We have seen from other articles that I have published on this site that those who have suffered severe and ongoing childhood trauma and have then, as adults, gone on to be diagnosed with borderline personality disorder (BPD) may be better served, in many cases, by being diagnosed with complex PTSD instead (in relation to this, you may wish to read my article: Traumatized As A Child And Wrongly Diagnosed With BPD?)
Psychiatrists, after all, are far from infallible and diagnosing psychiatric conditions can be a very inexact science. Perhaps one of the most famous (or notorious) experiments illustrating these concerns was carried out by David Roenhan and I summarize it and its implications below:
A research study (Rosenhan, 1973) that I remember very clearly from University when I was studying for my first degree in Psychology demonstrates just how disturbingly wrong psychiatrists’ diagnoses can sometimes be. It is a notorious study which was led by the psychologist Dr David Rosenhan.
In the experiment that he conducted, a group of eight academic researchers presented themselves at various psychiatric hospitals located in different areas across the USA. None of the researchers had ever been diagnosed with a psychiatric condition.
Each of these researchers reported to whichever psychiatrist happened to be in charge and responsible for new admissions on the particular day of their arrival and informed him that he was hearing a voice in his head which said the word ‘thud’. This was not true – it was just a fabricated symptom. However, this was the SOLE and ONLY way that the researchers misled the psychiatrists; they did not make up any other false symptoms or lie about their mental health in any other way whatsoever; from the point, they reported the false symptom onward, they behaved normally.
How did the psychiatrists respond? All eight, in each of the eight different hospitals, admitted each of the eight researchers into their care. Furthermore, each of the eight researchers (or pseudo-patients, as they could be called) were diagnosed with a severe psychiatric condition. All, too, were prescribed extremely potent anti-psychotic medication (which can have serious side-effects, it should not be overlooked). It is worth repeating here: this occurred despite the fact that all of the eight researchers acted entirely normally except for reporting hearing a voice in their head saying the word ‘thud’.
And the error was not swiftly corrected. Quite the contrary, in fact. Most of the researchers were detained in the psychiatric ward to which they had been admitted for several weeks. Some were detained for over eight weeks, at great expense. Try as they might, the researchers were simply unable to convince the doctors that they were, in fact, sane. Their attempts to do so were interpreted as denial or lack of insight into their own condition.
When the researchers finally explained they were simply there to conduct an experiment, matters were made even worse. They were seen as delusional and their claims were dismissed. In the eyes of the psychiatrists, their ‘illnesses’ now looked even worse than originally thought.
Eventually, in order to secure their release from detention, they found the only way to accomplish this was to go along with the psychiatrists’ notions that they were extremely mentally ill and then gradually ‘get better’.
But the farce does not end there. A media storm was created and one of the hospitals, shamed by events, was determined to prove that they could not be so easily hoodwinked a second time by the duplicitous Dr Rosenhan. To this end, they laid down a challenge. They told Dr Rosenhan to send more fake patients to their hospital and confidently declared that, this time, they would be able to identify the impostors.
About four weeks later the hospital triumphantly announced it had identified over 40 fake patients. There turned out to be one problem, however: Dr Rosenhan had not sent a single one. We can only imagine the embarrassment those who ran the hospital must have felt.
The experiment, now notorious, created a sensation and led to a major crisis in psychiatry, including a complete re-evaluation of the reliability (or otherwise) of psychiatric diagnoses. Whilst changes were made as a result of Dr Rosenhan’s study, the controversy surrounding the reliability, and, indeed, validity, of psychiatric diagnoses remains today.
Rosenhan, David (19 January 1973). “On being sane in insane places”. Science. 179 (4070): 250–258. Bibcode:1973Sci…179..250R. doi:10.1126/science.179.4070.250. PMID 4683124.
David Hosier BSc Hons; MSc; PGDE(FAHE).