Discussion Question:What other ways can you think of where mental health systems can work to humanize, empower, and personalize their care for patients who have mental illness or disorders? Why do you think that it is important to validate rather than ignore those who seek treatment for mental health issues and disorders?
On Being Sane in Insane Places
One of the more controversial articles published about mental hospitals is David Rosenhan’s “On Being Sane in Insane Places.” This account describes how 8 sane people gained admission to 12 different mental hospitals by complaining to the admissions office that they had been hearing voices that said, “Empty, hollow, and thud.’ The pseudo-patients behaved normally during the rest of the admission interview and throughout their hospitalization. Although all of them were eventually released from the mental hospitals, with the length of the hospitalization ranging from 7 to 52 days, all were released with the stigmatizing label “schizophrenia in remission.”
The most shocking aspect of the study concerns the experiences the pseudo-patients had while in the mental hospitals. In brief, they received almost no attention from the doctors, nurses, or even attendants, and they were sedated with over 2,000 pills (which they flushed down the toilets, as did many real patients). The few interactions they had with the staff were usually antitherapeutic. For example, Rosenhan describes how doctors ignored patients, as in the following exchange:
Pseudo-patient: Pardon me, Dr. X. Could you tell me when I am eligible for grounds privileges?
Physician: Good morning, Brett. How are you today? (Moves off without waiting for a response.)
In summing up the study, Rosenhan noted that the pseudo-patients experienced very strong feelings of powerlessness and depersonalization, leading to the conclusion that many mental hospitals are actually detrimental to the patients’ mental health. The flaws of the mental hospitals described in Rosenhan’s article are not unavoidable, as evidenced by the hospital system described by Polak, Deever, and Kirby (1977). For example, in a southwest Denver inpatient hospital alternative system, clients are diagnosed at home rather than in the hospital. Staff offices have been eliminated, leading to greatly increased patient-staff interaction. To avoid depersonalization, patients are often placed and treated in the homes of carefully screened families rather than in a large, impersonal hospital. Also, the daily cost of such treatment is considerably less than the standard rate in hospitals. All of this indicates that it is possible to develop a workable, cost-efficient alternative to psychiatric hospitals.