Messages Off of Everything, Everywhere, for Everyone...

 

It is  double standards which cause double binds.

The sense that we are not being heard by psychiatrists (and others) is reality based.

It's not that they are physically deaf but rather psychologically 'deaf' to what we are saying. 

 

Look for the patterns. Something to help make sense of it.

       from Survivor




 

 

 

 

 

 

 

 










 

 

 

 

The Real Meaning

Just because you don't understand what I am saying it does not prove that what I am saying cannot be understood, nor does it prove that I don't understand it myself.

Just because you see or hear no meaning in what I tell you, it does not mean there is no meaning there to see and hear.

If your ego is blocking the view and buzzing loudly in your ears, you will remain blind and deaf to the truth that is right in front of your nose. That is this:

I am saying what I mean, and meaning what I say.

I understand something that you do not.

For as long as you can't or won't accept that, because you are too busy defending your own errors, you won't be able to see me, or hear me, as I really am.

Timeless Visions, Voices and New Meanings
Voices Throughout the Ages, Changing Perceptions,  Reactionary People, Trapped Targets, Group Relationships etc.

On Being Sane...

When Complete, I will change this to a PDF File

On Being Sane in Insane Places

Part 1,2,3,4,5,6 What's "Normal"?


Dr. Rosenhan personally had himself admitted as a ''mental patient'' in 1972 and wrote of his findings regarding the experience.

The footnotes added to each section are my own and are being used in an attempt by me to connect the truth about this long entrenched group dynamic to the concrete details of my own experience, with my own psychiatrists, and the people they involved in my psychiatrization. This is my local wake -up call. Let's see how long they keep snoozing their way though life.

On Being Sane In Insane Places

By David L. Rosenhan, PhD.

Stanford University



How do we know precisely what constitutes "normality" or mental illness? Conventional wisdom suggests that specially trained professionals have the ability to make reasonably accurate diagnoses. In this research, however, David Rosenhan provides evidence to challenge this assumption. What is -- or is not -- "normal" may have much to do with the labels that are applied to people in particular settings.

If sanity and insanity exist, how shall we know them?

The question is neither capricious nor itself insane. However much we may be personally convinced that we can tell the normal from the abnormal, the evidence is simply not compelling. It is commonplace, for example, to read about murder trials wherein eminent psychiatrists for the defense are contradicted by equally eminent psychiatrists for the prosecution on the matter of the defendant's sanity. More generally, there are a great deal of conflicting data on the reliability, utility, and meaning of such terms as "sanity," "insanity," "mental illness," and "schizophrenia."

Finally, as early as 1934, {Ruth} Benedict suggested that normality and abnormality are not universal.

What is viewed as normal in one culture may be seen as quite aberrant in another. Thus, notions of normality and abnormality may not be quite as accurate as people believe they are.

To raise questions regarding normality and abnormality is in no way to question the fact that some behaviors are deviant or odd. Murder is deviant. So, too, are hallucinations. Nor does raising such questions deny the existence of the personal anguish that is often associated with "mental illness." Anxiety and depression exist. Psychological suffering exists. But normality and abnormality, sanity and insanity, and the diagnoses that flow from them may be less substantive than many believe them to be.

At its heart, the question of whether the sane can be distinguished from the insane (and whether degrees of insanity can be distinguished from each other) is a simple matter: Do the salient characteristics that lead to diagnoses reside in the patients themselves or in the environments and contexts in which observers find them? From Bleuler, through Kretchmer, through the formulators of the recently revised Diagnostic and Statistical Manual of the American Psychiatric Association, the belief has been strong that patients present symptoms, that those symptoms can be categorized, and, implicitly, that the sane are distinguishable from the insane. More recently, however, this belief has been questioned. Based in part on theoretical and anthropological considerations, but also on philosophical, legal, and therapeutic ones, the view has grown that psychological categorization of mental illness is useless at best and downright harmful, misleading, and pejorative at worst. Psychiatric diagnoses, in this view, are in the minds of observers and are not valid summaries of characteristics displayed by the observed.

Gains can be made in deciding which of these is more nearly accurate by getting normal people (that is, people who do not have, and have never suffered, symptoms of serious psychiatric disorders) admitted to psychiatric hospitals and then determining whether they were discovered to be sane and, if so, how. If the sanity of such pseudo patients were always detected, there would be prima facie evidence that a sane individual can be distinguished from the insane context in which he is found. Normality (and presumably abnormality) is distinct enough that it can be recognized wherever it occurs, for it is carried within the person. If, on the other hand, the sanity of the pseudo patients were never discovered, serious difficulties would arise for those who support traditional modes of psychiatric diagnosis. Given that the hospital staff was not incompetent, that the pseudo patient had been behaving as sanely as he had been out of the hospital, and that it had never been previously suggested that he belonged in a psychiatric hospital, such an unlikely outcome would support the view that psychiatric diagnosis betrays little about the patient but much about the environment in which an observer finds him.

This article describes such an experiment. Eight sane people gained secret admission to 12 different hospitals. Their diagnostic experiences constitute the data of the first part of this article; the remainder is devoted to a description of their experiences in psychiatric institutions. Too few psychiatrists and psychologists, even those who have worked in such hospitals, know what the experience is like. They rarely talk about it with former patients, perhaps because they distrust information coming from the previously insane. Those who have worked in psychiatric hospitals are likely to have adapted so thoroughly to the settings that they are insensitive to the impact of that experience. And while there have been occasional reports of researchers who submitted themselves to psychiatric hospitalization, these researchers have commonly remained in the hospitals for short periods of time, often with the knowledge of the hospital staff. It is difficult to know the extent to which they were treated like patients or like research colleagues. Nevertheless, their reports about the inside of the psychiatric hospital have been valuable. This article extends those efforts.

2. PSEUDOPATIENTS AND THEIR SETTINGS

The eight pseudo patients were a varied group. One was a psychology graduate student in his 20's. The remaining seven were older and "established." Among them were three psychologists, a pediatrician, a psychiatrist, a painter, and a housewife. Three pseudo patients were women, five were men. All of them employed pseudonyms, lest their alleged diagnoses embarrass them later.

Those who were in mental health professions alleged another occupation in order to avoid the special attentions that might be accorded by staff, as a matter of courtesy or caution, to ailing colleagues.

With the exception myself (I was the first pseudo patient and my presence was known to the hospital administration and chief psychologist and, so far as I can tell, to them alone), the presence of pseudo patients and the nature of the research program was not known to the hospital staffs.

The settings are similarly varied. In order to generalize the findings, admission into a variety of hospitals was sought. The 12 hospitals in the sample were located in five different states on the East and West coasts. Some were old and shabby, some were quite new. Some had good staff-patient ratios, others were quite understaffed. Only one was a strict private hospital. All of the others were supported by state or federal funds or, in one instance, by university funds.

After calling the hospital for an appointment, the pseudo patient arrived at the admissions office complaining that he had been hearing voices. Asked what the voices said, he replied that they were often unclear, but as far as he could tell they said "empty," "hollow," and "thud." The voices were unfamiliar and were of the same sex as the pseudo patient. The choice of these symptoms was occasioned by their apparent similarity to existential symptoms. Such symptoms are alleged to arise from painful concerns about the perceived meaninglessness of one's life. It is as if the hallucinating person were saying, "My life is empty and hollow." The choice of these symptoms was also determined by the absence of a single report of existential psychoses in the literature.

Beyond alleging the symptoms and falsifying name, vocation, and employment, no further alterations of person, history, or circumstances were made. The significant events of the pseudo patient's life history were presented as they had actually occurred. Relationships with parents and siblings, with spouse and children, with people at work and in school, consistent with the aforementioned exceptions, were described as they were or had been. Frustrations and upsets were described along with joys and satisfactions. These facts are important to remember. If anything, they strongly biased the subsequent results in favor of detecting insanity, since none of their histories or current behaviors were seriously pathological in any way.

Immediately upon admission to the psychiatric ward, the pseudo patient ceased simulating any symptoms of abnormality. In some cases, there was a brief period of mild nervousness and anxiety, since none of the pseudo patients really believed that they would be admitted so easily. Indeed, their shared fear was that they would be immediately exposed as frauds and greatly embarrassed. Moreover, many of them had never visited a psychiatric ward; even those who had, nevertheless had some genuine fears about what might happen to them. Their nervousness, then, was quite appropriate to the novelty of the hospital setting, and it abated rapidly.

Apart from that short-lived nervousness, the pseudo patient behaved on the ward as he "normally" behaved. The pseudo patient spoke to patients and staff as he might ordinarily. Because there is uncommonly little to do on a psychiatric ward, he attempted to engage others in conversation. When asked by staff how he was feeling, he indicated that he was fine, that he no longer experienced symptoms. He responded to instructions from attendants, to calls for medication (which was not swallowed), and to dining-hall instructions. Beyond such activities as were available to him on the admissions ward, he spent his time writing down his observations about the ward, its patients, and the staff. Initially these notes were written "secretly," but as it soon became clear that no one much cared, they were subsequently written on standard tablets of paper in such public places as the dayroom. No secret was made of these activities.

The pseudo patient, very much as a true psychiatric patient, entered a hospital with no foreknowledge of when he would be discharged. Each was told that he would have to get out by his own devices, essentially by convincing the staff that he was sane. The psychological stresses associated with hospitalization were considerable, and all but one of the pseudo patients desired to be discharged almost immediately after being admitted. They were, therefore, motivated not only to behave sanely, but to be paragons of cooperation. That their behavior was in no way disruptive is confirmed by nursing reports, which have been obtained on most of the patients. These reports uniformly indicate that the patients were "friendly," "cooperative," and "exhibited no abnormal indications."



3. THE NORMAL ARE NOT DETECTABLY SANE

Despite their public "show" of sanity, the pseudo patients were never detected. Admitted, except in one case, with a diagnosis of schizophrenia, each was discharged with a diagnosis of schizophrenia "in remission." The label "in remission" should in no way be dismissed as a formality, for at no time during any hospitalization had any question been raised about any pseudo patient's simulation. Nor are there any indications in the hospital records that the pseudo patient's status was suspect. Rather, the evidence is strong that, once labeled schizophrenic, the pseudo patient was stuck with that label. If the pseudo patient was to be discharged, he must naturally be "in remission"; but he was not sane, nor, in the institution's view, had he ever been sane.

The uniform failure to recognize sanity[1] cannot be attributed to the quality of the hospitals, for, although there were considerable variations among them, several are considered excellent. Nor can it be alleged that hospitalization ranged from 7 to 52 days, with an average of 19 days. The pseudo patients were not, in fact, carefully observed, but this failure speaks more to traditions within psychiatric hospitals than to lack of opportunity.

Finally, it cannot be said that the failure to recognize the pseudo patients' sanity was due to the fact that they were not behaving sanely. While there was clearly some tension present in all of them, their daily visitors could detect no serious behavioral consequencesnor, indeed, could other patients. It was quite common for the patients to "detect" the pseudo patient's sanity.[2]During the first three hospitalizations, when accurate counts were kept, 35 of a total of 118 patients on the admissions ward voiced their suspicions, some vigorously. "You're not crazy. You're a journalist, or a professor (referring to the continual note-taking). You're checking up on the hospital." While most of the patients were reassured by the pseudo patient's insistence that he had been sick before he came in but was fine now, some continued to believe that the pseudo patient was sane throughout his hospitalization. The fact that the patients often recognized normality when staff did not raises important questions.

Failure to detect sanity during the course of hospitalization may be due to the fact that physicians operate with a strong bias toward what statisticians call the Type 2 error. This is to say that physicians are more inclined to call a healthy person sick (a false positive, Type 2) than a sick person healthy (a false negative, Type 1). The reasons for this are not hard to find: it is clearly more dangerous to misdiagnose illness than health. Better to err on the side of caution, to suspect illness even among the healthy.

But what holds for medicine does not hold equally well for psychiatry. Medical illnesses, while unfortunate, are not commonly pejorative. Psychiatric diagnoses, on the contrary, carry with them personal, legal, and social stigmas. [3]It was therefore important to see whether the tendency toward diagnosing the sane insane could be reversed. The following experiment was arranged at a research and teaching hospital whose staff had heard these findings but doubted that such an error could occur in their[4] hospital. The staff was informed that at some time during the following three months, one or more pseudo patients would attempt to be admitted into the psychiatric hospital. Each staff member was asked to rate each patient who presented himself at admissions or on the ward according to the likelihood that the patient was a pseudo patient. A 10-point scale was used, with a 1 and 2 reflecting high confidence that the patient was a pseudo patient.

Judgments were obtained on 193 patients who were admitted for psychiatric treatment. All staff who had had sustained contact with or primary responsibility for the patient attendants, nurses, psychiatrists, physicians, and psychologists were asked to make judgments. Forty-one patients were alleged, with high confidence, to be pseudo patients by at least one member of the staff. Twenty-three were considered suspect by at least one psychiatrist. Nineteen were suspected by one psychiatrist and one other staff member. Actually, no genuine pseudo patient (at least from my group) presented himself during this period.

The experiment is instructive. It indicates that the tendency to designate sane people as insane can be reversed when the stakes (in this case, prestige and diagnostic acumen) are high. But what can be said of the 19 people who were suspected of being "sane" by one psychiatrist and another staff member? Were these people truly "sane" or was it rather the case that in the course of avoiding the Type 2 error the staff tended to make more errors of the first sort calling the crazy "sane"?[5] There is no way of knowing. But one thing is certain: any diagnostic process that lends itself too readily to massive errors of this sort cannot be a very reliable one.

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[1] Emphasis minePL

[2] Again emphasis minePL

[3]yet for the identified patient to complain that one's life is being destroyed is to invite further 'assessments' related to 'paranoia.'

[4] it always seems to be 'other' people perhaps, but certainly not THEM.

[5] Or, is it just that this happens all the time to supposedly 'real' patients, who tell the psychiatrists and staff they are 'not sick' but who can not be heard because of this very problem. Saying one is not 'sick,' often meaning physically, is defined as one of the signs that one IS sick, meaning physically, The tautology is ever present to justify all outcomes and protect the system. PL

4. THE STICKINESS OF PSYCHODIAGNOSTIC LABELS

Beyond the tendency to call the healthy sick a tendency that accounts better for diagnostic behavior on admission than it does for such behavior after a lengthy period of exposure the data speak to the massive role of labeling in psychiatric assessment. [1]Having once been labeled schizophrenic, there is nothing the pseudo patient can do to overcome the tag. The tag profoundly colors others' perceptions of him and his behavior. [2]

From one viewpoint, these data are hardly surprising, for it has long been known that elements are given meaning by the context[3] in which they occur. Gestalt psychology made the point vigorously, and Asch demonstrated that there are "central" personality traits (such as "warm" versus "cold") which are so powerful that they markedly color the meaning of other information in forming an impression of a given personality. "Insane," "schizophrenic," "manic-depressive," and "crazy" are probably among the most powerful of such central traits. Once a person is designated abnormal, all of his other behaviors and characteristics are colored by that label. [4]Indeed, that label is so powerful that many of the pseudopatients' normal behaviors were overlooked entirely or profoundly misinterpreted. Some examples may clarify this issue.

Earlier, I indicated that there were no changes in the pseudopatient's personal history and current status beyond those of name, employment, and, where necessary, vocation. Otherwise, a veridical description of personal history and circumstances was offered. Those circumstances were not psychotic. How were they made consonant with the diagnosis modified in such a way as to bring them into accord with the circumstances of the pseudopatient's life, as described by him?

As far as I can determine, diagnoses were in no way affected by the relative health of the circumstances of a pseudopatient's life. Rather, the reverse[5] occurred: the perception of his circumstances was shaped entirely by the diagnosis.[6] A clear example of such translation is found in the case of a pseudopatient who had had a close relationship with his mother but was rather remote from his father during his early childhood. During adolescence and beyond, however, his father became a close friend, while his relationship with his mother cooled. His present relationship with his wife was characteristically close and warm. Apart from occasional angry exchanges, friction was minimal. The children had rarely been spanked. Surely there is nothing especially pathological about such a history. Indeed, many readers may see a similar pattern in their own experiences, with no markedly deleterious consequences. Observe, however, how such a history was translated[7] in the psychopathological context, this from the case summary prepared after the patient was discharged.

This white 39-year-old male . . . manifests a long history of considerable ambivalence in close relationships, which begins in early childhood. A warm relationship with his mother cools during his adolescence. A distant relationship with his father is described as becoming very intense. Affective stability is absent. His attempts to control emotionality with his wife and children are punctuated by angry outbursts and, in the case of the children, spankings. And while he says that he has several good friends, one senses considerable ambivalence embedded in those relationships also . . .

The facts of the case were unintentionally distorted by the staff to achieve consistency with a popular theory of the dynamics of a schizophrenic reaction. Nothing of an ambivalent nature had been described in relations with parents, spouse, or friends.[8] To the extent that ambivalence could be inferred, it was probably not greater than is found in all human's relationships. It is true the pseudopatient's relationships with his parents changed over time, but in the ordinary context that would hardly be remarkable indeed, it might very well be expected. Clearly, the meaning ascribed to his verbalizations (that is, ambivalence, affective instability) was determined by the diagnosis: schizophrenia. An entirely different meaning[9] would have been ascribed if it were known that the man was "normal."

All pseudopatients took extensive notes publicly. Under ordinary circumstances, such behavior would have raised questions in the minds of observers, as, in fact, it did among patients. Indeed, it seemed so certain that the notes would elicit suspicion that elaborate precautions were taken to remove them from the ward each day. But the precautions proved needless. The closest any staff member came to questioning those notes occurred when one pseudopatient asked his physician what kind of medication he was receiving and began to write down the response. "You needn't write it," he was told gently. "If you have trouble remembering, just ask me again." [10]

If no questions were asked of the pseudopatients, how was their writing interpreted? Nursing records for three patients indicate that the writing was seen as an aspect of their pathological behavior. "Patient engaged in writing behavior" was the daily nursing comment on one of the pseudopatients who was never questioned about his writing.[11] Given that the patient is in the hospital, he must be psychologically disturbed. [12]And given that he is disturbed, continuous writing must be behavioral manifestation of that disturbance, perhaps a subset of the compulsive behaviors that are sometimes correlated with schizophrenia. [13]

One tacit characteristic of psychiatric diagnosis is that it locates the sources of aberration within the individual and only rarely within the complex of stimuli that surrounds him. [14]Consequently, behaviors that are stimulated by the environment are commonly misattributed to the patient's disorder. [15]For example, one kindly nurse found a pseudopatient pacing the long hospital corridors. "Nervous, Mr. X?" she asked. "No, bored," he said.

The notes kept by pseudopatients are full of patient behaviors that were misinterpreted by well-intentioned staff. Often enough, a patient would go "berserk" because he had, wittingly or unwittingly, been mistreated by, say, an attendant. A nurse coming upon the scene would rarely inquire even cursorily into the environmental stimuli of the patient's behavior. Rather, she assumed[16]that his upset derived from his pathology, not from his present interactions with other staff members. Occasionally, the staff might assume that the patient's family (especially when they had recently visited) or other patients had stimulated the outburst. But never were the staff found to assume that one of themselves or the structure of the hospital had anything to do with a patient's behavior. One psychiatrist pointed to a group of patients who were sitting outside the cafeteria entrance half an hour before lunchtime. To a group of young residents he indicated that such behavior was characteristic of the oral-acquisitive nature of the syndrome. [17]It seemed not to occur to him that there were very few things to anticipate in a psychiatric hospital besides eating.

A psychiatric label has a life and an influence of its own. Once the impression has been formed that the patient is schizophrenic, the expectation is that he will continue to be schizophrenic. When a sufficient amount of time has passed, during which the patient has done nothing bizarre, he is considered to be in remission and available for discharge. But the label endures beyond discharge, with the unconfirmed expectation that he will behave as a schizophrenic again. Such labels, conferred by mental health professionals, are as influential on the patient as they are on his relatives and friends,[18]and it should not surprise anyone that the diagnosis acts on all of them as a self-fulfilling prophecy.[19]Eventually, the patient himself accepts the diagnosis, with all of its surplus meanings and expectations, and behaves accordingly. [20]

The inferences to be made from these matters are quite simple. Much as Zigler and Phillips have demonstrated that there is enormous overlap in the symptoms presented by patients who have been variously diagnosed, so there is enormous overlap in the behaviors of the sane and the insane. The sane are not "sane" all of the time. We lose our tempers "for no good reason." We are occasionally depressed or anxious, again for no good reason.[21] And we may find it difficult to get along with one or another person again for no reason that we can specify. Similarly, the insane are not always insane. Indeed, it was the impression of the pseudopatients while living with them that they were sane for long periods of time that the bizarre behaviors upon which their diagnoses were allegedly predicated constituted only a small fraction of their total behavior. If it makes no sense to label ourselves permanently depressed on the basis of an occasional depression, then it takes better evidence than is presently available to label all patients insane or schizophrenic on the basis of bizarre behaviors or cognitions. It seems more useful, as Mischel has pointed out, to limit our discussions to behaviors the stimuli that provoke them, and their correlates.

It is not known why powerful impressions of personality traits, such as "crazy" or "insane," arise. Conceivably, when the origins of and stimuli that give rise to a behavior are remote or unknown, or when the behavior strikes us as immutable, trait labels regarding the behavior arise. When, on the other hand, the origins and stimuli are known and available, discourse is limited to to the behavior itself. Thus, I may hallucinate because I am sleeping, or I may hallucinate because I have ingested a peculiar drug. These are termed sleep-induced hallucinations, or dreams, and drug-induced hallucinations, respectively. But when the stimuli to my hallucinations are unknown, that is called craziness, or schizophrenia as if that inference were somehow as illuminating as the others.

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[1] Yes I agree. Getting the label placed as quickly as possible seems to be the most important thing to the bio psychs. The label gives the doctor control over the patient

[2] After I (PL) received my own label it was as if I had suddenly become someone else. Suddenly everything I said felt or did was up for 'interpretation by others. They now see me though the filter of their own belief system.

[3] Meaning connected to context. Did you get that part OK? Do you get it better if another 'doctor' tells you rather than a 'whack job' like me?

[4] I concur based on personal experience

[5] The "exact opposite" was the phrase I used. Remember? "schizophrenia is the exact opposite of what everybody believes it is."PL

[6] BACKWARDS. Effect defined as the cause.PL "It is about cause and effect. "Who would you rather be?" asks the training.

[7] "Translated" , as if the obvious truth were a foreign language. like the interpretations generated by the est routine.PL

[8] and even if ambivalence WAS there, WHY is the focus on one person and not the group as a whole, and why is ambivalence experienced in all relationships defined as 'pathological' in some but not in others?

[9] And THAT is about meaning connected to a premise isn't it? Gee...where have we heard that before?

[10] Writing behaviours PL

[11] No one who believes he or she already knows everything has any interest in asking or listening. Everything has been made meaningless the minute the 'patient' has been defined AS the patient. The same thing occurs with know-it-alls in families.PL

[12] Writing is part of the attempt to sort out all the contradictions with which the patient is being bombarded by others. ex cult members us this sorting method also.Pl

[13] Imagine there is no such 'disease' and keep reading. Imagine it is the dysfunctional con job of SOME of those 'blameless others.

[14] Yoo hoo. experts..are you HEARING that OK? the est hole understands it.PL

[15] Subjective GROUP projection. A defence mechanism. It's about responsibility.PL

[16] And what happens when we 'assume?"

[17] Formerly known 'as waiting for lunch.'

[18] Who are then trained to treat us 'as if."

[19] That's right. Produced with non stop pressure, stress and the constant invalidations of the self righteous.

[20] Most of us do, but not all of us, and those of us who don't, are subjected to further 'treatment' and labelled non compliant as I was. I told my recovery therapist that I was escaping this fate by the skin of my teeth and I knew it. We get several different labels for this same experience which seems to depend more on WHO we get in the psychiatric crap shoot and not on "symptoms.' That is how subjective the diagnoses are.

[21] This is also a value judgement often based on NO patient input at all.

5: THE EXPERIENCE OF PSYCHIATRIC HOSPITALIZATION

The term "mental illness" is of recent origin. It was coined by people who were humane in their inclinations and who wanted very much to raise the station of (and the public's sympathies toward) the psychologically disturbed from that of witches and "crazies" to one that was akin to the physically ill. [1] And they were at least partially successful, for the treatment of the mentally ill has improved considerably over the years. But while treatment has improved, it is doubtful that people really regard the mentally ill in the same way that they view the physically ill. A broken leg is something one recovers from, but mental illness allegedly endures forever. [2]A broken leg does not threaten the observer, but a crazy schizophrenic? There is by now a host of evidence that attitudes toward the mentally ill are characterized by fear, hostility, aloofness, suspicion, and dread. [3]The mentally ill are society's lepers.

That such attitudes infect the general population is perhaps not surprising, only upsetting. But that they affect the professionals attendants, nurses, physicians, psychologists and social workers who treat and deal with the mentally ill is more disconcerting, both because such attitudes are self-evidently pernicious and because they are unwitting. [4]Most mental health professionals would insist that they are sympathetic toward the mentally ill, that they are neither avoidant nor hostile. But it is more likely that an exquisite ambivalence characterises their relations with psychiatric patients, such that their avowed impulses are only part of their entire attitude.[5] Negative attitudes are there too and can easily be detected. [6]Such attitudes should not surprise us. They are the natural offspring of the labels patients wear and the places in which they are found. [7]

Consider the structure of the typical psychiatric hospital. Staff and patients are strictly segregated. Staff have their own living space, including their dining facilities, bathrooms, and assembly places. The glassed quarters that contain the professional staff, which the pseudopatients came to call "the cage," sit out on every dayroom. The staff emerge primarily for care-taking purposes to give medication, to conduct therapy or group meeting, to instruct or reprimand a patient. Otherwise, staff keep to themselves, almost as if the disorder that afflicts their charges is somehow catching.[8]

So much is patient-staff segregation the rule that, for four public hospitals in which an attempt was made to measure the degree to which staff and patients mingle, it was necessary to use "time out of the staff cage" as the operational measure. While it was not the case that all time spent out of the cage was spent mingling with patients (attendants, for example, would occasionally emerge to watch television in the dayroom), it was the only way in which one could gather reliable data on time for measuring.

The average amount of time spent by attendants outside of the cage was 11.3 percent (range, 3 to 52 percent). This figure does not represent only time spent mingling with patients, but also includes time spent on such chores as folding laundry, supervising patients while they shave, directing ward cleanup, and sending patients to off-ward activities. It was the relatively rare attendant who spent time talking with patients or playing games with them. It proved impossible to obtain a "percent mingling time" for nurses, since the amount of time they spent out of the cage was too brief. Rather, we counted instances of emergence from the cage. On the average, daytime nurses emerged from the cage 11.5 times per shift, including instances when they left the ward entirely (range, 4 to 39 times). Later afternoon and night nurses were even less available, emerging on the average 9.4 times per shift (range, 4 to 41 times). Data on early morning nurses, who arrived usually after midnight and departed at 8 a.m., are not available because patients were asleep during most of this period.

Physicians, especially psychiatrists, were even less available. [9]They were rarely

seen on the wards. Quite commonly, they would be seen only when they arrived and departed, with the remaining time being spend in their offices or in the cage. [10]On the average, physicians emerged on the ward 6.7 times per day (range, 1 to 17 times). It proved difficult to make an accurate estimate in this regard, since physicians often maintained hours that allowed them to come and go at different times.

The hierarchical organization of the psychiatric hospital has been commented on before, but the latent meaning of that kind of organization is worth noting again. Those with the most power have the least to do with patients, and those with the least power are the most involved with them. [11]Recall, however, that the acquisition of role-appropriate behaviors occurs mainly through the observation of others, with the most powerful having the most influence. Consequently, it is understandable that attendants not only spend more time with patients than do any other members of the staff that is required by their station in the hierarchy but, also, insofar as they learn from their superior's behavior, spend as little time with patients as they can. Attendants are seen mainly in the cage, which is where the models, the action, and the power are.[12]

I turn now to a different set of studies, these dealing with staff response to patient-initiated contact. It has long been known that the amount of time a person spends with you can be an index of your significance to him. If he initiates and maintains eye contact, there is reason to believe that he is considering your requests and needs. If he pauses to chat or actually stops and talks, there is added reason to infer that he is individuating you. In four hospitals, the pseudopatients approached the staff member with a request which took the following form: "Pardon me, Mr. [or Dr. or Mrs.] X, could you tell me when I will be eligible for grounds privileges?" (or " . . . when I will be presented at the staff meeting?" or ". . . when I am likely to be discharged?"). While the content of the question varied according to the appropriateness of the target and the pseudopatient's (apparent) current needs the form was always a courteous and relevant request for information. Care was taken never to approach a particular member of the staff more than once a day, lest the staff member become suspicious or irritated . .

[R]emember that the behavior of the pseudopatients was neither bizarre nor disruptive. [13]One could indeed engage in good conversation with them.

. . . Minor differences between these four institutions were overwhelmed by the degree to which staff avoided continuing contacts that patients had initiated. By far, their most common response consisted of either a brief response to the question, offered while they were "on the move" and with head averted, or no response at all.[14]The encounter frequently took the following bizarre form: (pseudopatient) "Pardon me, Dr. X. Could you tell me when I am eligible for grounds privileges?" (physician) "Good morning, Dave. How are you today? (Moves off without waiting for a response.) . . [15].

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[1] That may well have been the intention but in, my experience quite the opposite has happened. The witch hunt remains and the insults like being called "the whack job" from a few feet away remains the reality.PL

[2] At least, that is what psychiatry promotes isn't it?PL

[3] This is true for me for the last 16 years though there is always the pretence of acceptance and a facade of manners is very common from most.PL

[4] It is a lot more than just 'upsetting' to the psychiatrized one. In fact, this group behaviour is often the very thing that triggers psychosis. The lack of conscious awareness of the participants is what makes it an inescapable 'snare' for in speaking abut this as reality, the psychiatrized one is not seen or heard as she really is. This largely because the group is blind to itself; well 'hidden' behind their group delusion which I have named S.A.C.S. The same sort of phenomenon occurs in dysfunctional families and cults which I why I see the connections.PL

[5] That definitely speaks to my personal experience as well.PL

[6] We who see them are used to being silenced for being able to do so.PL

[7] These attitudes are then taken up by the rest of society including family and friends who then alter their own way of perceiving the 'patient' so that it fits in with the labelling and diagnostics of the 'experts.' On the receiving end of this it FEELS like being pushed out of concrete reality and into the alternate one designed by those who either cannot, or will not, face the truth.PL

[8] It does a fantastic job of creating a 'them and us' illusion. While NO faults can usually be found in the staff, no matter how glaringly obvious they may be, no end to the 'faults' are found in the patients, no matter how normal they may be speaking or acting. This makes the experience as surreal as it gets. PL

[9] My in hospital one barely spoke to me though he seemed to be enjoying himself when he did.PL

[10] Nurses, often blatantly dysfunctional in their own relationships, are very often the one who do the diagnosing by looking for 'signs' as suggested to them by the psychiatrists. Having it suggested, they seem to find what they are told to look for. They are also very good at closing ranks and keeping the institution's 'secrets.'PL

[11] I find this to be as true today,( 2009)as it was when this was written. It is also true that I was one of the people who spent the most time with individual patients when I was working there as a "special" and was one of the people most openly scorned by some of the staff for my efforts.PL

[12] I found 'dismissive' thinking and behaviour to represent the 'norm' among the hospital staff from the top down. An extraordinary level of arrogance is built into the sytem as a whole and it now feeds upon itself. It has begun to attack it's own whenever a professional dares to speak against the system. Current examples of this will be included in an article to follow. PL

[13] Some psychiatrists and other physicians are now being diagnosed using this term as evidence of a psychiatric illness.The system is now closing on itself tightening the noose (tautology) around the necks of it's own members.

[14]That is the most common response I got from anyone involved when it was not amused condescension, without the slightest attempt at concealment. After all, as the lunatic I was cast in a role of barely conscious or human.

[15] And it still works the same way today. That sort of thing is why we call it 'surreal.' It is like being 'invisible' as a human being to those who appear to be unable or unwilling to see us or hear us.





6 POWERLESSNESS AND DEPERSONALIZATION

Eye contact and verbal contact reflect concern and individuation; their absence, avoidance and depersonalization.[1] The data I have presented do not do justice to the rich daily encounters that grew up around matters of depersonalization and avoidance. I have records of patients who were beaten by staff for the sin of having initiated verbal contact.[2] During my own experience, for example, one patient was beaten in the presence of other patients for having approached an attendant and told him, "I like you." Occasionally, punishment meted out to patients for misdemeanors seemed so excessive that it could not be justified by the most rational interpretations of psychiatric cannon.[3] Nevertheless, they appeared to go unquestioned. Tempers were often short.[4] A patient who had not heard a call for medication would be roundly excoriated, and the morning attendants would often wake patients with, "Come on, you m_ _ _ _ _ f _ _ _ _ _ s, out of bed!" [5]

Neither anecdotal nor "hard" data can convey the overwhelming sense of powerlessness which invades the individual as he is continually exposed to the depersonalization of the psychiatric hospital. It hardly matters which psychiatric hospital [6] the excellent public ones and the very plush private hospital were better than the rural and shabby ones in this regard, but, again, the features that psychiatric hospitals had in common overwhelmed by far their apparent differences.

Powerlessness was evident everywhere. [7]

The patient is deprived of many of his legal rights by dint of his psychiatric commitment. He is shorn of credibility by virtue of his psychiatric label. [8]His freedom of movement is restricted. He cannot initiate contact with the staff, but may only respond to such overtures as they make. [9]Personal privacy is minimal. Patient quarters and possessions can be entered and examined by any staff member, for whatever reason.[10] His personal history and anguish is available to any staff member (often including the "grey lady" and "candy striper" volunteer) who chooses to read his folder, regardless of their therapeutic relationship to him. His personal hygiene and waste evacuation are often monitored. The water closets have no doors.

At times, depersonalization reached such proportions that pseudopatients had the sense that they were invisible,[11] or at least unworthy of account. Upon being admitted, I and other pseudopatients took the initial physical examinations in a semipublic room, where staff members went about their own business as if we were not there.[12]

On the ward, attendants delivered verbal and occasionally serious physical abuse to patients in the presence of others (the pseudopatients) who were writing it all down. [13]Abusive behavior, on the other hand, terminated quite abruptly when other staff members were known to be coming. Staff are credible witnesses. Patients are not.

A nurse unbuttoned her uniform to adjust her brassiere in the present of an entire ward of viewing men. One did not have the sense that she was being seductive. Rather, she didn't notice us. A group of staff persons might point to a patient in the dayroom and discuss him animatedly, as if he were not there.[14]

One illuminating instance of depersonalization and invisibility occurred with regard to medication. All told, the pseudopatients were administered nearly 2100 pills, including Elavil, Stelazine, Compazine, and Thorazine, to name but a few. (That such a variety of medications should have been administered to patients presenting identical symptoms is itself worthy of note.) [15]Only two were swallowed. The rest were either pocketed or deposited in the toilet. The pseudopatients were not alone in this. Although I have no precise records on how many patients rejected their medications, the pseudopatients frequently found the medications of other patients in the toilet before they deposited their own. As long as they were cooperative, their behavior and the pseudopatients' own in this matter, as in other important matters, went unnoticed throughout. [16]

Reactions to such depersonalization among pseudopatients were intense. Although they had come to the hospital as participant observers and were fully aware that they did not "belong," they nevertheless found themselves caught up in and fighting the process of depersonalization. [17]Some examples: a graduate student in psychology asked his wife to bring his textbooks to the hospital so he could "catch up on his homework" this despite the elaborate precautions taken to conceal his professional association. The same student, who had trained for quite some time to get into the hospital, and who had looked forward to the experience, "remembered" some drag races that he had wanted to see on the weekend and insisted that he be discharged by that time.[18] Another pseudopatient attempted a romance with a nurse. Subsequently, he informed the staff that he was applying for admission to graduate school in psychology and was very likely to be admitted, since a graduate professor was one of his regular hospital visitors. The same person began to engage in psychotherapy with other patients all of this as a way of becoming a person in an impersonal environment.[19]

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[1] The people who were assessing and evaluating me and others don't seem to see a person when they look at me but rather an 'object.' My protagonist's version of this is the word "Item." We who are forced into this kind of position frequently state we feel 'invisible' which is then hears as a self contained 'symptom."

[2] In any other setting this would be seen as blatant abuse but not when done to us 'attention seekers' who COMPLAIN of abuse just to 'seek attention." (Watch for the ever present tautologies in this)

[3] The ever present assumption is that all this is about the 'reason' of touse not labelled as the 'sick' one(s). The 'reason' is not logic; it is group catharsis of suppressed emotion.

[4] Yes and if I question this staff behaviour, I am presumed to be stupid/crazy and seeing things that are not there.

[5] The patient however, is expected to smile and and have perfect manners underscoring the double standard.

[6] Invalidation by design and by constant pressure. Often this is what brought the patient there in the first place.

[7] And it still is evident to everyone except the staff. They are so used to doing it it feels normal to them.

[8] Yes, people stop hearing you or taking anything you say at face value, just as they are taught to do. Of course they are all sure they are right to behave this way too. We are being treated as less than human for our own good after all. The psychological isolation is enough in itself to break a person down. That is though of as 'good' too much of the time as those who are losing their sense of self are so much easier to reprogramme according to the programmer's desires. Denying the humanity of the 'other' will excuse almost anything.

[9] Much like slave owner and slave. Or jailer and prisoner.

[10] If s/he complains he may well get told to stop being such a baby since the patient is not as 'real' as the nurse who would not tolerate such treatment personally.

[11] Say, where have we heard that before? Of course it may well be 'interpreted' by others as literal and then mocked from a few feet away.The 'sane' LOVE mocking as part of their group catharsis.

[12] it sure doesn't seem the same as 'diabetes' to us...

[13] Well it is not like anyone who actually MATTERS is complaining though is it? It is only some 'whack job' like me.

[14] They might do it on the streets or buses as well and so do other members of the community at large who tend to take their cues from the 'experts' and who don't question their leaders or this group behaviour.

[15] Yes as it suggests that what you get 'diagnosed' with and what 'medication' is for you has more to do with WHO you get than WHAT you "have."

[16] Because it's the illusions around the power and control issues that really matter in the situation just like in the dysfunctional family.

[17] Imagine trying to fight that from the position of being psychiatrized when those you must fight have TOTAL control over you.

[18] The fear of the psychological trap he was in was starting to be felt even though in HIS case he knew he could get out with help. Imagine when it is real and there is no escape possible.

[19] When 'real' patients or prisoners or abused children do this same thing it is called "Stockholm Syndrome.

Comments

Links to Articles on the Groupthink Phenomenon

Wikipedia
Eight Main Symptoms of Groupthink
What is Groupthink?

Same Old Play; New Century

R.D. Laing
/Schizophrenia/Existentialism/Philosopher ...

DOCTORS:
Medical Killing and the Psychology of Genocide ©
Socialization to Killing
They [the SS doctors] did their work just as someone who goes to an office goes about his work. They were gentlemen who came and went, who supervised and were relaxed, sometimes smiling, sometimes joking, but never unhappy. They were witty if they felt like it. Personally I did not get the impression that they were much affected by what was going on — nor shocked. It went on for years. It was not just one day.
Auschwitz prisoner doctor

Robert Jay Lifton

Robert Jay Lifton, M.D. 

 
...In addition to cruel medical experiments, many Nazi doctors, as part of military units, were directly involved in killing. To reach that point, they underwent a sequence of socialization: first to the medical profession, always a self-protective guild; then to the military, where they adapted to the requirements of command; and finally to camps such as Auschwitz, where adaptation included assuming leadership roles in the existing death factory. The great majority of these doctors were ordinary people who had killed no one before joining murderous Nazi institutions. They were corruptible and certainly responsible for what they did, but they became murderers mainly in atrocity-producing settings. ..

 

International Cultic Studies

 

“A Bio Medical Mission was at the heart of Naziism”

“Socialization to Evil is all too easy...”

Robert Jay Lifton

 

When Patients See These Images, Their 'Interpretations' of What is Being Seen is Very Different to That of the 'Interpretations' of Others. These are Human Beings; Not Objects of Assessment, Interesting Cases, or 'Subjects'. If You Were Being Treated Like That, How Would YOU Feel? Happy?

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The Entire Rosenhan Article, On Being Sane in  Insane Places, along with my own commentary relating it to my own experiences in the system, will soon be available from start to finish as a PDF file in this  section of this webpage.

The Pseudo-Patient Study

Listen:

Availability:

Last broadcast on Mon, 27 Jul 2009, 11:00 on BBC Radio 4.

 

Synopsis

Claudia Hammond revisits another classic psychology experiment, David Rosenhan's Pseudo-Patient Study, gaining access to his unpublished personal papers to discover how it changed our understanding of the human mind, and its impact 40 years on.

Between 1969 and 1972, the clinical psychologist David Rosenhan and seven other people - none of whom had a psychiatric diagnosis - got themselves admitted to 12 different psychiatric hospitals around the United States. They did this by presenting with a single symptom, saying that they heard a voice which said words such as 'empty', 'dull' and 'thud.' Once admitted, they acted completely normally. Nevertheless, they were kept in for periods of between 8 and 52 days. Seven of them were diagnosed with schizophrenia and were released as being 'in remission'; not one of them was judged to be sane.

After Rosenhan published On Being Sane in Insane Places in the journal Science in 1973, the psychiatric profession went on the defensive to protest its diagnostic competence. The study struck at the heart of their attempts to medicalise psychiatry and be accepted as proper doctors. Its impact was felt when the third edition of the profession's bible, the Diagnostic and Statistical Manual, came out in 1980: changes had been made which brought more rigour to the diagnostic process.

However, as Claudia discovers from Rosenhan's unpublished papers, for him the study was less an experiment of diagnostic efficacy than an anthropological survey of psychiatric wards. In a chapter of the book he never finished, she reads his poignant account of his own first admission, and his sense that 'minimal attention was paid to my presence, as if I hardly existed'.

Now suffering ill health and unable to speak, Rosenhan delegates his friends and colleagues professor of social psychology at Stanford University Lee Ross and clinical psychologist Florence Keller to speak to Claudia and show her the box containing previously unpublished material which throws new light on one of the most controversial and famous psychology experiments.

 

 

Recommended for Psychiatrists who believe that chemical imbalance explains everything and that the experience of psychosis is meaningless: here is a movie with "Message'' for you:

K-Pax,
starring Kevin Spacey, as the psych patient who FEELS like an ''alien'' from another planet. I suggest you focus, not so much on the concrete details of his fascinating delusion but rather on the concepts behind the details. You just might learn something.

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