A bit of a tangent, but looking at Dr. Morehead's editorial it's frustrating to see yet another psychiatrist repeat the claim that the Rosenhan study was a fraud. Cahalan did not prove it was faked, she insinuated it, and her book has major omissions that call the trustworthiness of her investigation into doubt. Implausible as it sounds, I'm convinced The Great Pretender was carefully written to support a pro-psychiatry agenda rather than provide an honest history.
Interesting... Yes, I didn't mention that part of Morehead's op-ed because I didn't find that part all that relevant or compelling. I didn't delve much into Calahan's book, and I never included the Rosenhan study in my own book because I found contemporary reality far more damning than an experiment in the past. But what omissions in particular, if I might ask?
The big one for me is that the book has only oblique references to labelling theory and no mention whatsoever of sociologist Thomas Scheff and his work. I've done a fair bit of digging myself and have concluded that Scheff's ideas provided the intellectual foundation for the Rosenhan's study. (I can elaborate with evidence if you'd like.) Last I checked, Scheff was still alive (though quite old), and there's no way a multi-year investigation resulting in a 300 page book could leave out such a major influence accidentally.
The result is that she completely fails to contextualize the experiment and what Rosenhan was trying to show. His motivation for the study becomes mysterious, and he appears more like an ideologue who set out to discredit the profession than someone who set out to explore an interesting question within a real sociological tradition. In effect, she provides a narrative that Rosenhan exposed some real problems with psychiatric practice but was dishonest and went too far — now "the mentally ill" get too little treatment rather than too much.
(I've seen a number of people on social media who've heard about Cahalan's 'debunking' and think Rosenhan was responsible for deinstitutionalization. Which is nonsense, of course. Mental hospitals began closing down years before 1973, but that's not the popular narrative.)
It's been a while, but if I remember correctly another omission is that she doesn't give the background for Spitzer and Rosenhan's disagreement. The two argued back and forth via letter because Spitzer was organizing an issue of the Journal of Abnormal Psychology in 1975 around Rosenhan's study. Rosenhan provided a followup paper, "The Contextual Nature of Psychiatric Diagnosis" while Spitzer and his colleagues provided several papers criticizing the experiment. Cahalan doesn't mention Rosenhan's followup at all, doesn't discuss the journal issue, but quotes liberally from criticism in Spitzer's contribution and generally sides with him.
It's quite odd. When I look at the debate, I see the psychiatrists and Rosenhan talking past each other; the psychiatrists seem to think the study was questioning whether they could _diagnose_ reliably, while Rosenhan is interested in the social processes around _labels_ and how they influence perception. Two different paradigms. Now I don't know how much of the psychiatrists' misinterpretation of Rosenhan was deliberate, but it strikes me that Spitzer and his colleagues — many of whom were working on DSM-III — framed the controversy over the study in such a way that their new diagnostic manual could resolve it. Spitzer and his medical model eventually triumphed; labelling theory was forgotten. But Cahalan doesn't seem to have been interested in clarifying the debate at all and essentially gives us a history from the side of the victors.
That's off the top of my head. I don't trust her. After comparing the story she tells with what I've read from the literature of the time, I'm compelled to view her evidence for 'fraud' quite skeptically. I suspect there are reasonable explanations for what she found, but she cherry-picked material to put Rosenhan in the worst possible light.
Thank you for sharing that! That's very interesting. And I agree on the issue of labeling theory. I interviewed John McKnight (The Careless Society) just a few years ago, who was a contemporary of the generation of Szasz, Illich, etc (and friends and colleagues with them), and he pointed right away to labeling theory and the Rosenhan study as part of the context for the ongoing development of their critiques. And if she dropped that out--really one of the core problems with psychiatric diagnosing--then that's a huge gap, all right.
My pleasure! I got a bit obsessed when it dawned on me.
I found a short review Rosenhan wrote in 1968 of "Being Mentally Ill" for Contemporary Psychology titled, "Madness: In the Eye of the Beholder".[1] So Rosenhan was reading Scheff and thinking about perception and labeling less than a year before he first went undercover in 1969.
He echoed the review title in the first section of his famous 1973 paper: "Psychiatric diagnoses, in this view, are in the minds of the observers and are not valid summaries of characteristics displayed by the observed" with a citation of several critics including Scheff. And Rosenhan's discussion later in the paper of type 1 and type 2 errors and clinician bias toward identifying illness comes directly from a chapter of "Being Mentally Ill".
Thank you so much for your profoundly humanitarian journalism Rob. It's staggering to read how routinely dishonest 'professionals' who work in mental health 'care' are. They can write whatever absurd exaggerations or abject lies they want and are never held accountable and the patient has no voice and no recourse to get the records corrected to reflect truth and reality. Thank you for your diligent efforts to expose these horrible abuses of psychiatry.
Oh yes, as electronic records are available and accessed widely it makes harmful lies and fabrications by psychiatry insidious and very detrimental to try obtain proper medical services for any physical condition.
Rather than “involuntary commitment,” “civil commitment,” please consider using “psychiatric imprisonment.” The former, more polite sounding words, are pharma/psych marketing terms.
I use varied terms. I think it's also important to use phrases, especially in titles, that people who don't know anything about the issue will understand. Anyone who actually reads my articles, I think, will quickly understand what I'm actually describing. For many, the reality is actually much worse than "imprisonment" in a lot of ways.
Forced incarceration of the 'unproductive' (mentally ill) is a capitalist business model. It's why Uncle Sam throws 80% of its mentally ill citizens in prison.
You might find my book interesting. Actually, the vast majority of those labeled with mental illnesses are not in prisons, but in private hospitals and public psychiatric wards in general hospitals, group homes, assisted living, long term care facilities, etc. They become prisons by any other name, but it's still an important distinction -- there's no "shortage" of psychiatric beds, they are overloaded.
Yes. I was quoting a rough statistic from back in the 1980s. It shocked me at the time. But as you say, things are more insidious and more sophisticated today. It is very dark. Very dystopian. Cultural gaslighting narratives are the tallest walls, I think. I worry about the future detention camps that are proposed to be built in the US. Will they be centres of forced labor as some conventional prisons are? Dare I say that the concentration camp never went away.
I have seen the UK version of care homes with locked doors. At best they are privatised human dustbins for profit. At worst they are killing factories. I'm deeply traumatised by what I've witnessed. We are in living memory of the Holocaust, which in part progressed smoothly because most people couldn't believe that something so monstrous could happen.
It's better to speak out and risk being thought of as a fool, than to not speak out at all.
After working in 7 psychiatric facilities, I’m unfortunately not surprised by anything you write. It all tracks and I didn’t even work in one of the states you listed. I don’t know if it helped, but one small act of resistance from within was charting reality which was usually that people were caring, insightful, helpful with their peers, and participating fully in therapy groups (which for me included observing though most participated enthusiastically when pressure to perform was removed.) We were often pressured to aggressively chart symptoms rather than from a strengths-based perspective because if the notes were too positive insurance would stop paying and then the hospital would discharge.
So sad. One person who worked with children said to me that she was constantly encouraged to describe the child as the devil's spawn in order to garner more funding and supports, but she worried about the day as an adult when one might go back and read what she'd written in those records.
It’s in LHSC psychiatry. They are still trying to trick me into the Emergency Dept. Im a Mental Health Professional so it’s not so easy, when I called for the DSM but it has been very very upsetting. They have successfully isolated me too. Ty ty ty. It’s so important, that I’m not alone. Ty. I think VAC are aware but not doing anything!
Especially excellent article. Thank you.
A bit of a tangent, but looking at Dr. Morehead's editorial it's frustrating to see yet another psychiatrist repeat the claim that the Rosenhan study was a fraud. Cahalan did not prove it was faked, she insinuated it, and her book has major omissions that call the trustworthiness of her investigation into doubt. Implausible as it sounds, I'm convinced The Great Pretender was carefully written to support a pro-psychiatry agenda rather than provide an honest history.
Interesting... Yes, I didn't mention that part of Morehead's op-ed because I didn't find that part all that relevant or compelling. I didn't delve much into Calahan's book, and I never included the Rosenhan study in my own book because I found contemporary reality far more damning than an experiment in the past. But what omissions in particular, if I might ask?
The big one for me is that the book has only oblique references to labelling theory and no mention whatsoever of sociologist Thomas Scheff and his work. I've done a fair bit of digging myself and have concluded that Scheff's ideas provided the intellectual foundation for the Rosenhan's study. (I can elaborate with evidence if you'd like.) Last I checked, Scheff was still alive (though quite old), and there's no way a multi-year investigation resulting in a 300 page book could leave out such a major influence accidentally.
The result is that she completely fails to contextualize the experiment and what Rosenhan was trying to show. His motivation for the study becomes mysterious, and he appears more like an ideologue who set out to discredit the profession than someone who set out to explore an interesting question within a real sociological tradition. In effect, she provides a narrative that Rosenhan exposed some real problems with psychiatric practice but was dishonest and went too far — now "the mentally ill" get too little treatment rather than too much.
(I've seen a number of people on social media who've heard about Cahalan's 'debunking' and think Rosenhan was responsible for deinstitutionalization. Which is nonsense, of course. Mental hospitals began closing down years before 1973, but that's not the popular narrative.)
It's been a while, but if I remember correctly another omission is that she doesn't give the background for Spitzer and Rosenhan's disagreement. The two argued back and forth via letter because Spitzer was organizing an issue of the Journal of Abnormal Psychology in 1975 around Rosenhan's study. Rosenhan provided a followup paper, "The Contextual Nature of Psychiatric Diagnosis" while Spitzer and his colleagues provided several papers criticizing the experiment. Cahalan doesn't mention Rosenhan's followup at all, doesn't discuss the journal issue, but quotes liberally from criticism in Spitzer's contribution and generally sides with him.
It's quite odd. When I look at the debate, I see the psychiatrists and Rosenhan talking past each other; the psychiatrists seem to think the study was questioning whether they could _diagnose_ reliably, while Rosenhan is interested in the social processes around _labels_ and how they influence perception. Two different paradigms. Now I don't know how much of the psychiatrists' misinterpretation of Rosenhan was deliberate, but it strikes me that Spitzer and his colleagues — many of whom were working on DSM-III — framed the controversy over the study in such a way that their new diagnostic manual could resolve it. Spitzer and his medical model eventually triumphed; labelling theory was forgotten. But Cahalan doesn't seem to have been interested in clarifying the debate at all and essentially gives us a history from the side of the victors.
That's off the top of my head. I don't trust her. After comparing the story she tells with what I've read from the literature of the time, I'm compelled to view her evidence for 'fraud' quite skeptically. I suspect there are reasonable explanations for what she found, but she cherry-picked material to put Rosenhan in the worst possible light.
Thank you for sharing that! That's very interesting. And I agree on the issue of labeling theory. I interviewed John McKnight (The Careless Society) just a few years ago, who was a contemporary of the generation of Szasz, Illich, etc (and friends and colleagues with them), and he pointed right away to labeling theory and the Rosenhan study as part of the context for the ongoing development of their critiques. And if she dropped that out--really one of the core problems with psychiatric diagnosing--then that's a huge gap, all right.
My pleasure! I got a bit obsessed when it dawned on me.
I found a short review Rosenhan wrote in 1968 of "Being Mentally Ill" for Contemporary Psychology titled, "Madness: In the Eye of the Beholder".[1] So Rosenhan was reading Scheff and thinking about perception and labeling less than a year before he first went undercover in 1969.
He echoed the review title in the first section of his famous 1973 paper: "Psychiatric diagnoses, in this view, are in the minds of the observers and are not valid summaries of characteristics displayed by the observed" with a citation of several critics including Scheff. And Rosenhan's discussion later in the paper of type 1 and type 2 errors and clinician bias toward identifying illness comes directly from a chapter of "Being Mentally Ill".
[1] https://archive.org/details/sim_contemporary-psychology_1968-07_13_7/page/360/mode/2up
(I can send a copy of the review if it doesn't load.)
Thank you so much for your profoundly humanitarian journalism Rob. It's staggering to read how routinely dishonest 'professionals' who work in mental health 'care' are. They can write whatever absurd exaggerations or abject lies they want and are never held accountable and the patient has no voice and no recourse to get the records corrected to reflect truth and reality. Thank you for your diligent efforts to expose these horrible abuses of psychiatry.
Thanks for your kind words of support.
And unfortunately the advent of electronic health records has opened up whole new avenues for "doctoring" of those records, too...
Oh yes, as electronic records are available and accessed widely it makes harmful lies and fabrications by psychiatry insidious and very detrimental to try obtain proper medical services for any physical condition.
Rather than “involuntary commitment,” “civil commitment,” please consider using “psychiatric imprisonment.” The former, more polite sounding words, are pharma/psych marketing terms.
I use varied terms. I think it's also important to use phrases, especially in titles, that people who don't know anything about the issue will understand. Anyone who actually reads my articles, I think, will quickly understand what I'm actually describing. For many, the reality is actually much worse than "imprisonment" in a lot of ways.
Forced incarceration of the 'unproductive' (mentally ill) is a capitalist business model. It's why Uncle Sam throws 80% of its mentally ill citizens in prison.
You might find my book interesting. Actually, the vast majority of those labeled with mental illnesses are not in prisons, but in private hospitals and public psychiatric wards in general hospitals, group homes, assisted living, long term care facilities, etc. They become prisons by any other name, but it's still an important distinction -- there's no "shortage" of psychiatric beds, they are overloaded.
Yes. I was quoting a rough statistic from back in the 1980s. It shocked me at the time. But as you say, things are more insidious and more sophisticated today. It is very dark. Very dystopian. Cultural gaslighting narratives are the tallest walls, I think. I worry about the future detention camps that are proposed to be built in the US. Will they be centres of forced labor as some conventional prisons are? Dare I say that the concentration camp never went away.
I have seen the UK version of care homes with locked doors. At best they are privatised human dustbins for profit. At worst they are killing factories. I'm deeply traumatised by what I've witnessed. We are in living memory of the Holocaust, which in part progressed smoothly because most people couldn't believe that something so monstrous could happen.
It's better to speak out and risk being thought of as a fool, than to not speak out at all.
Well said!
After working in 7 psychiatric facilities, I’m unfortunately not surprised by anything you write. It all tracks and I didn’t even work in one of the states you listed. I don’t know if it helped, but one small act of resistance from within was charting reality which was usually that people were caring, insightful, helpful with their peers, and participating fully in therapy groups (which for me included observing though most participated enthusiastically when pressure to perform was removed.) We were often pressured to aggressively chart symptoms rather than from a strengths-based perspective because if the notes were too positive insurance would stop paying and then the hospital would discharge.
So sad. One person who worked with children said to me that she was constantly encouraged to describe the child as the devil's spawn in order to garner more funding and supports, but she worried about the day as an adult when one might go back and read what she'd written in those records.
It’s in LHSC psychiatry. They are still trying to trick me into the Emergency Dept. Im a Mental Health Professional so it’s not so easy, when I called for the DSM but it has been very very upsetting. They have successfully isolated me too. Ty ty ty. It’s so important, that I’m not alone. Ty. I think VAC are aware but not doing anything!