Sunday, 9 December 2007

Symptomized

I've been meaning to post up a link to this for a while: it's the published report of an experiment which took place in the early seventies, titled "On Being Sane In Insane Places."

To greatly summarize, a varied group of people who might be considered "normal" (in this context, that should be taken to mean having an absence of any psychiatric symptoms) agreed to become pseudopatients, such that they would each attempt to gain admission to psychiatric hospitals. The way they would go about this was agreed in advance, each one would go to a different hospital and complain of hearing a voice saying specific things.

None of the hospitals or their respective staff knew of the experiment, and each "patient" would not, apart from reporting the particular symptom in their initial appointment, otherwise attempt to behave abnormally or falsify any aspect of their life history.

Once admitted, each "patient" would have to aim towards being discharged by convincing the hospital staff that they were "sane."

Although not without its perceived flaws (some mention of which is made here), it makes for compelling and unsettling reading.

It raised questions about how "normal" behaviours become symptomized when a person is labelled and viewed in a specific context and environment. For example, as part of the experiment the "patients" wrote notes about their experiences whilst in hospital, and in one case this was taken to be a sign of pathology by the staff, noting it as being "writing behaviour" and hence giving the connotation that there was something obsessive about it.

There are numerous other examples of how the ordinary facts of a person's life, background and behaviour are distorted to fit the picture of mental illness now that they are hospitalized.

Interestingly (among many other adjectives that could be applied), none of the staff in any of the hospitals were able to identify the presence of any of these pseudopatients, although many of the other actual patients did cotton on to the fact that there was nothing wrong with them.

I may (or knowing me, I may not... or not for some time) post some observations loosely related to the above stemming from my own experience through work and also from a personal perspective.

26 comments:

zola a social thing said...

Let me press the button and give them all another higher and higher burst of electric shock. Just give me the order ( so long as you are qualified and wear nice role-model clothes that I can trust).

Scottishleader said...

What then Zola?
Write a fuckin song about it?

lavenderblue said...

Who needs to read the book ?
We're HERE aren't we !!

trousers said...

Wrong experiment I think, zola - wasn't that the Stanford Experiment that you'd be referring to?

Hi scottishleader (merkin, I presume) - hopefully zola's comment will make more sense if you do a search for Stanford Experiment, or even have a look on wiki.

lav - go on, read the article - it's well worth it, honestly!

szwagier said...

Ugh, trousers, I think you're a bit muddled too, unless I've missed something. The Stanford Prison experiment was one thing, Stanley Millgram's obedience experiment something else. They're both mentioned in the top 10 social psychology experiments I pointed to here. I've heard of the Rosenhan experiment, too. It doesn't surprise me in the slightest.

When I was in hospital last year, there was one girl there who, while certainly ill, was nowhere near as 'crazy' as she pretended to be. Her main problem was a desperate need to be the centre of attention, and self-consciously 'weird' behaviour got her that. The doctors treated her as though she was strongly schizophrenic and gave her drug cocktails which would fell a moose. After 3 days she refused the medicine and on the fourth day she discharged herself, apparently 'cured'.

As for myself, a year ago I was told flatly I was not suffering from a "psychotic depressive illness". A year later, and now apparently I am. No explanation given. I'm on the lookout for a new psychiatrist...

lavenderblue said...

Erm,Szwag, this sickiatrist you are in need of...........I'm free !

lavenderblue said...

And yes, trousers,will do xx

Merkin said...

Merkin was not the Scottish Leader but I have a hunch who was.

The Milgram experiment, or something similar, may be the one Zo-Zo was thinking about.
I actually took part in such an experiment when I was a Psych undergraduate - and received the princely sum of 50p for my efforts.

http://tinyurl.com/5tjxs

trousers said...

Ah yes, I am getting muddled szwag, thanks for clarifying that. I've read about Stanford before and I think I must have read the other one at some point, and have managed to conflate the two.

trousers said...

Thanks for that merk, that is indeed the one that zola's comment brought to mind, notwithstanding my muddling it up with Stanford.

50p eh?

:)

Merkin said...

50p an hour was the going rate in nineteen-canteen - in the days when a pint of Guards heavy was 14p in the Beer Bar of the Men's Union.

Halcyon days indeed, glath-hopple.

szwagier said...

Lacender, thank you very much. Two questions:

1. How much do you charge?

2. Can you prescribe?

Otherwise, I'm all yours.

szwagier said...

Where did that 'c' come from? My humblest apologies, Lavender. :$

szwagier said...

Sorry, spamming again.

I've just noticed that I completely forgot to mention the point about the young female patient. We patients all knew she was putting it on. We knew she had problems, but they weren't the ones the doctors were treating her for.

Who would listen to us?

But Why? said...

OK. I admit it. I'm worried, and I'm banking on my assumption that the rate of mistaken admittance to psychiatric units is freakily low to keep me free...

lavenderblue said...

Let's all go down together...
and Szwagship - to you I am as ever free........

zola a social thing said...

It is this kind of "behavior" that fucked the Duck yer know.

anticant said...

Way back in the 1950s or '60s, a friend of mine greatly upset a Tory MP who was telling her that he'd been visiting a mental hospital in his constituency "and, do you know, they were just like the ordinary people we meet every day!" "But", said my friend, "they ARE the ordinary people we meet every day!"

He never spoke to her again and sent a letter via his secretary telling her not to see his wife any more and "he need not say why".

Wayfarer Scientista said...

fascinating. and a little perturbing.

officialalien said...

Is irony a postmodern ting?

bindi said...

and was there any overhaul of the system or the particular institutions after these failures were made apparent?

I went to visit a friend after he had been committed (I was 22 at the time), and on the way to reception saw him through a window doing tai chi in a common room where other patients were milling and doing their own thing, and I must admit I felt incredibly worried about him. I'm sure out of that context I would have thought he was just the same as ever. It was bloody scary in that context tho.

trousers said...

szwag, the example you give kind of underlines the point that some attitudes don't change. I'm saying that bearing in mind that I don't know the context of mental health service provision in Poland compared with that of the States where the experiment took place.

But I would expect that regardless of the setting and the nature of the service, there will always be a number of people putting it on for whatever reason, just as the converse is equally true - many people with genuine problems who are treated like they're just putting it on.

Given your example, I wonder if the doctors just wouldn't be interested in your (generic, as in, fellow patients) opinion at all, or would be inclined to view it as, say, sour grapes?

I can't articulate very clearly on this at the moment, but it does bring to mind a wider point on how appropriate it is to medicalise something to such a degree which is based on so many other factors.

but why?, as mentioned on your own thread, I'd only be worried if you were faking symptoms to actually seek admission :)

Mind you that does bring about more serious points as to which groups amongst the population are statistically more likely to be wrongly admitted, but I'd rather have that debate another time.

Thanks for that anti - I was going to say that's a wonderful example, which in a way it is - but it's also bloody appalling!

wayf, absolutely.

bindi - according to wiki, it did result in some tightening up of the system and in the revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Again I have to plead ignorance as regards any details about the American system.

Talking of the manual though, I heard a wonderful speech by a psychiatric nurse who said that had the criteria in the DSM been applied to him he would have been sectioned since he heard voices and had done since childhood.

The system in England has changed hugely since the time of the experiment. I can't say whether it (the experiment) had any impact or not, since there was already the beginnings of a move away from the old hospitals and towards community care.

Overall, my own experience is that service provision is much more enlightened and less dehumanizing: but my work is community based anyway, and so the setting does determine how people are viewed.

anticant said...

Szwag - for goodness' sake do stop sticking labels on yourself and letting others slap them on to you. As a Transactional Analyst I have very strong views about "experts" in white coats pushing people into pigeon holes. Very lucrative for them, of course, but quite unacceptable in my book.

The first essential step towards mental health is to take charge of your own destiny and be whatever you want to be at the moment. If that involves "going crazy" sometimes, so be it - though, as you observed with that young woman in the hospital, it's often attention-seeking behaviour by people who otherwise feel lonely and insignificant.

Another anecdote: I have a neighbour whose 90-year-old mother used to create havoc all around her by playing "crazy". She was immensely powerful! When she convinced herself she was unable to turn a gas tap off, and couldn't find a match, she ended up with not only her family, but the gas board, the fire brigade, and the police descending on her flat. When they pointed out that she could quite easily have turned the tap off, she said demurely "But I'm just a poor helpless old lady...."

kittyrex said...

I sure as hell have a great personal perspective from just recently. I was very upset, having literally just heard of the death of a friend and crying very loudly. One of my neighbours called the police, who called the mental health team, who decided they would committ me in spite of my trying to frantically explain.

I wouldn't go willingly so they handcuffed me and threw me into th back of a paddy van. I was in hospital for 24 hours, restrained to a bed, and forcibly sedated to that they could cathertise me. They ran blood and urine tests, without my consent and it wasn't until everything came up clear and I actually saw the head psychiatrist and explained, that they let me go. I had to walk back to my place 8 kms in bare feet and with no purse, money or keys.

It was absolutely horrific. Everybody treated me as if I truly was insane.

kittyrex said...

I sure as hell have a great personal perspective from just recently. I was very upset, having literally just heard of the death of a friend and crying very loudly. One of my neighbours called the police, who called the mental health team, who decided they would committ me in spite of my trying to frantically explain.

I wouldn't go willingly so they handcuffed me and threw me into th back of a paddy van. I was in hospital for 24 hours, restrained to a bed, and forcibly sedated to that they could cathertise me. They ran blood and urine tests, without my consent and it wasn't until everything came up clear and I actually saw the head psychiatrist and explained, that they let me go. I had to walk back to my place 8 kms in bare feet and with no purse, money or keys.

It was absolutely horrific. Everybody treated me as if I truly was insane.

trousers said...

Bloody hell kittyrex, I'm sorry to hear that. Must have been a very intense, nasty experience on top of having to deal with the loss of someone you knew. A case akin to shooting first, and asking questions later. Did you get (or seek) any kind of apology or anything else in the aftermath?

Frightening stuff, and I appreciate you stopping by to share it. It is, after all, perfectly appropriate to cry and wail loudly to express shock, anger and grief, and I don't really have the words at the moment to adequately respond. But thanks again, and more strength to you.