Is normal real? Is abnormal real? Who can tell the difference?
SYNOPSIS In spite of its bulk, the DSM is not accepted as the last word on diagnosing psychological problems by some. Are these efforts to identify catgories of mental illness useful, useless, or even harmful? Does labeling a patient mislead and possibly hinder treatment? By this critical view, psychiatric diagnoses are mainly in the minds of the observers who apply the labels.
Normal people (i.e., people who do not have, and have never suffered, symptoms of serious psychiatric disorders) were admitted to psychiatric hospitals to see if the sanity of such pseudo-patients was detected. If so, that would be evidence that a sane individual can be distinguished from the insane context in which he is found. If, on the other hand, the sanity of the pseudo-patients was not discovered that would support the view that psychiatric diagnosis says little about the patient but much about the environment in which an observer finds them.
The eight pseudo-patients, five men and three women, included a psychology graduate student in his 20's and seven older people, among them three psychologists, a pediatrician, a psychiatrist, a painter, and a housewife. Each went to a hospital admitting room, complaining of hearing voices, and gained admission to the psychiatric ward (usually with the diagnosis of schizophrenia). From there on they returned to their normal behavior (after an initial period of nervousness at being in such a setting).
Although not detected be the staff, fellow patients often identified the pseudo-patients as journalists or the like, rather than patients, because the pseudo-patients spent time writing about their experiences.
Rosenhan, D. L. (1973). On being sane in insane places. Science, 179, 250-258.
COMMENT Remember the social context for this, the era of "One flew over the cuckoo's nest" (book in 1962; movie in 1975).
Psychiatric diagnoses seem problematic, because sane people are not identified as such once in a mental hospital. This was a bitter pill for the mental health industry, but that should hardly be a reason for an ethics committee to block the project (i.e., no threat to public safety). This research clearly makes a substantial contribution to public safety, but at the expense of psychiatry and psychology.
Consider another variant: A fully functional car is taken to a series of auto repair garages, to see which will insist on doing some work and which won't. Is that deception "unethical"? An unnecessary repair is not just unethical, it is illegal, fraudulent. I don't know for sure that an ethics committee would refuse this "healthy car" scenario, but I do know that the public would readily approve of this deception as adding value to life.
Not only is the public concerned about sending an innocent person to jail, but the strategy of sending sane people to an asylum is well understood by the citizens in many countries.
This study is sometimes linked with Milgram and Zimbardo, but it seems to me in a class of its own. The results again are "creepy," and disquieting, but overall the manipulation(s) seem benign, and the results compel discussion.
Objections to this seem designed more to protect the establishment (Psychiatry) than the subjects, which is all too often what ethics committee seem to do today -- Nature editorial, 22 November 2001, Nature (vol. 414, Issue 6862, p. 379). Censorship in the service of the establishment, not ethics, and certainly not safety.
This is an excellent example of the value of deception in research, something which has been far too aggressively attacked by ethics committees. The outcome may be undesired by some, but we can't let that become an a priori consideration, else the censors have won.