My Favorite Article
(Several months back we requested folks to send us a summary of their favorite professional piece. Here are the replies. We welcome others to send offerings to romaedl@juno.com. Eds.)
Raymond Shred’s Favorite: David L. Rosenhan, “On Being Sane in Insane Places,” Science, Vol. 179 (Jan. 1973), 250-258
A cohort of putatively sane people (3 psychologists, graduate student, pediatrician, housewife, psychiatrist, and a painter) had themselves admitted as pseudo-patients at 12 different psychiatric hospitals. Beyond their initial feigned symptoms (hearing voices vaguely saying they were empty or hollow), they behaved as normally as possible for their stay. Their stays ranged from 7 to 52 days. Invariably, they were discharged with a diagnosis of “Schizophrenia, in remission.” Pseudo-patients were asked to keep a written record of their stay. This resulted in nursing log entries such as, “Patient engaged in writing behaviour.” The other patients seemed able to tell that the participants were not mentally ill but the staff could not. For me, this article is a strong reminder of our need to be very careful in our labeling of people and about our assumptions about them. In concert with my clinical experience, it has taught me that my judgment about who a
patient is and what they want or need is just my judgment. It may be a good judgment (that happens) but I need to clarify and confirm it with my client before I become invested in its truth. The hospital staff members in this study assumed that people had schizophrenia and therefore they behaved the way they did. Instead, they should be asking, “And, how do you do schizophrenia?”
Ron Bale’s Favorite: One of the most influential articles for me was written by Steven J. Kingsbury, a psychologist who then went to medical school and did a psychiatric residency. The article, referenced below makes a strong statement that the tension between psychology and psychiatry is not simply economics or “turf”. Instead, according to Dr. Kingsbury it has to do with a completely different mind set evolving through the training process. Dr. Kingsbury cites training differences including the fact that post-graduate medical training builds competence by sheer volume (e.g., long on-call periods seeing and making decisions about multiple patients) while Psychology training stresses intellectual understanding and dealing with the subtleties (e.g., typical psychology practicum or post-doc involves a few long term patients reviewed in detail with a clinical supervisor). Kingsbury sums it up stating that while psychologists get lost in thought, psychiatrists get lost in action. I teach in a family practice residency. This article has proven invaluable to me in understanding the mind set of the young physicians. It is also required reading for the psychology post-docs who spend time in our medical setting.
The reference is: Cognitive differences between clinical psychologists and psychiatrists.
By Kingsbury, Steven J. American Psychologist. 42(2), Feb 1987, 152-156.
Steven Ceresnie’s Favorite: McHugh’s article “Psychiatric Misadventures” describes (American Scholar, Autumn 1992) how over the course of his thirty year career, he witnessed “the power of cultural fashion to lead psychiatric thought and practice off in false, even disastrous, directions.” These mis-directions are the consequence, he claims, of one of three common mistakes — oversimplification, misplaced emphasis, or pure invention. McHugh’s first example of clinical misdirection is the discharge of severe, chronic mental patients from psychiatric hospitals, fueled by the fashionable anti-psychiatry crowd such as Thomas Szasz. To do this, clinicians embraced an oversimplified “myth of mental illness” view of mental disease, bringing “freedom” to schizophrenics, among others, as if it were society, and not their disordered thoughts and emotions, which shackled them to begin with.
McHugh goes onto reexamine those male patients who showed up at their outpatient psychiatric clinic and say something like, “As long as I can remember, I’ve thought I was in the wrong body. True, I’ve married and had a couple of kids, and I’ve had a number of homosexual encounters, but always, in the back and now more often in the front of my mind, there’s this idea that actually I’m more a woman than a man.” According to McHugh, follow-up studies of the psychological adjustment of these males who had “their disgusting male equipment” surgically removed, revealed wide levels of mental health, to say the least. McHugh offers a chilling observation:
“It is not obvious how this patient’s feeling that he is a woman trapped in a man’s body differs from the feeling of a patient with anorexia nervosa that says she is obese despite her emaciated, cachectic state. We don’t do liposuction on anorexics. Why amputate the genital of these poor men?”
Next, McHugh says the error of pure inventions brings out the hateful, bizarre sexual politics of psychiatry that can be seen in the experience in Salem, Massachusetts three hundred years ago when the local physician diagnosed “bewitchment” from what we now call “hysteria” — no doubt caused by Satan running amok. McHugh has much to say about he considers the modern version of the Salem witch trials — Multiple Personality Disorder, especially the claim the MPD is the result of repressed memories of sexual abuse in childhood
This article cautions how wrongheaded beliefs about psychological treatment mixed with professional authority and political power can lead to human psychological carnage. Nobody will agree with all of McHugh’s provocative views — but all will be forced to reexamine some of the things they know that “ain’t so.”
