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17 March, 2016

How computers created the picture of a 'mentally ill' society

The Rosenham experiment

By the early 70s, psychiatrist R.D. Laing had become a celebrity in America, and was one of the leaders of what was called the "anti-psychiatry" movement. He was about to use his growing power to attack one of the most powerful professions in America, the medical and psychiatric establishment. The results would be dramatic. But the outcome would be very different from what Laing intended. His ideas would undermine the all-controlling medical elite. But far from liberating people, what would actually emerge would be a revolutionary new system of order and control, driven by the objective power of numbers.

Psychiatry, Laing said, was a fake science, used as a system of political control to shore-up a violent collapsing society. Its categories of madness and sanity had no reality. Madness was simply a convenient label used to lock away those who wanted to break free.

Hundreds of young psychiatrists came to Laing's talks, and one of them was inspired, and decided to find a way of testing whether what Laing said was true or not. Could psychiatrists in America distinguish between madness and sanity? He was called David Rosenham, and he devised a dramatic experiment.

He assembled eight people, including himself, none of whom had ever had any psychiatric problems. Each person was then sent across the country to a specific mental hospital. At an agreed time, they all presented themselves at their hospital, and told the psychiatrist on duty they were hearing a voice in their head that said the word "thud". That was the only lie they should tell. Otherwise, they were to behave and respond completely normally.

As Rosenham revealed: “They were all diagnosed as insane and admitted to the hospital ... I told friends, I told my family I get out, when I get out that's all … I'll be there for a couple of days, then I'll get out. Nobody knew I'd be there for two months!

Once admitted, all eight fake patients acted completely normally, yet the hospitals refused to release them, and diagnosed seven as suffering from schizophrenia, and one from bi-polar disorder. They were all given powerful psychotropic drugs. They found there was nothing they could do to convince the doctors they were sane, and it quickly became clear that the only way out would be to agree that they were insane, and then pretend to be getting better.

When Rosenham finally got out and reported the experiment, there was an uproar. He was accused of trickery and deceit. And one major hospital challenged him to send some more fakes to them, guaranteeing that they would spot them this time. Rosenham agreed, and after a month, the hospital proudly announced that it had discovered forty-one fakes. Rosenham then revealed he had sent no-one to the hospital.

The effect of the "thud" experiment was a disaster for American psychiatry. It destroyed the idea that they were a privileged elite with specialist knowledge. But those in charge realised that psychiatry could not just give up. Another way had to be found of understanding and managing people's inner feelings in modern society. And, like R.D. Laing, they turned to the objective purity of mathematical analysis.

They set out to create a scientific system of diagnosing people's inner mental states, in which all human judgement would be removed, and replaced instead by a system based on the power of numbers. They gave up on the idea that they could understand the human mind, and cure it.

Instead, American psychiatry created a new set of measurable categories that were only based on the surface behaviour of human beings. Many were given new names, like Attention Deficit Disorder, and Obsessive Compulsive Disorder. What mattered was that these disorders could be observed, and thus recorded. The psychiatrists created a system in which the diagnosis could literally be done by a computer. The observable characteristics of each of the disorders were listed precisely, and questionnaires were then designed that asked people whether they had those characteristics. The answers were simply "yes" and "no". So they cold be asked by lay interviewers, not by psychiatrists. The computer would then decide whether people were normal, or abnormal.

The psychiatrists then decided to test this system, and at the end of the 1970s, they sent interviewers out across America with the questionnaires. Hundreds of thousands of people selected at random were interviewed. Up to this point, psychiatrists had only dealt with individuals who felt they needed help. This was the first time that anyone had gone out and asked ordinary people how they thought and felt. And the results, when processed by the computers, were astonishing. More than fifty percent of Americans suffered from some type of mental disorder.

As Psychiatrist Dr. Jerome Wakefield says: “These studies revealed very high rates of mental disorder. There are very very high rates of disorders out there. Half the population has a mental disorder at some point, seventeen percent of the population has a depressive episode at some point, figures like that. These rates astonished people, they're enormous rates. And the general conclusion was: there is a hidden epidemic.

More surveys were done, and yet again the computers returned the same disturbing data. The surveys showed that underneath the surface of normal life, millions of people, who never before would have been thought of as mentally ill, were secretly living with high levels of mental anxiety. The psychiatrists began screening programmes across the country. For many people, the checklists were a liberation, their private suffering was finally being recognised.

These new categories of disorders spread quickly in society, and terms like Borderline Personality Disorder, and Obsessive Compulsive Disorder took hold of the public imagination. But as this happened, it had unforeseen consequences. Millions of people began to use the checklist to monitor and diagnose themselves. They used them to identify what was aberrant or abnormal in their behaviour and feelings. But by definition, this also set up a powerful model for them of what were the normal behaviour and feelings to which they should aspire. And psychiatrists began to find more and more people coming to them, demanding to be made normal.

As Psychiatrist Paul McHugh says: “It was just a matter of asking people a couple of questions, checking the boxes in the diagnostic formula, and saying: 'there you are, you have this disease!', or 'I have this disorder, I'd better go to my doctor and tell him what I need!', and it was an amazing experience and a great change. Most people do not, previously at any rate, want to see themselves as in some way psychiatrically injured. But now, they tell me that they have an ideal in their mind about what the normal person is… 'I don't fit that model, I want you to polish me down so that I fit'.

This new system of psychological disorders had been created by an attack on the arrogance and power of the psychiatric elite in the name of freedom. But what was beginning to emerge from this was a new form of control. The disorders and checklists were becoming a powerful and objective guide to what were the correct and appropriate feelings in an age of individualism and emotion.

But this was a very different system of order. No longer were people told how to behave by an elite. Instead, they now used the checklist to monitor their feelings and police their own behaviour. They were reassured that these new categories were scientific and could be checked by the power of numbers.

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