Monday, 25 June 2007

Slightly Worrying...

In preparation for the high-school level intro to psych classes I am teaching, I have been rereading some of the classic studies in cognition, social psych, and abnormal psych. One of the classics in abnormal psychology is the Rosenhan Experiment.

Psychologist David Rosenhan, in 1972, was concerned about how mental illness was diagnosed and how people were institutionalized. He designed a very elegant study with impeccable ecological validity: he took eight "normal" people (i.e. not insane) and had them visit mental institutions across the US. They acted normally and were totally truthful about themselves, except they also said they heard a voice in their head saying "thud," "empty," and "hollow." The psychiactric staff at the hospital diagnosed seven with schizophrenia and one was diagnosed with bipolar disorder. As soon as they were admitted into the mental hospital all eight researchers acted normally and claimed the voice was gone. The psychiatric staff did not believe them, and insisted they were insane, citing evidence of "psychotic" behaviours by the pseudopatients. Their stays ranged from 7 to 52 days, with a mean age of 19 days before they were allowed to leave. He published his research (On Being Sane in Insane Places) in what is probably the most prestigious academic journal in the world, Science.

When these results were reported, it caused predictable controversy in the world of psychiatry. One prestigious mental hospital boasted that those kinds of mistakes would never happen at their institution, and challenged Rosenhan to send "fake" patients to their institution where they would easily be detected. Rosenhan accepted the challenge. Out of 193 admissions, the institution detected 41 "fakes", and 42 "suspected fakes." How many did Rosenhan send? Zero. Whoops. That kind of research is about as damning as I can think of for an academic discipline. If a discipline is to survive that kind of crisis, it must confront the problem fully and openly, else slip into ever-increasing irrelevance and disregard, until one day it wakes up and find itself nestled snuggly between phrenology and Aristotelian abiogenesis.

Here is the most worrying part: in my 600+ page textbook on Abnormal Psychology, published in 2001, which contains well over 3000 citations, with entire chapters devoted to schizophrenia, diagnosis, and mental institutions, none of Rosenhan's work is mentioned at all. That is a discipline in denial.

(Also worrying is that any genuine discussion on the Internet about the role of psychiatry tends to get hijacked very quickly by militant scientologists.)

Here is a slightly sensationalized, but generally accurate account of the study, originally shown on BBC2's The Trap:

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