Note that 1973 was a long time ago, and that the deinstitutionalization movement got a significant boost in support from the Rosenhan experiment. I imagine things are different now, although diagnostic criteria for mental illness are still primitive at best.
(Note that the main thing you’ll find when you search for replications is Lauren Slater’s book. Don’t trust it; she won’t share any evidence and has a history of lying).
First link: Patients were psychiatric nurses, faking specific illnesses during their whole stay. (Rosenhan had various people faking atypical symptoms until admission.) Doctors believing them aren’t to blame.
Among the findings of the project were that patients frequently found it difficult to get information on their treatment
Agrees with my experience. A computer for patients and access to Crazy Meds help, but I don’t know an easy fix for less geeky patients.
Second link: That’s a pretty good test. However, the doctors were shown patients who had been treated and were doing well. It’s harder to diagnose short-sightedness if your patient is wearing contact lenses.
So neither of these tests are nearly as stringent as Rosenhan’s.
Things may in fact be better now; however, based on an experience I had approximately ten years ago, they are not substantially better, and certainly not good enough. The patient in my anecdotal evidence was only freed upon the same conditions as those in the Rosenhan experiment, and the behaviour of the staff and doctors was spot on. If anything, the patient left the institution with more problems than she entered with.
Staff behavior is easiest to judge (patients can’t see hospital notes, and if you’re not faking you can’t judge the diagnosis much). Here’s my experience in the acute psychiatric wing of a Swedish public hospital:
I am not psychotic (as far as I know, ha) but had a symptom a few years back that I mentioned when asked. (I think they screen everyone for psychosis.) They focused on that a lot, but did not medicate me for it.
the pseudopatients were not able to obtain their release until
I was voluntarily hospitalized. I don’t know if demanding to leave would have worked. I was able to get day permissions and then released basically by being visibly happy then telling doctors so.
they agreed with the psychiatrists that they were mentally ill
Nobody asked me to self-diagnose!
and began taking antipsychotic medications
That one’s true—medication (not antipsychotics in my case) was not optional.
No staff member noticed that the pseudopatients were flushing their medication down the toilets
Taking meds is the only time we were actively watched (except for patients on suicide watch).
Their possessions were searched randomly, and they were sometimes observed while using the toilet.
often discussing patients at length in their presence as though they were not there, and avoiding direct interaction with patients
Some attendants were prone to verbal and physical abuse of patients when other staff were not present.
Nuh-uh.
Contact with doctors averaged 6.8 minutes per day.
30 minutes every weekday morning with two doctors and a nurse, in a private room. I think this is standard procedure in Sweden.
They have to be better along the “how long were they detained?” axis because for decades there were about 40% less asylum beds than there had been previously. I think it’s likely that the underlying thought processes and biases- i.e. normal people looking crazy enough to diagnose if you already think they’re crazy- are not significantly different, and that’s what most people care about anyway. (Being able to convince a doctor that I’m sane is more important to me than whether it takes 2 days or 19!)
Being able to convince a doctor that I’m sane is more important to me than whether it takes 2 days or 19!
Why is that? That’s the case if you need psychiatric certification for a job or a medical procedure or something. But generally, being locked up somewhere people can make you take arbitrary medication is bad, and grows worse over time (medication kicking in and unsafe to quit too quickly, effects of detention, damage to your outside life), whereas a piece of paper telling you to take some medication can be ignored. Is there something I’m missing, like insurance premiums?
Declared sane and released after 2 days > declared sane and released after 19 days > declared insane and released after 2 days > declared insane and released after 19 days.
I agree that some people might switch the ordering of the second and third outcomes.
My type 1 systems expect the total discounted long-term costs to be higher. My type 2 systems aren’t prepared to do the calculation themselves and are having trouble coming up with justifications, but it seems like self-image and social standing are the most visible concerns.
Note that 1973 was a long time ago, and that the deinstitutionalization movement got a significant boost in support from the Rosenhan experiment. I imagine things are different now, although diagnostic criteria for mental illness are still primitive at best.
Things are not entirely different.
Here’s another one
(Note that the main thing you’ll find when you search for replications is Lauren Slater’s book. Don’t trust it; she won’t share any evidence and has a history of lying).
First link: Patients were psychiatric nurses, faking specific illnesses during their whole stay. (Rosenhan had various people faking atypical symptoms until admission.) Doctors believing them aren’t to blame.
Agrees with my experience. A computer for patients and access to Crazy Meds help, but I don’t know an easy fix for less geeky patients.
Second link: That’s a pretty good test. However, the doctors were shown patients who had been treated and were doing well. It’s harder to diagnose short-sightedness if your patient is wearing contact lenses.
So neither of these tests are nearly as stringent as Rosenhan’s.
Things may in fact be better now; however, based on an experience I had approximately ten years ago, they are not substantially better, and certainly not good enough. The patient in my anecdotal evidence was only freed upon the same conditions as those in the Rosenhan experiment, and the behaviour of the staff and doctors was spot on. If anything, the patient left the institution with more problems than she entered with.
Staff behavior is easiest to judge (patients can’t see hospital notes, and if you’re not faking you can’t judge the diagnosis much). Here’s my experience in the acute psychiatric wing of a Swedish public hospital:
I am not psychotic (as far as I know, ha) but had a symptom a few years back that I mentioned when asked. (I think they screen everyone for psychosis.) They focused on that a lot, but did not medicate me for it.
I was voluntarily hospitalized. I don’t know if demanding to leave would have worked. I was able to get day permissions and then released basically by being visibly happy then telling doctors so.
Nobody asked me to self-diagnose!
That one’s true—medication (not antipsychotics in my case) was not optional.
Taking meds is the only time we were actively watched (except for patients on suicide watch).
Nuh-uh.
30 minutes every weekday morning with two doctors and a nurse, in a private room. I think this is standard procedure in Sweden.
They have to be better along the “how long were they detained?” axis because for decades there were about 40% less asylum beds than there had been previously. I think it’s likely that the underlying thought processes and biases- i.e. normal people looking crazy enough to diagnose if you already think they’re crazy- are not significantly different, and that’s what most people care about anyway. (Being able to convince a doctor that I’m sane is more important to me than whether it takes 2 days or 19!)
Why is that? That’s the case if you need psychiatric certification for a job or a medical procedure or something. But generally, being locked up somewhere people can make you take arbitrary medication is bad, and grows worse over time (medication kicking in and unsafe to quit too quickly, effects of detention, damage to your outside life), whereas a piece of paper telling you to take some medication can be ignored. Is there something I’m missing, like insurance premiums?
My preference ordering:
Declared sane and released after 2 days > declared sane and released after 19 days > declared insane and released after 2 days > declared insane and released after 19 days.
I agree that some people might switch the ordering of the second and third outcomes.
I understand that’s your preference ordering, I’m asking why you find being declared insane worse than 17 days of captivity.
My type 1 systems expect the total discounted long-term costs to be higher. My type 2 systems aren’t prepared to do the calculation themselves and are having trouble coming up with justifications, but it seems like self-image and social standing are the most visible concerns.