The
Rosenham experiment
By the early
70s, psychiatrist R.D. Laing had become a celebrity in America, and
was one of the leaders of what was called the "anti-psychiatry"
movement. He was about to use his growing power to attack one of the
most powerful professions in America, the medical and psychiatric
establishment. The results would be dramatic. But the outcome would
be very different from what Laing intended. His ideas would undermine
the all-controlling medical elite. But far from liberating people,
what would actually emerge would be a revolutionary new system of
order and control, driven by the objective power of numbers.
Psychiatry,
Laing said, was a fake science, used as a system of political control
to shore-up a violent collapsing society. Its categories of madness
and sanity had no reality. Madness was simply a convenient label used
to lock away those who wanted to break free.
Hundreds of
young psychiatrists came to Laing's talks, and one of them was
inspired, and decided to find a way of testing whether what Laing
said was true or not. Could psychiatrists in America distinguish
between madness and sanity? He was called David Rosenham, and he
devised a dramatic experiment.
He assembled
eight people, including himself, none of whom had ever had any
psychiatric problems. Each person was then sent across the country to
a specific mental hospital. At an agreed time, they all presented
themselves at their hospital, and told the psychiatrist on duty they
were hearing a voice in their head that said the word "thud".
That was the only lie they should tell. Otherwise, they were to
behave and respond completely normally.
As Rosenham
revealed: “They were all diagnosed as insane and admitted to the
hospital ... I told friends, I told my family I get out, when I get
out that's all … I'll be there for a couple of days, then I'll get
out. Nobody knew I'd be there for two months!”
Once
admitted, all eight fake patients acted completely normally, yet the
hospitals refused to release them, and diagnosed seven as suffering
from schizophrenia, and one from bi-polar disorder. They were all
given powerful psychotropic drugs. They found there was nothing they
could do to convince the doctors they were sane, and it quickly
became clear that the only way out would be to agree that they were
insane, and then pretend to be getting better.
When
Rosenham finally got out and reported the experiment, there was an
uproar. He was accused of trickery and deceit. And one major hospital
challenged him to send some more fakes to them, guaranteeing that
they would spot them this time. Rosenham agreed, and after a month,
the hospital proudly announced that it had discovered forty-one
fakes. Rosenham then revealed he had sent no-one to the hospital.
The effect
of the "thud" experiment was a disaster for American
psychiatry. It destroyed the idea that they were a privileged elite
with specialist knowledge. But those in charge realised that
psychiatry could not just give up. Another way had to be found of
understanding and managing people's inner feelings in modern society.
And, like R.D. Laing, they turned to the objective purity of
mathematical analysis.
They set out
to create a scientific system of diagnosing people's inner mental
states, in which all human judgement would be removed, and replaced
instead by a system based on the power of numbers. They gave up on
the idea that they could understand the human mind, and cure it.
Instead,
American psychiatry created a new set of measurable categories that
were only based on the surface behaviour of human beings. Many were
given new names, like Attention Deficit Disorder, and Obsessive
Compulsive Disorder. What mattered was that these disorders could be
observed, and thus recorded. The psychiatrists created a system in
which the diagnosis could literally be done by a computer. The
observable characteristics of each of the disorders were listed
precisely, and questionnaires were then designed that asked people
whether they had those characteristics. The answers were simply "yes"
and "no". So they cold be asked by lay interviewers, not by
psychiatrists. The computer would then decide whether people were
normal, or abnormal.
The
psychiatrists then decided to test this system, and at the end of the
1970s, they sent interviewers out across America with the
questionnaires. Hundreds of thousands of people selected at random
were interviewed. Up to this point, psychiatrists had only dealt with
individuals who felt they needed help. This was the first time that
anyone had gone out and asked ordinary people how they thought and
felt. And the results, when processed by the computers, were
astonishing. More than fifty percent of Americans suffered from some
type of mental disorder.
As
Psychiatrist Dr. Jerome Wakefield says: “These studies revealed
very high rates of mental disorder. There are very very high rates of
disorders out there. Half the population has a mental disorder at
some point, seventeen percent of the population has a depressive
episode at some point, figures like that. These rates astonished
people, they're enormous rates. And the general conclusion was: there
is a hidden epidemic.”
More surveys
were done, and yet again the computers returned the same disturbing
data. The surveys showed that underneath the surface of normal life,
millions of people, who never before would have been thought of as
mentally ill, were secretly living with high levels of mental
anxiety. The psychiatrists began screening programmes across the
country. For many people, the checklists were a liberation, their
private suffering was finally being recognised.
These new
categories of disorders spread quickly in society, and terms like
Borderline Personality Disorder, and Obsessive Compulsive Disorder
took hold of the public imagination. But as this happened, it had
unforeseen consequences. Millions of people began to use the
checklist to monitor and diagnose themselves. They used them to
identify what was aberrant or abnormal in their behaviour and
feelings. But by definition, this also set up a powerful model for
them of what were the normal behaviour and feelings to which they
should aspire. And psychiatrists began to find more and more people
coming to them, demanding to be made normal.
As
Psychiatrist Paul McHugh says: “It was just a matter of asking
people a couple of questions, checking the boxes in the diagnostic
formula, and saying: 'there you are, you have this disease!', or 'I
have this disorder, I'd better go to my doctor and tell him what I
need!', and it was an amazing experience and a great change. Most
people do not, previously at any rate, want to see themselves as in
some way psychiatrically injured. But now, they tell me that they
have an ideal in their mind about what the normal person is… 'I
don't fit that model, I want you to polish me down so that I fit'.”
This new
system of psychological disorders had been created by an attack on
the arrogance and power of the psychiatric elite in the name of
freedom. But what was beginning to emerge from this was a new form of
control. The disorders and checklists were becoming a powerful and
objective guide to what were the correct and appropriate feelings in
an age of individualism and emotion.
But this was
a very different system of order. No longer were people told how to
behave by an elite. Instead, they now used the checklist to monitor
their feelings and police their own behaviour. They were reassured
that these new categories were scientific and could be checked by the
power of numbers.
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