Have psychiatric wards changed?

[emad]

From The Times
July 27, 2009
A 1970s psychologist caused outrage by faking symptoms of mental illness for a study. But have lessons been learnt?
Ckaudia Hammond



If you found yourself locked up against your will in a psychiatric ward, you would probably do your best to get out. But in 1969 a group of people did just the opposite — they tried to get in. A young American psychologist called David Rosenhan persuaded seven friends (two psychologists, a psychiatrist, a doctor, a housewife, a painter and a student) to see whether they could convince doctors that they were mentally ill simply by claiming to hear voices. Now previously unpublished notes from Rosenhan’s private archive reveal what the experience was really like.

Between 1969 and 1972 the team of “pseudo-patients” presented themselves at 12 different US hospitals in five states on the East and West coasts. What would a sane person have to do to convince a doctor they were insane? Not a lot, it seems.


----------------------------

The profession reacted furiously, complaining that the fact that they could be tricked did not undermine their methods of diagnosis. It was not their job, they said, to look for hoaxers. Patients could present with fake symptoms in any field of medicine and be prescribed unnecessary treatment. Doctors rely on patients to tell the truth and do not expect them to invent symptoms. After all, a person who goes to his doctor complaining of severe stomach pains would be taken at his word and possibly even admitted to hospital.

But Rosenhan argued that however much psychiatry might want to be viewed like any other branch of medicine, the difference was the lack of further tests to confirm a diagnosis. None of the decisions to diagnose schizophrenia in the pseudopatients was reversed, even for the patient who had been observed for 52 days. Rosenhan wondered how a doctor who could not even tell which patients had mental health problems could ever expect to distinguish between different types of mental illness.
http://www.timesonline.co.uk/tol/life_and_style/health/mental_health/article6726435.ece

[MineralMan]

1. Well, as the venerable Dr. House says,

They all lie. Everybody lies.

[CoffeeCat]

2. Wow, this could have been interesting...

I don't see the point of chastising doctors because they admitted people because they reported that
they "heard voices". Many mental illnesses are diagnosed by patient reports. How else do you
diagnose depression, PTSD, OCD, anxiety or bipolar disorder?

There are no blood tests for these disorders, of which I am aware. :shrug:

What would have been really interesting and really eye opening is for "fake" patients to be diagnosed
and put in a mental hospital--for the express purpose of reporting on the conditions and practices inside.

Now THAT would be fascinating, and in my opinion, a much-needed investigation.

[elocs]

9. If a person reports they are hearing voices, then they should be considered to have schizophrenia

unless proven otherwise. That is the opinion of Dr. E Fuller Torrey the author of "Schizophrenia: A Manual for Families, Consumers, and Providers". He is renowned in the field and I am reading his book because my 17 year old goddaughter, who is like a daughter to me, has been diagnosed with paranoid schizophrenia and has ended up in the psych ward of different hospitals on 7 different occasions this year. Each hospital will keep her for the 2 weeks to make as much money (up to $1000/day) from keeping her as possible then they cut her loose and send her home virtually unchanged and a week or so later the entire thing happens all over again. Her mom's insurance (she works for a major hospital in Chicago, but it is out of network for her insurance) and she has maxed out the amount of coverage they will provide for this year already. From now on she is on her own and is on the verge of bankruptcy.

As far as faking it goes, there was an interesting story recently on "This American Life" about how a guy in England decided to fake mental illness to avoid serving time for assault (up to 5 years) because he had been told by others that he would serve easy time in a cushy mental hospital. He was unpleasantly surprised to end up in one of the worst mental facilities in Great Britain where the send the mass murderers and the pedophiles. We he tried to convince them he was sane he found he had done too good of a job convincing them he was not. In fact the more sane he acted, the more convinced they were that he was not sane or that it was only because he was in a controlled institution that he was ok. At the time of the story he had been in there for 12 years and had no real hope of getting out any time soon and he was just 18 when he went in.

In this story a psychiatrist said that nearly to a person everyone he had ever heard of who had faked mental illness to get out of prison time regretted doing it. It's easy to fake being mentally ill and harder to afterward prove you are not.

[emad]

11. they should be considered to have schizophrenia....or be Joan of Arc.

N/t

[Aragorn]

12. bipolar

Don't get hooked into one set of diagnostic biases. Bipolar is more likely for many many reasons. Are you aware of the large genetic study which just showed it is all probably bipolar anyway/ Why does it matter/ Because bipolar may turn out a whole lot better, and will only "improve some" if treated as schizophrenia. Psychiatry uses a silly approach to diagnosis - in practice anyway - by focusing on symptoms more than course of illness, family history, etc.

If you want a great researcher on this look for Dr. Akiskal in a search.

[RobinA]

14. I'm Sorry

about your goddaughter. However, what you are describing is an insurance issue, not the hospital trying to make money. Anybody in the hospital knows that you can't stabilze someone with schizophrenia in two weeks, especially at age 17 and when the illness is emergent.

As a person working in the system, all I can tell you and her mother is to learn everything possible about the illness and the system from a variety of sources (there are different ways of looking at the same thing in psychiatry as in any field) and fight, fight, fight. Don't be afraid to search for a doctor who you believe in and can trust. The best way of doing this is to know your stuff to more readily be able to recognize a doctor who knows his/her stuff. Don't get sucked in to a feel-good approach unless there is some science behind it.

[elocs]

16. Wrong! Yes it is about the hospital wanting to make money.

In one of the recent cases my goddaughter had been in a day school at the hospital when one of the staff claimed she had threatened them and they sent her upstairs to the psych ward. When her mom got there that evening and heard the story she insisted on taking her daughter home and not only did the hospital refuse to let her even see her daughter they also insisted on keeping her for 5 days (since insurance would pay) and even tried threatening mom with loss of her parental rights if she did not sign. All of this when the insurance company told the mom that her daughter did NOT have to stay 5 days anywhere. You should have heard the hissy fits when the mom dared to question the hospital (yes, how dare she since they are the experts).

I have seen the proof that for these hospitals it IS about the money since they will keep my goddaughter for as long as they can and then simply cut her loose and send her home when her mom has no way to take care of her. Once the insurance company will not longer pay--out she goes without working to do anything else to help her or to find another place for her. Oh no, they cannot stabilize her in 2 weeks but they are more than willing to keep her for that long, but her loose after 2 weeks, and then take her back again a week or 10 days later for another 2 weeks until all of the insurance money is bled dry. Of course now that there is no longer any insurance money they don't want to keep her for 2 weeks anymore.

[RobinA]

3. So...

if a psychiatrist did not admit a person who came in describing the symptoms of psychosis and then the person later went out and shot up the shopping mall, it would be the doctor's fault for not admitting him. Do we really want psychiatrists in a "No you don't," "Yes I do" battle with schizophrenics? Of course you can fake your way into a psychiatric hospital, although I would suggest not using one of the decreasing number of psychiatric beds if you don't need it and leave it for the many, many, many people who do but can't get admitted.

[jody]

17. Excellent point. n/t

[ejpoeta]

4. as someone who has been in the psych ward against my will, i would say

i wouldn't want to go back. though i rememember them on the phone asking if people wanted to come in or something... trying to fill beds. i guess if i wanted a break.... but you are there with some crazy people. there was a guy who was there for obsessing over someone, and he creeped me out... he would sit there and stare at me. there was a guy who insisted he was kurt cobain. there was a girl who had slit her arms. it was creepy. When i first went in and was in an area they keep you for a couple of days while they evaluate you and i could hear this woman screaming!!! i guess it took like six orderlies to hold her down. she went right upstairs where i ended up. they asked me questions about if i heard voices or thought i had special powers and stuff. i was honest and told them i thought about hurting myself. i am guessing that helped them to keep me against my will

[Wapsie B]

5. Well for one thing it's hard as hell to get anyone admitted for more than a 3-day stay anymore.

It's 3 days and you're out. And we wonder why someone who's unstable might become totally unglued shooting students on college campuses in this country? Another shining legacy of Ronnie Reagan, the defunding of our mental health system.

[elocs]

10. If you have insurance they will want to keep you for 5 days in a psych ward

and then keep you for up to 2 weeks per incident. After that time you are on your own, but they will be happy to readmit you again for another round of $1000/day warehousing.

[gorfle]

6. Not totally fair.

But Rosenhan argued that however much psychiatry might want to be viewed like any other branch of medicine, the difference was the lack of further tests to confirm a diagnosis.

The simple fact is that there just aren't a whole lot of tests that can be done to accurately diagnose mental problems. This doesn't mean we don't know that certain people are actually crazy, nor does it mean that doctors who specialize in these problems are quacks. Unfortunately, a whole lot of mental diagnoses are done simply by trained observation. If you present with well-faked symptoms, you will probably be taken for real, unless the doctor has some reason to suspect otherwise.

Fortunately, we may be on the cusp of a new generation of tools that can actually look into the brain and see how it functions. I have seen several news stories in the past several months about this. Perhaps some day we will have machines that can accurately diagnose mental illness, rather than relying on observation.

[hedgehog]

7. How many autoimmune diseases manifest themselves with

pain and fatigue well before there are any observable or measurable symptoms? Does this mean that rheumatologists are also fakes?

[BR_Parkway]

8. They used to be populated with Republicans, then Reagan let them

out to 1) cut costs and 2) get out the vote. Now we know them as FAUX news addicts, birthers, tea baggers...

[Posteritatis]

15. Some day I hope this site gets past that "let's assume mentally ill = Republic" idiocy. (nt)

[TZ]

13. Do you not realize that mentally ill people make up a HUGE

population of the homeless? But hey, thats better than getting ACTUAL help right? :sarcasm: