Suffer the Children


Justice, Fairness, and Society’s Treatment of the Mentally Ill

A psychiatric label has a life of its own.

Most of us are familiar with the famous experiment by Stanford University psychologist David Rosenhan which was originally published in the journal Science in 1973. Rosenhan began his experiment with the question "If sanity and insanity exist, how shall we know them?" Then he set out to find an answer to whether experts--namely psychiatrists--were able to distinguish insane people from sane people. Rosenhan did not doubt the existence of psychological suffering. But he believed that there was no bright line to be drawn between normal anguish and insanity.

      Rosenhan instructed his researchers, who consisted of three men and five women, to gain admittance to different mental hospitals. Once they were diagnosed and admitted, they were to drop any pretence of insanity and behave and speak as they normally did. All of the "pseudo patients" were admitted with diagnoses of schizophrenia and were kept in the hospitals from seven to fifty-two days-even though they behaved normally after admittance. They took notes on how they were treated, but nursing records indicated that the writing was a sign of their "pathological behavior." Because they were labeled with a severe diagnosis, the patients were not able to shake the label no matter how sanely they behaved. This led Rosenham to conclude: "A psychiatric label has a life and an influence of its own. Once the impression has been formed that the patient is schizophrenic, the expectation is that he will continue to be schizophrenic."

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      Further, he concluded that doctors cannot distinguish the sane from the insane in psychiatric hospitals, and that the consequences to patients in the hospital environment--"powerlessness, depersonalization, segregation, mortification, and self-labeling"--were not therapeutic and not in the best interests of either the patients or of society.

      A less known experiment of the same type was conducted a century before Rosenhan's by a feisty American newspaper reporter named Nellie Bly. Bly's editor at the The New York World asked her to take on the role of a mentally ill woman and spend ten days inside a madhouse. During this time she was to take notes and write about the conditions there. Her editor told her that he did not want a sensationalistic account, but simply wanted her to write of things as she found them. And with her editor's assurance that he would get her of the out of that place no matter what he had to do, Nellie took on the task of assuming the role of a madwoman.

      Adopting the pseudonym of Nellie Brown, Bly feigned insanity, and got herself admitted to Blackwell's Island Insane Asylum in New York. Like Rosenhan's researchers, Nellie Bly dropped the pretense of being insane as soon as was in the mental hospital. She talked and acted just as she did in ordinary life. But psychiatric labels are difficult to dismiss. Bly says that the more sanely she talked and acted, the crazier she was thought to be by all of the psychiatrists with the exception of one kind and gentle doctor.

      The conditions she found in the asylum were appalling, and resulted in a grand jury investigation, followed by an $850,000 increase in public funds for the care of New York's insane. When Bly left the asylum, she felt both pleasure and regret. She wished she could have taken with her some of the other unfortunate inmates who, she believed, were just as sane as she was.

      Although Bly and Rosenhan had different goals for their experiments in mental hospitals, they arrived at a similar conclusion. They both found that when a person has been labeled with a psychiatric diagnosis and institutionalized, the person becomes both dehumanized and powerless. She is no longer treated with the respect granted to "normal" people. Both experiments show that this process is not only an unjust treatment of our fellow human beings, it is also the opposite of therapeutic.This marginalizing of the troubled and vulnerable among us is intolerable in a society that seeks to be just.




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