Debunking Another Anti-Psychiatry Myth – A Review of The Great Pretender

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Image by Gerd Altmann from Pixabay

Marvin Ross

One of the main beliefs of the anti-psychiatry advocates is that mental illness does not exist. They love to cite the fact that there are no objective tests for mental illness like blood work but that is also a feature of many conditions that they do not dispute exist – Alzheimers and other forms of dementia and Parkinson’s come to mind.

The other contention is that psychiatrists cannot differentiate between the sane and the insane. I have to admit that I was not aware that this belief came about as the result of a “study” done by psychologist David Rosenhan published in Science in 1973. Rosenhan got himself admitted to a psychiatric hospital where he was diagnosed with schizophrenia based on telling the doctors he heard voices.

He claimed that this was the only symptom he presented with and, once admitted, he began to act as he normally did and was soon discharged with the diagnosis of schizophrenia in remission. Rosenhan then recruited a number of other sane pseudopatients who got themselves admitted to various other hospitals around the US where they too were diagnosed with schizophrenia save for one who was diagnosed manic depressive.

This 2017 video explains how the experiment was conducted and the results:

The study made a huge impact at the time although Rosenhan quickly dropped the topic and went on to do other work. He was offered a book contract with a generous advance but he failed to finish the book and the publisher sued to recover the money.

Thanks to the incredible investigative work of Susanna Cahalan in her book The Great Pretender, proof is provided that the study was highly flawed. Ms Cahalan obtained Rosenhan’s notes and found them to be sloppy to the point of being unprofessional and even unethical. He made errors about the length of time spent in hospital and even the capacity of one hospital. He claimed a hospital had 8000 patients when it only had 1510.

The published study had very exact percentages for staff time spent in various activities with patients but one of the pseudopatients interviewed by Ms Cahalan told her that no data was collected. The data presented in the study contained such statements as attendants spent only an average of 11.3 % of their time outside the cage (staff desk) while doctors spent only 2% of their time where they paused and chatted with patients.

These are very specific figures and yet there was no explanation as to how they were derived and calculated.

Dr Rosenhan initially went undercover to Haverford Hospital in the Philadelphia area and claimed that his data was not used in the study but, in fact, it was. Cahalan was able to obtain the actual medical record for his time in hospital and discovered that the symptoms he complained of were far more extensive than simply saying he heard voices.

The actual record showed that he told the doctors that he was sensitive to radio signals, that he could hear what others were thinking and that he tried to drown out the noises by putting copper pots over his ears. The use of copper pots is similar to schizophrenic patients covering their heads with tinfoil to protect against the rays aimed at them from outer space. He also said that being in hospital could better insulate out the noises. He also confeseed to being suicidal.

Ms Cahalan concluded that Dr Rosenhan intentionally distorted the facts for his paper.

One of his critics at the time, Dr Robert Spitzer, corresponded at great length with Rosenham  and was so outraged that he was motivated to develop an updated version of the DSM (version III). Spitzer quoted another physician who stated that:

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.”

If you describe symptoms that encompass all the markers of schizophrenia to a psychiatrist then you can expect them to diagnose you with schizophrenia.

There was a 9th psuedopatient in the research who wanted to emphasize the positive aspects of his 19 day stay in hospital but there is a footnote in the study saying that this data was excluded. Turns out that it was not excluded. The author found a draft paper of 9 pseudopatients and then the published paper with a footnote saying the 9th was removed.

Despite being removed, the numbers did not change. The average length of stay, the number of pills dispensed remained the same and the time that nurses spent with the patients did not change. If you remove one subject from a small sample size, the numbers will change but they did not in this case. Had the editors of Science been aware of these transgressions, Cahalan said, they would not have published the paper.

Research is essential for advancing our knowledge by investigating new areas or, and this is crucial as well, in replicating earlier studies to demonstrate their veracity. Studies that find negative results are also important but many have been suppressed. Since January 2018, those conducting clinical trials have been compelled by law to report all results even if negative. This was enacted to ensure that doctors and patients could determine if treatments were safe and effective and arose because it was not unusual for pharmaceutical companies to suppress data that did not support the efficacy of a drug under development.

But, as Science reported, many are not doing this and there has been no enforcement for their failure.

Research study results often involve a great deal of hype and publicity which is good for the researchers and their institutions. Promotions result and grant money flows so deception is common. The website, retraction watch, hosts a database of the flawed research that has had to be retracted and that is just the tip of the iceberg. I personally came across a research study from the Institute for Clinical Evaluative Science in Toronto which reported that doctors in Ontario were failing to abide by prescribing guidelines. The problem was that the guidelines came out after the research was complete. The researcher and the director refused to admit error but the editor of the journal it was to be published in made them add a correction. That correction was not conveyed to the many media outlets that reported on the flawed conclusion.

Cahalan does touch on these problems with research and cited the Reproducibility Project at the University of Virginia. An attempt was made to reproduce the results of 100 social psychology experiments and fewer than half could be replicated.

The most famous of psychology experiments also conducted at Stanford, The Prison Experiment, has also been exposed as a sham in a very detailed expose in Medium.

Research is crucial but findings need to be replicated and the lay audiences should be wary of basing beliefs on the results of only one study particularly if there is a great deal of media hype surrounding it.

 

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