May 20, 2005 12:57 AM   Subscribe

On being sane in insane places [via]
posted by dhruva (16 comments total)

Insanity is only evident once sanity is recognised. I think, deviant behaviour can be assigned within a hierarchy. Those at the top layer are explicitly treated as regular idiosyncracies, like a habit of having a fixed first action in the morning with no change barring emergencies. These are believed to be external fluid i.e. modifiable with the right effort. As you traverse towards the bottom layer, they are treated as innate, like hallucinations, and believed to be (almost) fixed. But is there a qualitative difference in essence?
posted by Gyan at 2:02 AM on May 20, 2005

Interesting research the first time round. I think I read about it recently; first the psychiatrists over diagnosed, then when they were told they were diagnosing 'normal' people as insane they swung the other way and the number of diagnoses dropped, despite there not being any more planted 'normal' people. I think that there is a name for this phenomenon.

Doing it again is brave.
posted by asok at 3:24 AM on May 20, 2005

If I ever get sick of the rat race, now I know how to go on a perpetual vacation.
posted by alumshubby at 3:59 AM on May 20, 2005

Mind-doctors make mistakes. Could be because they don't attend case-conferences?.
posted by TimothyMason at 4:29 AM on May 20, 2005

A related article: book review of Szasz Under Fire.
posted by Gyan at 5:13 AM on May 20, 2005

Nice link.

I'm no big fan of psychiatric diagnosis (I'm a psychotherapist), so I agree with everything regarding labeling etc in the paper. The schizophrenia research has been clear for years, that only about 30% of schizophrenics are seriously chronic, yet psychiatry always treats it as a chronic disease. It keeps getting worse and worse as psychiatrists loose the skills of therapy in favor of a biological model that they can't get to actually explain anything.

Still, the study is flawed because of how it has the people present. When someone comes to the admitting room of a hospital psych unit, their only symptom is not the auditory hallucinations that the paper details. The presentation itself consitutes a much more troubling symptom of mental distress. In other words, there are really two symptom sets in the experiment, one that the patient turns on and off, and which garners the big attention (the voices); and a second which seems to have prompted the hospital visit (distress at the first). Although the psuedopatients were able to stop feigning the first as soon as they got onto the unit, the second may actually have been exacerbated by the situation (the paper suggests this to be the case). It doesnt' surprise me that the patients were not immediately discharged.
posted by OmieWise at 5:44 AM on May 20, 2005

Reading Slater's article only confirms my feelings about the limitations of these experiments. Don't misunderstand, prescribing Riperidal is no joke, and that she got it so easily is a bit distressing. The larger issue is the paucity of treatment modalities in psychiatry, but not, I think, specifically the issue of diagnosis. I think psych diagnosis is a racket, but especially in Slater's article you can see that most everyone is keying off her distress and her desire to feel better.

"Well, no offense but you're obviously not fine," says Mr. Graver. "Or you wouldn't be here. So what's going on, Lucy?" he asks.

Her pulse is even elevated to add to the affect.
posted by OmieWise at 5:47 AM on May 20, 2005

"I'm not schizophrenic, I was part of a strange experiment where they put perfectly normal people in mental hospitals. Now my medical records say I'm schizophrenic, and everyone looks at me funny. Really!"

The crazy thing is - yeah, really!
posted by louigi at 6:46 AM on May 20, 2005

OmieWise writes "I think psych diagnosis is a racket"

Do you mean that it's essentially a conspiratorial profession-recycling of patients for gainsake or do you mean that it's a nominal absurdity?

And in your touching on the paucity of treatment modalities in psychiatry, am I reading some subtext that you woud advocate therapies outside of the usual medication and psychotherapy regimes and if so, what?? (leaving aside the perennial general stuff like diet, exercise, stress reduction, pyramid power, loving lifestyle and such quasipalaver)

These are genuine curiousity questions - I'm not having a go at you at all.

Labelling is always a problem in psychiatry. There's been some minor progress over the last 10 years or so in public education programs (in Oz) with conciousness raising and a wider network of telephone type response systems. People are a bit more aware and perhaps sympathetic towards behavioural anomalies and maybe even a little less judgmental about people with labels. My guess entirely though.
[Thanks dhruva - and don't bite me, but I haven't given more than a cursory glance at the links - my brain hurts]
posted by peacay at 6:56 AM on May 20, 2005

Interesting. Thanks.
posted by fungible at 7:06 AM on May 20, 2005

Yossarian saw it clearly in all its spinning reasonableness. There was an elliptical precision about its perfect pairs of parts that was graceful and shocking, like good modern art, and at times Yossarian wasn't quite sure that he saw it at all, just the way he was never quite sure about good modern art..."

Which is, of course, a roudabout way of saying that this is interesting stuff. Thanks for sharing.
posted by .kobayashi. at 8:36 AM on May 20, 2005

Hollow. Thud.
posted by davy at 11:13 AM on May 20, 2005

Interesting articles--thanks for the links.
posted by Prospero at 12:06 PM on May 20, 2005

I recall some of the first criticism of these experiments was by analogy to a presenting in an emergency having swallowed some blood, and then puking it back up. You would get treatment first, then people would ask questions, and it might be some time before it was established there was nothing wrong with you.

Also there is an implicit and perhaps quite reasonable presumption that people present because they feel they have a problem. I don't think malingerers or hypochondriacs are that frequent in the mental health biz (or in emergency wards, for that matter).

So this is cute, but it's a bit of a set up.

My reaction to the second piece was: "great! now I know how to score free drugs!"
posted by i_am_joe's_spleen at 2:47 PM on May 20, 2005

not a fan of the writing of the redux but:
Because of the cost and space restrictions, generally people don't get hospitalized involuntarily without third party intervention unless they violate one of three criteria:
a harm to others
a harm to themselves
unable to care for self

Now as "promiscuity" use to be grounds for hospitalization at one point, "harm" and "care of self" can be very subject to the cultural norms of very localized areas. Hairstyles and modes of artistic expression can be translated as "dishevelment" and "degraded ability." It's subject to the reasons for confinement, for instance from a family member or someone of significant power in a community.

In the case of when state hospitals and mental facilities use to be used to confine mostly immigrant populations and the poor, they tend to be a bit more touchy about such things when still in the shadow of that history, but in "erring on the side of caution" it is very easy for non patients to enter the system. I know of one instance of an 18 year old, who in light of personal circumstance, did think it was a way to feed and house himself.

If you develop a patient history, say for alcohol and drug related offenses or self injury, just for example, you will eventually get shunted down the system towards where interment in a long term state facility is almost an automatic next step.
Without resources or an active community network to run interference, depending on location, appointed defenders don't expect to win many cases that go to trial towards commitment, and many judges do reflexively "err on the side of caution."

It's not hard to get someone committed, but, hey, at least involuntary commitment is considered "time served."
So if you're really thinking long term in a criminal venture, rack up the points for that manslaughter charge, or work on that "mental defect" plea.
Obviously as joke (maybe) but as many psychiatric wards are holding centers for people on the way to jail or prison, that is the company you will keep on the crisis ward.

oh, the stories to tell
posted by philida at 9:44 PM on May 20, 2005

philida writes "Now as 'promiscuity' use to be grounds for hospitalization"

I worked at a lunatic asylum (yes, some of the signs were still up) in the UK and read with amazement some of the files of long term residents who had been sequestered away with a diagnosis of "moral insanity". Last I heard, many of them were to be foisted back into the general public after having lived for sometimes in excess of 60 years in an institution.
Madness indeed.
posted by peacay at 10:11 PM on May 24, 2005

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