Questions 1-9
Fill the blanks with the words given beolw.
| discharged | frauds | an expert | talked | writing down |
| several weeks | hearing voices | pscudopatients | recording | a few months |
| phoned | genuine patients | face value | a journalist |
Who’s Crazy?
A bizarre experiment in the United States has demonstrated that psychiatrists cannot distinguish effectively between people who are mentally disturbed and those who are sane.
According to its originators, the experiment demonstrates the fallibility of conventional psychiatric diagnosis. It also lends considerable support to the position taken by radical psychiatrists like RD Laing, who argue that diagnoses of mental disease are often no more than convenient labels designed to make life easier for doctors.
Eight perfectly normal people, by shamming symptoms of a mild kind, successfully gained admission to psychiatric wards where they remained undetected for as long as they could stand it Once admitted, their behaviour was normal in every way, but doctors and nurses continued to treat them as disturbed.
In every case but one the diagnosis was schizophrenia. Once they were labelled as mentally ill, everything the “pseudopatients” did tended to confirm the diagnosis in the eyes of the medical staff, though other patients in the hospital were much less easy to convince.
The eight pseudopatients included three psychologists, a pediatrician, a psychiatrist, a painter and a housewife. All eight assumed false names and those connected with the medical profession also invented false occupations, so as not to attract special attention from fellow-professionals. The hospitals chosen ranged from expensive private units to dingy publicly-run institutions.
To gain admission, the pseudopatients told the whole truth about their lives, their emotions and their personal relationships — all of which were within the normal range — and lied only about their names, symptoms, and in some cases their occupations. The symptoms they complained of were hearing disembodied voices saying the words “empty”, “hollow” and “thud”.
This was sufficient in every case for them to be classified as mentally ill. Once inside J they stopped pretending and behaved as normally as they could. Their stays inside varied from 7 to 52 days, with an average of 19 days.
As many as a third of the real patients inside detected that they were frauds. "You’re not crazy. You're a journalist or a professor. You’re checking up on the hospital,’’ was a typical comment from a fellow-patient.
The pseudopatients spent much of their time taking extensive notes, but even this did not apparently raise any suspicions in the doctors’ mind. "Patient engages in writing behaviour," was the daily nursing comment on one patient, but nobody troubled to ask him what he was writing.
The experiment was carried out under the supervision of Professor D. L. Rosenhan of Stanford University, himself one of the eight fake patients. Writing about the experiment in this week’s Science, he concludes: “We cannot distinguish the sane from the insane in mental hospitals ... how many people, one wonders, are sane but not recognized as such in our psychiatric institutions? ... How many have been stigmatized by well-intentioned, but nevertheless erroneous, diagnoses?”
In Professor Rosenhan’s view, the hospital itself is an environment that distorts judgment As evidence, he quotes what happened to patients who asked doctors perfectly sensible questions. They took the form: “Pardon me, Dr. X, could you tell me when I will be eligible for ground privileges?” — or some similar request, courteously presented. In almost three quarters of the cases, the psychiatrist’s response was to walk on, head averted and some were staying for more than 3 weeks. Only one doctor in 25 stopped and tried to answer the question.
But the clinching piece of evidence comes from another experiment in which a hospital was warned that pseudopatients would be presenting themselves. Faced with this threat to their professional reputation, the doctors admitting patients became much more conservative in their diagnosis. Of 193 patients presenting themselves, one doctor was firmly convinced that 41 were frauds, while another doctor suspected 23. In fact, no fake patient had arrived at all.
In the present state of knowledge, there seems little hope of more accurate diagnostics. Doctors should try to err on the side of caution, in Rosenhan’s opinion, and “refrain from sending the distressed to insane places”. That, and a more benign environment inside institutions, could help to sort out the insane from the merely confused.
Who Says Who Is Mad?
How reliable are conventional psychiatric diagnoses? A study in which eight normal people attempted to gain admission to different psychiatric hospitals has given us some alarming answers. Each of the eight the hospital asking for an appointment. Upon arrival at the admission office, each of them complained of which appeared to be saying empty , “hollow”, and “thud". All of them were judged to be mentally ill, and all of them were admitted to hospital. As soon as these had been admitted to the psychiatric ward, they stopped simulating signs of abnormality and their behaviour was normal, friendly and cooperative. The only unusual aspect of their behaviour was that they spent a fair amount of time their observations about the ward, its patients, and the staff. All eight people were released within of admission. But it was not because the psychiatric staff discovered that they had been sane all the time. Instead, all of them were with a diagnosis of “schizophrenia in remission”, indicating that the deception had not been detected. Interestingly, several of the real patients became suspicious about the pseudopatients. They said things like “You are not crazy. You're or a professor. You are checking up on the hospital”. In a reversed experiment, 41 of the 193 were judged to be pseudopatients. If we accept these findings at they suggest that the distinction between the sane and the insane is so blurred that it is entirely possible for the sane to be mistaken for the insane — at least by psychiatrists.