Visited countries: “Select in the table below the countries you’ve visited and produce a map of the world with those countries in red. You can even put the map on your website or blog by simply pasting the code you’ll get!” —World66

“Our fourth annual review of the most shameful, dishonest, and just plain stupid moments of the past year. —” Business 2.0

Thirty years ago, one of the most significant papers in the history of psychiatry, psychologist David Rosenhan’s “On Being Sane in Insane Places”, was published in Science and rocked the psychiatric establishment. Rosenhan and eight other volunteers faked their way into psychiatric hospitals with the single complaint that they had hallucinated a voice; they feigned no other symptoms, spoke honestly about their lives after admission, and reported that the voice had stopped once they were in the hospital. One and all were diagnosed as schizophrenics and their subsequent behaviors — for example, Rosenhan’s note-taking during his hospitalization — were pathologized in light of that diagnosis.

Rosenhan and his confederates were given some therapy, and when they told of the joys, satisfactions and disappointments of an ordinary life – remember, they were making nothing up save the original complaint – all found that their pasts were reconfigured to fit the diagnosis: “This white 39-year-old male … manifests a long history of considerable ambivalence in close relationships … affective stability is absent … and while he says he has several good friends, one senses considerable ambivalence in those relationships.”

The other patients sensed that the volunteers were not truly psychotic, he reports.

Rosenhan drew the conclusion that, in an important sense, diagnosis resides not within the person but in the context, and that a diagnostic system so vulnerable to error should not be considered reliable. The backlash was immense, and included some of the most prominent psychiatrists in the field criticizing his findings by observing that diagnosticians do not expect to be deliberately lied to and that the volunteers had not acted ‘sane’ after their admission —

Had their behaviour been normal, they would have walked to the nurses’ station and said, “Look, I am a normal person who tried to see if I could get into the hospital by behaving in a crazy way or saying crazy things. It worked and I was admitted to the hospital, but now I would like to be discharged from the hospital.”

Furthermore, although Rosenhan’s intentions in not identifying the facilities in which the deceptions had taken place were honest, critics at those hospitals could not challenge his accounts of how the pseudopatients were perceived or treated.

Thoughtful psychologist Lauren Slater (who is ‘out of the closet’ about having a psychiatric history herself), to whose work I have admiringly linked here in the past, reviews Rosenhan’s study and its critics’ counterclaims —Guardian.UK. Robert Spitzer, the brilliant but conceited guardian of the diagnostic system as embodied in its bible, the Diagnostic and Statistical Manual, (who mounted one of the fiercest counterattacks on the original paper and did not have a kind word to say for the misfurtunes that happen to have befallen Rosenhan in the intervening decades) said that with the current refinement of diagnostic criteria, Rosenhan’s findings “could never happen today” …So Slater decided to replicate the experiment again. Her experience departs from the Rosenhan experiment, both in its outcome and the kindness with which she was treated, but is at least as dramatic an indictment of the way psychiatry is done today as Rosenhan’s was thirty years ago (…and she puts it back in Spitzer’s face). I share her unspoken disdain for his cockiness, and as well her veneration and affection for Rosenhan (who was as she wrote, ironically, institutionalized and mute with a mysterious paralytic illness; he has since recovered, equally mysteriously), whose study albeit flawed should be considered heroic and whose crucial lessons we in the mental health field ignore at our peril.

The shoddy (although well-intentioned) way in which clinicians drew their conclusions about Slater’s feigned distress is, unfortunately, the norm rather than the exception throughout the mental health field today. Patients are referred into my psychiatric hospital bearing labels determined by sloppy, uninformed, arbitrary guesswork bearing no similarity to the elaborate process of applying criteria which should be used to diagnose them accurately. Once stuck on, a diagnostic label follows a patient around immutably. This ‘conceptual abuse’ would not be so provocative to watch if it did not dictate the patient’s medication treatment and to a large extent the interpersonal attitude toward them by many in the mental health field.

Slater’s article on Rosenhan’s work is adapted from her just-released book, Opening Skinner’s Box: Great Psychological Experiments Of The 20th Century. According to the publisher’s website, some of the other chapters cover “Harlow’s wire monkeys, Moniz?s lobotomy, Skinner?s pecking pigeons, Milgram?s horrific ?shock? machine, Kandel?s surprisingly illuminating sea slugs and the light they cast on the molecular workings of memory.” I know she also covers the controversial work of Elizabeth Loftus on “false memory”, and I wonder if she covers Milgram’s other seminal work, the famous “six degrees of separation” study.

Gary Trudeau had John Kerry’s number in October, 1971. —Slate

I am amazed at the number of people who post entries in their weblogs that would get them in trouble if the wrong people read them… and then are astonished when they do, and the weblogger gets fired, has a family blowout, loses a friend, or a relationship, or gets an unexpected visit from The Authorities. To complement the Darwin Awards (which “honor those who improve our gene pool…by removing themselves from it”), we ought to have a set of Social Darwins (for those who do society a favor by removing themselves from the social running in some way), and I would nominate some of these ‘kiss ‘n’ tell’ webloggers. I am confident that any trouble into which I get as a result of my posts here will have been deliberate, not inadvertent. Oh, wait just a minute, I’ll be right back, there’s a knock at the front door…

The scream that may not have been; a reporter makes a cogent case that it was an artifact of the sound equipment used that night. —ABC [via Interesting People]