The Mental Health “Crisis”.

cuckoo's nest

Many years ago (but not so many that I don’t remember that time) a standard method of treating many of the mentally ill in the United States was by committing them to institutions–mental hospitals, sanitariums, psychiatric wards, and so forth.

I do remember one in Ohio because a church group I was with went Christmas Caroling there one year.

However, certain factors conspired to bring that practice into disrepute.  Movies such as One Flew over the Cuckoo’s Nest played a big roll.  But the true nail in the coffin of the practice was a study by Stanford Scientist David Rosenhan.

In this study, Rosenhan reported the results of having volunteers present themselves for examination by doctors and report certain symptoms, specifically that they heard voices that said “Thud, empty, hollow.” As a result of this all of the volunteers were diagnosed with mental illness, mostly schizophrenia.

Therein followed descriptions of the terrible conditions of mental health institutions, including that the patients eventually had to leave the institutions “against medical advice” i.e. that they were not considered well enough for release–even though they weren’t mentally ill in the first place but simply reporting specific symptoms as part of the investigation.

This study was very damning of the mental health field in general and in-patient care in particular.

The problem is that it was bad science from beginning to end.

The first of the “patients” in the study was clearly Rosenham himself.  And hospital records show that his actions did not match those claimed in his paper.  Far from simply reporting hearing voices that said “thud, empty, hollow” he had put a copper pot over his head to drown out the voices and that he had been feeling suicidal.  These are clearly more severe and more concerning issues than the simple “thud, empty, hollow.” Indeed, one form of auditory hallucinations–auditory hypnogogic hallucinations, that is hearing sounds and voices just before falling asleep–affects between 1/4 and 1/3 of the population at some time and is really nothing to worry about (although the late Nobel Prize winning physicist Richard Feynman, according to his biography, talked about those at a psych eval at a draft exam not long after WWII and was disqualified from service).

Then there was the case of Harry Lando, one of the subject participants who, far from experiencing the horrid conditions that were the theme of Rosenham’s piece, instead reported a quite positive experience.  Instead of incorporating Mr. Lando’s experience and attempting to assess the range of experiences folk had, Mr. Lando was dropped from the study.  One has to wonder how many others were “dropped” in the interest of presenting Mr. Rosenham’s desired result.

Misrepresentation of the initial conditions and exclusion of data that does not fit a particular outcome are hallmarks of polemic attempting to masquerade as science.  Unfortunately, it was very successful, particularly when combined with movies like One Flew over the Cuckoo’s Nest.  This led to a backlash against institutionalizing mentally ill individuals and was one of the motivators between attempting to “mainstream” mental patients into general society.  In particular, involuntary commitment became much more difficult to such an extent that when Reagan “closed the mental hospitals” it was simply because they were largely empty.

Were there problems with in-patient mental health care in the US?  Of course there were.  But by misstating the circumstances that led to in-patient care–suggesting that many, if not most, were in such care for minor issues that really did not justify hospitalization–and excluding more positive experiences in care, Rosenham’s “study” did not provide fodder for an evaluation of the system seeking improvement of the diagnosis process leading to hospitalization and improvement of the conditions of hospitals.  Instead, it was an excoriation of the system from top to bottom, an excoriation from which it still has not recovered.  This is very much a case of throwing out the baby with the bathwater.

And, as a result, we have various other “crises”:  the homelessness crisis where many street people have issues where they should be hospitalized, the drug addiction crisis where many are either driven by mental health issues or attempts to self-medicate, and various crises involving crime (one should note that this was all part of the general rise in crime during the 70’s 80’s and early 90’s).  And before anyone objects, no, most folk with mental health issues are neither homeless, nor drug users, nor otherwise criminals.  Those who are, however, are those who should be hospitalized for their own sake and for the sake of society.

This is just one example of the damage that bad science can do when it becomes a driver for public policy.

 

 

7 thoughts on “The Mental Health “Crisis”.”

  1. One might also mention that although one solution to bad mental health hospitals is to close the hospitals, another is to make them better. The second solution, of course, has the benefit of not releasing thousands of mentally ill people to wander the streets, defecating on the sidewalks and harassing the citizenry.

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  2. Then again, there was the use of extra-legal involuntary confinement as a shortcut to imprison people without proper trial. The book “Beneath a Ruthless Sun” goes into one such case, where a mentally disabled white Jessie Daniels was framed for raping the wife of a prominent Florida businessman, instead of the black man who actually did it. Seems he didn’t want the ‘disgrace’ of it being known that a black man did it.

    So, the poor kid (literally) was railroaded into Chattahoochee. His poor mom spent 14 years trying to get him a proper trial and hearing.

    There’s a fair few other famous cases likewise, but the big one was Kenneth Donaldson, and the case “O’Conner v. Donaldson” was one of the reasons that they tossed it.

    A lot of those institutions were pretty hellish- over crowded and under staffed. Like a really bad nursing home.
    Truth is, it’s hard to say what’s worse.

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    1. Didn’t say that there weren’t issues with the then existant “system” (or collection of systems. In fact, I said there were. However, there’s a difference between studying the actual state of affairs to find out where things stand and working to fix issues thus found and using bad science to “force” a predetermined result with the result of tossing out needed treatment as well.

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  3. On my better days I think the closing of mental hospitals is the perfect example of social activism, bad science, and the law of unintended consequences, and on my more cynical days I think it is, and always was, about the money to be saved by dumping the residents onto the streets.

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      1. You are right about the governments lack of interest of in saving money.
        I think the money flows away from mental health care and into other projects and pockets.
        I wonder what a forensic account would find if if the task was to find out who profited from closing mental health facilities.

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