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On Being Sane in Insane Places and Visa Versa

I'm in Santa Barbara, California, where there is deep-seated school and government corruption. The retaliation against whistleblowers is severe. "Here's to the Crazy Ones" (googleable). I'm crazy enough to think I can change the world.


k8longstory 4

Mental Health News

On Being Sane In Insane Places:

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

By Gary G. Kohls, MD

Reproduced by permission

In 1973, D. L. Rosenhan published a ground-breaking psychiatric study in January 19 issue of Science magazine*. The article exposed a serious short-coming in the psychiatric hospitals at the time, and therefore it became very controversial. Dr. Rosenhan, a professor of psychology and law at Stanford University, designed the study to try to answer the title question:

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

The now famous (some offended and embarrassed psychiatrists and psychologists regarded it as infamous) experiment that was carried out involved 8 different psychiatric hospitals and 8 different people, including the author. Each of the 8 people were totally and certifiably sane pseudo-patients who were mostly professional people.

Each of the 8 secretly gained admission to a different mental hospital by falsely complaining to a psychiatrist that they had been hearing voices over the past few weeks. The voices in each case were saying only the three words empty, hollow, and thud. No visual hallucinations or other psychological abnormalities were relayed to the examining psychiatrist or discovered in the intake exams. All eight pseudo-patients were immediately admitted.

Seven of the experimental group were diagnosed with schizophrenia and one was labeled manic-depressive. All 8 ultimately had discharge diagnoses of schizophrenia, in remission, despite the fact that absolutely no psychotic or manic behaviors were observed.

Following admission, each pseudo-patient acted totally sane, and each said that the voices had disappeared. When given the chance, starting on day 1, each of them asked about when they could be discharged.

Despite inquiring about their discharge and despite the fact that each one of the group acted totally normally throughout, none of them was discharged before one weeks stay. The length of stay averaged 19 days, ranging from 7 to 52 days.

The pseudo-patients engaged in all the normal ward activities except for the fact that they never swallowed the pills that were given to them. The only obvious difference between the behaviors of the experimental group and the regular patients was that the 8 took notes during their hospitalizations. On one occasion, a staff member wrote in the patients chart: the patient engages in note-taking behavior. Otherwise none of the staff seemed interested in any of the patients behaviors. Thus the pseudo-patients eventually stopped trying to hide the fact that they were recording their impressions of their stays.

The average daily contact with the therapeutic staff was only 6.8 minutes per day (mean 3.9 25.1 minutes) and that included admissions interviews, ward meetings, group and individual psychotherapy contacts, case conferences and discharge meetings.

The group observed that attendants only came outside the cage 11.5 times per 8-hour shift but usually only interacted minimally with the patients when doing so. The staff psychiatrists rarely interacted meaningfully with any of the patients, even the pseudo-patients. If any interaction occurred, it was usually rather patronizing.

None of the professional therapeutic staff ever suspected that any of the 8 were pseudo- patients, whereas many of the real patients knew for certain that the 8 were faking. Their fellow patients often said things like: Youre not crazy. Youre a journalist or a professor. Youre checking up on the hospital. The staff never tumbled to the subterfuge. Therefore the only people who recognized normality were those who themselves had been labeled insane.

Upon the release of the Rosenhan paper, there arose an enormous uproar from psychiatrists and psychologists about the ethics of performing such a study. Rosenhan was attacked viciously by those who had been fooled or had themselves hastily jumped to erroneous diagnostic conclusions in the past.

Because of the controversy, Rosenhan announced a follow-on study that was to be done in a specific research and teaching hospital whose staff had heard about the first study but doubted that such errors could occur in their hospital. The hospital staff was told that sometime in the next 3 months there would be one or more pseudo-patients attempting to be admitted to their hospital. However, by design, no pseudo-patients ever actually attempted admission.

Among the total of 193 patients that were admitted for psychiatric treatment during the 3-month period, 41 genuine patients (20 % of the total) were suspected, with high confidence, of being pseudo-patients by at least one member of the staff. 23 of the 41 were considered suspect by a psychiatrist, and 19 were suspected by both a psychiatrist and one other staff member. On the bright side, their heightened vigilance saved 41 normal people from receiving a diagnosis of mental illness and the administration of brain-altering drugs.

Among the conclusions the reader can draw from these two experiments are these important and quite logical ones:

1) The sane are not sane all of the time, nor are those labeled insane actually insane all of the time. Definitions of sanity or insanity therefore may often be erroneous.

2) Sanity and insanity have cultural variations. What is viewed as normal in one culture may be seen as quite aberrant in another. As just one example, there was a famous experiment contrasting American and British psychiatrists and each countrys diagnostic differences. The two groups studied identical video-taped interviews of a group of psychiatric patients. In that series of cases, schizophrenia was diagnosed far more often by American psychiatrists than for the British psychiatrists (by a factor of 10 as I recall the study).

3) Bizarre behaviors in people constitute only a small fraction of total behavior. Similarly, violent, even homicidal people are nonviolent most of the time.

4) Psychiatric diagnoses, even those made in error, carry with them personal, legal and social stigmas that can be impossible to shake and often last a lifetime.

It is a known fact that hallucinations can occur in up to 10% of normal people. Vivid flashbacks in patients with PTSD (posttraumatic stress disorder) have, in the past, been commonly and tragically misdiagnosed as hallucinations, particularly in the combat veteran. Hallucinations can occur during certain phases of sleep, sleep deprivation, half-waking states or from drug effects either because of withdrawal symptomatology or neurotoxic/psychotoxic effects from prescription or illicit drugs (even large doses of psychostimulants such as caffeine or nicotine can cause mania, and it is not uncommon for Ritalin and Adderall to cause psychotic episodes).

It is well known that mania (and thus a false diagnosis of bipolar disorder of unknown etiology) can occur from even standard doses of antidepressant drugs (especially the SSRIs (selective serotonin reuptake inhibitors) or during withdrawal from tranquilizing drugs such as the Valium-type benzodiazepines or the major tranquilizers such as antipsychotic drugs like Zyprexa, Abilify, Seroquel and Geodon.

One study showed that 8% of patients admitted from one psychiatric hospital emergency room were diagnosed with SSRI drug-induced mania. Therefore that 8% of patients were not suffering from a psychiatric disorder of unknown etiology. The cause of their ER visit was therefore not caused by a mental disorder (of unknown etiology) but rather because of a drug-induced neurological disorder that was self-limited and best treated by stopping the offending drug.

Rosenhan rightly points out: How many people, one wonders, are sane but not recognized as such in our psychiatric institutions? How many have been needlessly stripped of their privileges of citizenship, from the right to vote and drive to that of handling their own accounts? How many have feigned insanity in order to avoid the consequences of their behavior (Ed note: recall Jack Nicholsons character in One Flew Over the Cuckoos Nest), and, conversely, how many would rather stand trial than live interminable in a psychiatric hospital but are wrongly thought to be mentally ill? How many have been stigmatized by well-intentioned, but nevertheless erroneous, diagnoses?

To those concerns, I would add, how many patients have suffered the brain-disabling and neurotoxic consequences of dangerous, dependency-inducing, and very powerful psychiatric drugs, that if used long enough can easily produce deadly withdrawal effects when stopped?

Rosenhans study has significant implications for our society today, and perhaps more so, for in 1973 there was only Elavil, Stelazine, Compazine, Thorazine and a few other psychiatric drugs to be concerned about. Eventually these were discovered to be brain-damaging substances and we can justifiably say good riddance. However, today there are scores and scores of second and third generation drugs that were never tested for long-term safety or efficacy before they were granted marketing approval by the FDA. Many of them are commonly used in hugely expensive cocktail combinations which have never even been tested for safety or efficacy in the animal lab, much less in clinical settings.

All of these psychiatric drugs are now recognized as materials that are hazardous to the environment (HazMat substances) and need to be handled with extreme care unless they are ingested. The irony of that reality should give us all pause.

Dr. Kohls practiced holistic mental health care until his retirement two years ago. Most of the patients that came asking for his help exhibited a variety of drug-induced neurological and physical disabilities and drug dependencies from the multitude of drugs they had been on chronically.

Dr. Kohls reminds people that they should not try to stop their prescription drugs without the help of a physician knowledgeable about basic brain neuroscience, brain nutrition and the intricacies and treatment of drug withdrawal syndromes.

*On Being Sane In Insane Places; D. L. Rosenhan; Science 1973, Vol. 179 p. 250 258



Excellent. Thanks for posting this.

I've read about this experiment before but not in quite so much detail, very interesting! :-)

yes, excellent xx

thank you a good read for sure

Thank you .. I've been taking stelazine [trifluoperazine] since 1997. Initially I was on it 3 times a day but had all sorts of side effects so I cut down to taking it 'only as needed'. It has helped when I'm extremely manic and can't reel myself in. But, now that I've read this I don't want to ever take it again and I'm considering going to a new doc to discuss other meds. Just worried about the new meds since they haven't been tested.. maybe I'll just smoke pot and that'll be that.

Dear Sun in Bloom,

I developed tardive dyskenesia from Abilify and then had some other side effects from stopping it cold turkey, so I would work closely with you pdoc.

It turned out that I wasn't bi-polar, just RTSD from years of trauma at the hands of corrupt school administrators.

I have to admit that my life is much better without medication, simply because I am more connected to my heart, mind, and body and my daily practice of yoga, tai chi, or meditation allows me to take responsiblity for the progress and regression that I make in my daily life.

I work with many colleagues as an education reform activist, and people are coming around to accepting my impulsive actions because, "sometimes, we have to be a little bit crazy when the world itself has gone mad."

I have recently been counseled to "Let Go; Let God" and it works wonders---just "thank" your mind for whatever thought floats in and then, if it brings anything that isn't good, just "flush it out of your mind, let it go, and stop nattering, complaining, or gossiping. TELL ONLY MIRACLES."


k8longstory 4
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