- why won’t professionals answer patients’ questions
- Ask the mentalists – Boundaries
- Ask the Mentalists – Artificial Language Barriers
- Ask the Mentalists – Charting
- Ask the Mentalists – PRN Lorazepam
- Question for MN
- Newbie Questions
- What happens to well-meaning professionals?
- What if your patients are smart?
- A question regarding suicide
- Ch-Ch-Ch-Ch-Chan… Oh You Get The Idea
(Guest post by Jessa)
In the Mental Nurse forums, Nell and I were discussing plans for a survival guide to mental health care (you should contribute when we get around to making a more formal request) and we got off on a tangent about our linguistic bones of contention with mental health care. These linguistic bones of contention are one of those things that I have asked professionals about while I have been under their care, but that they have refused to discuss with me (as per “why won’t professionals answer patients’ questions”).
Some mental health care professionals have forbidden the word “should” and have told me, “Don’t should on yourself.” I know that they did this because they wanted me to avoid the attitudes of obligation and guilt for not fulfilling those, often unrealistic, obligations. Even when I acknowledged this before challenging the benefits of demonizing a helping verb, no professionals have conceded that it is ridiculous to ban the word completely. When I was having therapy with a member of the “Don’t ‘should’ on yourself” Cult, she was talking to me and used the word “should” in one of those perfectly legitimate, no obligations implicated, sorts of ways. I pointed at her with my whole arm until she asked why I was committing such an egregious social faux pas. I said that she had used the word “should” and that I was calling her on it, which is a favorite past-time of the members of the “Don’t ‘should’ on yourself” Cult. At first, she denied using the word “should” (oh the horror, what a sin!), but once I got her to admit to having used it, things didn’t go as I had hoped. I hoped she would admit to ridiculousness of her ways, but instead, she confessed that she wasn’t a very good therapist, but that her boss was a much better therapist and would never use the word “should”. What is the deal here? Why can’t professionals admit that, while fighting the obligation and guilt-inducing sentiments that sometimes accompany the word “should”, it is inappropriate to ban the word altogether?
I have also been told that I should (note the irony here, they still managed to express the same sentiment of obligation even when they didn’t use the word “should”, which means I can accurately use the word when I summarize what they said) not use the words “good” and “bad” because they have implications of moral judgment. I was not allowed to describe emotions in terms of good and bad. I protested that “good” and “bad” have many other definitions beyond implications of moral judgment and that, even if they are crude words that oversimplify complex concepts, they are very frequently used in these ways out in the real world. None of this, predictably, made any difference. Again, why the extremism?
I have even argued that the words that professionals sometimes like to substitute for these, “healthy” and “unhealthy”, can take on the same implications of moral judgment that they are trying to avoid by banning “good” and “bad”. To some extent, “healthy” and “unhealthy” are not a direct, one-to-one translation of “good” and “bad”; sadness would be a “bad” but possibly “healthy” emotion. However, since this language was used not only for emotions, but also for thoughts and actions (where most of the moral implications come in anyway), instead of transparently making a moral judgment by calling a patient’s thought or action “bad”, they mask this by describing a patient’s thoughts and actions as “unhealthy”. That moral neutrality is only an illusion. It is pretty damning for any argument that “health” language is not used to make moral judgments when you remember that Soviet political dissidents were often sent to mental hospitals rather than prison because this more effectively stops both the dissident and his message.
When I describe myself in terms of mental illness, I often call myself “crazy”. I do this for several very specific, thoughtful reasons. It is a flippant way to describe myself, rather than saying, “I’m mentally ill,” or “I’ve suffered from depression, anxiety, anorexia, and self-injury” which takes on a much more serious tone. This way I can choose which tone I want to bring to the conversation, political correctness offers me only one tone. Calling myself crazy also expresses that I am comfortable with my position as a nutter and don’t care to hide it, and it probably also indicates that I am open to talking about it. If my only option is the politically correct, “I’m mentally ill,” that is more likely to be understood as meaning that I am uncomfortable with the topic and don’t want to talk about it. Clearly, I have thought about this more than the professionals who reflexively, probably out of political correctness, tell me I’m not crazy. Even when I explain myself, they are reticent to let me call myself crazy, even though I’m not forcing the word on them. Why, why, why?
There are, of course, many more linguistic problems in mental health care, but these are the ones with which I have had the most trouble. Perhaps others would want to ask about the linguistic problems they find the most troublesome.
Calling myself crazy also expresses that I am comfortable with my position as a nutter and don’t care to hide it, and it probably also indicates that I am open to talking about it. If my only option is the politically correct, “I’m mentally ill,” that is more likely to be understood as meaning that I am uncomfortable with the topic and don’t want to talk about it. Clearly, I have thought about this more than the professionals who reflexively, probably out of political correctness, tell me I’m not crazy. Even when I explain myself, they are reticent to let me call myself crazy, even though I’m not forcing the word on them. Why, why, why?
I had this discussion at length with the only counsellor I ever saw more than once. Bless her. I could see where she was coming from: it’s a generally derogatory word, and I tend to both flat-out hate myself and use self-deprecating humour as a shield, so that needed calling. My position was more of the “co-opting derogatory terms” one, which is a whole other debate I really don’t want to get into, but I’m generally of the opinion that it’s my right as a mad person to describe my experiences as I damn well please, and it’s not really anyone else’s place to censor that. If I use derogatory or vulgar language it’s usually because my experience was shitty. Nobody else gets to use that language, because it wasn’t their experience.
Also, she wasn’t a fan of labels; she was of the “getting mental help doesn’t mean you’re mentally ill!” school, whereas I’m more “yes, it does, but there’s nothing necessarily wrong with that.” I like labels. I think they’re useful, and a bit validating. I think being able to label my problems as X, Y, Z is a lot more reassuring and less blame-y than a nebulous “the girl’s gone wrong”. I say “crazy” because it takes far too long to say “depression that sometimes involves rages and hallucinations and catatonia but mostly is more vanilla than that; panic attacks that turned into full-on agoraphobia; OCD; a bunch of unhealthy coping mechanisms I’m trying to kick; and the arse-end of an eating disorder.” “Crazy” sums it up pretty well.
Rather than dismissing it with the meaningless catch-all of “political correctness”, I did see where she was coming from, and I appreciated her effort. I’d just rather she saw my view after the third or fourth time of explaining! And it was easier to deal with coming from her, because she was generally helpful and empathetic. This kind of stuff coming from my idiot psych gets very short shrift. Context is everything.
But yeah. At the point where it becomes a rule the mad person isn’t supposed to break, rather than something to be discussed constructively, it’s just punitive and stupid.
Just out of curiosity, Jessa, have you noticed differences in language between the different professions?
Last year I was helping to run a therapy group for troubled teenagers, and a clinical psychologist asked me to accept a referral of one of her clients because this client “has some self-evaluative issues”.
My initial thought was, “Self-evaluative issues? Aw, psychologist-speak. Bless bless.” Then it occurred to me that it wasn’t really any sillier than a psychiatrist saying that a juvenile delinquent “has a conduct disorder”.
Z:
To some extent I have noticed that there are different languages spoken within mental health care. More than differences between professions, though, it has been different pet phrases and such among different treatment teams. The team on the eating disorder unit had a slightly different language than the team on the self-injury unit, the anxiety program, the acute ward, and so on. There were probably differences among the professions in each of those contexts and profession specific trends between contexts, but it was that there was a different language among all the professionals in the different contexts that I noticed most.
It wasn’t that each context had a peculiar pet phrase for all the same things either. One place might have a pet phrase for something that other places are content to describe like normal people.
+ On the self-injury unit, wanting to be alone was called “isolating”, as an active verb.
+ On the eating disorder unit, pretty much anything not normal was called “eating disorder behaviors” or “behaviors” for short, with “behavior” used as a discrete, countable noun, rather than the normal amorphous mass noun. (Am I too linguistic technical here?)
+ One outpatient therapist was fond of talking about “defense mechanisms”, which is a more common phrase, but he used it much more than any other mental health care professional I’ve ever met.
+ On the self-injury unit, doing things to distract oneself from the urge to self-injure was called “using your alternatives”, though I expect this was in large part because the program was called “S.A.F.E. Alternatives”.
Other than that, all I can really offer that I’ve noticed that consistently differs between the professions, is that psychiatrists are more apt to linguistically pathologize things. Not that they are conceptually pathologizing more than anyone else, but the use the words of pathology more often. Someone in another mental health care profession might call pointless repetitive thoughts “ruminations”, while a psychiatrist is more likely to call the same thing “obsessions”.
Ah, you’re a more patient (no pun intended) woman than me. I’d give it about 20 minutes before I started screaming “AAAAAAAARGH! THAT IS NOT EVEN ENGLISH! LEARN THE SODDING LANGUAGE AND THEN WE’LL TALK!!!!!!”
But then I’m the kind of person who adds and removes apostrophes from public signage with a marker pen.
Not so much patience as social anxiety. They talk about learning assertiveness, but they took advantage of my passivity all the time. That was more why I dealt with it than anything else. If I was a patient now, I would be hated by the professionals because I would be a trouble maker, except that if I were a patient, that would mean I was sick, and when I am sick I am also passive.
I had to go to a training about harassment and discrimination and ethics at work yesterday. It was basically just a powerpoint that enraged me from the misspellings, random punctuation and capitalization, terrible grammar, and inconsistent formatting. This was something they showed every employee. Things like that make me wonder why schoolteachers bother teaching grammar, they say it is because you will look bad if you have bad grammar in the workplace, but this doesn’t seem to matter to the people who are actually in the workplace.
It seems to me that psychiatrists and psychologists in particular also sometimes deliberately misunderstand what a patient is telling them in plain English. There was a dreadful clinical psychologist I had the misfortune to encounter years ago who seemed to assume that if I said something was true it wasn’t and vice versa, which was an incredibly simplistic approach, IMHO. She refused to accept some facts that were common knowledge (the differences between the eleven-plus exam for state schools and the common entrance exam for independent schools in the UK education system, for instance) and others, like births, deaths, marriages etc., that were on public record. She refused to check these facts for herself by asking any of my nearest relatives although she was happy to use false information provided by my stepmother, who was referred to as my mother, to blame my “biological” mother for neglecting and abandoning me before she died of cancer. (My stepmother, who never met her predecessor, never adopted me either. Instead she neglected me completely herself and hardly ever spoke to me, except to abuse me thoroughly verbally.) Defending my mother from her false accusations was considered extremely suspect by the female psychologist who thought I was trying to avoid confronting the truth because it was too painful. Not loving a stepmother who hated my guts was obviously a symptom of a defective personality.
On a more recent occasion a psychiatrist invented an alternative date for my father’s second marriage two years after the actual event, which I had just described to him in some detail. I believe it is a criminal offence to knowingly put false facts in medical notes., but it doesn’t seem to bother anyone at the local mental health trust, who have failed to address a succession of complaints.
Instead I am now supposed to be “obssessed” with “perceived injustice”. There used to be a similar mental illness in the Soviet Union’s diagnostic manual, which enabled dissenters to be locked up by psychatrists and treated for disagreeing with authority.
I think there are an awful lot of other common linguistic problems on any acute ward that caters for an inner-city community with a lot of cultural diversity and employs staff who are equally diverse. The potential for confusion caused by so many different idioms and accents is similar to the confusion that might be caused on a smaller version of the Tower of Babel.
I speak several languages myself, including French and Portuguese, which I had to learn simultaneously and often mixed up together with English in the same sentence when I was a kid, and sometimes still do, when I’m under a lot of pressure – or else I get confused by things other people say because I there are some words, which sound the same but mean different things in different languages – like key and qui and so on. I also speak Urdu, but only when I’ve got a very high fever and am actually delirious (I wasn’t even aware of this myself until a doctor from Pakistan asked me where I learnt it, because I had no conscious recollection of it at all. In fact I must have been bilingual when I was still learning to talk because I lived in Karachi before I was four).
I have, however, never had any trouble communicating with all sorts of people who don’t work in mental health.
Ah, I’ve had that one. Not to the same degree or with the same malice that you seem to have. But I now have a reputation for “never being happy with anything”, because of my habit of correcting them when my notes are full of factual errors. (Personal favourites include saying I didn’t hallucinate when I told them I did, and saying I “denied drinking to excess” when I’d said I thought I drank too much to self-medicate the agoraphobia.)
Also, I had a nurse therapist completely fail to understand when I said I was grieving for my mental health, and I needed some help making my peace with that. First he was completely baffled, then he said he’d never come across that problem before, then he suggested religion might help. Idiot.
The trouble is anything they write down becomes gospel even if they got it wrong and the error is then perpetuated. They don’t like me either because I won’t take this lying down. I have been told that facts are merely minor details and experts can make a diagnosis at twenty paces without knowing anything about a patient. Or they have have a brief and confusing conversation about an extremely complex situation with well-meaning – or not as the case may be – but often hysterical relatives and only note what they remember after the relatives have gone. It never occurs to them they might have misunderstood something or been misled by someone because relatives are considered incapable of being in denial or concealing something vital or not having perfect recall and confabulating instead.
I did nearly ten years altogether as a volunteer with the Patients’ Council and then as a paid user development worker before I built a big website for users and carers which was funded by the local mental health trust. This was reduced to one sentence in my notes which implied I had spent the whole ten years hanging round their mental hospital for no apparent reason. Apparently I am also unaware that there are any other mental patients round here apart from me!
I am sure they would rather I jumped off a bridge than admit that they have ever made a mistake.
That whole “if a professional said it, it must be true; if a patient said it, it is probably a lie or a delusion” thing is enraging. I know that sometimes therapists would try to make me angry because they thought I needed to experience anger. However, none of the things they did to try to make me angry worked, what did make me angry was all this crap.
Diversity can open the door to linguistic difficulties, but I think that professionals would be more likely to recognize these difficulties if they were as diverse a population as their patients, which they rarely are. Mental illness does not discriminate among race, social status, economic means, political beliefs, religion, etc, but the means and desire to become a mental health care professional is much more discriminating in these ways. I think this is a large part of why their definition of mental health is so narrow: they don’t have a concept of what mental health looks like for the poor, for minorities, for outcasts, for political radicals, for people of non-standard (for them) religions. This is, of course, an oversimplification, but the professionals have a lot more in common outside having decent mental health than their patients have outside poor mental health (and that is not always a given, since some people are dumped in mental health care for other reasons) or than they have with their patients.
In the UK the staff are often as diverse as the patients, particularly in areas like mine, even the shrinks, many of whom are Asian or African or West Indian, with the occasional Scandinavian or other European. A lot of the nurses come from Commonwealth countries and may or may not have been born and bred in Britain, but there are also a lot of Filipinos and Portuguese who have worked in the NHS since they came here and others who have arrived more recently, often as a result of wars and/or famine.
This also affects the patients, who may be recent immigrants, asylum seekers and refugees. There were a lot of people from the Balkans a few years ago (Serbians, Croats and Albanians and Romanies who had often been persecuted there) and there are still quite a lot of Eastern Europeans who are trickling home now because of the credit crunch.
In some parts of this area the ethnic “minorities” make up almost 50% of the population. It is not unusual for a Singhalese from Sri Lanka, for instance, to be treated by an Asian clinician who happens to be a Tamil, or for West Indian patients to be observed by nurses from Nigerian or Ghana, regardless of any historical or cultural prejudices and preconceptions.
I have often heard patients say that the domestic staff, of every creed and colour, are often the kindest people they meet on an acute ward.
That said, I have met a lot of nurses too who are exceptional and I do realise how difficult it must be to work in a multi-cultural melting pot that keeps changing.
I guess it’s a bit different in the USA, where the staff may be more homogenous.
It does seem that the mental health care professions are more racially homogeneous in the US than the UK. I can remember seeing 6 non-Caucasian psychiatrists and and 3 non-Caucasian other staff in my experience of mental health care, total. I only remember 2 Caucasian psychiatrists, but dozens upon dozens of other Caucasian professionals.
But, Nell, you only mentioned racial diversity in the UK. Racial diversity is great and all, but I think that some of the other categories of possible diversity could have more impact in these areas. Religion, economic status, politics, family structure, social groups, etc. You mentioned yourself that you think professionals should have to live on unemployment benefits as part of their training. I would say that the lack of economic diversity (though this is obviously difficult to change, if they are working in a mental hospital, they are obviously not going to be on unemployment) is part of what causes the attitude you think could be mended by living on unemployment benefits as a part of training.
Mental health care professionals are more educationally homogeneous, which is, like economic status, unavoidable. That is part of why they do absurd things like take Crime and Punishment away from me a suggest I watch soap operas instead; someone reasonably educated in both areas would not do that.
I imagine, and you can tell me if I am wrong, that mental health care professionals are more homogeneous than their patients in terms of satisfaction with the political, social, and, especially, the mental health care status quo. Though mental health care likes to believe it is politically and socially neutral, it tends to reinforce the political and social status quo. People who do not agree with the status quo are, I would guess, less likely to work in a profession that enforces a situation with which they disagree. However, I doubt there is much about disagreeing with the political and social status quo that would prevent someone from becoming a patient
No one will coerce someone who is dissatisfied with mental health care to become a mental health care professional and those who are dissatisfied are probably less likely to do so (though I know it isn’t entirely out of the question). However, potential patients who are dissatisfied with mental health care are often coerced into patienthood. Nevertheless, the fact that more people who are dissatisfied with mental health care are involved in it as patients than as professionals does not necessarily mean that their objections are not valid.
And thus my rant on why I think mental health care professionals are, as a group, less diverse than their patients.
It does seem that the mental health care professions are more racially homogeneous in the US than the UK. I can remember seeing 6 non-Caucasian psychiatrists and and 3 non-Caucasian other staff in my experience of mental health care,
Of the four psychiatrists in my unit, only one of them is British.
Previously I worked in a community CAMHS team, which had 3 psychiatrists (a consultant, a staff grade and an SHO). None were British.
Jessa, I absolutely agree that other categories of possible diversity – religion, economic status, politics, family structure, social groups, etc. – have a great deal of impact in the UK as well as the US. I also think that mental health professionals are more educationally homogenous and may not be as well read as some their patients, as I pointed out in another post on this thread with reference to Candid and Kafka. The idea of popular culture being “better” for you than Dostoevsky is a case in point – although personally I’d rather watch – or read – something more amusing than a soap opera or a dense Russian novel. I did read quite a few when I was a lot younger than I am now and I don’t think I could face another one – I prefer my literature lighter these days. This doesn’t stop me thinking mental health professionals should have some acquaintance with literature and/or the Humanities.
(Perhaps we should suggest a reading list for them in the survival guide. George Borrow, who wrote Romany Rye and Lavengro in about 1840-50, would be one of my choices, because he encountered quite a few people with obvious mental health problems on his extensive travels and seems to have had a lot of psychological insight long before Freud popularised various theories that had already been written about, by Henry James’ brother William, amongst others.)
I don’t think I ever implied that the objections of people, whatever their education, who are coerced into patienthood aren’t valid. I know they are and I spent a long time trying to do something about it before I became so disillusioned that I decided to give it a rest for a few years. This is the only forum I feel like being involved in at the moment but I still do a bit of informal “advocacy” and support a couple of individuals as and when I can. I’m just not interested in helping the local service providers tick any more boxes or going to any more committee meetings or seminars or conferences myself. I’m only a couple of years away from a old age pension and I’d rather do something a bit less frustrating before I get too old to do anything at all!
Nell, I didn’t think you implied that the objections of patients coerced into mental health care aren’t valid. That was a more general statement, because I could see how someone might argue that the fact that patients have more objections to mental health care than professionals is evidence that those objections are invalid. I wasn’t arguing against anyone in particular, just pre-empting that possible argument.
Oh, and Crime and Punishment occupies a special place in my heart. I really didn’t understand literature in school until we read Crime and Punishment. I didn’t understand how people had so much to say about the books that wasn’t explicitly in the plot; I didn’t understand where they came up with those things. But when we read Crime and Punishment, I finally understood what I was missing. I hadn’t understood literature because I was completely unable to identify with any of the emotions of the characters until I met Raskolnikov because those characters had emotions other than fear and sadness, but fear and sadness were the only emotions I understood. Suddenly I now understood motivations and could find a particular scene in the book within a few minutes, something I had never been able to do before because plots seemed so random to me before because I couldn’t understand why happy people did the things they did, but I did understand sad people.
I love literature and Crime and Punishment was my gateway into understanding. I’m decently good at deciphering literature now, although I still do miss things that might seem obvious to other people because I don’t understand an emotion or because my social skills aren’t quite up to par.
Neurolinguistic Bullshitting is the phrase the professionals use to describe this part of their training.
I have a shit life, wife, job and my kids are evil – Dysthymia
I live in a mugging hot spot and am scared to go out – Agrophobia and Generalised Anxiety Disorder
And so on. By these standards most people are mentally ill at some point in their lives, they just cope with it better than us….
Whatever it’s called it’s incredibly irritating when used by smug bastards who have never lived on unemployment benefits on a sink estate in an inner city. I think it should be an essential part of their training to spend several months in the kind of circumstances so many of their patients live in, preferably with a large and regular dose of their own medication. Until they have experienced that I don’t think they should be allowed to practise.
Sounds like the real criteria for sanity in this country is to be a happy little camper regardless of circumstances beyond your control or any other of the vicissitudes life happens to throw at you, like Candide in the best of all possible worlds. I did actually hear a shrink use that phrase once after modestly apologising for being a “Panglossian” whilst simultaneously impressing his colleagues with his knowledge of classic French literature (perhaps he didn’t realise Candide was a satire).
Less than happy campers can be helped to achieve the right attitude by
altering their brain chemistry until they are suitably numb and able to enjoy
bread and circuses.
Why is it, I wonder, that jumping out of a window after losing a fortune has never been considered insane?
All Candide did for me was want to strangle the fucker. But I had to study it in French class at school. My teacher didn’t seem to think it was a satire though.
Still though, sledgehammer, meet nut. I don’t need my satire laying it on that thick. argh.
I think your teacher must have been missing something, though I do agree about wanting to strangle the little fucker, although not nearly as often as I wanted to strangle Pangloss.
According to Wikipedia, who I think are fairly accurate in this case, “Candide is known for its sarcastic tone…It parodies many adventure and romance clichés, the struggles of which are caricatured in a tone that is mordantly matter-of-fact. Still, the events discussed are often based on historical happenings, such as the Seven Years’ War and the 1755 Lisbon earthquake. Voltaire ridicules religion, theologians, governments, armies, philosophies, and philosophers through allegory…As Voltaire expected, Candide has enjoyed both great success and great scandal. Immediately after its secretive publication, the book was widely banned because it contained religious blasphemy, political sedition and intellectual hostility hidden under a thin veil of naïveté.
A suitable case for treatment, perhaps?
Try telling him you’ve only got one buttock. If he gets it, he’ll shut up, and if he doesn’t, he hasn’t actually read the book and he’s just name-dropping.
… or he’ll declare you delusional and dope you to the gills. My bad!
I probably would have done if I had been consulting him as a patient but but we were actually at a meeting between providers of services (board of directors, senior management, etc.) and service users and he was defending his position as chief shrink by insisting there was absolutely nothing wrong with the status quo – so there was no need for any new fangled ideas like a 24 hour crisis service and no point in constructive criticism.
I did, however, have to explain what “Kafkaesque” meant to a clinical psychologist from Goa, who’d never heard of Kafka or read The Trial. (There are an awful lot of professionals, I’ve found, who bandy that word around themselves but haven’t read the book either and don’t know how it ends.)
I can’t help feeling that clinicians should be required to take a short course in literature or even Humanities as part of their training.
J: Calling myself crazy also expresses that I am comfortable with my position as a nutter and don’t care to hide it
Cawww.. I just wanna pinch your cheeks like a little scallywag in a paternalistic way.
N: I can’t help feeling that clinicians should be required to take a short course in literature or even Humanities as part of their training
I often wish I’d read more – but I get by with my observational “empirical” knowledge. I’m just lucky they invented google before I got completely found out.
Talking of which….
I’ve two points to make which aren’t direct answers but speak to the same phenomenon :
1. The Rosenhan Experiment (1972)
People who simply said “I hear voices” got admitted to a psych unit and proceeded to behave normally. They were mostly eventually discharged with “Schizophrenia” diagnoses.
When the psychologist later told some up-their-own-arse hospital he would be putting more fake patient’s in.. they claimed to spot 83 out of 193 impostors. He hadn’t sent any.
http://en.wikipedia.org/wiki/Rosenhan_experiment
I think it needs doing again after these 30+ years.
2. shit my google broke.
Well I’m not volunteering! Quite a few of those “schizophrenics” had trouble getting out.
Something else that ooccurred to me: There is also a massive prejudice against intellectuals, particularly women, in the general public, in Britain anyway, if the recent vituperation against an intelligent student on University Challenge is anything to go by. Intellectuals also tend to be one of the first groups to be “culled” in revolutions. It seems to be part of Yuman Nature.
Of course intellectuals can be prejudiced too. Scholars have argued for generations about Hamlet’s comment about the difference between a hawk and a handsaw, which he made when he was supposed to be mad but may only have been pretending. The scholars didn’t have a clue that a hawk is a tool that is held in the left hand by various craftsmen, including plasterers. The scholars, who wouldn’t know a hand tool if it hit them, preferred to believe that a handsaw was a type of falcon. It didn’t occur to them to consult an artisan.
Sounds like whoever failed to spot 83 out of 193 imposters when they’re weren’t any couldn’t tell a hawk from a handsaw either.
I love the Rosenhan Experiment for all of it’s validating-my-own-experience power. I do agree it needs to be done again. People have done things that kind of resembled it, but not really. Too bad it was on the line ethically at the time and definitely past it now. I wish that professionals could experience patienthood in this way. Even though it doesn’t include the experience of actually being mentally ill, they would be able to see in their patients some of the similar frustrations they experienced as a pseudo-patient and attribute those things to patienthood rather than to mental illness.
Personally I don’t see how it could be ‘ethically challenging’ – except for the poor professionals who get shown up for quackery.
A non-mad patient would not be admitted.
A mad patient would not be discharged.
Isn’t that the way the system works?
Sorry… going OT…
I’ve heard arguments that the pseudo-patients would be using up resources that could otherwise be serving actual patients. Even if the system was working properly, the pseudopatients would be using up referral resources. This argument is one I can get behind, to an extent.
I have also heard arguments that pretty much just say it is mean to lie and try to trick the professionals, which would be the “shown up for quakery” argument. This one could be valid if it weren’t for the fact that it is those who are worried about being outed as quacks that use this argument. I believe Robert Spitzer was in this camp. I don’t have very high regard for Robert Spitzer.
I used Rosenhan’s study in my undergrad thesis, so I also read a bunch of the published responses, many of which questioned the ethics. I still have copies of those, so perhaps I will read them over again to remind myself if there were any more robust objections.
I think I remember reading an article in which an Observer journalist tried repeating the experiment off her own back to see what would happen in today’s climate. If I remember rightly she got given a prescription for some antidepressants and asked to come back in a couple of weeks.
Given the scenario set up for the pseudopatients in the Rosenhan experiment – a single non-threatening voice saying “thud”, no delusional beliefs, no thought disorder, no suicidal or homicidal ideas – I suspect they probably wouldn’t get a hospital bed. Not in the current strapped-for-beds state of the NHS.
Going OT? Is that a reference to Scientology, Occupational Therapy or the Old Testament? Or did you mean OTT?
Off Topic