I�ve just discovered that Part II of the extracts from Slater�s book in the Guardian of 31 January (cited in my previous message) is no longer available online. (The Guardian has just imposed restrictions on viewing parts of their website).
This gives me the opportunity to make a correction. In my previous message on Slater�s book I wrote concerning Slater�s account of her attempt to replicate Rosenhan�s psychiatric hospital experiment: > When I read that paragraph at the time, alarm bells rang. In a total of > eight visits to ER departments, is it likely that Slater would have been > prescribed no less than 25 antipsychotics and 60 antidepressants? I should have written *nine* visits, including the one she had already described in detail. As the extracts in the Guardian are no longer available online, I have appended below the section of one of them in which Slater describes her initial experience in her attempt to replicate Rosenhan�s experiment. The question that jumps to my mind is, how accurate is her account? She does not say she made a tape recording, and in any case it is inconceivable that the hospital would not have cottoned on to her had she been doing so overtly. (It�s difficult to imagine she could have done it covertly.) How much of what she reports happened as she describes it? Or � perish the thought � is there some truth in Michael B. Miller�s suspicion (that I had originally thought over-the-top) that the conversations were a product of her imagination: >From a SCCPNET list serve message by Michael B. Miller: �The third problem with Slater's book is that she claims to have conducted several difficult and/or ethically-questionable studies of her own � a replication of Rosenhan, a 40-year follow-up of Milgram's subjects and self-experimentation with opiates. These reported studies present a problem because we have no means of determining if she actually conducted any of them. My guess, based on her reports of her findings and on other observations of her conduct, is that she fabricated all three of these studies.� That some of us should even be contemplating that this might be the case indicates the problems that arise when accuracy of reporting ceases to be a prime concern of the writer. Allen Esterson Former lecturer, Science Department Southwark College, London [EMAIL PROTECTED] http://www.human-nature.com/esterson/index.html http://www.butterfliesandwheels.com/articleprint.php?num=10 ----------------------------------- Into the cuckoo's nest part II Guardian Saturday January 31, 2004 [�] Since Rosenhan, psychiatry has tried admirably to locate the physiological origins of mental disease - mostly in vain. Much of the current research is a knowing or unknowing response to Rosenhan's challenge and to the inherent anxieties it raises in "soft" scientists. Spitzer says, "I'm telling you, with the new diagnostic system in place, Rosenhan's experiment could never happen today. [In the 1970s, Spitzer and a group of colleagues completely revised the Diagnostic and Statistical Manual on Mental Disorders, or DSM for short, tightening the diagnostic criteria, taking away from it signs of subjectivity and psychobabble.] You would not be admitted and in the ER they would diagnose you as deferred." (Deferred, by the way, is a special category that allows clinicians to do just that, officially put off a diagnosis due to lack of information.) "No," repeats Spitzer, "that experiment could never be successfully repeated. Not in this day and age." I decide to try. Many things are the same. The sky is a poignant blue. The trees are turning, each scarlet leaf like a little hand falling down on our green autumn lawn. "You're what?" my husband says to me. "I'm going to try it," I say. "Repeat the experiment exactly as Rosenhan and his confederates did it, and see if I get admitted." "Excuse me," he says, "don't you think you have your family to consider?" "It'll never work," I say, thinking of Spitzer. "I'll be back in an hour." "And suppose you're not?" "Come get me," I say. I do my preparations. I don't shower or shave for five days. I call a friend with a renegade streak and ask if I can use her name in lieu of my own, which might be recognised. The plan is to use her name and then have her, later, with her licence, get the records so that I can see just what has been said. This friend, Lucy, says yes. She should probably be locked up. "This is so funny," she says. I spend a considerable portion of time practising in front of my mirror. "Thud," I say, and crack up, no pun intended. "I'm, I'm here ..." - and now I feign a worried expression, crinkled crow's- feet at my eyes - "I'm here because I'm hearing a voice and it's saying thud", and then, each time, standing in front of this full- length mirror, smelly and wearing a floppy black velvet hat, I start to laugh. If I laugh, I'll obviously blow my cover. Then again, if I don't laugh, and if I tell the whole truth about my history save for this one little symptom, as Rosenhan and company did in the original experiment, well, then I might really go the way of the ward. There is one significant difference in my re-test setup. None of Rosenhan's folks had any psychiatric history. I, however, have a formidable psychiatric history that includes lots of lock-ups, although, really, I'm fine now. I kiss the baby goodbye. I kiss my husband goodbye. I haven't showered for five days. My teeth are smeary. I am wearing paint- splattered black leggings and a T-shirt that says, "I hate my generation." "How do I look?" I say. "The same," my husband says. I drive there. I have chosen a hospital miles out of town with an emergency room set up specifically for psychiatric issues. I have also chosen a hospital with an excellent reputation, so factor that in. It is on a hill. It has a winding drive. In order to enter the psych ER, you must stand in front of a formidable bank of doors in a bustling white hallway and press a buzzer, at which point a voice over an intercom calls out, "Can I help you?" I say, "Yes." The doors open. They appear to part without any evidence of human effort, to reveal a trio of policemen sitting in the shadows, their silver badges tossing light. On a TV mounted high in one corner, someone shoots a horse - bang! - and the bullet explodes a star in the fine forehead, blood on black fur. "Name?" a nurse says, bringing me to a registration desk. "Lucy Schellman," I say. "And how do you spell Schellman?" she asks. I'm a terrible speller and I hadn't counted on this little hurdle; I do my best. "S-H-E-L-M-E-N," I say. The nurse writes it down, studying the idiosyncratic spelling. "That's an odd name," she says. "It's plural." "Well," I say, "it was an Ellis Island thing. It happened at Ellis Island." She looks up at me and then scribbles something I cannot see on the paper. I'm worried she's going to think I have a delusion that involves Ellis Island so I say, "I've never been to Ellis Island - it's a family story." "Race," she says. "Jewish," I say. I wonder if I should have said protestant. The fact is, I am Jewish, but I'm also paranoid - not as a general rule, of course, but at this particular point - and I don't want the Jewish thing used against me. Of what am I so scared? No one can commit me. Since Rosenhan's study - in part because of Rosenhan's study - commitment laws are far more stringent, and so long as I deny homicidal or suicidal urges, I'm a free woman. I am in control. I don't feel in control, though. At any moment someone might recognise my gig. As soon as I say, "Thud", any well-read psychiatrist could say, "You're a trickster. I know the experiment." I pray the psychiatrists are not well-read. This emergency room is eerily familiar to me. I have been in many that were just like this, but that was a long time ago. Still, the smells bring me back: sweat and fresh cotton and blankness. I feel no sense of triumph, just sadness, for there is real suffering somewhere here. I am brought to a small room that has a stretcher with black straps attached to it. "Sit," the ER nurse tells me, and then in walks a man, closing the door behind him - click click. "I'm Mr Graver," he says, "a clinical nurse specialist, and I'm going to take your pulse." A hundred per minute. "That's a little fast," says Mr Graver. "I'd say it's on the very high side of normal. But, of course, who wouldn't be nervous, given where you are and all. I mean, it's a psych ER. That would make anyone nervous." And he shoots me a kind, soft smile. "Say," he says, "can I offer you a glass of spring water?" And before I can answer, he's jumped up, disappeared, only to re-emerge with a tall, flared glass, almost elegant, and a single lemon slice of the palest white-yellow. The lemon slice seems suddenly so beautiful to me, the way it flirts with colour but cannot quite assume it. He hands me the glass. This, also, I had not expected - such kindness, such service. Rosenhan writes about being dehumanised. So far, if anyone's dehumanised here, it's Mr Graver, who is fast becoming my own personal butler. I take a sip. "Thank you so much," I say. "Anything else I can get you? Are you hungry?" "Oh no no," I say. "I'm fine really." "Well, no offence but you're obviously not fine," says Mr Graver, "or you wouldn't be here. So what's going on, Lucy?" he asks. "I'm hearing a voice," I say. He writes that down on his intake sheet, nods knowingly. "And the voice is saying?" "Thud." The knowing nod stops. "Thud?" he says. This, after all, is not what psychotic voices usually report. They usually send ominous messages about stars and snakes and tiny hidden microphones. "Thud," I repeat. "Is that it ?" he says. "That's it," I say. "Did the voice start slowly, or did it just come on?" "Out of the blue," I say, and I picture, for some reason, a plane falling out of the blue, its nose diving downward, someone screaming. I am starting, actually, to feel a little crazy. How hard it is to separate role from reality, a phenomenon social psychologists have long pointed out to us. "So when did the voice come on?" Mr Graver asks. "Three weeks ago," I say, just as Rosenhan and his confederates reported. He asks me whether I am eating and sleeping OK, whether there have been any precipitating life stressors, whether I have a history of trauma. I answer a definitive no to all of these things: my appetite is good, sleep normal, my work proceeds as usual. "Are you sure?" he says. "Well," I say, "as far as the trauma goes, I guess when I was in the third grade, a neighbour named Mr Blauer fell into his pool and died. I didn't see it, but it was sort of traumatic to hear about." Mr Graver chews on his pen. He's thinking hard. "Thud," Mr Graver says. "Your neighbour went thud into his pool. You're hearing 'thud'. We might be looking at post-traumatic stress disorder. The hallucination could be your memory trying to process the trauma." "But it really wasn't a big deal," I say. "It was just ..." "I would say," he says, and his voice is gaining confidence now, "that having a neighbour drown constitutes a traumatic loss. I'm going to get the psychiatrist to evaluate you, but I really suspect that we're looking at post-traumatic stress disorder with a rule out of organic brain damage, but the brain damage is way far down the line. I wouldn't worry about that." He disappears. He is going to get the psychiatrist. My pulse goes from 100 beats a minute to 150 at least - I can feel it - for surely the psychiatrist will see right through me or, worse, he will wind up being someone I know from high school, and how will I explain myself? The psychiatrist enters the little locked room. He is wearing baby- blue scrubs and has no chin. He looks hard at me. I look away. He sits down, and then he sighs. "So you're hearing 'thud'," he says, scratching the chinless chin. "What can we do for you about that?" "I came here because I'd like the voice to go away." "Is the voice coming from inside or outside your head?" he asks. "Outside." "Does it ever say anything other than thud, like, maybe, kill someone, or yourself?" "I don't want to kill anyone or myself," I say. "What day of the week is it?" he asks. Now, here I run into another problem. It's actually a holiday weekend, so my sense of time is a little thrown off. Sense of time is one way psychiatrists judge whether a person is normal or abnormal. "It's Saturday," I say, I pray. He writes something down. "OK," he says. "So you're experiencing this voice in the absence of any other psychiatric symptoms." "Do I have post-traumatic stress disorder," I ask, "like Mr Graver suggested?" "There's a lot we don't know in psychiatry," the doctor says, and suddenly he looks so sad. He rubs the bridge of his nose, his eyes momentarily closed. With his head bowed, I can see a small bald spot on the dome of his scalp, and I want to say, "Hey. It's OK. There's a lot we don't know in the world." But instead I say nothing and the psychiatrist looks sad, and baffled, and then says, "But the voice is bothering you." "Sort of, yeah." "I'm going to give you an antipsychotic," he says, and as soon as he says this the sadness goes away. His voice assumes an authoritative tone; there is something he can do. "I'm going to give you Risperdal," he says. "That should quiet the auditory centres in your brain." "So you think I'm psychotic?" I ask. "I think you have a touch of psychosis," he says, but I get the feeling he has to say this, now that he's prescribing Risperdal. It becomes fairly clear to me that medication drives the decisions, and not the other way around. In Rosenhan's day, it was pre-existing psychoanalytic schema that determined what was wrong; in our days, it's the pre-existing pharmacological schema, the pill. Either way, Rosenhan's point that diagnosis does not reside in the person seems to stand. "But do I appear psychotic?" I ask. He looks at me. He looks for a long, long time. "A little," he finally says. "You're kidding me," I say, reaching up to adjust my hat. "You look," he says, "a little psychotic and quite depressed. And depression can have psychotic features, so I'm going to prescribe you an antidepressant as well." "I look depressed?" I echo. This actually worries me, because depression hits closer to home. I've had it before and, who knows, maybe I'm getting it again and he sees it before I do. He writes out my prescriptions. The entire interview takes less than 10 minutes. I am out of there in time to eat Chinese with the real Lucy Schellman, who says, "You should've said 'thwack' instead of 'thud', or 'bam bam'. It's even funnier." Later on, I fill my prescriptions at the all-night pharmacy. And then, in the spirit of experimentation, I take the antipsychotic Risperdal, just one little pill, and I fall into such a deep, charcoal sleep that not a sound comes through, and I float, weightless, in another world, seeing vague shapes - trees, rabbits, angels, ships - but as hard as I peer, I can only wonder what is what. --- You are currently subscribed to tips as: [EMAIL PROTECTED] To unsubscribe send a blank email to [EMAIL PROTECTED]
