TO HOLD OR TO HELP?

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Tanya Muscatwalla, SY 


Psychiatric hospitals were established approximately around the 16th century, mainly to hold the people who were considered mentally ill, criminal or even homeless. At what point did the purpose of these hospitals change from holding these patients to helping them? Until the 19th century, misdiagnoses were common, which led to the experiment by Dr. Rosenhan- a psychiatrist at Stanford University- called “On Being Sane in Insane Places.” In this experiment, he sent some of his students as ‘pseudo patients’ who did not have any psychological conditions to these hospitals, with fake symptoms. All of these students were diagnosed with disorders and none of the nurses or doctors could identify the misdiagnosed patients. These students later stopped showing the symptoms, however, the doctors and nurses did not notice, and simply diagnosed them and forced them to stay in the hospital. This was the purpose of Rosenhan's experiment, to point out the flaws in the system. 

There was an anti psychiatry movement in the 1960s, caused by the mass idea that psychiatric treatment did more harm than good. This movement was one of the reasons for Rosenhan’s experiment, conducted soon after, in 1973. Rosenhan himself had admitted himself as a pseudo patient in one of the hospitals, to test his hypothesis. He claimed that the conditions were inhumane and that it was an overall stressful environment. This was the cause for the revision of the DSM (Diagnostic and Statistical Manual of Disorders.)

This raises the question of the reliability and validity of the diagnoses at these rehabilitation centers. The issue that was highlighted in the aforementioned study is that one reported symptom caused psychiatrists or psychologists to jump to conclusions about the patients’ condition, rather than observing them over a period of time. The experiment also highlighted that the conditions of the psychiatric rehabilitation centre were not good, causing even the clinically ‘sane’ individuals to ‘lose their mind’. These participants observed the conditions and made notes about whether the nurses understood that they did not have any real psychological disorder. Even though the nurses did not realise that they did not have any conditions, the other patients did. It is evident that differentiating between the people who do not have mental health issues and the people who do in psychiatric hospitals is challenging. The hospital environment creates a unique setting where the interpretation of behaviour can be easily misconstrued. This study was relevant because it’s findings showed an unacceptable amount of type I (false positive) errors by competent psychiatric staff and showed the danger of psychiatric harm to patients by the prevailing psychiatric practices of that time. 

However, this experiment was conducted in 1973, and since then times have changed. The rehabilitation centers and psychiatric hospitals have improved their conditions, and the DSM and ICD models have been updated. This experiment has added more negative stigma to the already existing stigma on these hospitals. Patients who have visited rehab centers say that it is actually helpful and extremely misportrayed by the media. It is not all ‘Padded rooms’, ‘Straight Jackets’, and ‘Psychosis’ (Murphy, 2022). Before the 1900s, these hospitals were called ‘mental asylums’, hence the negative association. However, now people check themselves in voluntarily or are checked in by loved ones to get better soon. The goal of these rehabilitation centers is ‘effective treatment with a short-term stay.’ (Pedersen, 2022). These places act as a break from daily stressors for people with mental health conditions, however, it may also be frightening for people with more severe conditions. The goal still remains the same–  to protect them from danger, and help them function better in society.  

Due to the negative stigmas and media portrayal, Rosenhan's experiment and the treatment of people in mental asylums in the 1970s and 80s, people question the reliability and validity of psychiatric hospitals and rehabilitation centers. Hence, there are researches to disprove this. An observational study evaluated the reliability and validity of the Discharge Mobility and Discharge Self-Care Scores, which are two quality measures for U.S. inpatient rehabilitation facilities (IRFs), using data from Medicare patient stays across around one thousand facilities. Reliability had been assessed through split-half analysis and correlations, and showed strong results. Construct validity was seen and these findings confirm that these quality measures are reliable, valid, and consumer-friendly indicators of IRF performance (Deutsch, et al., 2023). 

Through this, one can see the research that rehabilitation centers are reliable and valid. Yet, researches are not required to know that these psychiatric help centers are vital for individuals. It is helpful for so many people–  people with addiction issues, post-traumatic stress disorders, anxiety disorders, or even people experiencing hallucinations and delusions. These people may feel overwhelmed by their surroundings or may feel like a danger to themselves or others, which is why these centers are important. One should not fall prey to media misportrayals, and should instead help those who require it. 

 

 

About the author 

Tanya Muscatwalla is a second-year student of Bsc Applied psychology. However, if she is watching a show, or reading a book, she will forget who you are, leave alone which degree she is pursuing. She loves watching sitcoms, be it Friends, New girl, Brooklyn nine nine or Big bang theory. She also loves reading psychological thrillers, some of her favorites being The silent patient, Rock paper scissors, and of course, Sharp Objects.  

 

 

References 

Agarwal, A. (2023). ""On Being Sane in Insane Places" … it is a work half done.". 

Indian   journal of psychiatry, 65(5), 601–603.

https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_773_22 

 

Deutsch, A., Palmer, L., Vaughan, M., McMullen, T., Kwon, S., Karmarkar, A., & Ingber, M. J. (2023). Reliability and Validity of the Inpatient Rehabilitation Facility Discharge Mobility and Self-Care Quality Measures. Journal of the American Medical Directors Association, 24(5), 723–728.e4. 

 https://doi.org/10.1016/j.jamda.2023.03.015 

 

Murphy, L. (2022). The Truth About Mental Hospitals. The Bucs’ Blade. 

https://bucsblade.com/opinion/2022/03/09/the-truth-about-mental-hospitals/#:~:text=From%20personal%20experience%2C%20I%20can,hospital%20had%20a%20different%20story. 

 

Navidad, A. E. (2023). Rosenhan (1973) Experiment – ‘On being sane in insane places’. Simply Psychology. 

https://www.simplypsychology.org/rosenhan_experiment.html 

 

Pedersen, T., & Wade, D. (2022). What to Expect from a Modern Day Psychiatric Hospital. PsychCentral. 

https://psychcentral.com/blog/a-day-in-the-life-of-a-mental-hospital-patient 

 

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