Thud, empty, hollow.

July 26, 2009 8:59 PM

Revisiting Dr. Rosenhan. Between 1969 and 1972, seven friends embarked on what became known as the Rosenhan Experiment, posing as patients in a dozen psychiatric hospitals. While the medical staff diagnosed the poseurs as 'schizophrenic', their fellow patients quickly caught on to their ruse. The resulting paper, On Being Sane in Insane Places, became an instant classic.
posted by grounded (49 comments total)

Reminds me of a recent This American Life episode where a guy pretends to be crazy to avoid a prison term and ends up stuck in an asylum after being diagnosed as a sociopath.
posted by look busy at 9:11 PM on July 26, 2009 [1 favorite]

It's certainly an interesting nexus, where the social intereacts so heavily with the medical. I think it's a good reminder that everyone deserves compassion and a presumption of humanity that outstrips sane and not sane.

I remember once sitting at the bus stop when a crazy guy starting talking to me (I'm quite popular for this kinda thing. Must be cause I don't try to take up more than one seat). He was - as most strange public transport users are - entirely harmless. Seemed kinda manic, kept babbling about 'blue' the word, the colour, the feeling, etc.

I just listened, and nodded, occasionally adding something of my own about blue. We talked for maybe five minutes. As my bus pulled up and I said goodbye, he stopped his chatter for a second, and said, "you know, thanks, thanks, just thanks man, for talking to me."

Nearly made me cry. Here's a harmless dude with a slight eccentricity who's so frequently treated like a maniac freak he felt that he had to thank me just for treating him like a fucking human being.. It wasn't like I cancelled my plans and spent the afternoon travelling around with him, buying him lunch etc.

Seeing some of the sentiments my "sane" grandmother utters in regards to race and whatnot, and the simple, jokey converstion the "insane" dude at the bus stop had, I can see the limited - and highly relative - value the term has. And I applaud the people with the courage to try and navigate that professionally, as helpers, carers etc.
posted by smoke at 9:26 PM on July 26, 2009 [51 favorites]

That was an interesting TAL episode, look busy, but I feel that that the story was more nuanced than that: the writer of the piece (the fabulous Jon Ronson, mentioned many times previously in MetaFilter) did a fine job in gaining different perspectives on the case, and as a result changed his mind several times about whether Terry, the focus of the piece, was sane or not. The general medical consensus was that he was a sociopath: as a young man he had beaten a stranger half to death over the course of several hours for making an innocuous comment, claimed insanity, was sent to Broadmoor, and was now playing a game with his doctors and the institution. In the process he had gained some sympathy from people who had motives of their own in gaining attention for the case (including the Scientologist who led Ronson to Terry). And Ronson's own conclusion, regardless of Terry's state of sanity, was that it was a really stupid idea to claim that you are insane when you are not under almost any circumstance, simply because the law will tend to make the safest judgment and choose to believe you, the rate of false positives regarding insanity being fairly low, even among the self-identified.

Which is not to say that Terry deserved his treatment, if sane (although he has been independently diagnosed a number of times) or that psychological diagnosis and treatment does not have plenty of room for improvement, only that we've moved on a little from the paternalistic practices of the 60's and earlier, as described in the experiment grounded has FPP'd.
posted by Bora Horza Gobuchul at 9:59 PM on July 26, 2009 [7 favorites]

I had a former boss who had worked as a psychologist in a mental hospital, and he was incredibly critical of them. He said that they were a racket, top to bottom. Once you were in, you were not getting out until your insurance expired, at which point you'd be mysteriously declared fit to leave. There wasn't much real treatment, just whatever could be done to bilk your insurance as much as possible.

He said to never, NEVER voluntarily check yourself into a psych ward for any reason whatsoever. They will not help you, and in fact will probably make you a lot worse.

I have no personal experience, but he was a very sharp guy, and I didn't have any reason to doubt him. This article rings true with what he used to say.
posted by Malor at 10:01 PM on July 26, 2009 [7 favorites]

Reminds me of a recent This American Life episode where a guy pretends to be crazy to avoid a prison term and ends up stuck in an asylum after being diagnosed as a sociopath.

It reminded me of this guy who pretended to be crazy to avoid a prison term and ended up stuck in an asylum. The problem was, he kept antagonizing the Big Nurse, got sent for electroshock therapy and ended up lobotomized. Then The Chief threw the shower room control panel through a window and escaped.
posted by ActingTheGoat at 11:07 PM on July 26, 2009 [8 favorites]

One of the odd things about the anti-psych folks, as represented in that TAL story, is that they kept saying how unjust it was that "Terry" was being kept in Broadmoor along side the "real" patients who were clearly insane. But if the place is filled with dangerous people with severe mental illnesses, isn't that a testament to the necessity of psychiatry?
posted by martens at 12:13 AM on July 27, 2009

Which is not to say that Terry deserved his treatment, if sane (although he has been independently diagnosed a number of times) or that psychological diagnosis and treatment does not have plenty of room for improvement, only that we've moved on a little from the paternalistic practices of the 60's and earlier, as described in the experiment grounded has FPP'd.

Rosenhan's experiments have been repeated from time to time with some variations (c.v. David Reynolds amongst others) for the same result. Which is not to dismiss psychiatry, but to admit in the absence of organic symptoms and pathology for a lot of conditions, they will be diagnosed solely through the subjective lens of a pyschiatrists judgement and this will naturally be effected by expectations. What's the difference between an excited, boisterous child and ADD? What's the difference between deep grieving, loneliness and depression? A judgement call.
posted by outlier at 12:36 AM on July 27, 2009 [2 favorites]

I'm not really crazy. I'm only pretending to be crazy. Pretending to be crazy isn't crazy, is it?
posted by twoleftfeet at 1:20 AM on July 27, 2009

martens - not really, I think... if you're only talking about removing dangerous people from public society that can be achieved just as well by the legal system without any need for psychiatric diagnosis or treatment...

(not taking a position on the broader questions, just that specific point)
posted by russm at 2:11 AM on July 27, 2009

Mental hospitals are like nightmare versions of high school as imagined by Metallica fans. You really are trapped. You really don't have rights. You really are treated with minimal respect and maximum suspicion. The people around you are really crazy. You really are being fed drugs to control your mind. And really, really all they care about is getting you to the point where you can be released into the real world, hold down a shitty job, and live your worthless crazy life in a way that doesn't upset people.
posted by fleacircus at 2:24 AM on July 27, 2009 [14 favorites]

Once you were in, you were not getting out until your insurance expired, at which point you'd be mysteriously declared fit to leave. There wasn't much real treatment, just whatever could be done to bilk your insurance as much as possible.

He said to never, NEVER voluntarily check yourself into a psych ward for any reason whatsoever. They will not help you, and in fact will probably make you a lot worse.

Well, while we're trading anecdotes, about a year ago I voluntarily committed myself and it saved my life. I left the hospital feeling much better than I went in. (That's an understatement. I left the hospital able to function — I could walk down the street without obsessively hunting for sharp objects, and that was a really pleasant change.) They could have kept me, and kept billing my insurance, for a few more weeks than they did by declaring me a danger to myself or to others — the evidence would have been there if they wanted to cherry-pick it — but they didn't bother, and I checked out under my own power as soon as I felt ready.

I get it. Mental hospitals are scary. And, yes, I'm sure a certain percentage of them are rackets because a certain percentage of everything is a racket; and I'm sure a certain percentage of them are run by control freaks because a certain percentage of the population at large are control freaks. So I'm really sorry your friend had such a bad experience working at one — but I don't think his experience generalizes as far as he thinks it does. It's not all a scam, and it's not all Nurse Ratched shit either. Some of 'em just do what they set out to do.
posted by nebulawindphone at 4:32 AM on July 27, 2009 [24 favorites]

True Story: In college, I had a friend from a small town who was probably the sanest member of our group of misfits. One day he got high before going out to dinner with his mother and sister when they were visiting. The mother - probably because she was from a small town - did not recognize a marijuana high and thought he was on heroine. The next morning at a 8am, my friend gets a knock on his dorm room door. It is his mother with the college police. They arrest him and take him to the drug rehab ward of a mental hospital.

In the rehab ward, it becomes immediately apparent that my friend is no drug addict, because he isn't going through any kind of withdrawal. The rehab clinic folks think, "Their must be something wrong with him or he wouldn't be here. It must be psychological." So they send him up to the psych ward.

In the psych ward he is the only patient not crying, talking to himself, scowling, or otherwise looking crazy. I know because I visited him. The doctors see he isn't currently exhibiting any symptoms of psychological distress, but they think "Their must be something wrong with him or he wouldn't be here. It must be the manic phase of bipolar disorder." So after seventy-two hours of involuntary commitment, the sanest person I know in college is diagnosed as bipolar by people with Phd's. He is told by the college that because he is diagnosed with mental illness he cannot come back to school unless he agrees to counseling. He chose to drop out of school.
posted by SugarFreeGum at 5:02 AM on July 27, 2009 [5 favorites]

When I went for martial counselling the counsellor (a MSW) had me fill out a questionnaire about how I was feeling. One of the questions was "Have you felt sad at any point in the past three months?" I marked down occasionally. On the basis of that one question (literally - we hadn't even talked yet!) she diagnosed me with clinical depression. When I pointed out I had felt sad on the anniversary of my freakin' daughter's death and that to me sadness was a normal, healthy emotion that I expected everyone to feel on occasion and she still countered that I was "depressed" I lost all respect for her (and indeed, all the counselling was worthless with her judgemental moralising).
posted by saucysault at 5:22 AM on July 27, 2009

Oh, and the only three possible answers to her question were never, occasionally and often. I thought it was a trick question for diagnosing severe clinical depression versus repressed clinical depression.
posted by saucysault at 5:26 AM on July 27, 2009

Thanks for the post, grounded. I'd never heard of Rosenhan and his experiment. This is so very interesting.

I guess it comes as no surprise that much of the linked Times article was simply lifted wholesale from the linked Wikipedia page. Such is modern journalism!

I've scanned Rosenhan's "On Being Sane In Insane Places" (don't have time to carefully read it right at the moment) and it looks really interesting. But, none of the actual institutions are named anywhere, are they? I suppose they never were.

God, can you imagine someone trying something like this today? A whirlpool of lawsuits...
posted by flapjax at midnite at 5:27 AM on July 27, 2009

From time to time I work within the mental health system in Australia. One stark difference is that the mental health system here is almost entirely state funded. Certainly, there are private psychiatrists and private psychiatric institutions, but the majority of the state's psychiatric inpatients are treated in the public system, free of charge. The average duration of stay is something in the region of 10-14 days. The pressure for beds is such that doctors are under some significant pressure to free up beds for new admissions. The idea that you could be kept in a psychiatric facility until your insurance ran out is absolutely laughable here.

If anything, the criticism can be made that patients are being discharged too early in some cases. 14 days is barely enough time to commence someone on antipsychotics and titrate the correct dose.
posted by tim_in_oz at 5:29 AM on July 27, 2009

Honestly, I think one huge difference — at least in the US — comes from the dreadful under-funding of mental health, both by the government and by private insurers. I don't think the first of Rosenhan's experiment could have been done at all post-Reagan. A bunch of totally lucid non-violent, non-suicidal guys show up in your hospital, and then they say they want to leave again? Well, sure, you could hold the hearing and have them involuntarily committed, but that takes up money and resources, it'll cost even more to keep 'em and odds are their insurance (if they have any) won't cover the full cost, and meanwhile you've got the real deal, homeless treatment-noncompliant paranoid schizophrenics, some of 'em scared for their life or threatening to hurt other people, who you're forced to put back out on the street after a month because nobody's gonna pay for them to stay longer. So you let the thud-empty-hollow crew go home, you save the money, and you keep a bed open for another few days for the guys who are really suffering because it's all you can do for them.

Anymore AFAICT, the only people who are held long-term against their will are those with rich families funding their treatment, and the criminally insane — who the government, surprise surprise, has the money for.

The whole thing's very complicated, and I think by and large it's a bad thing that mental health is underfunded the way it is. (Just recently in another thread we were having Yet Another Conversation about how big-city libraries have turned into impromptu day shelters for the mentally ill. There is clearly a need there that's just not getting met, and it's tragic.) But it does mean that the lock-em-up-lobotomize-em-and-throw-away-the-key bullshit just isn't practical on a large scale anymore for the majority of patients, and that's I suppose a sort of silver lining.
posted by nebulawindphone at 5:34 AM on July 27, 2009 [5 favorites]

Saucysuit: On the basis of that one question (literally - we hadn't even talked yet!) she diagnosed me with clinical depression.

That's terrible. That question is part of the Beck Depression Inventory, but no-one should be diagnosing depression on the basis of one question. They shouldn't even make that diagnosis after giving you the whole BDI, not without talking to you.

I can assure you that there are good counsellors out there; plainly you didn't get one. [The last time I visited a psychiatrist, I spent a good 10-15 minutes telling him I was depressed, then he gave me the BDI, then he made the diagnosis].
posted by Infinite Jest at 5:41 AM on July 27, 2009

Er, on non-preview, isn't that an interesting contrast? You're right, tim_in_oz, that folks with good mental health coverage on private insurance here can stay (or be kept) on a psych ward for a long time. But my perception is that there aren't many such people. It's difficult for independent adults — i.e. people who aren't still carried on their parents' insurance — to be so badly mentally ill that they can be involuntarily committed and still hold down a good enough job to get that sort of coverage. It's very common for otherwise good health insurance to suck big sweaty balls when it comes to mental health; you can have a solid middle-class job with benefits and still be unable to afford even therapy or outpatient psychiatry, much less any sort of inpatient psychiatric care.
posted by nebulawindphone at 5:46 AM on July 27, 2009 [1 favorite]

Hmmmm, I'm engaging in writing behavior. Must be nuts.
posted by localroger at 5:55 AM on July 27, 2009 [3 favorites]

The whole thing's very complicated, and I think by and large it's a bad thing that mental health is underfunded the way it is.

The overwhelming message I get from people who work within my jurisdiction as well as people I've spoken to who work in the US and UK systems is that mental health is simply chronically under-resourced. The move away from mass institutionalisation is doubtless a good thing for the most part, but I feel that perhaps we haven't yet come up with an effective model to replace it. Short-term acute patient management seems to be faring better, but the chronically mentally ill - especially those with dual diagnoses eg drug addiction or intellectual disability - really seem to suffer for want of appropriate facilities.
posted by tim_in_oz at 6:02 AM on July 27, 2009 [1 favorite]

Hopefully, we will one day move beyond the self-report and observation that so many clinicians have to rely on for mental health diagnoses. I think they are getting closer but we've a long way to go.

Hey, quality mental health care saved my life. Genetically disposed to recurring clinical depression, I received treatment from different amazing professionals in my late twenties/early thirties that allowed me not just to function. I ENJOY life. I mourned a bit when we finally brought my depression under control for the school and childhood experiences that could have been more, well, normal and enjoyable. But then I moved on and thank my caregivers every morning that I wake up and make coffee and take my daughter to preschool and sit down to work. I'm not kidding. At the happiest moments of my life, I think of the unflappable, reassuring, compassionate MSB who held my hand through some pretty discouraging times. The fiercely committed, coolly intellectual, funny Psych doc who kept trying and trying with me 'til we got the meds right.

Yeah. Quality mental health care rules. It can make all of the difference.
posted by jeanmari at 6:07 AM on July 27, 2009 [5 favorites]

It's difficult for independent adults — i.e. people who aren't still carried on their parents' insurance — to be so badly mentally ill that they can be involuntarily committed and still hold down a good enough job to get that sort of coverage.

Adults who cannot hold a job due to a mental health disability can qualify for SSDI/SSI, which if awarded will give them some income with which to secure permanent housing, and they can also apply for Medicaid which will provide some coverage for medications and outpatient mental health treatment. The quality of treatment in community mental health settings varies widely from agency to agency, some places are great and some places are abyssmal, which is what you get when you pay your staff peanuts from meager funding streams. And obviously the quality of Medicaid coverage since it is tax payer funded is variable and is in the process of being hit hard due to the economic crisis.

I'm not sure what the general concept of a "mental hospital" is here but there are different types of inpatient mental health settings, some of which are wings inside perfectly reputable and even highly reputable general hosptials or teaching hospitals that are set aside for mental health treatment, and some are stand alone inpatient facilities the feel a little more like drug rehabs. None of these are actual state mental hospitals, which in Pennsylvania are strictly for severely mentally ill people with histories of serious violence who are returning to a treatment setting from the prison system and require longterm locked ward observation because they have been deemed by a judge to be too great a public safety risk to return to the community for community mental health treatment.
posted by The Straightener at 6:25 AM on July 27, 2009

I've had some experience with psych wards and psych hospitals with a family member. It varies. A stay can be a life-changing, even life-saving positive experience, or it can be completely worthless. Even in the same hospital at different points in time (say, when funding has changed or there's been a staff turnover with a negative effect).

I'd say on the whole it's very true that you're infinitely more likely to be booted out of a psych ward when you need to stay, than kept there when you could just as well leave, for the funding reasons already mentioned above.

We seem to have fallen off the other side of the horse.
posted by edheil at 6:43 AM on July 27, 2009

A friend of mine was having troubles with his wife and they were talking about divorce. Over breakfast one morning they started arguing about who got custody of the kids and house and he stormed out headed for work.

After he left the wife called the police and created a bullshit story about a violent argument and how her husband was depressed, and she feared that in a car he was a danger to himself and the public. The police pulled him over and approached with drawn guns and he was carted off for a psyche evaluation.

No one would listen to his explanations that his wife was dicking him because they were planning a divorce and of course he was agitated and angry at being taken out of his car at gunpoint. The hospital ended up keeping him, claiming he was depressed. By the time his parents had moved in to get him out, his wife had managed to file papers.

When he got home she pretty much told him, "You will give me what I want, or I will make sure the judge thinks you're crazy and you'll never see your kids."

He ended up giving her the house, a car, and alimony and when he steps a toe out of line she reminds him that his visits can become supervised with a call to the police saying she fears for her kids lives.

I really wish this was total fiction but it's not, and that's what scares the crap out of me. I believe sane people end up in wards, and they aren't even doing it for science.
posted by FunkyHelix at 7:13 AM on July 27, 2009 [10 favorites]

I was eighteen when I worked in a psychiatric ward as an orderly. One teenage patient had been committed for depression and sleeping with a prostitute - I don't know how much each weighed in his parents' decision to place him there. At first he was rebellious, refusing to cooperate or talk with his psychiatrist. Then, after a few days, he decided he wanted to get out of there and tried being as cooperative as possible. (I know his motivations because he talked with me regularly.) His psychiatrist decided he was faking being helpful. To test the patient, he told the patient he was going to be locked away permanently. He lunged at the psychiatrist. Which was given as the proof he had deep unresolved problems and needed to be committed for a longer time.
posted by dances_with_sneetches at 7:58 AM on July 27, 2009 [1 favorite]

Opening Skinner's Box: Great Psychological Experiments of the Twentieth Century by Lauren Slater has some background about the Rosenhan experiment.
posted by jonp72 at 8:59 AM on July 27, 2009

I'm pretty sure the Rosenhan Experiment gets covered in Adam Curtis's BBC documentary "THE TRAP". It's long and involved and absolutely required viewing for anyone who thinks they have a clue of what's really been going down over the past half-century of western history.

This link is to Part 1. I don't think the Rosenhan Experiment stuff pops up until much later.
posted by philip-random at 9:16 AM on July 27, 2009 [2 favorites]

nebulawindphone: And, yes, I'm sure a certain percentage of them are rackets because a certain percentage of everything is a racket; and I'm sure a certain percentage of them are run by control freaks because a certain percentage of the population at large are control freaks.

The thing is, unlike most institutions, a racketeer or a control freak in a mental hospital can destroy the rest of your life. You had a good experience, but the risks in checking into one of these wards are extraordinarily high. You are putting yourself at the total mercy of a bureaucracy, making yourself entirely defenseless against any organizational dysfunction, and completely without remedy if you're abused or taken advantage of. Your word doesn't count for shit anymore once you're a "mental case", so no matter how they abuse you, if you're the only witness, you have zero ability to seek redress.

This is not a good situation to ever put yourself in voluntarily with anyone, if you have any other workable options.
posted by Malor at 9:25 AM on July 27, 2009

Actually, after 72 hours you go in front of a judge in mental health court, where you can work with a court appointed mental health advocate to be released. If there is no petitioner in court who feels you should be held longer, and usually doctors are the only ones very effective at advocating for longer inpatient stays, you are almost certain to be released. Even if you are held longer, you go back to mental health court and repeat the whole process at regular intervals, precisely to prevent the scenario you describe, which, by the way, is a little heavy on the hyperbole.
posted by The Straightener at 9:57 AM on July 27, 2009 [1 favorite]

The involuntary commitment system may screw up in the short term, but in the long term it is pretty stacked to keep people out of mental institutions and on the street. Never mind that on the street they often end up committing crimes and are locked up in a different kind of institution without decent mental health services. We have a dearth of voluntary options for the mentally ill, not an excess of involuntary ones.
posted by Antidisestablishmentarianist at 10:14 AM on July 27, 2009 [1 favorite]

This is not a good situation to ever put yourself in voluntarily with anyone, if you have any other workable options.

Well, we agree on this much. If you can sort out your shit as an outpatient, you shouldn't go inpatient — the same way you shouldn't have surgery if there's a pill or a yoga pose that works just as well, the same way you shouldn't take someone to court if you can work things out amicably in private. Checking into a mental hospital is calling in the big guns.

But first of all, some people can't sort their shit out as outpatients. Sometimes calling in the big guns is what you need to do.

And second, you're flat-out exaggerating the risks. Look: you wouldn't say to someone who needed a bypass, "Never have surgery. They'll botch it up, you'll wake up under anesthetic and suffer horrible torment, the complications will kill you, and it'll be your family's word against the doctors' in court so they'll never win a lawsuit." All those things do happen sometimes, and it's horrible when they do happen, but there are safeguards in place against them, they're mercifully quite rare and the risk is sometimes worth it. The same thing goes here: I'm sure the abuses you're describing do occur, but there are safeguards against them, they're quite rare as a result, and sometimes having a good shot at sanity is worth the risk.
posted by nebulawindphone at 10:54 AM on July 27, 2009 [5 favorites]

Belmont this is for you.

I was severely depressed in 2001 (I'd been fired, dumped, and it was 9/12) and after calling my insurance company for guidance, I was told to check into a psychiatric hospital. The rationale was they could try medications and observe me, and I could have regular contact with therapists and a psychiatrist in a placid setting. This did sound better than just making an appointment and waiting, and then getting a prescription and waiting some more without guidance and supervision and in my house where I was already depressed.

So I went to Belmont Treatment Center in Philadelphia. I feel weird about naming it, like maybe I'm unfair, but I never name them and maybe it's time I did. I was interviewed by a nurse and an admitting psychiatrist, and they agreed with my insurance company's recommendation. I signed some papers and that was that. I was told that though I was high functioning, those wards were full and I would be in the general ward. They took me to the general ward, strip searched me, took everything away, showed me to my cot and left me alone. I just went to sleep, and the next morning everyone was called to take their medication. So of course I wanted to know what I was taking because silly me, I thought I was supposed to be proactive about my own healthcare. They refused to tell me. So I at least wanted to know who the psychiatrist was and when I would see him (the prescribing doctor was not the admitting one I had already spoken to, this was someone who had never seen me). I was told that I would see him sometime that day. I took the meds, and then....well everyone sits around all day basically. I tried to read magazines but other patients would tear them out of my hands and laugh. On the Tv was depressing 9/11 coverage. There was nowhere to go and nothing to do. Of course I didn't see the doctor.

By the second day I was getting upset because I was taking random medication and still hadn't even seen the doctor. I went to the nurse's station and asked when exactly I could see him. They said there's no way they could know if it would be that day, the next day, or the next week (since the weekend was coming). There was no way I felt I could just be there aimlessly for days or a week without any idea of what my treatment consisted of or what the gameplan was. Just typing this it seems so silly to expect anything like that in a psych hospital. I waited half a day and went back to the nurse's station. Now I am officially a "problem patient". I was told summarily to leave. I refused without getting some real answers (oops!). I told them I wanted to leave as this obviously wasn't working out (Ha!). That's when they told me I had to stay for 72 hours. I said I'd signed no such thing. An hour or so goes by, they check my paperwork and clearly I hadn't been given that one paper agreeing to 72 hour admission (I don't know if it's the law, but I know I at least had to be advised). I saw that the paper was blank from where I was standing, it's not that they actually told me they made a mistake.

Then the psychiatrist finally comes, only to say "You've proven you're crazy by the way you're acting, and now you're gonna be here a while." He laughs and walks away. What? So I get the harebrained idea to use the payphones to call 911 and tell them I'm being held against my will. A janitor wisely tells me that the cops are unlikely to believe a patient calling from the psych ward. Good point, I hung up. Despondent and demoralized, I sat on the sofas until a shackled patient came up and attacked me. That was it. I went back to the nurse's station and this time they immediately called for assistance in sedating me. At that point I did lose it and started yelling at them which was probably not a good idea but I was piping mad and felt powerless. They dragged me to the bed, by the shackled guy who was just shaking his head at me because ooh boy that chick is crazy! I calmed down quite a lot and was sedated with something that took me weeks to recover from. Before I drifted off to sleep, a security guard said that he didn't think I was really crazy, but the only way for me to prove it was to just be quiet and leave them alone. Anyway, when I woke up I learned I had been released (after 48 hours, natch). Never did get to talk to the doctor.
posted by Danila at 11:25 AM on July 27, 2009 [18 favorites]

I think that inpatient care could be more...empirical? Tested? Researched? Scientific? I'm not sure what word I'm going for here.

Example--and take this with a huge grain of salt because I don't have the info with me--I have read that there is little to no evidence linking it to improved outcome (or reduced suicide completion) for patients with borderline personality disorder. So why are they being sent there? There are a lot of questions there. If anyone knows of anything that has been published about this let me know.
posted by kathrineg at 11:50 AM on July 27, 2009

Danila, I'm so sorry that happened to you.
posted by paduasoy at 12:41 PM on July 27, 2009

Belmont has had a shitty reputation for forever, a while back they were taken off the list of inpatient facilities eligible to take involuntary commitments from Philadelphia and Delaware Counties.
posted by The Straightener at 1:29 PM on July 27, 2009

Infinite Jest - nope, it wasn't as involved as BDI, it as less than ten questions and that question was the only one relating to depression. Which is what made her diagnoses even more ridiculous. It is very easy to see how vulnerable people or people learning ESL get misdiagnosed and railroaded though the system by crappy therapists.
posted by saucysault at 2:10 PM on July 27, 2009

I only ever told that story to my family and a very close friend I had at the time. I must be getting over it because I didn't feel sick at all thinking about it. And I am not trying to rag on mental health treatment and hospitals in general. I know there are plenty of people whose lives have been saved by them (Friends Hospital and Brooke Glen Behavioral Hospital really helped my loved ones).

The reason this article got me thinking about it is the experience of being sane when you're expected to be insane. Now obviously I wasn't mentally healthy or I wouldn't have gone there on my own as I did. But they just have a certain way they "deal with" the patients and I was a patient and I would be "dealt with" that way. Everything from not explaining medications to not answering simple questions to not caring how the patients interact with each other, it all just broke me down bit by bit.
posted by Danila at 3:18 PM on July 27, 2009

There is virtually no research supporting inpatient treatment for anything-- basically, it's to keep people who are a danger to self or others incapacitated or to make money.

Unfortunately, there is no "FDA" for mental and behavioral healthcare not involving drugs-- if I want to open up a clinic tomorrow touting my new rollerblading therapy as a cure for bipolar children, I can do so and even get insurance coverage for it provided I can convince a doctor to sign on as part time medical director, even though I have no degrees and no evidence suggesting my idea helps.

The whole premise behind inpatient is flawed: taking people away from safe familiar places and people when they are most stressed is counterproductive. The reason for the move to "deinstitutionalization" of the mentally ill was exactly this-- unfortunately, they simply cut the money for inpatient and the outpatient support that they were supposed to fund never materialized.

The few productive uses of inpatient are for short-term stabilization on meds and for extremely disturbed foster kids who are having multiple placements and are too much for one family to handle. Or, for homeless people who need habilitation as opposed to rehab. And, possibly, for addicts who live with drug dealers and don't have anywhere else to go.

Unfortunately, we've developed this idea that inpatient "programs" can "keep people safe" because 'at least they aren't on the street." Well, that would be true if the programs actually screened the people that they hired, allowed patients unmonitored contact with authorities and friends/family and if they were better monitored by regulators and evidence-based. As is, they are recipes for abuse because you have vulnerable people held incommunicado and seen mostly by minimum wage line staff who don't know what they are doing and aren't paid well, typically-- if you've seen the Stanford Prison Experiment, you'll know why. Add to this the idea that "tough love" is the best way to help people and you wind up with abusive therapy seeping even into the "best" programs.

The sad thing is, it's hard to change this because people think that cutting inpatient was done purely to cut costs-- so they think "expensive = more effective" and can't really believe that for most people, outpatient is not only cheaper but safer and better.
posted by Maias at 3:45 PM on July 27, 2009 [2 favorites]

I think that the thought processes of mental health professionals can be influenced by dealing with very sick people day in and day out. It's kind of in the sense of being a hammer and seeing everything as a nail.

I once took a college course taught by a woman who spent most of her time dealing with chronic pain patients, and she seemed unable to see the class as a group of mostly mentally normal people. She would make sweeping statements (that she would refuse to back down from) such as "crying is never helpful or an appropriate response" which is probably true for chronic pain patients, but not when its included in a broader range of human experiences.
posted by fermezporte at 3:50 PM on July 27, 2009 [1 favorite]

I can think of a few people that DID benefit from short, self-admitted stints of in-patient care. Almost entirely because they were not in a safe, familiar situation before but instead in a stressful pressure-cooker interpersonal tangle where they were being manipulated by other people. The breather of inpatient care allowed them to process how they really felt while feeling safe. This is in Canada though, so I am not sure how different the mental health system is compared to the United States (except the obvious - there were no insurance worries). It was also very important to them that they felt in control of the situation and knew they could check themselves out (and indeed, they did, refreshed and able to better cope). In the three specific incidents I have intimate knowledge of, the in-patient care allowed them to feel empowered. I wish everyone had that experience.
posted by saucysault at 4:04 PM on July 27, 2009

Lots of disturbing stories here, wow.
posted by JHarris at 5:45 PM on July 27, 2009

Unfortunately, we've developed this idea that inpatient "programs" can "keep people safe" because 'at least they aren't on the street."

I think one benefit of involuntary commitment is when the person in question is a legitmate threat to the community. If someone with a history of violent behavior when symptomatic can be routed into the mental health system at the time of a decomp thereby preventing an incident that may wind them in the prison system instead then I think that's a win, if not exactly a huge one. Things can get a lot worse than an involuntary inpatient stay on a psych unit, i.e. a stay of incarceration on the prison mental health ward where the only treatment available to patients is Thorazine and restraints.

But when you are talking about someone who is routinely committed as a threat to community you are talking about extremely serious mental illness of a magnitude that nobody in this thread is talking about.
posted by The Straightener at 6:04 PM on July 27, 2009

nebulawindphone: All those things do happen sometimes, and it's horrible when they do happen, but there are safeguards in place against them, they're mercifully quite rare and the risk is sometimes worth it.

Do you have any evidence for all that, or are you just, as I suspect, pulling that out of your ass?
posted by Malor at 7:19 PM on July 27, 2009

when a crazy guy starting talking to me

kinda reminds me of that one scene in happy-go-lucky :P watch! (cf. the future & evolution ;)

cheers!
posted by kliuless at 7:30 PM on July 27, 2009

Malor, no offense, but you have offered exactly one anecdote in this thread and demonstrated no familiarity with the legal procedures for involuntary commitment that are meant to act as a safeguard against anyone but those who are legitimately a threat to themselves or the community from being held against their will in a psychiatric unit. The sad fact is that people who do not meet these criteria do sometimes wind up in the system due to the unethical actions of family members or law enforcement officers, but as someone who has argued on the phone with mental health delegates trying to get a pre-approved order for an involuntary commitment when it was necessary and almost not been able to get it because the standards are so hard to meet I can assure you there are safe guards in place to prevent people from being held against their will for no reason. And, as I already stated upthread, this whole court procedure is set into motion again, and again, again over very short periods of time after the initial commitment with each future involuntary stay become harder to petition for precisely because the system is set up to err on the side of granting people their freedom and referring them to outpatient resources rather than holding people for indeterminate stays the way the system used to work.

As Maias pointed out, once in the system you come into contact with the reality of mental health services provision, which is that as a nation we put little value on these services, do not adequately fund them, do not adequately research best practices, and simultaneously overrun the capacity of the services we have, such that the often under-trained, under-paid staff who work in the facilities are also over-worked and tasked with managing a too-large population that is extremely difficult even for the most skilled professionals to handle. As a result, atrocious things can and do happen. Are there safeguards? Yes, for instance as I already stated upthread, the facility Danila had her bad experience with was cutoff from receiving referrals by the city's Department of Behavioral Health once notice of such instances made their way to that agency, which is the gatekeeper for all mental health services referrals in the city. Also, as I already stated upthread after 72 hours a patient will get to meet with the court appointed mental health advocate where they can make allegations of sub-par care that will help strengthen their case for being released as soon as legally possible.

You need to moderate your tone, because honestly you are not really bringing much to the table in this discussion, yourself.
posted by The Straightener at 7:52 PM on July 27, 2009

I am pretty sure it is a bad idea to stick all the mentally ill people in one place. If anything it seems to make it more difficult to get a sense of sanity. I also think in the future our reliance on drugs to control the symptoms of mental illness are going to seem as criminal as our past use of tooth extraction and frontal lobotomies. Interesting article covering this second point.
http://www.guardian.co.uk/education/2002/jan/10/medicalscience.healthandwellbeing

As for the article, I thought it was less and indictment of the institution and more a problem with the methods used to diagnose mental illness. The current methods are almost hopelessly subjective.

As are the treatments. It pains me to hear some of the stories of incompetent, uncaring or plain evil mental health professionals. If you or someone you love has a mental illness find someone that seems to understand you and that you trust.
posted by psycho-alchemy at 9:54 PM on July 27, 2009

I also think in the future our reliance on drugs to control the symptoms of mental illness are going to seem as criminal as our past use of tooth extraction and frontal lobotomies.

...what? All drugs or any specific ones?
posted by kathrineg at 10:38 AM on July 28, 2009

I also think in the future our reliance on drugs to control the symptoms of mental illness are going to seem as criminal as our past use of tooth extraction and frontal lobotomies.

...what? All drugs or any specific ones?
posted by kathrineg at 10:38 AM on July 28 [+] [!]


I would not say it is the drugs themselves but the methods by which we combine many of them and the lack of actual proof that they do what they say they do. Meaning no one has yet made a study that shows that the level of certain neurotransmitters in the brain are the cause of mental illness and no one has done any studies examining how these drugs interact when they are combined.
posted by psycho-alchemy at 2:07 AM on July 31, 2009