On being insane in sane places

p.pete

There was a thread started last week which had to be closed but was actually touching upon a very interesting area. Reason for closure was because certain institutions were mentioned in a not too positive way and I want to avoid any potential legal issues. So as long as any serious allegations don't specifically point fingers this should be fine.

Anyway - there was a study done in the seventies where a group of sane people got themselves institutionalised and then gave feedback on their experiences.

They claimed they heard a "Thud" sound in their head and gave no other symptoms whatsoever - sleeping fine, appetite fine, not interfering with work etc. The people who took part managed to get themselves institutionalised into various locations from having this one symptom. Once inside they all then claimed to be perfectly fine again.

The study highlighted many problems with the American psychiatric system at that time. Obviously things have changed a lot since then and this was done with the American system - but it's still an interesting area.

Without being liablous, has anybody had any direct experiences or perhaps work in the area and have an opinion? Like I said at the start, it's an interesting and important area but unfortunately also one where a lot of finger pointing is going to occur! The thread will be closed again if it starts to go off the rails

Zillah

That was a very interesting article. Although I do wonder at its relevance given that its over 30 years out of date. Excellent idea none the less. Personally the idea of entire psychiatric hospitals struck me as a matter of bureaucracy rather than mental health. A personal relationship and tailored treatment are obviously the best way to help the majority of patients, the notion of grouping them all together in a prison-like environment with the associated imbalance of power and depersonalisation seems like it would be detrimental to the mental health of the majority of people.

Since One Flew Over the Cuckoo's Nest I've had a very distasteful impression of psychiatric hospitals.

p.pete

Actually, mean't to add a little more detail of the original thread being referred to. It was basically outlining some bad experiences in psych wards (one in particular but this'll be closed again if named). Basicly the poster claims they were called names, threatened for questioning remarks, given unwanted drugs when panadol was asked for. Also bullied into getting a haircut that wasn't wanted, treated unfailrly and various other incidents.

This all sounds horrific and to me you'd hope and expect people to be treated with the greatest care and dignity. Without being too specific it'd be interesting to hear from people who've had similar or conflicting experiences - or anyone working in the area that might be able to provide a detailed response.

For me the American study pointed to in the original post is very interesting if a little dated, but I'd be interested to know if anything like that has ever been undertaken in Irish or maybe just European context?

Valmont

Author Lauren Slater outlined the case quite comprehensively in her book Opening Skinner's box -Great psychological experiments of the twentieth century. I think it showed a fundamental flaw in the diagnosis used by psychiatrists and it seemed that at the time they had a predilection towards labeling patients psychotic without really examining what was wrong with them. I think most of the participants in the study were diagnosed as schizophrenic and were held in secure units for quite a while.

The part I like was when the report was published, several psychiatric hospitals issued Rosenthal and his associates a challenge that they were to send as many "psuedo - patients" within the next few months and that they would correctly identify the false patients. A few months later they said they had found around forty or so (I can't recall the exact number) but in reality Rosenthal hadn't sent any pseudo-patients at all. The embarassment and damage to psychiatry in America was quite colossal.

Lauren Slater attempted to recreate this experiment by herself and to cut a long story short she was just given prescriptions for psychiatric medicine and brushed aside.

Although one psychiatrist had a good point about the integrity of Rosenthals methods

"If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood, the behaviour of the staff would be quite predictable. If they labeled and treated me as having a peptic ulcer, I doubt that I could argue convincingly that medical science does not know how to diagnose that condition"

I don't know much about psychiatry but it seems to me that they are too ready to give patients a course of prozac before exploring other possible solutions to the problem.

Zillah

Valmont wrote:

"If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood, the behaviour of the staff would be quite predictable. If they labeled and treated me as having a peptic ulcer, I doubt that I could argue convincingly that medical science does not know how to diagnose that condition"

The metaphor is not valid. The urgency required if a patient is vomitting blood is absolutely nothing like the situation like those in the pseudo-patient experiment.

What would be a more apt comparison is that if I stayed at the hospital for two weeks under their care and they continued to treat me for a peptic ulcer even though there was absolutely not a shred of evidence except that one episode of vomitting.

Valmont

Zillah wrote:

The metaphor is not valid. The urgency required if a patient is vomitting blood is absolutely nothing like the situation like those in the pseudo-patient experiment.

What would be a more apt comparison is that if I stayed at the hospital for two weeks under their care and they continued to treat me for a peptic ulcer even though there was absolutely not a shred of evidence except that one episode of vomitting.

It is just a simple analogy to help understand the psychiatrists viewpoint. I don't think going into specifics will illustrate anything else.

Zillah

Valmont wrote:

It is just a simple analogy to help understand the psychiatrists viewpoint.

Only if the psychiatrist's viewpoint is a fallacy. Like I said, the metaphor is not valid, the situations do not compare.

EdgarAllenPoo

If it was that easy for them to get themselves institutionalised, how did they get released again?

snorlax

my last placement was in psychiatry in a community setting. I used to visit the psychiatric hospital as that is where we sometimes got referrals from and that is where the consultant psychiatrist used to have the team meetings.

some of the patients were there quite simply becuse there was no where for them to go and they relied on the hospital for food/ shelter and looking after their often more pressing physical problems (most being elderly clients). A lot we're "institutionalised", eg having spent most of thier lives there and knowing no different and sometimes unwilling (or afraid) to move out into the high and medium support hostels offered in the community. Probably something to do with the "sick role" (health psychology), that they were reliant and almost fearful of independence.
there was a difference between those admitted decades ago and those clients who were younger and knew more what the outside world offered but needed some sort of support/ help to gain full indepence to live indepently in the community (and this is where occupational therapy comes in). These younger clients were often more determined to leave the hospital and often seemed to fair better in the hostels or living on their own as the case may be.

Valmont

Zillah wrote:

What would be a more apt comparison is that if I stayed at the hospital for two weeks under their care and they continued to treat me for a peptic ulcer even though there was absolutely not a shred of evidence except that one episode of vomitting.

I don't see in the original quote where the author stated that he wasn't
kept for two weeks or even ten for that matter. Now, we could argue all month about whether he meant the initial diagnosis by the doctors exclusive of any further tests or as I saw it, that when he said

"If they labeled and treated me as having a peptic ulcer"

By this I just assumed that he was kept and treated as you said in your improved version. So really the metaphor is valid or invalid, it just depends on how you look at it, which leads me too

Valmont wrote:

it is just a simple analogy to help understand the psychiatrists viewpoint. I don't think going into specifics will illustrate anything else

snorlax

right let's move back on topic, thank you.I found a good article about psychiatric services in Ireland (from the Irish College of psychiatrists) www.irishpsychiatry.com/adultpoldoc.doc well worth a read and gives some insight into how irish services are operating at the moment.

Zillah

GDM wrote:

If it was that easy for them to get themselves institutionalised, how did they get released again?

Did you read the article? It says they were released after their schizophrenia went into remission.

Valmont

I think Rosenhan was held for 52 days before being discharged

p.pete

There was a strongly related news item on BBC South last night, I've tried to find a web link but no luck so far. Former psychiatric patients are pushing a bed from Hove to London in protest of treatment. Among their complaints are forced restraint, drug use and no choice of treatment being offered.

They feel that too often drugs are used as a first resort without considering anything else, one of the guys interviewed said there was quite strong side effects and there was no alternative offered. They accept that in some cases (violence for example) restraint has a place but it's being used to liberally.

I'll try find a web link but I think it's interested that it was only covered on a small regional level and isn't showing up anywhere I've looked so far (google news mainly). I think they were only setting off yesterday, so it'd be interesting if the issue gains more attention as they get closer to London.

Valmont

I'd be interested in that article. I really recommend the book I mentioned before by Lauren Slater, it really has an in depth look at the overzealous use of drugs by psychiatrits in lieu of alternative forms of treatment available to them. It also has some really great experiments as well that I'm sure would be of interest to anyone in this forum.

JuliusCaesar

Psychiatrists operate under a double burden (as I see it):
1. They depend on a system of diagnostics which is questionable (DSM or ICD)
2. In the public service, they have very little time to spend with patients. Half an hour to an hour to assess and 10mins per visit therafter. (outpatients)
and thirdly (a gripe of mine)
3. In the private service, the hospitals make most of their money on admissions and so there may be more pressure to admit. In any case, not having a cachement area, they are poor on outpatient services.

Gibs

just going back to the original experiement mentioned above, an interesting post-script is that many of the "normal" patients were rumbled almost straight away by the other patients in the psychiatric wards, while the staff, apparently, didn't see past their initial presentation.