How can anyone be sure of a correct diagnosis? – The Rosenhan experiment

I have said for the years that I have been diagnosed with the wrong diagnosis  After receiving my medical file last month, I discovered that it was very vague and has no description of any symptoms that I have suffered from over the years let alone the ones that I ‘should have’ for the accused diagnosis.  

The reason I call it an accused diagnosis is because in fact it is a rumour even within the mental health trust that I have said diagnosis.  Nowhere in my file is their mention of anyone having given me any kind of a diagnosis, what there is mention of in my first visit by a psychiatric nurse is suspected personality disorder possibly borderline.  From that day on every report of me has Borderline Personality Disorder on the top of the page as though that ABSOLUTELY IS my diagnosis, as though someone qualified has assessed me and made a diagnosis, when in fact the truth is that no one qualified has ever seen me for long enough to make such a diagnosis!

The psychiatrists spend no more than 10 minutes in a room with me and don’t discuss any of my symptoms.  The ones I mention I’ve had they gloss over and when questioned about my diagnosis they come up with so called pathological symptoms I supposedly suffer from, that I have never made any mention of and that are often the twisted imagination of the psychiatrist himself.

I have repeatedly said how the psychiatrist conveniently finds symptoms that are not there in order to fit the alleged diagnosis, I can only wonder what motive he has for doing this!  What I do know is that I am unable to get a referral to a psychologist, that I have been told there is nothing more they can do for me despite never having received any more than 6 sessions of psycho therapy back in 2001.  This is not long enough to develop a trusting relationship with the therapist or even begin to open up about issues that I have long kept hidden and felt ashamed of.  However, my records say I have received 2 years of ongoing psychotherapy!  There is no actual evidence of that in my file however, despite the fact that all appointments with any medical professional are recorded and kept in my file.

Reading about Rosenhan’s experiment certainly helps fit the pieces of the puzzle together for me!  Please share your thoughts on this article about hi experiment.

Rosenhan experiment

The Rosenhan experiment was a famous experiment into the validity of psychiatric diagnosis conducted by psychologist David Rosenhan in 1973. It was published in the journal Scienceunder the title “On being sane in insane places.  ” The study is considered an important and influential criticism of psychiatric diagnosis.

Rosenhan’s study was done in two parts. The first part involved the use of healthy associates or “pseudopatients” who briefly simulated auditory hallucinations in an attempt to gain admission to 12 different psychiatric hospitals in five different states in various locations in the United States. All were admitted and diagnosed with psychiatric disorders. After admission, the pseudopatients acted normally and told staff that they felt fine and had not experienced any more hallucinations. Hospital staff failed to detect a single pseudopatient, and instead believed that all of the pseudopatients exhibited symptoms of ongoing mental illness. Several were confined for months. All were forced to admit to having a mental illness and agree to take antipsychoticdrugs as a condition of their release.

The second part involved asking staff at a psychiatric hospital to detect non-existent “fake” patients. The staff falsely identified large numbers of ordinary patients as impostors.

The study concluded, “It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals” and also illustrated the dangers of dehumanization and labeling in psychiatric institutions. It suggested that the use of community mental health facilities which concentrated on specific problems and behaviors rather than psychiatric labels might be a solution and recommended education to make psychiatric workers more aware of the social psychology of their facilities.

The pseudopatient experiment

Rosenhan himself and eight mentally healthy associates, called “pseudopatients”, attempted to gain admission to psychiatric hospitals by calling for an appointment and feigning auditory hallucinations. The hospital staffs were not informed of the experiment. The pseudopatients included a psychology graduate student in his twenties, three psychologists, a pediatrician, a psychiatrist, a painter and a homemaker. None had a history of mental illness. Pseudopatients used pseudonyms, and those who worked in the mental health field were given false jobs in a different sector to avoid invoking any special treatment or scrutiny. Apart from giving false names and employment details, further biographical details were truthfully reported.

During their initial psychiatric assessment, they claimed to be hearing voices of the same sex as the patient which were often unclear, but which seemed to pronounce the words “empty”, “hollow”, “thud” and nothing else. These words were chosen as they vaguely suggest some sort of existential crisis and for the lack of any published literature referencing them as psychotic symptoms. No other psychiatric symptoms were claimed. If admitted, the pseudopatients were instructed to “act normally,” report that they felt fine and no longer heard voices. Hospital records obtained after the experiment indicate that all pseudopatients were characterized as friendly and cooperative by staff. All were admitted, to 12 different psychiatric hospitals across the United States, including rundown and underfunded public hospitals in rural areas, urban university-run hospitals with excellent reputations, and one expensive private hospital. Though presented with identical symptoms, 11 were diagnosed with schizophrenia at public hospitals, and one with manic-depressive psychosis, a more optimistic diagnosis with better clinical outcomes, at the private hospital. Their stays ranged from 7 to 52 days, and the average was 19 days. All were discharged with a diagnosis of schizophrenia “in remission,” which Rosenhan takes as evidence that mental illness is perceived as an irreversible condition creating a lifelong stigma rather than a curable illness.

Despite constantly and openly taking extensive notes on the behavior of the staff and other patients, none of the pseudopatients were identified as imposters by the hospital staff, although many of the other psychiatric patients seemed to be able to correctly identify them as imposters. In the first three hospitalizations, 35 of the total of 118 patients expressed a suspicion that the pseudopatients were sane, with some suggesting that the patients were researchers or journalists investigating the hospital.

Hospital notes indicated that staff interpreted much of the pseudopatients’ behavior in terms of mental illness. For example, one nurse labeled the note-taking of one pseudopatient as “writing behavior” and considered it pathological. The patients’ normal biographies were recast in hospital records along the lines of what was expected of schizophrenics by the then-dominant theories of its etiology.

The pseudopatients were required to get out of the hospital on their own by getting the hospital to release them, though a lawyer was retained to be on call for emergencies when it became clear that the pseudopatients would not ever be voluntarily released on short notice. Once admitted and diagnosed, the pseudopatients were not able to obtain their release until they agreed with the psychiatrists that they were mentally ill and began taking antipsychotic medications, which they flushed down the toilet. No staff member noticed that the pseudopatients were flushing their medication down the toilets and did not report patients doing this.

Rosenhan and the other pseudopatients reported an overwhelming sense of dehumanization, severe invasion of privacy, and boredom while hospitalized. Their possessions were searched randomly, and they were sometimes observed while using the toilet. They reported that though the staff seemed to be well-meaning, they generally objectified and dehumanized the patients, often discussing patients at length in their presence as though they were not there, and avoiding direct interaction with patients except as strictly necessary to perform official duties. Some attendants were prone to verbal and physical abuse of patients when other staff were not present. 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. Contact with doctors averaged 6.8 minutes per day.

The non-existent impostor experiment

For this experiment, Rosenhan used a well-known research and teaching hospital, whose staff had heard of the results of the initial study but claimed that similar errors could not be made at their institution. Rosenhan arranged with them that during a three month period, one or more pseudopatients would attempt to gain admission and the staff would rate every incoming patient as to the likelihood they were an impostor. Out of 193 patients, 41 were considered to be impostors and a further 42 were considered suspect. In reality, Rosenhan had sent no pseudopatients and all patients suspected as impostors by the hospital staff were ordinary patients. This led to a conclusion that “any diagnostic process that lends itself too readily to massive errors of this sort cannot be a very reliable one”. Studies by others found similarly problematic diagnostic results

Resources:  The details about the Rosenhan Experiment has been copy pasted from Wikipedia, to read the full article go to – http://en.wikipedia.org/wiki/Rosenhan_experiment

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2 Comments (+add yours?)

  1. emma johnson
    Oct 06, 2010 @ 20:51:23

    Hi just flew over from my blog where you left a lovely comment. As i said there; i suffer from mental illness myself and i am ashamed to say i rarely write about it on my blog as people do not seem to understand or even want to. So i wanted to say i feel what you are doing here is so admirable, well done and keep it up. In relation to your post, i know exactly what you mean. I myself have never been properly diagnosed, nor do they seem to want to. Instead they say i suffer from treatment resistant depression and o.c.d i am convinced this is not the case but feel as i have not responded to psycotherapy etc, this is how they choose to handle me, and i am certainly not getting the support i need. My treatment did nothing and my medication increases my anxiety but no one seems to want to do anything more. So i understand and my advice is to keep at them, until they hear what you are trying to say.
    Thanks again for your comments on my blog and please don’t be a stranger.
    Emma x

    Reply

    • sweetdeanie
      Oct 06, 2010 @ 21:08:53

      Hi Emma, I definitely hear you! It’s hard work getting correct diagnosis or anyone to listen to you once you’ve been labelled with any mental illness, after all who’s going to listen to the ‘crazy person’ over the professionals? I have actually put forwards a 2 page statement to be entered in to my medical file that will be kept as a cover page. It states which parts of my medical file I believe to be wrong and why as well as a list of my ongoing symptoms that I feel have been overlooked. When I go for my second opinion the Psychiatrist will be required to read that statement before reading the rest of my file and to not make a judgement based on the opinions of his predecessors. I’m hoping to have some success with this route because all I really want is to make as close to a recovery as is possible in order for me to return to a working environment and maybe even to achieve my dreams. I have had ambitions since I was small and I currently feel those ambitions and my ability is being wasted because of an illness that I’m sure can be treated with the help of a good therapist.

      I hope you can find a way to get the support you need in the near future too, I don’t believe anyone is a ‘lost cause’ and it pains me when I hear such things. We’re all human and imperfect and I see no reason why anyone would truly believe that another person is ‘better’ than someone else. To consider someone as a lost cause is to consider them as ‘broken’ of ‘faulty’ and I believe those are attributes you associate with inanimate objects not living creatures!

      I’ve signed up for the RSS feed on your site so will be kept up to date with new entries from you, thank you for visiting my site too and I hope to see you hear again soon.

      SD x

      Reply

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