Spitzer also writes that ‘schizophrenia in remission’ was a diagnosis rarely used by psychiatrists at the time of the experiment, and as such this indicates that the diagnoses given were a function of the patients’ behaviours
Agree that if all Rosenhan had observed was “discharged with an ‘in remission’ diagnosis” that would prove hospitals can detect sanity well. But the stays were long—maybe psychosis is much sneakier than depression or hypomania and requires longer observation? And Rosenhan observed more—accepting treatment and agreeing with diagnoses as conditions for release, for example.
Rosenhan reports that the psychiatrists did not spend much time with the pseudopatients. [...] Whilst the medical staff’s lack of engagement with the pseudopatients is regrettable, it does point towards poor clinical skills rather than an indictment of psychiatric classification.
Not sure what difference that makes in practice.
He is struck by what he sees as Rosenhan’s actual failure to provide data demonstrating where normal hospital experiences were categorized as pathological.
Okay for the nurse report mentioning “engages in writing behaviour”, though I’d like to know what is reported in that weird style and what isn’t. But how about ” A group of bored patients waiting outside the cafeteria for lunch early were said by a doctor to his students to be experiencing “oral-acquisitive” psychiatric symptoms.”?
The ease with which the pseudopatients gained admission on the basis of what are reported to be mild symptoms
Yup. I don’t think that’s bad if beds aren’t scarce. It’s only bad if patients aren’t released easily.
Spitzer remarks that the doctors should have been wary of making a diagnosis of schizophrenia in a previously unknown patient presenting without any history of insidious onset. However he is more lenient toward the pseudopatients’ psychiatrists, writing that, given the information available, schizophrenia was the most reasonable diagnosis.
How about referring the patient to someone who knows more about schizophrenia, and can decide if the diagnosis and hospital stay are needed?
Hunter takes exception to Rosenhan’s assertion that the pseudopatients acted ‘normally’ in the hospital:
The pseudopatients did not behave normally in the hospital. Had their behaviour been normal, they would have talked to the nurses’ station and said “Look, I am a normal person who tried to see if I could get into the hospital by behaving in a crazy way or saying crazy things.”
Oh, excuse me, I didn’t realize the study was supposed to apply to faking experimenters. I thought it was about misdiagnosed patients who figure clamoring they’re sane won’t help, and might believe the diagnosis.
the pseudopatients would likely not have been, unlike Rosenhan’s assertion, admitted on the basis of their hallucinations solely. Their presentation to hospital and request for admission may also have carried diagnostic weight as it suggested much greater distress.
Good point, but no one’s criticizing admission, they’re criticizing
throughout their stay, the pseudopatients do not appear to have been assessed in detail.
which pretty much implies that hospitals’ function is to lock away loonies, not treat them.
The poor diagnostic skills and apparent lack of curiosity of the psychiatrists that the pseudopatients met is not an indictment of the classification per se, rather its application.
Again, if it’s not fulfilling its purpose in practice, who cares?
Rosenhan would favour a classification system based on behaviours:
It seems more useful … to limit our discussions to behaviours, the stimuli that provoke them, and their correlates
Yet despite this early on in the paper he writes that “Anxiety and depression exist”
It’s not hard to describe those in terms of behavior. Most likely the benefit is that diagnosing patients would require actually examining them.
his study consisted of only eight subjects
There wasn’t that much variation in outcomes, but fine, do a replication.
Overall, this picks some valid nits, but sweeps most interesting data under the carpet. An average of 19 days to notice someone has no symptoms is not negligible!
Link the second:
If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood, the behavior of the staff would be quite predictable. If they labeled and treated me as having a bleeding peptic ulcer, I doubt that I could argue convincingly that medical science does not know how to diagnose that condition.
Rosenhan replied that if they continue thinking that you still have an ulcer during x weeks despite having no other symptoms of ulcer, that makes for a big problem.
Also, doctors sometimes have to detect malingering outside of experiments.
Kety also argued that psychiatrists should not necessarily be expected to assume that a patient is pretending to have mental illness, thus the study lacked realism.
When it gets cold or rainy, the hospital fills up with homeless people. Word has spread on the streets that if you go to the emergency room and tell the nurse that evil spirits are telling you to kill everyone, you will get a nice bed and three warm meals a day
Thanks for spending the time to respond point by point. I’d love to do the same, but this thread would become a bit unwieldy. However, of all the argument mapping software I’ve looked at, this one seems to be the best:
http://workflowy.com/
This document can be edited by anybody with this link, so please feel free to chime in. As I mentioned earlier, I’m starting a blog. The goal being to crowdsource ideas on how to make better argument mapping software from the LW community (rather than having discussion isolated to scattered posts). A huge part of this is sketching out example argument maps like the one aove.
For the most part, I agree with the sentiment expressed by Rosenhan. In fact, I agreed so much that I failed (I blame wikipedia :) ) to look at counter-arguments until recently as part of an effort to re-examine my old beliefs and formalize them into argument maps. Thanks for posting this. I wouldn’t have been motivated to formalize this into bullet points otherwise.
Did someone delete all of your arguments? I got there, and nothing was there. Maybe I’m doing something wrong and so I can’t see what you’re talking about?
I mean that by separating the pro and con arguments it becomes more difficult to trace the lines of argument and counterargument. Rebuttals are harder to follow if you have to sort through a list of bullet points to find the one that’s relevant to them.
I also made the comment to test whether or not you could see my comments. You can. That probably means that I’m doing something wrong or that you’re writing in some equivalent of invisible e-ink. I can’t think what I might be doing wrong though. I’m not too concerned about seeing the site though, so don’t worry about it.
Link the first:
Agree that if all Rosenhan had observed was “discharged with an ‘in remission’ diagnosis” that would prove hospitals can detect sanity well. But the stays were long—maybe psychosis is much sneakier than depression or hypomania and requires longer observation? And Rosenhan observed more—accepting treatment and agreeing with diagnoses as conditions for release, for example.
Not sure what difference that makes in practice.
Okay for the nurse report mentioning “engages in writing behaviour”, though I’d like to know what is reported in that weird style and what isn’t. But how about ” A group of bored patients waiting outside the cafeteria for lunch early were said by a doctor to his students to be experiencing “oral-acquisitive” psychiatric symptoms.”?
Yup. I don’t think that’s bad if beds aren’t scarce. It’s only bad if patients aren’t released easily.
How about referring the patient to someone who knows more about schizophrenia, and can decide if the diagnosis and hospital stay are needed?
Oh, excuse me, I didn’t realize the study was supposed to apply to faking experimenters. I thought it was about misdiagnosed patients who figure clamoring they’re sane won’t help, and might believe the diagnosis.
Good point, but no one’s criticizing admission, they’re criticizing
which pretty much implies that hospitals’ function is to lock away loonies, not treat them.
Again, if it’s not fulfilling its purpose in practice, who cares?
It’s not hard to describe those in terms of behavior. Most likely the benefit is that diagnosing patients would require actually examining them.
There wasn’t that much variation in outcomes, but fine, do a replication.
Overall, this picks some valid nits, but sweeps most interesting data under the carpet. An average of 19 days to notice someone has no symptoms is not negligible!
Link the second:
Also, doctors sometimes have to detect malingering outside of experiments.
Yvain does:
Thanks for spending the time to respond point by point. I’d love to do the same, but this thread would become a bit unwieldy. However, of all the argument mapping software I’ve looked at, this one seems to be the best: http://workflowy.com/
I transferred your points and counter-points into this and then responded to a few of them (I’ll finish responding when I’ve got a bit more time):
This document can be edited by anybody with this link, so please feel free to chime in. As I mentioned earlier, I’m starting a blog. The goal being to crowdsource ideas on how to make better argument mapping software from the LW community (rather than having discussion isolated to scattered posts). A huge part of this is sketching out example argument maps like the one aove.
For the most part, I agree with the sentiment expressed by Rosenhan. In fact, I agreed so much that I failed (I blame wikipedia :) ) to look at counter-arguments until recently as part of an effort to re-examine my old beliefs and formalize them into argument maps. Thanks for posting this. I wouldn’t have been motivated to formalize this into bullet points otherwise.
Did someone delete all of your arguments? I got there, and nothing was there. Maybe I’m doing something wrong and so I can’t see what you’re talking about?
I just checked, and nobody deleted all of my arguments. If you click on this link:
https://workflowy.com/shared/c9e57ddb-d684-ede5-0511-8b8d11c561e0/
I still see nothing.
Do you see the “meta” note that I made on there?
I do see your meta comment… I’m not sure what you mean by it though.
I mean that by separating the pro and con arguments it becomes more difficult to trace the lines of argument and counterargument. Rebuttals are harder to follow if you have to sort through a list of bullet points to find the one that’s relevant to them.
I also made the comment to test whether or not you could see my comments. You can. That probably means that I’m doing something wrong or that you’re writing in some equivalent of invisible e-ink. I can’t think what I might be doing wrong though. I’m not too concerned about seeing the site though, so don’t worry about it.