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... I learning about the Rosenhan experiment....
Rosenhan experimentFrom Wikipedia, the free encyclopediaJump to: navigation, search
St. Elizabeth's psychiatric hospital, Washington, D.C., one of the sites of the Rosenhan experiment.The Rosenhan experiment was a famous experiment into the validity of psychiatric diagnosis conducted by psychologist David Rosenhan in 1973. It was published in the journal Science under the title "On being sane in insane places."[1] The study is considered an important and influential criticism of psychiatric diagnosis.[2]
Rosenhan's study was done in two parts. The first part involved the use of healthy associates or "pseudopatients" who briefly simulated auditory hallucinations in an attempt to gain admission to 12 different psychiatric hospitals in five different states in various locations in the United States. All were admitted and diagnosed with psychiatric disorders. After admission, the pseudopatients acted normally and told staff that they felt fine and had not experienced any more hallucinations. Hospital staff failed to detect a single pseudopatient, and instead believed that all of the pseudopatients exhibited symptoms of ongoing mental illness. Several were confined for months. All were forced to admit to having a mental illness and agree to take antipsychotic drugs as a condition of their release.
The second part involved asking staff at a psychiatric hospital to detect non-existent "fake" patients. No fake patients were sent, yet the staff falsely identified large numbers of ordinary patients as impostors.
The study concluded, "It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals" and also illustrated the dangers of dehumanization and labeling in psychiatric institutions. It suggested that the use of community mental health facilities which concentrated on specific problems and behaviors rather than psychiatric labels might be a solution and recommended education to make psychiatric workers more aware of the social psychology of their facilities.
Contents [hide]
1 The pseudopatient experiment
2 The non-existent impostor experiment
3 Impact and controversy
4 Related experiments
5 See also
6 External links
7 References
[edit] The pseudopatient experimentRosenhan himself and eight mentally healthy associates, called "pseudopatients", attempted to gain admission to psychiatric hospitals by calling for an appointment and feigning auditory hallucinations. The hospital staffs were not informed of the experiment. The pseudopatients included a psychology graduate student in his twenties, three psychologists, a pediatrician, a psychiatrist, a painter and a housewife. None had a history of mental illness. Pseudopatients used pseudonyms, and those who worked in the mental health field were given false jobs in a different sector to avoid invoking any special treatment or scrutiny. Apart from giving false names and employment details, further biographical details were truthfully reported.
During their initial psychiatric assessment, they claimed to be hearing voices of the same sex as the patient which were often unclear, but which seemed to pronounce the words "empty", "hollow", "thud" and nothing else. These words were chosen as they vaguely suggest some sort of existential crisis and for the lack of any published literature referencing them as psychotic symptoms. No other psychiatric symptoms were claimed. If admitted, the pseudopatients were instructed to "act normally," reporting that they felt fine and no longer heard voices. Hospital records obtained after the experiment indicate that all pseudopatients were characterized as friendly and cooperative by staff. All were admitted, to 12 different psychiatric hospitals across the United States, including rundown and underfunded public hospitals in rural areas, urban university-run hospitals with excellent reputations, and one expensive private hospital. Though presented with identical symptoms, 11 were diagnosed with schizophrenia at public hospitals, and one with manic-depressive psychosis, a more optimistic diagnosis with better clinical outcomes, at the private hospital. Their stays ranged from 7 to 52 days, and the average was 19 days. All were discharged with a diagnosis of schizophrenia "in remission," which Rosenhan takes as evidence that mental illness is perceived as an irreversible condition creating a lifelong stigma rather than a curable illness.
Despite constantly and openly taking extensive notes on the behavior of the staff and other patients, none of the pseudopatients were identified as imposters by the hospital staff, although many of the other psychiatric patients seemed to be able to correctly identify them as impostors. In the first three hospitalizations, 35 of the total of 118 patients expressed a suspicion that the pseudopatients were sane, with some suggesting that the patients were researchers or journalists investigating the hospital.
Hospital notes indicated that staff interpreted much of the pseudopatients' behavior in terms of mental illness. For example, one nurse labeled the note-taking of one pseudopatient as "writing behavior" and considered it pathological. The patients' normal biographies were recast in hospital records along the lines of what was expected of schizophrenics by the then-dominant theories of its etiology.
The pseudopatients were required to get out of the hospital on their own by getting the hospital to release them, though a lawyer was retained to be on call for emergencies when it became clear that the pseudopatients would not ever be voluntarily released on short notice. Once admitted and diagnosed, the pseudopatients were not able to obtain their release until they agreed with the psychiatrists that they were mentally ill and began taking antipsychotic medications, which they flushed down the toilet. No staff member noticed that the pseudopatients were flushing their medication down the toilets and did not report patients doing this.
Rosenhan and the other pseudopatients reported an overwhelming sense of dehumanization, severe invasion of privacy, and boredom while hospitalized. Their possessions were searched randomly, and they were sometimes observed while using the toilet. They reported that though the staff seemed to be well-meaning, they generally objectified and dehumanized the patients, often discussing patients at length in their presence as though they were not there, and avoiding direct interaction with patients except as strictly necessary to perform official duties. Some attendants were prone to verbal and physical abuse of patients when other staff were not present. A group of bored patients waiting outside the cafeteria for lunch early were said by a doctor to his students to be experiencing "oral-acquisitive" psychiatric symptoms. Contact with doctors averaged 6.8 minutes per day.
"I told friends, I told my family, 'I can get out when I can get out. That's all. I'll be there for a couple of days and I'll get out.' Nobody knew I'd be there for two months … The only way out was to point out that they're [the psychiatrists] correct. They had said I was insane, 'I am insane; but I am getting better.' That was an affirmation of their view of me." — David Rosenhan in the BBC program "The Trap."[3]
[edit] The non-existent impostor experimentFor this experiment, Rosenhan used a well-known research and teaching hospital, whose staff had heard of the results of the initial study but claimed that similar errors could not be made at their institution. Rosenhan arranged with them that during a three month period, one or more pseudopatients would attempt to gain admission and the staff would rate every incoming patient as to the likelihood they were an impostor. Out of 193 patients, 41 were considered to be impostors and a further 42 were considered suspect. In reality, Rosenhan had sent no pseudopatients and all patients suspected as impostors by the hospital staff were ordinary patients. This led to a conclusion that "any diagnostic process that lends itself too readily to massive errors of this sort cannot be a very reliable one". Studies by others found similarly problematic diagnostic results.[citation needed]
[edit] Impact and controversyRosenhan published his findings in Science, criticizing the reliability of psychiatric diagnosis and the disempowering and demeaning nature of patient care experienced by the associates in the study. His article generated an explosion of controversy.
Many defended psychiatry, arguing that as psychiatric diagnosis relies largely on the patient's report of their experiences, faking their presence no more demonstrates problems with psychiatric diagnosis than lying about other medical symptoms. In this vein psychiatrist Robert Spitzer quoted Kety in a 1975 criticism of Rosenhan's study:
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 behavior of the staff would be quite predictable. If they labeled and treated me as having a bleeding peptic ulcer, I doubt that I could argue convincingly that medical science does not know how to diagnose that condition.[4]
http://en.wikipedia.org/wiki/Rosenhan_experiment
eyeno wrote:They both suck. They are both dangerous. Using one to refute the other (even though I understand it) becomes a stale argument after a while. (for me)
c2w? wrote:What, exactly, prompts you to say that commonly prescribed psychotropic medications are likely and/or known possibly to be useless or even harmful?
http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050045
Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration
Irving Kirsch1*, Brett J. Deacon2, Tania B. Huedo-Medina3, Alan Scoboria4, Thomas J. Moore5, Blair T. Johnson3
1 Department of Psychology, University of Hull, Hull, United Kingdom, 2 University of Wyoming, Laramie, Wyoming, United States of America, 3 Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, Connecticut, United States of America, 4 Department of Psychology, University of Windsor, Windsor, Ontario, Canada, 5 Institute for Safe Medication Practices, Huntingdon Valley, Pennsylvania, United States of America
Abstract
Background
Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance. Yet, the efficacy of the antidepressants may also depend on the severity of initial depression scores. The purpose of this analysis is to establish the relation of baseline severity and antidepressant efficacy using a relevant dataset of published and unpublished clinical trials.
Methods and Findings
We obtained data on all clinical trials submitted to the US Food and Drug Administration (FDA) for the licensing of the four new-generation antidepressants for which full datasets were available. We then used meta-analytic techniques to assess linear and quadratic effects of initial severity on improvement scores for drug and placebo groups and on drug–placebo difference scores. Drug–placebo differences increased as a function of initial severity, rising from virtually no difference at moderate levels of initial depression to a relatively small difference for patients with very severe depression, reaching conventional criteria for clinical significance only for patients at the upper end of the very severely depressed category. Meta-regression analyses indicated that the relation of baseline severity and improvement was curvilinear in drug groups and showed a strong, negative linear component in placebo groups.
Conclusions
Drug–placebo differences in antidepressant efficacy increase as a function of baseline severity, but are relatively small even for severely depressed patients. The relationship between initial severity and antidepressant efficacy is attributable to decreased responsiveness to placebo among very severely depressed patients, rather than to increased responsiveness to medication.
But because Zoloft was also not significantly different than a placebo on the primary measure of the study, the results were far from straightforward.
Kiddie Prozac Docs Took Millions From Drug Makers
By Brandon Keim June 9, 2008
http://www.wired.com/wiredscience/2008/ ... -antidepr/
Three prominent advocates of antidepressant use by children received millions of dollars from antidepressant manufacturers, casting into question the integrity of their already-controversial research.
The New York Times reported Saturday that Harvard University psychiatrists Joseph Biederman and Timothy Wilens received $1.6 million each from drug companies between 2000 and 2007. Thomas Spencer, another Harvard psychiatrist, received $1 million.
The payments were uncovered by Congressional investigators searching for conflict-of-interest violations. Federal law requires researchers who receive National Institutes of Health funding to report annual outside earnings above $10,000 to their universities. Biederman, Wilens and Spencer all took NIH money, but never reported the full extent of their drug company income.
That the researchers’ results were influenced by the payments isn’t clear, but the situation is ugly. Biederman has a very high profile; as the Times describes, he
is one of the most influential researchers in child psychiatry and is widely admired for focusing the field’s attention on its most troubled young patients. Although many of his studies are small and often financed by drug makers, his work helped to fuel a controversial 40-fold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder … and a rapid rise in the use of antipsychotic medicines in children.
SNIP
http://www.nytimes.com/2008/06/08/us/08conflict.html?_r=4&ref=health&oref=slogin&oref=slogin&oref=login
A world-renowned Harvard child psychiatrist whose work has helped fuel an explosion in the use of powerful antipsychotic medicines in children earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007 but for years did not report much of this income to university officials, according to information given Congressional investigators.
J. Scott Applewhite/Associated Press
Dr. Joseph Biederman belatedly reported at least $1.6 million in consulting fees.
By failing to report income, the psychiatrist, Dr. Joseph Biederman, and a colleague in the psychiatry department at Harvard Medical School, Dr. Timothy E. Wilens, may have violated federal and university research rules designed to police potential conflicts of interest, according to Senator Charles E. Grassley, Republican of Iowa. Some of their research is financed by government grants.
Like Dr. Biederman, Dr. Wilens belatedly reported earning at least $1.6 million from 2000 to 2007, and another Harvard colleague, Dr. Thomas Spencer, reported earning at least $1 million after being pressed by Mr. Grassley’s investigators. But even these amended disclosures may understate the researchers’ outside income because some entries contradict payment information from drug makers, Mr. Grassley found.
In one example, Dr. Biederman reported no income from Johnson & Johnson for 2001 in a disclosure report filed with the university. When asked to check again, he said he received $3,500. But Johnson & Johnson told Mr. Grassley that it paid him $58,169 in 2001, Mr. Grassley found.
SNIP
http://www.nytimes.com/2008/10/04/health/policy/04drug.html?_r=1&em
October 4, 2008
Top Psychiatrist Didn’t Report Drug Makers’ Pay
By GARDINER HARRIS
One of the nation’s most influential psychiatrists earned more than $2.8 million in consulting arrangements with drug makers from 2000 to 2007, failed to report at least $1.2 million of that income to his university and violated federal research rules, according to documents provided to Congressional investigators.
The psychiatrist, Dr. Charles B. Nemeroff of Emory University, is the most prominent figure to date in a series of disclosures that is shaking the world of academic medicine and seems likely to force broad changes in the relationships between doctors and drug makers.
In one telling example, Dr. Nemeroff signed a letter dated July 15, 2004, promising Emory administrators that he would earn less than $10,000 a year from GlaxoSmithKline to comply with federal rules. But on that day, he was at the Four Seasons Resort in Jackson Hole, Wyo., earning $3,000 of what would become $170,000 in income that year from that company — 17 times the figure he had agreed on.
The Congressional inquiry, led by Senator Charles E. Grassley, Republican of Iowa, is systematically asking some of the nation’s leading researchers to provide their conflict-of-interest disclosures, and Mr. Grassley is comparing those documents with records of actual payments from drug companies. The records often conflict, sometimes starkly.
“After questioning about 20 doctors and research institutions, it looks like problems with transparency are everywhere,” Mr. Grassley said. “The current system for tracking financial relationships isn’t working.”
SNIP
http://www.boston.com/news/local/articles/2008/10/08/e_mails_suggest_pfizer_tried_to_suppress_study_on_drug/
E-mails suggest Pfizer tried to suppress study on drug
Suits say company misled on Neurontin
Pfizer Inc. promoted the positive findings of a small Neurontin study. (MARK LENNIHAN/ASSOCIATED PRESS/FILE)
By Liz Kowalczyk
Globe Staff / October 8, 2008
Top drug company marketing executives suppressed a large European study suggesting their blockbuster medication Neurontin was ineffective for chronic nerve pain, and they privately strategized about how to silence a British researcher who wanted to go public with the data, according to newly filed documents and e-mails that are part of a Boston court case.
compared2what? wrote:eyeno wrote:They both suck. They are both dangerous. Using one to refute the other (even though I understand it) becomes a stale argument after a while. (for me)
eyeno, I believe that if you were paying attention, you would have noticed that no one is in fact using one to refute the other in any crude, simplistic, quid pro quo sense and without offering any explanation or elaboration of the attached argument on its merits.
Psychiatry and Scientology are not even close to comparably dangerous. Or comparably powerful and influential. Scientology dwarfs psychiatry in all three regards. You do have to go out of your way to learn and understand that, because -- unlike psychiatry -- Scientology is influential and dangerous enough to scare the media into silence 99.9 percent of the time. Plus, they've also infiltrated the media on a fairly regular basis over the years, though that's not the kind of thing one generally gets to know in real time, unfortunately.
Anyway. Do yourself a favor and look into it some time. Because you are being misled, and not by anyone who has your best interests in mind.
And seriously. Do that for yourself. Not for me.
Thanks.
" am a 36 year old male. I have been on 120mg Cymbalta for about 6 - 7 months now. I want to let everyone know that at first life was great on this drug then I noticed a huge weight gain just in my belly region also noticed different things like different songs playing in my head like the wheels on the bus and the Barney song lol. Then I took lab test and my liver enzymes were up. A few months later they were still up. Then about 2 weeks ago I had more labs done and my liver enzymes were through the roof. I have also lost the ability to ejaculate during sex no matter how long we "do it" that my friends cause severe depression in my case."
Now I'm trying to quit this junk
and come to find out that I'm trying to pry open the gates
of hell. Why am I trying to quit? Well it was my side
effects, that I also thought to be a part of life and told
myself everything is normal."
compared2what? wrote:The Rosenhan experiment does not do anything to rebut the mountains and mountains of data of every conceivable kind attesting to the reality and the frequency of real, painful and sometimes fatal psychiatric disorders. It says nothing about them whatsoever, in fact. It does say something about the slipshod and horrifying clinical practices of psych wards. though.
Quit thinking about yourselves, please. For one stone fucking second. There are people out there who need your help and attention and commiseration for what THEY are experiencing and not for what YOU are experiencing.
That's it. I've got nothing else to say.
compared2what? wrote:I would not hold that therefore psychiatry itself is intrinsically abusive, or that it does nothing but cause patients a great deal of harm.
compared2what? wrote:Nor would I hold that psychotropic medications do not work at all for anyone.
compared2what? wrote:Or that it's helpful (not harmful) to focus on psychiatric abuses to the point that you attribute everything, including the plight of the mentally ill, to the inherent evils of psychiatry.
Here's an analogy for what I feel you're doing to me:
1) Monsanto's seed program exists for profit and doesn't address hunger, although that's what they claim they do.
2) I criticize Monsanto's seed program, and even point out ways that it exacerbates the problem of hunger.
3) Therefore I must be denying that hunger exists! Or else, I'm saying that Monsanto invented hunger by false diagnosis. Or else, I'm claiming that Monsanto is the leading cause of hunger. (Or else, as some really do believe: I'm preventing Monsanto from solving world hunger, because Step 1 is already untrue.)
compared2what? wrote:The threat that your potential (or, ftm, actual) misdiagnosis represents to you is a very minor, trivial, non-life-wrecking fucking thing compared to the threat that someone's real major mental illness represents to that person.
compared2what? wrote:That person's plight is already invisible and little understood by practically everybody in the world. It very badly needs some shining light and attention brought to it. You're not doing that. As you just made completely clear, you are thinking about yourself. And only yourself. I'm all for that, in its way. The unexamined life and so on and so forth.
compared2what? wrote:But there's a very vulnerable population that gets no attention at all because, among other things, one of the bulk suppliers of information and rhetoric to the anti-psych patient movement happens to be an entity that regards all sick people as the defective and subhuman authors of their own unhappiness.
compared2what? wrote:It also wants to clear the planet of you, btw. So I'm sure it's very grateful to you for cooperating with its campaign to deprive you and everybody else of as much medical care of every kind as it possibly can.
So go to town. It's your funeral. And forgive me for not joining in.
compared2what? wrote:The Rosenhan experiment does not do anything to rebut the mountains and mountains of data of every conceivable kind attesting to the reality and the frequency of real, painful and sometimes fatal psychiatric disorders. It says nothing about them whatsoever, in fact. It does say something about the slipshod and horrifying clinical practices of psych wards. though.
Quit thinking about yourselves, please. For one stone fucking second. There are people out there who need your help and attention and commiseration for what THEY are experiencing and not for what YOU are experiencing.
That's it. I've got nothing else to say.
undead wrote:)(some ranting, anger and pontificating.)
So for anyone interested in having a discussion about alternatives to psychiatry, one angle that is often overlooked is the racial perspective. Psychiatry is an almost entirely white phenomenon. The special place it holds in the legal system (good points hava1) is one of the biggest indicators of the systemic racism of the society of the United States. Alternatives from other cultures such as acupuncture, massage, yoga, Ayurveda, and psychedelic medicines have been excluded from public funding and the mainstream medical system, although this is (very) slowly changing. The medical system will only change for the better when these alternatives from other cultures are allowed an equal place in the range of treatment options, because all we are going to get from the current status quo is more disease profiteering.
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