I was reading over the summer about David Rosenhan’s Pseudo-Patient Study, a landmark study in the history of psychiatry done back in the late 1960’s-early 1970’s. (Great radio show about it here). Rosehahn and a team of eight collaborators submitted themselves to admittance into mental institutions, all presenting with the same symptom. They made sure it had never appeared in the literature before. Each of them said that they had heard voices in their heads. Over recent weeks the voices had become discernible. The voices said, “It is empty. It is hollow. There is nothing in it.”

Which is funny, because their symptoms admitted to the state of their symptoms.

Each of the participants was admitted to hospital and they spent between 8 and 52 days inside before being released.

The point of the study was not to see if they could “break-in” to a mental hospital but to see how they would be treated once inside. The moment that they were admitted, each participant (their identities have always been kept secret) reverted to their totally normal behaviour.

And yet they were treated as if they were mental by the staff. Simple, normal behaviour patterns with mis-attributed to lunacy. Note-taking, which is what you would expect scientists doing experiments to do, was seen as compulsive. Being in a mental institution is more boring than being in the Big Brother house. One of the participants so looked forward to meal time that he would go to the refectory five minutes early. This was interpreted as a psychotic oral fixation.

The point of the study is not the naive reading that psychiatry is bunk or that mental institutions are stupid. Psychiatry assumed that no one ever wanted to break into a mental institution. They implicitly trusted presented symptoms. They did not make allowance for malingerers so one would be confident that these smart men would be able to get admitted.

What is shocking about the study however is how context shapes perception. It doesn’t matter how normal you behave and how tranquil you appear, when you have the label “PATIENT” slapped on your head in a mental institution you will be read as a mentalist.

Which is pretty deep. The labeling of people as “Deviant” will prompt us to read deviancy into their behaviour. The label “irrational” will likely do the same.

Or maybe it just means you shouldn’t take a job where you have to pretend to be mental.

Your Correspondent, More powerful than morphine