Hello everyone, I am a small point, a little spiritual point.
Today I will talk to you about a brain hole problem:
If you wake up and find yourself in a mental hospital. No matter how you argue, it is treated as a mental illness attack, and the nurse keeps you firmly tied to the hospital bed.
What can you do to prove your mental health? Rescue yourself?
Highly educated "Death": The Real Version of "Flying Over the Madhouse"
A psychologist on the other side of the ocean also had this damn curiosity, so he "died" to try.
In 1973, David L. Rosenhan was already a researcher at Stanford University, teaching.
However, after teaching, he had a sudden idea, sneaked into the mental hospital, and spent 9 days of extreme boredom.
In the past 9 days, he has questioned: if a large number of healthy people sneak in, how many people can be found in the hospital to "pretend to be sick"?
Rosenhann doesn't just stop at "thinking," but in action.
He consulted the relevant lawyers and asked about the consequences of the infiltration to avoid that the "spies" really could not leave the mental hospital smoothly.
After all obstacles were removed, he began to formally recruit volunteers.
This kind of large-scale realistic version of "werewolf killing" that tests IQ and acting skills is, of course, a talent that can be improvised at the recruitment point.
Stills from Flying Over the Madhouse, 1975
In the end, Rosenhann determined the high configuration of "3 women and 5 men" as the "death squad".
The squad is quite good, there are 4 big names in the psychology industry alone: 3 psychologists and 1 psychiatrist respectively.
In addition, there are also members of the social elite: 1 graduate student, 1 pediatrician, 1 painter, and 1 housewife.
All 8 people participated voluntarily, and they were very physically and mentally healthy before participating.
In order to successfully "go undercover", Rosenhann unified the caliber of 8 people and intimately attached a tutorial on pretending to be sick:
Before visiting the doctor, do not bathe, shave, or brush your teeth for 5 consecutive days.
After meeting the doctor, I asked them to claim that they had "auditory hallucinations" — "someone kept making a 'banging' sound in my ear" — and other than that, everything went as usual.
Everyone thinks, this lineup, this kind of setting, who will be released by the hospital first?
Anyway, tonight's chicken legs, the little dots are all pressed on the four psychology big guys!
Behind Enemy Lines: The course of action of the undercover squad
After a long training session, Rosenhann sent 8 volunteers to 12 psychiatric hospitals.
Some of these mental hospitals are quite famous, and some are ordinary public hospitals.
According to the tutorial of the big guy, 8 "patients", 1 was diagnosed with bipolar disorder, and the rest were diagnosed with "schizophrenia".
According to the pre-agreed code: once the doctor recommends hospitalization, they tell the doctor that their auditory hallucinations have all disappeared!! (Ah, yes, that's it.) ）
However, they were still sent to the mental hospital of their dreams and came to the place where the dream began.
After entering a mental hospital, every undercover agent must behave no differently from a normal person. Yes, eating and drinking Lasa is done according to mental health people.
Network, undercover in a mental hospital photo
The only behavior that doesn't look like a normal person is the need to record your experience in a small book every day.
The small book must not be discovered by the doctor, and must secretly record the information, and after the doctor determines that the "patient's" mind has returned to normal, it will be taken out and handed over to the organization.
In this way, no one knows exactly how long they will be locked up, during which time they need to spend their days and nights with real psychopaths.
If the doctor prescribes psychiatric drugs, they will secretly throw them into the toilet and wash away, and no one will take them without permission.
First, the side effects of psychotropic drugs were very large at that time; second, I was worried that if I really took the drugs and had some abnormal behavior, it would really be indefensible.
At this time, the 8 brave pioneers, all of their "freedom rights" were entrusted to the hospital - only if they were judged to be "recovered", they could end their undercover careers.
So, the 8 players with excellent IQ and acting skills, who can get out of trouble the fastest? How long does it take?
You know, "You're here to visit!" ”
This undercover operation is far less difficult than initially imagined.
The task of "protecting small books and recording daily experiences" given by the organization was originally thought to consume a lot of brain CPU. Unexpectedly, it is not difficult to implement.
At first, they recorded intelligence very secretly, but after a while, the undercover agents discovered that the doctors did not care about this recording behavior.
Nurses only write that they are "addicted to writing" every day in the case, and this behavior is further confirmed as "the symptom of schizophrenia".
However, the days in a mental hospital are somewhat cruel.
In hospitals, medical staff and patients are isolated. The patients were fenced off with glass, and outside the "glass observation room" was a separate living area for the medical staff – with bathrooms, conference rooms, and canteens.
The entire "glass cage" of health care workers appeared less than 11.3% of the office hours.
Medical staff, just outside the "glass cage" to observe the patients and undercovers.
"Sometimes even going to the bathroom is watched," one volunteer describes.
Doctors and nurses often talk about their patients' conditions (they don't think that mentally ill people can't think normally, so they don't shy away), but they are reluctant to talk to patients.
The daily conversation, after saying the routine inquiry of "good morning, xx, how are you feeling today", the doctors are eager to escape immediately, leaving no time for patient feedback.
This life has been so long that the volunteers feel breathless.
Even though they had stressed that they could no longer hear the "bang bang" hallucinations, they were still arranged for various treatments - 8 people were given more than 2100 pills in total.
They were detained for 7 days at the shortest and 52 days at the longest, with an average of 19 days.
During this period, not a single medical staff found that the "undercover" had no mental illness at all, and when they were discharged from the hospital, the undercover files were marked with a "recovery period for mental illness".
The funny thing is that the first to identify the identity of "undercover" is not a doctor at all, but a patient in the hospital. One of the undercover hospitals, there are 118 patients, 35 of whom were found to be undercover as feigned illness.
"Hey, brother, I know you're not mentally ill, you're either a reporter or an editor, you're coming to our mental hospital for covert visits!"
Don't worry, there's a follow-up to the story
After the experiment, Rosenhann announced the results of the experiment.
He believes that behind this absurd farce is a flaw in the diagnostic criteria at the time, which triggered the label effect.
Labelling refers to labeling others, such as mentally ill people in a text, by stereotypes or prejudices and falling into preconceived thinking.
From the moment they entered a mental hospital, they were labeled as mentally ill, and these labels made them believe that whatever they did, they were considered to have the effects of mental illness behind their behavior.
Once a person is designated abnormal, all of his other behaviors and characteristics are colored by that label. —David Rosenhann
Rosenhann believes that the label effect is due to the vague diagnostic criteria at the time.
DSM II, the controversial diagnostic criterion at the time
In the DSM-2 at the time, the description and diagnostic criteria for schizophrenia included:
Disorders characterized by characteristic disorders of thinking, mood, and behavior. It has the characteristic of interfering with thinking. This can lead to misunderstandings about reality, sometimes delusions and illusions.
Hallucinations, often psychological self-preservation. Contradictory mood changes, restricted and inappropriate emotional responses, and loss of compassion for others.
The main features of this psychosis are a slow and hidden decrease in external attachment and interest, as well as apathy and apathy that leads to poor interpersonal relationships, and adjustment at a lower functional level.
In general, this condition is not as severely psychotic as schizophrenia, catatonia, and paranoia.
In the psychiatric manual at that time, the diagnostic criteria for schizophrenia were not perfect.
There are many more subjective and empty contents such as "psychological self-protection", "contradictory emotional changes", "external attachment and interest reduction", lack of obvious external symptoms, duration and other measurable standards.
This made the diagnosis of schizophrenia at the time highly susceptible to labeling effects.
Unconvinced by the aftermath of the dramatic experiment
Rosenhann's experiment and his theory of the label effect, when published in the journal Nature, drew the displeasure of psychologists and psychiatric institutions.
The original text of the newspaper of that year
A psychiatric hospital wrote a 30-page essay criticizing Rosenhann's theory, and the rationale was quite like this:
"If I drink 1L of blood first, hang up the emergency room, and spit blood when I get to the hospital." Wouldn't the paramedics give me an emergency room right away? If I conclude from this that medicine cannot diagnose diseases of the digestive tract, it would be unconvincing. ”
So the psychiatric hospital issued a challenge to Rosenhann: "You send undercover again, and if I can use the diagnostic criteria to screen out who is pretending to be sick, even if you lose." ”
The two agreed that Rosenhann would send a steady stream of fake patients to the psychiatric hospital over the next 3 months, which would screen the fake patients.
Within 3 months, the psychiatric hospital had a total of 193 clients.
The hospital carefully screened and confirmed that Rosenhann had sent 41 undercover agents and a list of 42 suspected undercover agents.
Statistical reports of psychiatric hospitals
When the hospital confidently handed over the answer sheet, Ron Hansen said that he did not send a single undercover agent.
Since then, Rosenhann has become famous, and the mental hospital has been discredited.
Due to the influence of the label effect, the hospital naturally believes that all clients must have undercover agents who pretend to be sick, and the bias seriously affects the accuracy of diagnosis.
Rosenhann's experiment reduced the number of patients in Psychiatric hospitals in the United States by 50 percent.
The American Psychiatric Association revisited diagnostic criteria and issued the Diagnostic Manual of Psychiatry (DSM-3, 1980).
What are the differences in diagnostic criteria today?
In the ancient days of the history of psychology, the diagnostic criteria contained a lot of Freud psychoanalytic school content — what does that mean? It contains a large number of subjective judgments such as the "subconscious" as an illustration, and lacks objective measurement standards.
Psychoanalysis, as a branch of psychology, does go a long way in tracing the causes of trauma. However, it is clear that it is more suitable for the scope of psychological counseling than as a diagnostic criterion and basis.
In 1974, the American Psychiatric Association began rewriting the diagnostic criteria, and in 1980 published the DSM-3, which rejected the diagnostic content of the vast majority of psychoanalytic schools.
In the history of the development of psychology, similar absurdities are not uncommon, but now this absurdity is difficult to reproduce.
DSM V, the latest diagnostic criteria for schizophrenia
And this rule, with clinical application, is constantly standardized.
In the latest version of the DSM-5 (2013), the diagnostic criteria for mental illnesses such as schizophrenia are quite mature and the classification is more refined.
With the development of neuroscience, the current diagnosis of mental illness has long relied not only on the patient's own feedback, but also on the use of a lot of advanced technology to check people's physical changes, including fMRI, CT and other advanced neuroanagraphy technology.
We have a more thorough understanding of the origin and understanding of organic lesions, and there are very few misdiagnoses.
Today, "if I'm put in a mental hospital, how do I prove I'm not mentally ill?" "There's no need to worry about that.
With the increased awareness of delabeling, even patients who have been misdiagnosed and admitted will be reasonably rediagnosed and released.
Rosenhann's skeptical spirit has greatly promoted the diagnosis mechanism of psychiatric disease and the improvement of the mechanism of psychiatric hospital admission.
His research has helped psychotherapy into a new generation of greater science and humanism.
-END-
Author: He Zhichao
Image source: Pexels, network
Debut: Yidianling0
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