On Being Sane in an Insane Place—The Rosenhan Experiment in the Laboratory of Plautus’ Epidamnus

Michael Fontaine, PhD
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On Thursday, September 11, 2014, I was honored to present the Grand Rounds lecture to the Department of Psychiatry at Upstate Medical University in Syracuse, New York. This was the department of which Dr. Thomas Szasz was formerly a member and, to celebrate his work, the department has been hosting a number of events to celebrate his prolific career. More information about the Grand Rounds celebration is available at Szasz.com, hosted by Dr. Jeffrey Schaler.  Jeff himself gave the first Szasz-themed Grand Rounds lecture back in February 2014. I found my hosts—Szasz’s colleagues—a gracious and thoughtful group, eager to discuss ideas and explore their consequences with surprising candor.

The title of my talk was ‘On Being Sane in an Insane Place—The Rosenhan Experiment in the Laboratory of Plautus’ Epidamnus.’ I adapted it from my 2013 Current Psychology paper.  My starting point is David Rosenhan’s 1973 “experiment,” in which he and a number of confederates pretended to hear voices in order to gain admission to psychiatric hospitals.  Once they had been admitted they had trouble getting back out.  Rosenhan’s stated aim was to prove that psychiatric diagnoses lack validity.  I argue that a stage comedy written some 2200 years ago by the ancient Roman playwright T. Maccius Plautus anticipates Rosenhan’s experiment in virtually identical form. It too casts doubt on the medical model of madness, but it seems to go beyond Rosenhan’s attempt to limit the problems his actions exposed to questions of diagnosis, and more closely approaches the view of Thomas Szasz that mental illness is not a medical matter.

40 COMMENTS

  1. The other side of the coin is represented by Gurt Postel, a postman who decided to pretend to be a psychiatrist in Germany. Hugely successful he reduced the compulsory admission rate by 86% as the medical director of his hospital. He made up and lectured to psychiatrists on “Bi polar of the third degree”….. his audience of psychiatrists lapped this nonsense up without batting an eyelid.

    Caught out when he was recognised…. not because of anything he did. Hero. Champion imposter of imposters.

    http://www.gert-postel.de/english.htm

    http://en.wikipedia.org/wiki/Gert_Postel

    • There is much drama in life, and much life in drama. Thomas Szasz, for one, would go so far as to call a fraud a fraud in a field that was fraught, nay, saturated, with fraud. I guess the question becomes, in the end, who are the actors, and who is the audience. The Rosenhan Experiment, too. Was it mock theater, or genuine science, a little bit of both, or complete fraud? The problem I have, I suppose, is that if there is any point to made from this sort of comparison, and analysis, it becomes very muted in effect. In a field with as much deception as you find in the mental health field, a confidence game such as that which was perpetuated so effectively by Gurt Postel is almost inevitable. Excuse me, scratch the almost.

      Also, just a technical matter, I don’t know that hellebore compares with Prozac so much as it does with Thorazine, and derivatives, being the ancient chemical fix for insanity rather than melancholy. Nonetheless, I do imagine all three to be poisonous or toxic substances, and all too often, unrecognized as such.

        • Fraud

          A false representation of a matter of fact—whether by words or by conduct, by false or misleading allegations, or by concealment of what should have been disclosed—that deceives and is intended to deceive another so that the individual will act upon it to her or his legal injury.

          http://legal-dictionary.thefreedictionary.com/fraud

          Actually, Rosenhan lied, and that could be construed as fraud, while hospitals, responding in kind, found pseudo-patients who weren’t pseudo-patients, again, if your aim is to say you’ve got “unreal” patients, fraud.

          • Blind experiment
            A blind or blinded experiment is an experiment in which information about the test that might lead to bias in the results is concealed from the tester, the subject, or both until after the test.

            The hospital volunteered to participate, to my knowledge.

            How else (a lie/fraud) do you test a new medicine Frank?

  2. “The psychiatrist ’s questions are all in line with Hippocratic medicine, but no matter the answer, Menaechmus cannot win. His gestures, perplexity, irritation, frustration,and especially his anger — all are taken as symptomatic of an abnormal mental condition. Yet even his cooperation and compliance are, too.” (p.11)

    From your article Michael. I wonder if you have heard the term Kafka trapping?

    “The aim of the kafkatrap is to produce a kind of free-floating guilt in the subject, a conviction of sinfulness that can be manipulated by the operator to make the subject say and do things that are convenient to the operator’s personal, political, or religious goals. Ideally, the subject will then internalize these demands, and then become complicit in the kafkatrapping of others.”

    http://esr.ibiblio.org/?p=2122

    I know that my experience is reflected in your description of the assessment process. The amount of kafka trapping I have seen done by psychiatrists leads me to believe that it is not done unconsciously. Your denial that you are mentally ill is proof that you are mentally ill.

    Any thoughts on this?

    Regards
    Boans

  3. I saw an absolutely brilliant version of Kafka’s The Trial performed by a student group a few years ago and I was amazed at how like the psychiatry it play is. I spoke to one of the performers afterwards who clearly didnt’ get what I was on about, but I’m glad someone else has highlighed this.

  4. We don’t really need to focus on what happened 2000 years ago.

    Psychiatry, big pharma, that’s a problem today, now, and a lot of people know it is.

    Unless they had a method for the truth winning out back then that is capable of overturning the behemoth of self intrest and corruption faced now, today, then what can really be learned ?

    • As I tried to point out above, if anybody was paying attention, 2000 years ago things weren’t so bad. It’s today when we’ve really got a problem. Let me try again…

      Most, however, did not receive medical treatment but stayed with family or wandered the streets, vulnerable to assault and derision.

      The Greek and Roman states didn’t incarcerate mad folk in prisons called hospitals or asylums. Not like is done today. That kind of thing, segregating and locking people up in places called Lunatic Asylums, wasn’t taking place on any sort of scale in the western world until the latter half of the seventeenth century.

      Psychiatry, in other words, was much less of a problem then than it is today. For this reason, maybe it is a good idea to look back, huh? What do you think?

      • Frank: both Szasz and Foucault provide an historical context in order to demonstrate that Western Civilization chose the path of institutional. It was not forced upon them. Foucault focuses on this process of institutionalization in France that occurred a little earlier than in England. Szasz focuses more England because he believes that the roots of modern psychiatry can be more accurately be traced there. Szasz sees Psychiatry as an end run around the English system of law because English law was more protective of individual rights than other emerging nation states.

        • Frank: both Szasz and Foucault provide an historical context in order to demonstrate that Western Civilization chose the path of institutional.

          Western Civilization, of course, not meaning ancient Greece and Rome, no, by western civilization you’re referring to a more recent France and England.

          It was not forced upon them.

          Define “them”. It was forced on that part of them that was identified as patient, or presumed allegedly “ill”, by that part of them that was identified as state, or institutional authority. I’m not excluding either from western civilization.

          I have some understanding of the origins of institutional psychiatry in England with the advent of the trade in lunacy. I have less understanding of its origins in France. I have read both Szasz (numerous books) and Foucault (Madness and Civilization) on the subject.

          Would you, please, point to the institutional psychiatry that existed in ancient Greece and Rome? As far as I can tell, there wasn’t any. People weren’t imprisoned in places they called mental hospitals or lunatic asylums back then. This doesn’t mean, as the Wikipedia piece shows, that there weren’t people falsely thrown in jail back then, nor that there weren’t some imprisoned by their families. Still, when I think of it, no “medical treatment” is a vast improvement, and the claim is that this ‘no treatment’ is what most received.

          The impetus of my argument here is that the ancients were more tolerant of odd behaviors than we are in our more systematically repressive modern world. I’d say there is a lot that we might be able to learn from the ancients in this regard.

          • Frank: I am not well versed in either Greek or Roman History, but I have been poking around on Directory of Online Journals to see how non-western countries such as Iran have responded to the western medical model of “mental Illness.” From what I can gather, Iran adheres to bio-psychiatry model, and the Cuba, whose culture and economic system has been influenced by Spain, U.S., and Russia, adapted there mental health system from the French model. Cuba is out of favor with the U.S. Govt. but like Latin America is part of the West, albeit in the Third World. One of Che’s close compatriots in the war of liberation from Batista was a psychiatrist, who was instrumental in overhauling the Cuban Psychiatric system. Zypreza is widely dispensed in Cuba, but there is apparently a lively debate over the use of ECT. I also looked at some of the other ALBA countries such as Bolivia, Ecuador, Nicaragua, and Venezuela. I believe that both Ecuador and Bolivia show a low psychiatrist to population ratio, both with only a few asylums throughout the country. Looking through history or at different cultures currently, helps to dispel common sense assumptions about a society’s institutions. That is what Robert Whitaker stumbled upon, even though he initially assumed most of the claims of psychiatry to be grounded in science, rather than what Szasz terms, scientism.

          • I imagine mental health treatment must be playing a large role in the shape that western imperialism is presently taking. One of Robert Whitaker’s latest messages is that the results from the World Health Organization studies that figured so prominently in Mad In America, the book, are beginning to longer apply because of the exportation of western pseudo-science. Thomas Szasz, R.D. Laing, and others have been right in taking on scientism. Science isn’t halting this exportation, this pharmacological cough cough industry “revolution” that must eventually overrun the entire world. Psychiatrists have brain scans, gene studies, other studies, suppressed studies, journal articles, ghost written pharmaceutical company articles, etc., etc., to bolster their bias in the biology of “mental disorder”. They don’t care. Psychiatry is their stock and trade, their bread and butter, and the more of it there is, the more secure their position in society is. If there are not 1 in 5 people with a “mental illness” in this country or that, it must be because their skill in diagnosis is not up to the state of the art. Point, all of this business began with institutional psychiatry in the seventeenth century. Shamanic practice may be preferable, but not to the western imperialist who would complain that, not coming from the west, it is ‘old hat’.