Speaker 1: Welcome to stuff to Blow your Mind from house stop
Speaker 1: works dot com. Hey, who wasn't disposed to blow your mind?
Speaker 1: My name is Robert Lamb and I'm Joe McCormick. So, Robert,
Speaker 1: I've got a scenario for you. Throw it at me.
Speaker 1: Imagine you are on a jury. Okay, so you have
Speaker 1: been picked. You're not one of the people who got
Speaker 1: sent home early and normally get out of it. Yeah,
Speaker 1: but you're there on the jury and you're hearing the
Speaker 1: trial of a man who ran a muck in a
Speaker 1: bowling alley and so he went nuts. He took his
Speaker 1: bowling shoes off, he started throwing bowling balls at people,
Speaker 1: and fortunately no one was killed, but several people were
Speaker 1: seriously injured. And now this man is standing trial for
Speaker 1: his bowling ball rampage. And at trial, the man's attorney
Speaker 1: attempts to mount a defense based on the insanity plea,
Speaker 1: the claim that the accused did commit the acts in question,
Speaker 1: but is not responsible for his actions because his mental
Speaker 1: state prevents him from understanding them. Uh. And then the
Speaker 1: prosecution brings out an expert witness who is a highly
Speaker 1: respected and very confident sounding forensic psychiatrist who testifies that
Speaker 1: he has interviewed the defendant and found that the defendant
Speaker 1: shows all the normal signs of a person in perfect
Speaker 1: command of his actions. But then the defense brings forth
Speaker 1: another highly respected and confident sounding forensic psychiatrist who testifies
Speaker 1: exactly the opposite, that the defendant symptoms are consistent with
Speaker 1: those of a person who is disconnected from reality and
Speaker 1: cannot tell right from wrong. If you have no psychiatric
Speaker 1: expertise yourself, how are you supposed to tell which one
Speaker 1: of these expert witnesses is correct. This is the problem
Speaker 1: that one encounters with a number of these trials, right,
Speaker 1: because it ultimately comes down to a who can either
Speaker 1: who can make the better case for insanity or insanity,
Speaker 1: or if they both kind of make equally pressing cases,
Speaker 1: then it comes down to something as simple as a
Speaker 1: as a character judgment on the part on your part
Speaker 1: of the accused. Yeah, now, I might say that it's
Speaker 1: possibly true that this scenario I've come up with it's
Speaker 1: kind of contrived. It might be worth saying that apparently
Speaker 1: less than one percent of defendants in US cases plead insanity,
Speaker 1: and then for those that do enter such a plea,
Speaker 1: the rates of success are low, so pleading insanity typically
Speaker 1: doesn't get you very far in the US legal system.
Speaker 1: But the example does raise a few questions about how
Speaker 1: we deal with concepts of mental uh, let's say, mental
Speaker 1: normality and mental abnormality, as as the lay public understands them.
Speaker 1: Throughout this episode, we're gonna be using the words sane
Speaker 1: and insane to give a sense of the way that
Speaker 1: they're used in the milieu of the experiment we're going
Speaker 1: to talk ab out in this episode. But every time
Speaker 1: you hear those words, you should imagine that we're putting
Speaker 1: some huge, big finger quotes around them, because, as we
Speaker 1: discussed at the end, these are probably not the most
Speaker 1: useful terms or concepts for describing or helping people in
Speaker 1: the real world, but they still are salient concepts too
Speaker 1: many people. Like if you take the average person and
Speaker 1: ask them if they think the difference between sane and
Speaker 1: insane is a real, actual thing and they can tell
Speaker 1: the difference, they'll say, yeah, right, yeah, I mean, we
Speaker 1: we encountered this all the time, right The just the
Speaker 1: basic idea that I'm here on this side of the wall,
Speaker 1: and then there are people inside the hospital, there are
Speaker 1: people receiving care, there are people that are incarcerated. That's
Speaker 1: the insane side of the wall, and there's a bearer
Speaker 1: between us. It's kind of a Sneeches and star Belt.
Speaker 1: He'd sneeches approach to mental health. You can easily divide
Speaker 1: everybody into one of two categories. Either those that have
Speaker 1: it all thegether and are seeing everything straight and have
Speaker 1: an acceptable understanding of reality, and in those who do not. Yeah,
Speaker 1: And so today we want to talk about a landmark
Speaker 1: experiment in the history of psychology, one that's been written
Speaker 1: about and talked about a lot for years, often celebrated.
Speaker 1: It's highly cited, and it concerns the question of how
Speaker 1: do we know precisely what constitutes normality or mental illness?
Speaker 1: And if there is a difference between sanity and insanity,
Speaker 1: can anybody tell the difference? Even professionals, Yeah, especially professionals
Speaker 1: that because this uh, I mean, that's what this whole
Speaker 1: experiment hinges on is is how do our professionals, how
Speaker 1: do our mental health professionals judge uh and and evaluate
Speaker 1: individuals that are entering the system. Yeah. So the experiment
Speaker 1: in question was carried out by the Stanford professor and
Speaker 1: psychologist David Rosenhan, who lived from nineteen twenty nine to
Speaker 1: two thousand twelve, And I found this in an obituary
Speaker 1: of him, that his education path seemed to be interestingly varied.
Speaker 1: So he got a BA in mathematics in nineteen fifty
Speaker 1: one from Yeshiva College, and then and then a master's
Speaker 1: in economics, and then a PhD in psychology from Colombia,
Speaker 1: and then he went on to sort of branch into
Speaker 1: two different fields and work on unifying concepts between them.
Speaker 1: So he's a professor of law and of psychology. And
Speaker 1: according to his Stanford obituary which I read, he he
Speaker 1: was sort of known for applying psychology to legal practices
Speaker 1: like jury selection and jury consultation. And he held various
Speaker 1: honors during his lifetime, like being the head of the
Speaker 1: A p A and and stuff like that. So he
Speaker 1: was very respected psychologist and jurist, one might say. But
Speaker 1: in nineteen seventy three, rosen Hand published in the journal
Speaker 1: Science a piece that was old on being sane in
Speaker 1: insane places. And it begins with this question that we
Speaker 1: talked about a minute ago. If sanity and insanity exist,
Speaker 1: how shall we know them? That's what he says. Yeah,
Speaker 1: He presents this quite nicely, and as we were discussing
Speaker 1: prior to to the recording session here, the whole paper
Speaker 1: is just so well written. It's so accessible to uh to,
Speaker 1: to the average leader, to the average reader, it's not
Speaker 1: it's not you know, lost in a bunch of psycho babble. Yeah,
Speaker 1: you can find this paper online and I do highly
Speaker 1: recommend reading it as it is. It is not just
Speaker 1: clear and very interesting, it's a great piece of writing.
Speaker 1: But so Rosenhan opens by pointing out the same thing
Speaker 1: we did at the beginning of our podcast. He says
Speaker 1: that it's common in murder trials where the defendant sanity
Speaker 1: is under dispute, for perfectly respectable psychiatrists to testify in
Speaker 1: direct contradiction of one another about the mental state of
Speaker 1: the accused. And I actually went and read a couple
Speaker 1: of articles about what happens when somebody tries to enter
Speaker 1: an insanity polae in court, like how can the the
Speaker 1: experts try to figure out whether they are faking it
Speaker 1: or not? And there are various methods they have, But
Speaker 1: one of the things that struck me about the way
Speaker 1: that forensic psychiatrists go about trying to evaluate the mental
Speaker 1: state of a person accused of a crime is they're
Speaker 1: trying to see if the person fits a known diagnosis.
Speaker 1: So they're trying to say, here the known symptoms of
Speaker 1: schizophrenia or here the known symptoms of x known state
Speaker 1: of psychosis as described in the literature, and can the
Speaker 1: defendant match the description that I have here? And if
Speaker 1: they just present sort of like an odd collection of symptoms,
Speaker 1: it's generally ruled that they're probably faking right there. They're
Speaker 1: they're just putting together things that seem to them like
Speaker 1: they qualify as crazy, right, And one of the big
Speaker 1: ones that often shows up is someone will be they'll
Speaker 1: be trying to defend the accused by saying that they
Speaker 1: are insane, and then the prosecution will point out something
Speaker 1: something in their actions that is clearly premeditated and uh,
Speaker 1: thus uh disputing any idea that this was just a
Speaker 1: spontaneous manifestation. Oh yeah. There are often very various features
Speaker 1: of the crime itself that make it clear that the
Speaker 1: person was in a fairly lucid state when they committed that,
Speaker 1: like if they try to destroy evidence and you know,
Speaker 1: do smart, clear thinking ways of avoiding responsibility for the crime.
Speaker 1: But anyway to investigate this question. If sanity and insanity exist,
Speaker 1: how shall we know them? David Rosenhan staged an experiment
Speaker 1: that's one of the most interesting I've ever come across
Speaker 1: in the history of psychology, and it was essentially an
Speaker 1: under cover sting operation to determine what it takes to
Speaker 1: convince a mental health facility that a person is insane,
Speaker 1: and then what it takes to convince them that that
Speaker 1: same person is sane. Indeed, so this took place between
Speaker 1: nine seventy two, So they're there as we'll discuss, uh,
Speaker 1: their various locations that are employee. Here you have eight
Speaker 1: same people and they're gained a secret admission to twelve
Speaker 1: different hospitals. So we're talking three women, five men, um
Speaker 1: one of the psychology graduate student in his twenties. The
Speaker 1: remaining seven were older and quote unquote established. So among
Speaker 1: them you have three psychologists, a pediatrician, a psychiatrist, a painter,
Speaker 1: and a housewife. And uh oh, and then also rosen himself.
Speaker 1: Rosenhan himself is involved here to Yeah, he was one
Speaker 1: of the mental health professionals, and the mental health professionals
Speaker 1: gave false professions in their biographies. They were describing themselves
Speaker 1: to the these mental hospitals basically for fear of being
Speaker 1: treated differently than other patients. And that makes sense to me,
Speaker 1: because if if you want to know how the hospital treats,
Speaker 1: you know, the average person who walks up, you don't
Speaker 1: want to say hi, I'm a psychiatrist. I know, they
Speaker 1: might sort of be on their guard when they're dealing
Speaker 1: with you. And likewise, they went in under false names
Speaker 1: as you might expect. Yes, Rosenhan himself was one of
Speaker 1: the patients, um though he was not a fully clandestined
Speaker 1: one as the other one as the other people were.
Speaker 1: He Rosenhan himself was the first of these pseudo patients
Speaker 1: as they're called, and his presence was quote known to
Speaker 1: the hospital administration and the chief psychologist and so far
Speaker 1: as he says, I can tell to them alone. So
Speaker 1: he was known, but nobody else was known, and he
Speaker 1: was only known to a couple of people at the
Speaker 1: hospital and nobody else there. Yeah, there has I mean,
Speaker 1: obviously you would have to have some sort of arrangement
Speaker 1: employ here. You can't just They couldn't have carried out
Speaker 1: this experiment by just doing cold blind calls on various institutions, right,
Speaker 1: but no nobody else was known to anybody, which just him.
Speaker 1: And so the eight patients that they went to twelve
Speaker 1: different hospitals. So obviously some of them were admitted more
Speaker 1: than once, and they went to twelve different hospitals in
Speaker 1: the sample, and they were trying to cover a broad
Speaker 1: range of the different kinds of mental facilities that you
Speaker 1: could go to. So they were in five different states
Speaker 1: on the east and west coast, and the hospitals were
Speaker 1: a varying condition. Some were old and shabby, as they said,
Speaker 1: and some were newer. They had different levels of funding,
Speaker 1: different patients to staff ratios, and only one of the
Speaker 1: twelve hospitals was a private hospital and that made an
Speaker 1: interesting difference in how the diagnoses were treated. Later. But
Speaker 1: how did the so called pseudo patients get admission to
Speaker 1: the hospital. It was a pretty simple trick, and they
Speaker 1: all did exactly the same thing. Yeah, they all show
Speaker 1: up and uh claim that they are hearing voices, that
Speaker 1: they're experiencing auditory hallucinations, Yes, which of course is is
Speaker 1: is often a key symptom of schizophrenia, right, And so
Speaker 1: when they were asked about what the voices said, the
Speaker 1: participant would say that the voice was an unfamiliar voice
Speaker 1: of the same sex as the pseudo patient and that
Speaker 1: they were generally difficult to understand, but that they had
Speaker 1: said the words quote, empty, hollow, and thud, and I
Speaker 1: was like, wow, what an interesting combination of words. What
Speaker 1: would a psychiatrist make of that? But Rosenhunt explains that
Speaker 1: these words were chosen because they sort of went both ways,
Speaker 1: and number one, they formed an easy association with concepts
Speaker 1: of existential anxiety, like you could imagine somebody having thoughts
Speaker 1: like my life is empty. I'm so you know, existence
Speaker 1: is so hollow? Should I kill myself and land on
Speaker 1: the floor with a thud? But they never said any
Speaker 1: of that explicitly, just empty, hollow and thud. Those were
Speaker 1: the only words, empty hollow, that that would be a
Speaker 1: great name for like a nineties goth act. Oh yeah, yeah, yeah,
Speaker 1: I love it. That's a that's a tattoo already on somebody.
Speaker 1: But anyway, they also picked these because this type of
Speaker 1: psychosis described in these terms did not match any in
Speaker 1: the medical literature at the time. So this didn't match
Speaker 1: an existing diagnosis that could be found. Okay, so it's
Speaker 1: a little more abstract than just it was less on
Speaker 1: the nose. If someone is showing up and saying, oh, well,
Speaker 1: I have this symptom, the symptom in this system, and
Speaker 1: they go, oh, those symptoms are exactly what I have
Speaker 1: on the paper here. More, it leaves the uh, the
Speaker 1: individual making the diagnosis, room for at least the illusion
Speaker 1: of discovery. R So, as you would expect, the people
Speaker 1: who showed up at the hospitals faking these symptoms were
Speaker 1: immediately detected and sent home. Oh no, wait, that's not
Speaker 1: the case. In fact, all twelve times they were admitted
Speaker 1: to the hospitals, with eleven out of the twelve times
Speaker 1: they were diagnosed with schizophrenia, and then interestingly, one out
Speaker 1: of the twelve times they were diagnosed with manic depressive psychosis,
Speaker 1: which Rosenhan. Rosenhan points out that the manic depressive psychosis
Speaker 1: had at the least of the time a more favorable
Speaker 1: prognosis than schizophrenia, so that this was a condition that
Speaker 1: you were more likely to recover from. Things looked better
Speaker 1: for you had a better outlook, and for whatever reason,
Speaker 1: this one different diagnosis. The better diagnosis took place at
Speaker 1: the one private hospital in the study, but note that
Speaker 1: it's not necessarily a more accurate diagnosis because these people
Speaker 1: were all faking and all said the same thing. It's
Speaker 1: just the diagnosis that tended to turn out better for
Speaker 1: the patient. Okay, So this is adding possibly an interesting
Speaker 1: layer of class bias into what they found these hospitals
Speaker 1: behave like. So they were admitted, they were put into
Speaker 1: these hospitals, and then what did they do. Did they
Speaker 1: continue to pretend that, oh, I'm hearing these voices that
Speaker 1: at step, of course, is to sort of straighten up
Speaker 1: and said and uh and resume their normal behavior, claim
Speaker 1: that their symptoms are completely gone. But it's important to
Speaker 1: note they're not coming clean either. They're not saying actually surprised.
Speaker 1: This is all part of a study, right, They're just saying, oh,
Speaker 1: I feel fine now, I'm not experiencing those auditory hallucinations
Speaker 1: that I was talking about earlier. Right. They immediately resumed
Speaker 1: normal behavior, claim their symptoms were entirely gone and they
Speaker 1: were on their best behavior. So they were very good patients. Uh,
Speaker 1: at least they tried to be, and they self reported
Speaker 1: that they were good patients. They were described by the
Speaker 1: nursing reports kept at the facilities as quote friendly, cooperative,
Speaker 1: and exhibited no abnormal indications. So according to the reports,
Speaker 1: they didn't do anything weird or disruptive. Uh that they
Speaker 1: seemed perfectly well behaved and normal. But nobody caught on.
Speaker 1: Well maybe not nobody. None of the people who should
Speaker 1: have caught on caught on. The the hospital staff uh
Speaker 1: and psychologist, psychiatrists, the attendants, the nurses. Nobody caught onto
Speaker 1: the fact that these people were faking, but some of
Speaker 1: the other patients did. In fact, that was fairly common.
Speaker 1: So during the course of the of three different hospitalization records,
Speaker 1: participants recorded that out of a hundred and eighteen fellow
Speaker 1: patients on the admissions ward, thirty five of them quote
Speaker 1: voiced their suspicions somewhat vigorously. You're not crazy, you're a
Speaker 1: journalist or a professor, referring to the continual note taking
Speaker 1: you're checking up on the hospital. So the other patients
Speaker 1: were detecting what was going on with these people, but
Speaker 1: the hospital staff was not. Huh, that's fascinating. So how
Speaker 1: did the staff respond. They forced the studio pay since
Speaker 1: first of all, to admit to having a mental illness
Speaker 1: and made him agree to take antipsychotic drugs as a
Speaker 1: condition of their release. So there they said, Okay, you're
Speaker 1: doing better. You're you're not having you're not experiencing these
Speaker 1: auditory hallucinations anymore. UM, to sign this and then agree
Speaker 1: to this a particular drug treatment, and you can go
Speaker 1: on your way. Okay. So how long did that take?
Speaker 1: Was that just like two or three days before they
Speaker 1: did that? Between let's see whether the length of the
Speaker 1: hospital stays or between seven and fifty two days. So
Speaker 1: an average day of nine average day of nineteen days.
Speaker 1: So this one overnight, Yeah, a week confined to the
Speaker 1: hospital was the shortest. Somebody was in there for fifty
Speaker 1: two days. In fact, that might have been rosen Hunt himself.
Speaker 1: I'm not sure, but there was a point where he said,
Speaker 1: I didn't know how long I was going to be
Speaker 1: in there, but I thought it would be a few days.
Speaker 1: I didn't expect it to be two months. Um. But yeah,
Speaker 1: an average day of nineteen days in the hospital with
Speaker 1: no symptoms whatsoever while they're there, and then a note
Speaker 1: on all of those anti psychotic drugs that they were
Speaker 1: required to take as a condition of their release. Um.
Speaker 1: The report says that the pseudo patients were administered more
Speaker 1: than two thousand pills. It was like pills over the
Speaker 1: course of this including the drugs uh, I don't even
Speaker 1: know if I'm not familiar with these, elavil, stella, zine, composine, thorazine,
Speaker 1: I know those, uh, to name a few of them.
Speaker 1: And then Rosenhan points out in this note that quote
Speaker 1: such a variety of medications should have been administered to
Speaker 1: patients presenting identical symptoms is itself worthy of note? It
Speaker 1: kind of makes you wonder about the extent to which,
Speaker 1: at least at the time, some of the drugs prescribed
Speaker 1: for psychological diagnoses were I don't know, perhaps somewhat arbitrary,
Speaker 1: but anyway, that they didn't take the pills, so only
Speaker 1: two pills over the course of the entire experiment were swallowed.
Speaker 1: The rest they pocketed deposited in the toilet. And then
Speaker 1: they also said that they noticed some of the real
Speaker 1: patients doing the same thing, because I mean, and they
Speaker 1: had to actually consume two of them in order to
Speaker 1: set the precedent that they were taking them. Because that's
Speaker 1: because that's a common reaction to being administered all these pills,
Speaker 1: right that you can start start refusing to take them
Speaker 1: or secret them away. Yeah, well, at least they for
Speaker 1: whoever took those two pills, I guess. I mean the
Speaker 1: fact that they could get away with not taking the
Speaker 1: pills for so long, I mean almost nobody took the
Speaker 1: pills and then they didn't get caught. I think that's
Speaker 1: interesting also key to the experiment, of course, that they're
Speaker 1: not taking all these pills and then because then you
Speaker 1: would have to factor in, well to what effect is
Speaker 1: this massive drug intake affecting their behavior and therefore, uh,
Speaker 1: their reception by the staff. Right, So you had all
Speaker 1: these diagnoses, you had these schizophrenia diagnosis, but then people
Speaker 1: they reported their symptoms were gone and eventually were released,
Speaker 1: though sometimes after a kind of a long stay in
Speaker 1: the hospital that I that I know in many cases
Speaker 1: was not pleasant for these people. Yeah, and they were
Speaker 1: all diagnosed with schizophrenia quote in remission before their release.
Speaker 1: And this is a really key point because Rosenhn is
Speaker 1: careful to point out the distinction between in remission and
Speaker 1: sane It's suggesting sort of the categorization of schizophrenia in
Speaker 1: remission retains a level of categorical stigma that's associated with
Speaker 1: the fact that the patient is still considered fundamentally an
Speaker 1: insane person. They're just not showing symptoms right now. Like,
Speaker 1: once you have been deemed insane, it almost seems as
Speaker 1: if the hospital will not consider you sane again. Yeah,
Speaker 1: it's it's it's as if it's affected your sort of
Speaker 1: baseline sanity score, and it's it's forever going to be
Speaker 1: a little lower, no matter what your particular manifestation level
Speaker 1: is going to be. Yeah, though then again, I mean
Speaker 1: even that might be more progressive than what was actually
Speaker 1: displayed in practice in the hospital, because I don't know,
Speaker 1: it seems kind of cruel to think of sanity on
Speaker 1: a like sliding scale of numbers, like a like a
Speaker 1: D one role. But what we have here doesn't even
Speaker 1: seem like the sliding scale. You're just either in the
Speaker 1: club or you're not. You're in the normal sane person club,
Speaker 1: or you are outside that club and you don't get
Speaker 1: to get in. You either have the star or you don't. Now,
Speaker 1: I do want to mention as well that that in
Speaker 1: in the paper, Rosenhan also comments on the conditions that
Speaker 1: that they encountered, then he himself encountered a part of Yeah,
Speaker 1: just talking about like the language that was used, the
Speaker 1: attitude that was used against the patients, as well as
Speaker 1: just the feeling of powerlessness that that that he felt
Speaker 1: inside these institutions. And uh and therefore the ramifications that
Speaker 1: that that those conditions would have upon any individual that's
Speaker 1: placed in their care, especially someone who might have some
Speaker 1: level of of actual mental illness. But one of the
Speaker 1: main takeaways of this, at least the first half of
Speaker 1: this experiment, and we'll get to the very interesting second
Speaker 1: half in a moment um, is what they called called
Speaker 1: the uniform failure to recognize sanity. And Rosenhan points out
Speaker 1: on the paper that that shouldn't be attributed to these
Speaker 1: just being like bad hospitals, because they went for a
Speaker 1: whole range of them. They went from you know, they
Speaker 1: went to some shabby hospitals, but then also to some
Speaker 1: very nice hospitals, and it just seemed like, you know,
Speaker 1: once you were there and you presented a few symptoms,
Speaker 1: they said, okay, yes you are insane. You know, given
Speaker 1: all of this, I can imagine if I was running
Speaker 1: a hospital at the time of rosen Hans's experiment, I
Speaker 1: would I would respond with, well, you know what that
Speaker 1: could ever happened. Here, it never happened. Here's one thing
Speaker 1: for these other institutions to fail to to to see
Speaker 1: through this scheme and to properly diagnose these pseudo patients.
Speaker 1: But you try that mess with me, buddy, and I'm
Speaker 1: going to spot your pseudo patients and kick them right
Speaker 1: out the door. Give me your best shot. And in fact,
Speaker 1: there was there was one hospital that did exactly that.
Speaker 1: There was a hospital administration that took issue with rosen
Speaker 1: Hans findings and they put a challenge to him. They
Speaker 1: were like, okay, okay, hold on a second, you send
Speaker 1: us your pseudo patients and we will rout them out.
Speaker 1: And what did Rosahn do? He agreed, he so he said,
Speaker 1: I'll send you send them, I'll send them on beyond
Speaker 1: your guard. And so they were on their guard. In
Speaker 1: the following weeks, out of one new patients that the
Speaker 1: staff identified, forty one as potential pseudo patients, with twenty
Speaker 1: three receiving suspicion from at least one psychiatrist and nineteen
Speaker 1: of these receiving suspicion from one psychiatrist and one other
Speaker 1: staff member. So they were and they they upped their security.
Speaker 1: They were ready for it, and they were pointing out
Speaker 1: pseudo patients left and right, calling out of the woodwork.
Speaker 1: Uh so how many did rosen Han actually send zero?
Speaker 1: He sent nobody right. So this is an interesting because
Speaker 1: now we have two different types of classical errors that
Speaker 1: are being attributed to a psychiatric diagnosis in these hospitals.
Speaker 1: We have the type two error, which is the false positive.
Speaker 1: You have somebody who comes in, uh, fakes a very
Speaker 1: simple simple symptom, resumes normal behavior and is not detected
Speaker 1: as a sane person. So that's a that's a false
Speaker 1: positive identification of mental illness. Then in the second half
Speaker 1: we've got tons of false negatives. People showing up with
Speaker 1: actual complaints saying I have a mental illness, I need help,
Speaker 1: and the hospital saying you faker. It's like a game
Speaker 1: of Werewolf where you don't have an individual with the
Speaker 1: werewolf roll. Uh do, you just end up making accusations
Speaker 1: left and right. Okay, So what conclusions can we draw
Speaker 1: from this experiment? Now? Remember, as we said, this was
Speaker 1: back in nineteen seventy three, published in seventy three, took
Speaker 1: place between sixty nine and seventy two, So, uh, it's
Speaker 1: not a direct common terry on the current day. Yeah,
Speaker 1: so this was back then, and we can at least
Speaker 1: hope that things are to some extent largely informed by
Speaker 1: this study better today, but at least back then. The
Speaker 1: takeaways where that the diagnostic process for distinguishing sanity and
Speaker 1: insanity is not reliable. It has shown massive errors, just
Speaker 1: complete failure to identify correctly people's mental state going both ways,
Speaker 1: the type one error and the type two error. Uh.
Speaker 1: The other takeaway that I sort of get from this
Speaker 1: is that sane and insane do not seem to be
Speaker 1: helpful designations to begin with, but rather the sort of
Speaker 1: arbitrary and likely harmful ones. They might be a completely
Speaker 1: artificial distinction. Now, that doesn't mean that mental illness isn't
Speaker 1: real and that you can't experience, you know, true suffering
Speaker 1: and symptoms from afflictions that affect the mind and the psyche.
Speaker 1: These are definitely real things, and that's acknowledged by rosen
Speaker 1: Han in the study. But it's more that these catch
Speaker 1: all categories that fundamentally designate a person as sane or
Speaker 1: insane just don't make sense and they don't really work.
Speaker 1: So I think the study provides a powerful example of
Speaker 1: white might be best to find different ways of talking
Speaker 1: about mental illness. Thus some you know, saying like Ted
Speaker 1: has a mental illness rather than Ted is a mentally
Speaker 1: ill person. Yeah, and this is very much an issue
Speaker 1: still today, just in our attempts to try and talk
Speaker 1: about mental illness and deal with it. And of course
Speaker 1: this has been in the news a lot recently, uh,
Speaker 1: in response to the gun violence in America. Totally, I
Speaker 1: know what you mean. Whenever there's another mass shooting in America,
Speaker 1: one of the narratives that pops up in the media
Speaker 1: is whether or not we need to do something in quotes,
Speaker 1: do something about mental illness to stop things like this
Speaker 1: from happening. Now. I think there probably are a lot
Speaker 1: of ways we could improve how we treat and care
Speaker 1: for people with mental illnesses. But I think sometimes I
Speaker 1: worry that a subset of the people advocating this narrative
Speaker 1: of do something about mental illness are less focused on
Speaker 1: specific ways we could improve treatment and more focused on,
Speaker 1: in a kind of vague and general way, just increasing
Speaker 1: stigma even more, which is unfounded. I mean, most people
Speaker 1: who have a mental illness of one kind or another
Speaker 1: are not dangerous and do not commit acts of violence.
Speaker 1: But it's just this idea that you know that having
Speaker 1: a mental illness makes you sort of a tainted person,
Speaker 1: you're just automatically suspect. And that's certainly a major theme
Speaker 1: in rosen Hans's experiment. Yes, absolutely that. The third main
Speaker 1: takeaway that I wanted to introduce was, and I wanted
Speaker 1: to quote rosen Hans's own words because I can't put
Speaker 1: it any better. Quote. Having once been labeled schizophrenic, there
Speaker 1: is nothing the pseudo patient can do to overcome the tag.
Speaker 1: The tag profoundly colors others perceptions of him and his
Speaker 1: behavior unquote. So instead of observing a person's behaviors to
Speaker 1: determine mental illness, the observers use the diagnosis of mental
Speaker 1: illness to interpret the behaviors. So the context seems to
Speaker 1: rule how observations of behavior are interpreted. Sitting in a
Speaker 1: coffee shop writing in a journal is considered by most
Speaker 1: people normal behavior. Sitting in a mental institution with a
Speaker 1: diagnosis of schizophrenia writing in a journal is considered pathological
Speaker 1: writing behavior. The behavior is the same, but they're using
Speaker 1: the diagnosis to to interpret the meaning of what the
Speaker 1: person's actions are, and the same thing is reported by
Speaker 1: Rosen Han in some of the therapy sessions and the
Speaker 1: notes that were taken on those. So a person can
Speaker 1: talk about the relationships in their life and say, um,
Speaker 1: you know, my wife and I rarely argue. Every now
Speaker 1: and then we get angry with one another, but most
Speaker 1: of the time we have a very loving relationship. Okay,
Speaker 1: so that sounds perfectly normal. But if you're trying to
Speaker 1: look at this with a kind of with an eye
Speaker 1: for instability and and you know, problems in one's personal life,
Speaker 1: you can just latch onto the part where you said, well,
Speaker 1: every now and then we get angry and argue, and say,
Speaker 1: you know has issues with angry arguments at home, and
Speaker 1: that becomes a part of this psychological diagnosis. I mean,
Speaker 1: everybody gets angry with people that they love every now
Speaker 1: and then. It happened, it's totally normal. Now to just
Speaker 1: to put this in a certain uh in the framework
Speaker 1: of the time and sort of in the timeline of
Speaker 1: American um psychiatric care, I found this pretty helpful. So,
Speaker 1: according to American psychiatrist Alan Francis, who was a chair
Speaker 1: on the task force that created the American Psychiatric Association's
Speaker 1: Diagnostic and Statistics Manual four or the d s M
Speaker 1: four UM in war Uh. He said that the predominant
Speaker 1: post war, post World War two model and psychiatry was
Speaker 1: psychoanalytic with an extremely confident focus on treatment. So it's
Speaker 1: out there, we can treat it, and we can treat
Speaker 1: it well. That was kind of according to Francis, that
Speaker 1: was we know what we're doing here. Step back, Yeah,
Speaker 1: let the professionals handle it. The institutions can handle it.
Speaker 1: But then of course came rosen Han's experiment, and along
Speaker 1: with some other revelations, it really took the wind out
Speaker 1: of everyone's sales, right, exposing the unreliability of psychiatric diagnosis.
Speaker 1: And I can imagine if you worked in the field
Speaker 1: of psychiatry or psychology at the time, this would come
Speaker 1: as a huge blow to you. Yeah. Indeed. Uh. In
Speaker 1: his book Saving Normal and Insiders Revolt against Out of
Speaker 1: Controlled Psychiatric Diagnosis ds M five, Big Pharma and the
Speaker 1: Medicalization of Ordinary Life, Francis writes that before d s
Speaker 1: M three, which very much previous edition, yeah, but but
Speaker 1: still comes after rosen Hans experiments UM, he said that
Speaker 1: psychiatry was quote pure art forms, something brilliant, sometimes brilliant
Speaker 1: usually idiosyncratic and always chaotic. Yeah, I mean, I have
Speaker 1: heard this charge before. H And I don't want to
Speaker 1: make judgments against psychiatry or psychology. I mean, I don't
Speaker 1: have any relevant expertise that can let me stand in
Speaker 1: judgment of them. But I've definitely heard people make the
Speaker 1: accusation than in some ways, especially historically, psychology is more
Speaker 1: of an art than a science. I could see where
Speaker 1: one could make a case for that. Yeah. And then
Speaker 1: of course another feature of it is that seemingly, at
Speaker 1: this time at least, there is a lot that it
Speaker 1: seems to grow out of an expert's intuitions, you know,
Speaker 1: like that you can't it's difficult to do very accurate,
Speaker 1: unbiased quantitative measurements of a person's psychological state. So you
Speaker 1: I mean, I guess you can derive sort of standard
Speaker 1: batteries like of of question errors and and psychological tests.
Speaker 1: But still in the field, I think you're going to
Speaker 1: have a lot of intuition coming into play. You're having
Speaker 1: an expert who knows something about the field, has read
Speaker 1: the medical literature, knows what the standard diagnoses and the
Speaker 1: descriptions of them are, and then sort of looks at
Speaker 1: what he or she sees and gets a feeling or
Speaker 1: intuition about what's going on here. Then then again, I
Speaker 1: think you could probably also say sometimes medical doctors, you know,
Speaker 1: somatic illness doctors, would do the same thing, say, you know,
Speaker 1: I'm just kind of looking at your symptoms and getting
Speaker 1: a feel for the fact that you've probably just have
Speaker 1: some virus infect viral infection of the upper respiratory system. Well,
Speaker 1: you know, that actually leads me to one of the
Speaker 1: big criticisms that was leveled against rosen Hans experiment at
Speaker 1: the time, um and uh. And one of the individuals
Speaker 1: doing this was the Columbia psychiatrist and DASM three chair
Speaker 1: Robert Spitzer, And that is that psychiatric diagnosis relies on
Speaker 1: the patient honestly reporting what they feel, and rosen Hans
Speaker 1: experiment would seem to bend, if not break that right
Speaker 1: because each pseudo patient story is a lie. And and
Speaker 1: let's not forget that a healthy person can still enter
Speaker 1: a hospital emergency room complain of non existent pain and
Speaker 1: received treatment. That might be a useful criticism, But then again,
Speaker 1: I think a lot of the point of rosen Han's
Speaker 1: experiment was about the hospital not catching on over time,
Speaker 1: So I can maybe understand the original admission to the hospital,
Speaker 1: especially if the hospital is strapped for time, they can't
Speaker 1: spend a lot of time with the patient. Um, but
Speaker 1: they didn't have complex, fake psychological personas that were designed
Speaker 1: cleverly to trick the psychologist. They just said empty, hollow thud,
Speaker 1: heard a voice said it. That's it. They get in
Speaker 1: and then they completely all symptoms went away, normal behavior,
Speaker 1: and then they couldn't get out for a long time. Yeah.
Speaker 1: And and to your point, they're judging the individual who
Speaker 1: is no longer claiming to have any kind of auditory hallucinations.
Speaker 1: They are diagnosing them as something other than saying yes
Speaker 1: absolutely and again playing on that that really problematic distinction,
Speaker 1: the overall categorical distinction between sane and insane. But I
Speaker 1: think this is a really strong indication that it is
Speaker 1: not good for us to use these categories of sane
Speaker 1: person and insane person. Just a fact I want to
Speaker 1: mention is that according to the U s National Institute
Speaker 1: of Mental Health in there were an estimated forty three
Speaker 1: point eight million adults aged eighteen or older in the
Speaker 1: United States with any mental illness. So that's just any
Speaker 1: mental illness of all the kinds recognized in the past year,
Speaker 1: and this represented eighteen point five of all US adults.
Speaker 1: So there's a huge chunk of people in any given country.
Speaker 1: But we have the stats here for the United States
Speaker 1: that at any given time will experience a mental illness.
Speaker 1: But this doesn't mean they've always had it. It doesn't
Speaker 1: mean they always will have it. It doesn't mean they're
Speaker 1: a bad or suspect person for having it. I mean,
Speaker 1: we don't think that about people who have illnesses of
Speaker 1: the body. We don't label somebody who has a somatic
Speaker 1: body illness as a sick person who from thereafter is
Speaker 1: known as a person who has been sick. Yeah. I
Speaker 1: mean it's like we end up treating the human mind
Speaker 1: as this fixed state that is not susceptible to change
Speaker 1: and influence. Yeah, it's almost as if we're importing a
Speaker 1: kind of magical thinking. They're too, Like the having a
Speaker 1: mental illness is in a very unfair way treated like
Speaker 1: being in a state of sin or being in uh,
Speaker 1: having some kind of magical taint to you that makes
Speaker 1: people afraid of you. This is a thing that was
Speaker 1: described in the part of the report where rosen Han
Speaker 1: talks about the conditions inside the hospital, which is a
Speaker 1: very also a very salient part of the report and
Speaker 1: another great reason you should read it. But one of
Speaker 1: the things he talks about is the lack of contact
Speaker 1: between the staff and the patients, like that there's just
Speaker 1: really very little interaction, and that sometimes it's as if
Speaker 1: people who don't claim to suffer from a mental illness
Speaker 1: were afraid that they could catch it by being near
Speaker 1: or interacting with the people who did have a mental illness.
Speaker 1: There was like a like an aversion that drove them away.
Speaker 1: And this was partially explaining the lack of interaction between
Speaker 1: the staff and the patients. Yeah, and I can definitely
Speaker 1: imagine an unwillingness to have to look at and think
Speaker 1: about this thing that we UH often have an inability
Speaker 1: to to talk about and to to even quantify in
Speaker 1: a in a meaningful sense. There was one last paragraph
Speaker 1: I wanted to read from rosen Hans studied because I
Speaker 1: just found it absolutely fascinating. I wonder what you thought
Speaker 1: about this, Robert, but let me read it first. The
Speaker 1: quote is conceivably when the origins of and stimuli that
Speaker 1: give rise to a behavior are remote or unknown or
Speaker 1: when the behavior strikes us as immutable, trait labels regarding
Speaker 1: the behavior arise the trait labels like insane that we
Speaker 1: were talking about. When, on the other hand, the origins
Speaker 1: and stimuli are known and available, discourse is limited to
Speaker 1: the behavior itself. Thus, I may hallucinate because I am sleeping,
Speaker 1: or I may hallucinate because I have ingested a peculiar drug.
Speaker 1: These are termed sleep induced hallucinations or dreams or drug
Speaker 1: induced hallucinations, respectively. But when the stimuli to my hallucinations
Speaker 1: are unknown, that is called craziness or schizophrenia. As if
Speaker 1: that inference were somehow as illuminating as the others. I
Speaker 1: thought that was absolutely fascinating because it almost uh tracks
Speaker 1: this this problem we have in dealing with mental illness
Speaker 1: as a function of our lack of understanding. Like, like,
Speaker 1: we think we're very advanced or much more advanced than
Speaker 1: we used to be in fields like psychiatry and psychology
Speaker 1: because we're I guess we're a lot better than we
Speaker 1: used to be. I mean, we no longer think people
Speaker 1: have demons in them. Uh, we understand that that there
Speaker 1: are conditions that can affect the mind, that can cause
Speaker 1: people suffering and distress or cause people abnormal behavior, and
Speaker 1: that there are hopefully physical or or at least like
Speaker 1: you know, talk based ways of treating those and helping
Speaker 1: get people get relief and and fix the problem that's
Speaker 1: affecting them. But we're still very imprecise with psychology, aren't we.
Speaker 1: I mean, it's not like in many ways of treating
Speaker 1: body illnesses where we've come up with extremely just laser
Speaker 1: targeted ways of fixing the problems that arise. If you
Speaker 1: get a broken bone, you know, you can get a
Speaker 1: surgery or a splint put on. You know, there there
Speaker 1: are ways of fixing it that we're pretty sure are
Speaker 1: gonna work and aren't gonna have too many weird side effects.
Speaker 1: And you can do the same thing with say antibiotics
Speaker 1: or other you know, drug treatments that we have for
Speaker 1: body illnesses. And there is just a fundamental lack of
Speaker 1: precision and lack of technological advancement we have in treating
Speaker 1: illnesses that affect the mind. Yeah, and it it definitely
Speaker 1: reminds me of content that looked at in the past,
Speaker 1: just talking about like what is in the same way
Speaker 1: we're talking about what is saying and what is insane,
Speaker 1: um and and as flawed as those categories are, But
Speaker 1: then you know what is what is an actual experience
Speaker 1: of reality versus a skewed experience of reality, especially when
Speaker 1: you start thinking of any human perception of reality is
Speaker 1: essentially flawed. It's imperfect, it's based, it's it's not it's
Speaker 1: not one for one, you know, So, so how do
Speaker 1: you start There is no objective Yeah, there is no
Speaker 1: objective reality. All reality is a subjective reality, and the
Speaker 1: individual on the other side of the glass, their experience
Speaker 1: of of subjective reality is just different. So then how
Speaker 1: do you treat it? How do you quantify it? Uh?
Speaker 1: You end up falling back on these false terms. Yeah, absolutely,
Speaker 1: And I think that point Rosenhan makes uh still largely
Speaker 1: applies today. Even though we may have come somewhere since
Speaker 1: since the nineteen seventies, we still are at this place
Speaker 1: where the fact that we don't understand the origins of
Speaker 1: of of somebody's problem makes us treat it with less
Speaker 1: compassion than we should. And so, if there's one takeaway
Speaker 1: from today's episode, try to ditch the concepts of sane
Speaker 1: and insane. And I know they're deeply ground into us,
Speaker 1: but I say, do your best to chuck them out.
Speaker 1: I mean, when you encounter somebody who has a mental
Speaker 1: illness and has symptoms, think about what can be done
Speaker 1: to help the person's symptoms or there or alleviate the
Speaker 1: problems in their direct experience, rather than saying, this is
Speaker 1: an insane person. Yeah, or even if you just go
Speaker 1: back your daily life, it's so easy to fall into
Speaker 1: the mindset of just walking down the street and going
Speaker 1: that person saying that one's that one's insane, that one's crazy,
Speaker 1: that one's crazy, that one maybe a little crazy, that
Speaker 1: one's sane. Uh. But but again that's just falling upon
Speaker 1: this this this this false dichotomy of a mental experience. Yeah.
Speaker 1: So anyway, I think that's a very fascinating paper, but
Speaker 1: really highly recommended. You can find it online. There are
Speaker 1: copies you can find you can read the whole text
Speaker 1: for will make sure to link to it as well
Speaker 1: on the landing page for this episode. So fantastic in
Speaker 1: the in the history of psychology and science, and really
Speaker 1: in the history of human empathy. I think. Yeah. All right,
Speaker 1: So in the meantime, check us out at stuff to
Speaker 1: Blow your mind dot com. That's where you'll find all
Speaker 1: the episodes, various videos, blog post links out to social
Speaker 1: media accounts like Twitter and Facebook. Will Blow the Mind
Speaker 1: on both of those and I tumbling. We're stuff to
Speaker 1: blow your mind. And if you want to write us
Speaker 1: and let us know your feet back about today's episode
Speaker 1: or what you thought about the topic of the categories
Speaker 1: of sanity and insanity and how we diagnose them, you
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