The Believing Brain - Michael Shermer [9]
All eight were admitted, seven of them diagnosed as schizophrenic and one as manic-depressive. They were, in fact, a psychology grad student, three psychologists, a psychiatrist, a pediatrician, a housewife, and a painter (three women, five men), none of whom had any history of mental illness. Outside of the faux auditory hallucination and false names, they were instructed to tell the truth after admission, act normally, and claim that the hallucinations had stopped and that they now felt perfectly fine. Despite the fact that the nurses reported the patients as “friendly” and “cooperative” and said they “exhibited no abnormal indications,” none of the hospital psychiatrists or staff caught on to the experiment, consistently treating these normals as abnormals. After an average stay of nineteen days (ranging from seven to fifty-two days—they had to get out by their own devices), all of Rosenhan’s shills were discharged with a diagnosis of schizophrenia “in remission.”
The power of the diagnostic belief engine was striking. In the recorded radio conversation,3 Rosenhan recounted that in his admission interview the psychiatrist asked 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 fairly well but had occasional fights, and that he “almost never” spanked his kids, the exception being when he spanked his daughter for getting into a medicine cabinet and his son once for running across a busy street, adding that the psychiatrist never inquired into the context of either the spousal fights or the spankings. Instead, Rosenhan explained, this was all “interpreted as reflecting my enormous ambivalence in interpersonal relationships and a great deal of difficulty in impulse control, because in the main I don’t spank my kids, but boy I get angry and I then spank them.” The psychiatrist, Rosenhan concluded, “having decided that I was crazy, looked into my case history to find things that would support that view, and so ambivalence in interpersonal relationships was a damn good example.”
The diagnostic belief bias was pervasive. Because Rosenhan’s charges were bored out of their skulls in these institutions, to pass the time they kept detailed notes of their experiences. In one poignant descriptor, the staff reported that “patient engages in writing behavior” on a list of signs of pathology. The painter pseudopatient began churning out canvas after canvas, many of which were of such good quality that they were hung on the mostly barren walls of the institution she entered—which happened to be a hospital for which Rosenhan was a consultant.
I come in one day for a case presentation conference to hear the staff going across her paintings over time saying, in effect, “look, here you can see real disturbances in her sensorium, you can see how things are erupting into consciousness, libidinous pushes, and here you can already see it sealed over,” and so on. It’s clear that in this matter, with regard to projectives of all kind, you read in what you want to read in to it. The statements that mental health professionals make about patients often tell us more about the professionals than they do about the patients.
Tellingly, the real patients—not privy to the psychiatrists’ diagnoses of the pseudopatients—suspected something was up right away. Of the 118 patients whose remarks were recorded, 35 of them indicated that they knew what was really going on. As one exclaimed: “You’re not crazy. You’re a journalist,