Psychiatry: who was the first to put on a white coat is the one and the doctor

2024 Author: Seth Attwood | [email protected]. Last modified: 2023-12-16 15:55

It turns out to be very simple. All you have to do is pretend and voila, you're in a hospital bed. And maybe even tied down. At least, this is proved by the experiment of the American psychologist David Rosenhan. It also questions the entire system of psychiatric diagnostics.

Doctor, I hear voices

This was in 1973. Rosenhan himself and his mentally healthy colleagues (two psychologists, one undergraduate student in psychology, a pediatrician, a psychiatrist, an artist and a housewife) decided to test the reliability of psychiatric methods, for which they tried to get into various psychiatric hospitals in the United States as patients. And they succeeded. And it's easy. It was enough to change the information about the place of work and introduce himself as a pseudonym (of course, none of the pseudo-patients in psychiatric hospitals had any medical records, but the true names, surnames and information about education and work, of course, would raise doubts among doctors, as well as problems in the future for the participants in the experiment). All other information about the "patients" was true. Including their natural behavior.

Except for one - each of them informed the doctors that he hears voices belonging to people of his own sex. The voices are most often illegible, but in them, according to patients, one can guess something like the words "empty", "hollow", "knock". And nothing more. Such words were specially selected - in part, they contained signs of some kind of existential crisis (a state of anxiety and discomfort at the thought of the meaning of one's own existence), on the other hand, there was no literature that allowed these manifestations to be considered symptoms of psychosis. The pseudo-patients only complained of voices, no other symptoms bothered them.

And the patient is healthy

All pseudo-patients were hospitalized. In this case, they were instructed to behave appropriately, to report that they do not feel discomfort and no longer hear any voices. Which they did, but there was no response from the doctors (although the hospital records described the pseudo-patients as “friendly and helpful”). Doctors in all hospitals - there were eight clinics in total in different states of the United States; with different incomes: from poor rural ones to those enjoying well-deserved fame in scientific circles, as well as prestigious paid hospitals - they were in no hurry to let out pseudo-patients. At the same time, they were prescribed psychotropic drugs (which they flushed down the toilet, as well as real patients).

And even though they all showed the same symptoms, they were given different diagnoses. At least one - manic-depressive psychosis (the rest had "schizophrenia"). The duration of the stay of patients in hospitals ranged from 7 to 52 days (average 19), after which they were discharged with a diagnosis of "schizophrenia in remission." For David Rosenhan, this was proof that mental illness is perceived as irreversible and becomes a label for life. During all this time, none of the doctors doubted the correctness of the diagnosis given to the pseudo-patients, but such doubts were regularly expressed by real patients: out of 118 patients, 35 expressed suspicion that the pseudo-patients are healthy and are researchers or journalists.

Longing and loss of oneself

And also an unceremonious invasion of personal space. Such feelings, according to the participants in the experiment, they constantly experienced during their stay in psychiatric hospitals. Their things were randomly checked, and even when the patients themselves were not there (they went to the toilet). People were also treated like things, despite the fact that the hospital staff could be generally described as decent (the notorious professional deformation was obviously to blame).

Often, the discussion of the wards was conducted in their presence (and one of the doctors told the students about a group of patients crowded in line waiting for lunch that they were experiencing symptoms of "increased oral sensibility"), while some of the service staff, in the absence of doctors, were completely rude or even pushed patients.

Any action or statement of patients was perceived solely in the light of their diagnosis. Even the fact that one pseudo-patient was taking notes was interpreted by a certain nurse as a pathology and considered it to be a manifestation of graphomania (a pathological desire to compose works applying for publication). Another nurse, in the presence of patients, unbuttoned her blouse and straightened her bra, clearly not taking the people in the ward for full-fledged men.

Healthy cannot be sick

The authority of psychiatry was shaken, but this was not enough for the insidious David Rosenhan. Following the first, he set up a second experiment. This time it was exactly the opposite. Rosenhan warned the doctors of a well-known psychiatric hospital (the latter had its own educational and research base and, having familiarized herself with the results of the previous experiment, claimed that such things could not be repeated in their institution) that one or more pseudo-patients.

Of the 193 people who applied to the clinic during this period, 41 were caught in the simulation, another 42 were suspected. Imagine the surprise of the doctors when they learned that Rosenhan had not sent a single pseudo-patient to them! The results of his experiments were published in the prestigious journal Science, where Rosenhan made the disappointing conclusion: "No diagnosis that too easily leads to significant errors of this kind can be very reliable." Similar results have been obtained in studies by other specialists.

There are no healthy - there are unexamined

For example, the experiment of psychologist and journalist Lauryn Slater, who, a few years later, exactly repeated the actions and phrases of Rosenhan's pseudo-patients, went to one of the psychiatric clinics (in this case, a hospital with a very good reputation was chosen). The journalist was considered insane and was prescribed psychotropic medication. The same thing happened in eight other clinics where Slater went. The woman was prescribed 25 antipsychotic drugs and 60 antidepressants. At the same time, the conversation with each of the doctors, according to the journalist, lasted no more than 12.5 minutes. In fairness, it should be said that during the hospitalization (which was not compulsory, the woman herself suggested that the doctors go to the hospital), the clinic staff treated her more than humanely. Nevertheless, the question of the misdiagnosis and prescription of potent drugs remained open. This was again confirmed by other experiments.

Take, for example, a study by the famous psychotherapist and professor at the University of Oklahoma, Maurice Temerlin, who divided 25 psychiatrists into two groups and invited them to listen to the actor's voice. The latter portrayed a mentally healthy person, but Maurice told one group that it was the voice of a psychotic who looked like a neurotic (less severe pathology compared to psychosis), and the second did not say anything at all. 60% of psychiatrists in the first group diagnosed the speaker with psychosis (in most cases it was schizophrenia), in the second - the control group - no one made a diagnosis.

In 1998, a similar study was conducted by other American psychologists, Loring and Powell, who handed out to 290 psychiatrists a text with a clinical interview of a certain patient. At the same time, they told the first half of the doctors that the patient was black, the other that he was white. The conclusion turned out to be predictable: psychiatrists attributed "aggression, suspicion and social danger" to the black-skinned patient, despite the fact that the texts of the clinical interviews of both were completely identical.

In 2008, a similar experiment was carried out by the BBC (on the Horizon program). Ten people took part in it: half of them had previously been diagnosed with various mental disorders, the other half had no diagnoses. All of them were examined by three eminent psychiatrists. The task of the latter was simple - to identify people with psychiatric pathologies. Bottom line: only two out of ten were given the correct diagnosis, one was wrong, and two healthy people were mistakenly “recorded” as “unhealthy”.

Controversy

The experiments sparked fierce controversy. Someone was forced to agree with the unreliability of psychiatric diagnostics, someone gave reasons. The author of the Classification of Mental Disorders (DSM-IV) Robert Spitzer responded to the criticism as follows: “If I drank a liter of blood and, concealing it, with bloody vomit appeared in the emergency department of any hospital, then the behavior of the staff would be quite predictable. If they diagnosed me and prescribed treatment, as with a stomach ulcer, I would hardly be able to convincingly prove that medical science has no knowledge of the diagnosis of this disease. " Nevertheless, after the experiment of the aforementioned journalist Lauryn Slater, Robert Spitzer had to admit: “I am disappointed. I think doctors just don't like to say, "I don't know."

The good news is that all these experiments have helped make mental hospitals literally more human. True, judging by the study by Lauryn Slater, this applies only to Western clinics so far. A similar experiment in Russia in 2013 was conducted by a journalist named Marina Koval, who got a job as a nurse in one of the provincial psychiatric hospitals. And then she wrote an article in which she told everything that she saw: the monstrous living conditions, beatings and theft of personal belongings of the wards, threats against them, smoking of the medical staff. And also the appointment of psychotropic drugs that turn patients into obedient and completely uncomplaining people. This is despite the fact that, according to Koval, in modern Russian mental hospitals there are many apparently quite healthy people who were brought there by an ordinary nervous breakdown. But after being registered and diagnosed, as in the case of the pseudo-patients of Rosenhan, the questions of "normality" no longer worried anyone - in the minds of the doctors, these people remained sick forever.

Was there schizophrenia?

“All mental states (including disorders) are derived from that culture and the language to which we belong,” says the famous Petersburg psychoanalyst Dmitry Olshansky. - Any diagnosis arises and disappears in the same way as one literary style replaces another. At the beginning of the 16th century, a roguish romance replaces a chivalric romance, the diagnosis of "depression" replaces "melancholy". We can even strictly date the period of existence of some diseases: for example, hysteria existed from 1950 BC. e. (the first mention of hysteria in the Kahun papyrus) until the 1950s. e., that is, almost 4 thousand years. Today, no one is sick with hysteria, and therefore such a disease does not exist in medical reference books. The same goes for diseases such as "melancholy" and "obsession".

All medical diagnoses are as much a literary product of the era in which they exist, as are the conditions they describe. Therefore, there is nothing surprising in the fact that doctors see in a person those diseases and those disorders that are prescribed by science at the moment, they attribute to the patient what is dictated by the development of medical literature at the moment. People see only what they are ready to see. Strictly speaking, the entire human civilization is a product of fiction and invention, and medicine, as a part of it, is no exception. Rosenhan's experiment only proves this common truth.

The question of the "reality of psychiatric diagnoses" is just as meaningless as the question of the reality of the mental world in general: "does schizophrenia really exist or was it invented by doctors?", "Does love really exist or was it invented by philosophers?" do we really experience feelings or is it just a model of behavior that we have learned in the process of education? " Psychiatry deals with the same fictional phenomena as mathematics or linguistics. And we have no reason to discriminate against it against the background of all other sciences and accuse it of being more fictional.

How is the diagnosis made

- Despite the fact that in psychiatry the diagnosis remains quite subjective and largely depends on the experience of the personal characteristics of the doctor, there are many ways to verify the diagnosis, - says the candidate of medical sciences, assistant of the Department of Psychiatry and Narcology of the North-Western State Medical University named after N. I. I. Mechnikova Olga Zadorozhnaya. - These are various psychometric scales, structured interviews, tests and, most importantly, what all psychiatrists are guided by when making a diagnosis - the criteria for mental illness set out in the International Classification of Diseases. This, in turn, is also a kind of general agreement, based, nevertheless, on the vast clinical material and traditions of the main schools of psychiatry.

There are a lot of psychotropic drugs currently created. For the treatment of severe mental disorders, mainly antipsychotics, antidepressants, tranquilizers are used. The drugs of these groups act on receptors located on the membranes of neurons in the central nervous system. Modern drugs make it possible to effectively deal with the most dangerous manifestations of mental illness, but, unfortunately, they do not completely cure. A person with schizophrenia or manic-depressive psychosis is forced to take therapy for life. However, not all mental disorders require lifelong therapy. There are so-called borderline mental disorders, such as neuroses, as well as mental reactions caused by severe extraordinary events, shocks. Such conditions can be cured and the person will return to their previous healthy state.

Hospitalization in a psychiatric hospital in our country is regulated by the Law "On psychiatric care and guarantees of the rights of citizens during its provision." According to this law, mental health care is provided only on a voluntary basis. It is possible to forcibly hospitalize a patient in a hospital only by a court decision. This procedure is carried out in strict accordance with the law and on time. Without a court decision, a person can spend no more than one week in the hospital. Also the statement. The average length of stay of a patient in the hospital is determined by his diagnosis and should usually not exceed two months.