Inspector Rosenhan Visits The Asylum
As part of the Mad World exhibition which examined missing voices from the story of psychiatry. The word ‘Madness’ is a rich word, and in its labyrinths are held important stories of humanity. It means a lot of different things to different people, and for me it has come to be a word which sometimes symbolises the best qualities in humans. Billy, a man who is part of ‘the old and the bold’ that keep our ambulance service running told me:
“A man needs a little madness or else he never dares cut the rope and be free.”
The quote is from Zorba the Greek by Nikos Kazantzakis – and holds in it the message – make of it what you will… So starts the exploration of Mad People’s History, a degree course developed in Ryerson University, Toronto Canada…
…More importantly, it is the history of people who have lived under this label and it is a history which belongs to the people – and as a part of the public domain – rather than the potentially dusty vaults of academia.
As short a time ago as the 1960s in Britain homosexuality was treated as both a crime and a mental illness. This medicalizing of a natural form of sexuality was a narrow, and dangerous ideological stand.
People were driven mad by a culture which told them they were unnatural and either opted or were forced into aversion therapy. Peter Price talked about his experiences of this in The Independent newspaper in August 1996:
“The treatment he was to undergo was intended to “cure” him of his homosexuality. Within a day of his arrival, Price was confined to one room, pumped full of nausea-inducing drugs, kept in a bed smeared with his own vomit and faeces. His fear tipped into paranoia. ‘It was like being in a horror movie'”
We must question our fear of otherness and make an inquiry into any development which offers ‘scientific treatment’ that acts upon an alienated group. This notion of being self critical as a culture is imperative if a sane (healthy) society is to be reached towards. In an open society which is based upon rational enquiry, there should be no fear of raising questions about the failings that precipitate cultural behaviour that strips people of voice, agency and dominates their physical presence.
In this examination, we should have the honesty to approach the sociology as a contextualizing body of knowledge for psychology, and understand psychology as a primary tool to approach psychiatry. The medical model of pharmacy seems to impose itself on every other field and overshadow decades of observation and study that has value in understanding mass behavioural data.
When we look at how different ethnic groups have varying rates and experiences of mental health problems, it prompts deeper investigation. Our social circumstances no doubt affect how we feel, and how we feel no doubt affects how we behave. How we measure behaviour is no doubt affected by who measures it, and what they are attempting to measure behaviour with. Different diagnoses rates of different ethnic groups reflect their different cultural and socio-economic contexts and there are issues around people gaining access to culturally appropriate treatments.
The Mental Health Foundation has done a lot of work in this area, and has found that, in general, people from black and minority ethnic groups living in the UK are:
- more likely to be diagnosed with mental health problems
- more likely to be diagnosed and admitted to hospital
- more likely to experience a poor outcome from treatment
- more likely to disengage from mainstream mental health services, leading to social exclusion and a deterioration in their mental health.
These differences may be explained by a number of factors, including poverty and racism. The differences may also be because the same social supports and mental health services often fail to understand or provide services which are acceptable and accessible to non-white British communities, and some argue everyone. People can be culturally alienated and isolated from the most basic and fundaments of human needs – community, company and care.
It is more likely that mental health problems go unreported and unaddressed because people who feel pushed to the peripheries of society and those who are marginalized may see what support there is as repellant for they have been made to feel an outsider. It is suggested that it is also likely that mental health problems are over-diagnosed in people whose first language is not English.
It is clear that when a prevalent culture deems something to be a threat to its dominant norms, it outlaws it and structures it out. More worrying is the propensity for human civilisations to create thought crime. Culture’s can become decided by relatively few people without considering the many and the madness of crowds can inflict upon the few as we find Arthur Miller writing about in The Crucible – in cultures if people can find distaste in something, then it can lead to interpret people using two instruments; the penal and medical system.
The abuses of medicine are like that of any institution – a type of unquestioned expertism which fails to value expertise beyond its borders. It is important to be able to publicly analyse the failings and abuses of our most precious institutions, because humans are simply capable of injustices/inequities as are structures.
It is well documented and understood that in Victorian times women who did not yield to the mantle and trappings of the patriarchal culture were often declared mad and committed to an insane asylum. The person who had the power was the husband or father or nearest male, and the right to be heard was non-existent.
We would like to think that these dark days are behind us, but there is still a power differential today which exists and plays a significant role in who gets to decide who gets the attention of the physician. Kate Millet wrote The Loony Bin Trip as a deconstruction of when she was involuntarily committed to an Asylum between 1982 and 1985:
“Kate Millett, the feminist author and maverick intellect, sips her coffee in the plush hotel bar and considers a question: Were you truly insane? “No,” she said. “I think I’ve had unusual experiences, happy and unhappy ones. But I was not mad. Madness is manufactured when psychiatry intervenes.”
As a society, we cannot allow the notion that gendered abuses do not go on in these modern times. I have heard accounts of women having been sectioned by their husbands for wanting to separate or get a divorce. Indeed, wherever there exists a power differential, there exists the potential danger of abuse of the power that one human being can wield over another.
Children lack agency. I recall a boy being sectioned by his parents when I was in high school. He had gone out, got drunk, returned home and called his Dad an asshole – or words that effect. He was swiftly deposited in the hospital and went through a diagnosis, period of interment and medication before release.
Is this mad ? I can hear a voice in my head saying – this cannot happen, not in modern medicine; not in this great and just society – but this voice we must guard against by analyses and open discussion…
But really – that little voice in my head goes – there must have been something that he had done to warrant being locked up and medicated. These things dont happen for no reason… And then I read Sir Ken Robinson’s The Element and happen across an account of Paulo Coelho’s experience of psychiatry courtesy of his parents:
“This is what happened to Paulo Coelho. Mind you, his parents went further than most to put him off. They had him committed repeatedly to a psychiatric institution and subjected to electroshock therapy because they loved him.
The next time you feel guilty about scolding your children, you can probably take some comfort in not resorting to the Coelho parenting system. The reason Coelho’s parents institutionalized him was that he had a passionate interest as a teenager in becoming a writer.
Pedro and Lygia Coelho believed this was a waste of a life. They suggested he could do a bit of writing in his spare time if he felt the need to dabble in such a thing, but his real future lay in becoming a lawyer. When Paulo continued to pursue the arts, his parents felt they had no choice but to commit him to a mental institution to drive these destructive notions from his head.
‘They wanted to help me,’ Coelho has said. ‘They had their dreams. I wanted to do this and that but my parents had different plans for my life. So there was a moment when they could not control me anymore and they were desperate.’ Coelho’s parents put Paolo in an asylum three times…. Coelho’s novel The Alchemist was a major international best seller, selling more than forty million copies around the world.”
Mad World Exhibition
Various factors affect how we feel and how we behave – malnutrition, physical damage, drugs, heavy metals, endocrine disorders, poverty, trauma – these can all influence how we interact with the world and how the world interacts with us. It is important to acknowledge the vital advances in understanding and health benefits which the medical establishment has brought about its project always a work in progress. The Mad World Exhibition and archive is an opportunity for people to add to the conversation what they think should be a part of how we perceive the word Madness.
Now, in the UK and western world, the dominant perspective is one which medicalizes behaviour, and the medical world has become the overriding voice which gets to speak about what meanings are attributed to these phenomena, and what they represent.
This exhibition invites the world to come into the exhibition, look at what is on view and try to decide who is ‘sane’ and who is ‘crazy’ by looking at the art and exhibits. The idea reformulates psychologists David Rosenhan and Martin Seligman’s famous work ‘On Sane People in Insane Places’.
Here we have brought together work from a number of artists, and woven a panorama of histories revealing perspectives around ‘madness’ which are not commonly found in the rhetoric of the medical institutions.
Historiographer, Michel-Rolph Trouillot suggests that everywhere a fact is created, so too is a silence. You are warmly invited to come and peer in on the silences of the mental asylum, and discover the histories, organisations, and individuals who have dared have a perspective of their own revealing the alternative and sometimes uncomfortable.
Diagnosis of Concepts and Themes
The idea was to create an art exhibition with a collection of named or anonymous artists and artworks (themed and unthemed) – some of which would have a medical ‘diagnosis’ and some of which do not. The works are to be interspersed with information on pivotal concepts and histories of psychology/psychiatry written in potted form.
The public viewers were asked to make judgements about who was ‘diagnosed’ and who was not before witnessing the solution to the logic problem posed to ‘Inspector Rosenhan’, which suggests that a rethinking of the way the idea has been approached needs to take place.
The premise of the idea is adapted from a logic problem which Raymond Smullyan created. It is themed with the famous experiment by David Rosenhan and Martin Seligman which produced the paper ‘On Sane People In Insane Places’, the textbook ‘Abnormal Psychology’ and contributed to ‘Learned Helplessness’.
Premiss: The Asylum of Doctor Rosenhan
Inspector Michel of Direction Générale de la Sécurité Extérieure was called over to Britain to investigate eleven insane asylums where it was suspected that something was wrong. In each of these asylums, the only inhabitants were patients and doctors – the doctors constituted the entire staff.
Each inhabitant of each asylum, patient or doctor, was either sane or insane. Moreover, the sane ones were totally sane and a hundred percent accurate in all their beliefs; all true propositions they know to be true and all false propositions they knew to be false.
The insane ones were totally inaccurate in their beliefs; all true propositions they believed to be false and all false propositions they believed to be true. It is to be assumed also that all the inhabitants were always honest – whatever they said, they really believed. In the first asylum Michel visited, he spoke separately to two inhabitants whose last names were Jones and Smith.
“Tell me,” Craig asked Jones, “what do you know about Mr. Smith”
“You should call him Doctor Smith,” replied Jones. “He is a doctor on our staff”
Sometime later, Michel met Smith and asked, “What do you know about Jones ? Is he a patient or a doctor ?”
“He is a patient,” replied Smith.
The inspector mulled over the situation for a while and then realized that there was indeed something wrong with this asylum: either one of the doctors was insane, hence shouldn’t be working there, or, worse still, one of the patients was sane an shouldn’t be there at all.
How did Michel know this ?
Theme: On Sane People In Insane Places
Rosenhan’s study was done in two parts; the first involved the use of 8 healthy associates (pseudopatients) including David Rosenhan himself. They went into 12 mental hospitals in five different states pretending to have a single symptom: They heard voices that said ’empty’, ‘meaningless’ and ‘thud’. From the start, these pseudopatients acted the way ‘normal’ people did, but however, they were labelled as ‘crazy’ and treated as such.
Each person was admitted and diagnosed with psychiatric disorders. After their admission, the pseudopatients acted normally and told staff that they felt fine and no longer experienced any hallucinations. Martin Seligman and David Rosenhan assumed false names and wound up in the locked men’s ward of a state mental hospital in October of 1973. In that time the two psychologists discussed:
- How they and other patients were being treated
- Their personal and academic lives
- The legal rights of mental patients
- How to choose a therapist
- The dehumanizing effects of labelling
- The diagnosis of schizophrenia
- The misdiagnosis of schizophrenia
- The experience of psychopathology of hospitalisation
- The range of psychological miseries which could be communicated
All the ‘pseudopatients’ were forced to admit to having a mental illness and agree to taking anti-psychotic drugs as a condition of their release. The average time that the patients spent in the hospital was 19 days. All but one were diagnosed with schizophrenia “in remission” before their release.
The second part of the study involved a hospital administration challenging Rosenhan to send pseudopatients to their facility, whom its staff would then detect. Rosenhan agreed and in the following weeks out of 193 new patients the staff identified 41 as potential pseudopatients, with 19 of these receiving suspicion from at least 1 psychiatrist and 1 other staff member.
In fact, Rosenhan had sent no one to the hospital.
Here is a quote from his paper: “At its heart, the question of whether the sane can be distinguished from the insane (and whether degrees of insanity can be distinguished from each other) is a simple matter: Do the salient characteristics that lead to diagnoses reside in the patients themselves or in the environments and contexts in which observers find them?.
At the time, the study concluded “It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals. The hospital itself imposes a special environment in which the meaning of behaviour can easily be misunderstood. The consequences to patients hospitalized in such an environment – the powerlessness, depersonalization, segregation, mortification, and self- labelling – seem undoubtedly counter-therapeutic.”
Mad by Arrangement and Organisation
The people who want their identity protected will at no time will have their identities revealed – thus it will remain as a thought experiment without impacting on peoples personal territory; anonymity is big here, where it is wanted.
Getting the public to guess who is diagnosed and who is ‘sane’ giving their thoughts on sanity, madness, psychiatry, and psychology will be a critical part of the exhibition which provides a process which aggregates the thoughts and perspectives together as part of the exhibition.
There is no correct or incorrect, thus there will be no finite answers given so that it brings people into the territory of the original Rosenhan’s experiment; more important is the journey through the concepts involved.
The purpose is to promote more enlightened attitudes of the complexities of state of mind and the perception of behaviour. Discussion is going to be fostered through events/happenings in the gallery and debates are opened out in the light of everyone’s contributions.
Also, in the midst, a host of projects which have been supporting people in this area will be put in the spotlight including Mad People’s History, Asylum Magazine, Oor Mad History, Mad Matters, CAPS Consultancy, Advocard and more.
All Welcomed: Mediums and Formats
All practical formats will be welcomed and included in the display. There is a film room which will be displaying several films, there will be an audio loop for spoken word and sound pieces. Paintings, drawings, photographs and sculptures are all going to hold a place in the exhibition.
The written word will play a prominent role as hidden narratives will be revealed in the mix. There will also be a whole section of the exhibition where people will be invited to contribute their personal comments, stories and thoughts on the themes by hanging them on hooks and clips provided.
Digital will also play a role, where an interactive website will be set out for people to contribute to electronically. Performance art will be used to open the exhibition, along with some short talks.
Each artist who is involved is encouraged to write something on the theme of madness/mental health/sanity – however, their work of art can be themed in whatever way they choose. Writing about their encounters with mental health is optional but not compulsory.
Historically many artists were labelled mentally ill because of their art at various times – for example under Hitler’s reign of terror many great creative minds were interred as producers of deviant art, and in the jazz community of the united states those who dared to speak out about racism were jailed, medicalised or worse. This is why the very notion of madness and normality need to be healthily questioned.
The key thing is that the work does not have to be focused on the theme of mental health because the theme is about normality and questioning ideas of norms. The art creates it’s own context within the premiss and theme of Rosenhan visits the asylum by asking the public to work out who is mad and who is sane. By the time they leave the gallery, the public will realise that the question is insane and that it is not a valid way of looking at the world, nor people.
How people identify their own experience is too often left out in this area of life. The labels which people suffer are usually imposed from one person to another reducing the person who is labelled to a process of definition outside of their control. Placing definitions on people is a hazardous thing when one account is ruled out or over ruled. I recall a friend who had Parkinson’s disease being put on a section order and locked inside a psychiatric ward as a doctor had decided that they were experiencing delusions.
My friend, an elderly investigative journalist in his earlier years had worked in Vietnam, North Africa and America in this role. He had been telling accounts of the dark histories which happened in industry; in short conspiracies. The doctor had failed to check the facts and historical veracity to what he had been saying. My friend understood himself as a writer and journalist; the doctor saw him as a mental patient because he was in a psychiatric hospital…
As my friend said: “The doctor sees disease, the police see criminals and the journalist sees conspiracy…”; sometimes it is a professional psychosis that we encounter.
Self Labelling and Identity
The snippets of history and thinkers – such as R.D. Laing, Thomas Sasz, Ken Robinson – who challenge the medical and orthodox models of viewing behaviour and mental health, illustrate the history of ‘madness’ along with the emergence of critical perspectives. We need to be critical or else we are all lost.
A short film made documenting the first Mad World exhibition:
This is an ongoing and open project. If you have anything which you want to contribute to the Mad World Archive – which came of the exhibition, please get in touch. Two large exhibitions have taken place over the past three years and more will come based on the above premiss. The archive is there to create a public resource of authentic and uncut perspectives which talk about issues surrounding mental health that are less often voiced.
Visit Asylum Magazine for open access to 30 years back catalogue of critical psychiatry and a continuing platform for those who have something to publish about their experiences and thoughts: