorders. I think there were two in the entire book that I couldn't come up with examples that would fit the pattern. My friend, who is actually sane only came up with 3. A vast majority of these behaviors weren't problematic for us, and thus by defintion are not mental illness.

But the real problem is that it's actually very difficult to distinguish between normative "sane" behaviour and most insane behaviour. The line between the two is often, though obviously not always, a very fine one.

Well, the distinguishing feature is supposed to be that it causes significant disruption in your life, which, in theory, makes it a lot more clear cut than it might otherwise be.

Of course, that means self-reporting distress, and that's not really reliable either (people can lie in order to receive benefits or not stand trial, or people can not allow themselves to see just how sick they are, and thus not report it accurately)

Self-reporting is an unreliable measure for anything. I have never taken seriously any sociological studies based on it.

Dan Rowden wrote:Self-reporting is an unreliable measure for anything.

Contradicting yourself, aren't you?

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No, I'm talking about the average person in the context of what their reality is.