Can psychiatrists pretend to be mentally ill?

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can. Stanford University psychology professor David Rosenhan (David Rosenhan) once pretended to be admitted to a mental hospital, revealing the dark history of psychiatric diagnosis.

Speaking of mental illness, we can easily think of this picture: a dim psychiatric ward, a man in a hospital gown was held down by nurses and doctors, and was forcibly injected with tranquilizers. As the patient slowly calmed down, he A faint murmur came from his mouth, “Let me out…I am not mentally ill…”

“In a mental hospital, not admitting your mental illness is the evidence that you have mental illness.” This section that often appears in movies and TV shows reflects the way people diagnose mental illness in the past-clinical observation, but it is really reliable. ?


Really fly over the lunatic asylum

How do we know exactly what is normal and what is mental illness? In the 1960s, Stanford University psychology professor David Rosenhan (David Rosenhan) pondered this question for a long time. In order to verify whether the diagnosis of the professionally trained medical staff was correct, he did a famous experiment from 1968 to 1972.

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Rosenhan himself and 7 other perfectly normal volunteers (5 males and 3 females) disguised themselves as mentally ill patients, and came to 12 different mental hospitals as “undercover”. These 12 hospitals are located in 5 states on the east and west coasts of the United States, with varying degrees of newness and old age, and the ratio of doctors to patients. Except for a private hospital, the others are supported by state or federal funds, and one of the projects is also supported by university funds.

The pretenders provided false names, occupations, and lied to have some symptoms of auditory hallucinations, such as hearing some strange sounds mumbling words such as “nothingness”, “emptiness”, or “boom” sound. In addition, they truthfully reported their personal experience, current situation and other information.

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They can easily convince medical staff that they have a mental illness and are successfully hospitalized. However, they were forced to undergo a series of treatments despite the fact that they no longer had auditory hallucinations after admission.

At the beginning of the experiment, they were most worried about “the lies will be exposed immediately,” but it turns out that no one cares about them that much, and they don’t need to worry about it. During the hospitalization, they also recorded observations of the ward, patients, and staff. At first, these notes were taken in secret, but soon they discovered that such worries were unnecessary. As a result, they began to boldly take notes in public.

After an average hospitalization period of 19 days (ranging from 7 to 52 days), they were finally released, but almost all the discharge diagnoses of schizophrenia stated “remission”. This shows that doctors still recognize them as mentally ill patients-they can’t distinguish the real patients. Ironically, among the 118 patients who were actually hospitalized, 35 people expressed doubts about the pseudonymous patients, and some of them had tough attitudes. When the undercover guys kept taking notes, someone asked, “You are not a lunatic, are you a reporter or a professor?”

Professor Rosenhan’s experiment continues.

The next experiment was arranged in a research and teaching hospital. Rosenhan told the doctors, nurses, psychologists, and psychiatrists in the hospital that in the next three months, an unknown number of fake patients will be sent in and they have to make judgments about this.

As a result, of the 193 hospitalized patients, 41 were highly suspected of being fake patients by at least one hospital staff; 23 of them were suspected by at least one psychiatrist. But in fact, during this time, Rosenhan did not send any fake patients over.

This test once again pointed out that psychiatrists and medical staff have great problems with the diagnosis of mental illness. Although the hospital argued that some patients were only worried about their condition and did not really get sick, this research still had a huge impact on the psychiatric diagnosis at that time.

In 1973, these two experiments were written by Rosenhan in a paper entitled “On Being Sane In Insane Places” (On Being Sane In Insane Places) and published in the journal Science. This paper revealed the unreliability of diagnosis in psychiatric hospitals, and immediately attracted widespread attention.

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Difficult mental illness diagnosis

After the results of Rosenhan’s experiment were published, the American Psychiatric Association revised the Diagnostic and Statistical Manual of Mental Disorders (DSM). The new version of DSM published in 1980 listed a more comprehensive list of symptoms for each mental illness.

DSM is formulated by the American Psychiatric Association and is regarded as a psychiatric instruction manual, which provides the basis and methods for the diagnosis of various mental illnesses. The first edition (referred to as DSM-I) was published in 1952 and mainly reflected the specific views of famous psychologists at the time that all mental illnesses are the result of the environment. In the following decades, DSM has been continuously revised, corrected and expanded. By 2013, the fifth edition of DSM had been published.

Although DSM is authoritative, it has limitations. For example, in DSM Version 5, a person must have 5 of the symptoms described in order to be diagnosed with major depression. “This is an arbitrary classification,” said Leonard Simms, an expert in the description and classification of mental illness. “People with 4 depression symptoms may suffer more injuries than people who meet the 5 criteria.”

This shows that it is not easy to diagnose mental illness through clinical observation.

At present, doctors sometimes supplement their clinical diagnosis with more advanced technical means. With the development of medical imaging, neuroscientists can use more advanced methods to study various mental diseases. Technologies such as PET imaging and MRI have gradually become new evidence for psychiatric diagnosis. However, different mental illnesses may also cause fluctuations in similar brain areas. For example, in people with anxiety, schizophrenia, and even sleep deprivation, it is common for the “emotional center” of the brain to be active and less active in parts of the frontal lobe.


Stigma impact of mental illness

“Once labeled as schizophrenia, the pretender will be subject to this label.” Professor Rosenhan emphasized the impact of the diagnosis on personal behavior in his report.

Whether it is “mental disorder,” “mental illness,” or “schizophrenia,” these terms have negative effects. In the article “Normal People in the Mental Ward”, Rosenhan pointed out that, whether normal or not, any behavior of fake patients is regarded as pathological by hospital staff: writing is part of compulsive behavior; corridor pacing is returned Because of the patient’s mental disorder; arriving at the cafeteria early at lunch is a characteristic of the syndrome. The point is that hospital staff misinterpreted normal behavior by relying on the label “Confirmed by Mental Illness”.

It can be said that the label of mental illness is like a mask that cannot be removed. Once diagnosed, no matter how you live normally, you will be branded as pathological.

This is the so-called “stigmatization.” The stigmatization of mental illness has brought many effects to patients. In Professor Rosenhan’s paper, he also described his own experience in the mental hospital: “Medical staff either only give brief answers to patients’ questions, or they turn their heads and do not answer at all.” Even if some patients tried To please doctors or nurses, they are just perfunctory or ignored.

Mental patients endure not only the torture caused by the illness, but also social indifference and even abuse. Because of the shame caused by the mental illness label, many patients deliberately conceal the fact that they are sick. People with a life experience of mental illness often report that they feel degraded, excluded, and dehumanized by the many health professionals they come into contact with.

In a 2003 report from the Department of Psychology at the British Institute of Psychiatry, researchers found that the consequences of stigma and discrimination are long-lasting and may even incapacitate people.

Going back to the scene at the beginning of this article, when people want to prove their sanity, they are actually afraid of the consequences of stigmatization: mental patients will be treated as aliens. There may not be clear boundaries in the diagnosis of mental illness. Whether it is from disease or health, anyone needs to integrate into society and be accepted by others.

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