Tuesday, October 25, 2005

In defense of insanity. Tom Cruise is.

Science, like all human endeavors, has a long history of causing unintended suffering. If you knew the wrong doings of surgery, you would surely condemn it to the dustbin of history. For instance in the beginning of surgery (according to Wikpedia: )

" and before advent of anesthesia, surgery was a traumatic painful procedure and surgeons were encouraged to be as swift as possible to minimize patient suffering. This also meant that operations were largely restricted to amputating and external growth removals. In addition, the need for strict hygiene during procedures was little understood, which often resulted in life threatening post-of infections in patients."

But it is not without regard to your safety that today when your hernia hurts or when your appendix ruptures we suggest surgery as a sensible and sane option.

A just case against the practice of surgery could have been made in ancient times, the same case made against medical surgery can be made about psychiatry and those practitioners who attempt to soothe and comfort those who suffer from mental disease.

It is true that Psychology is a new Science and we may not be very far removed from the times of out right barbarism. But the contention that the mental sciences have not progressed is false.

There may very well be validity to criticisms that we are an over medicated society. And I must completely agree with the notion that we must be careful with the labeling of "deviant" behaviors as mental illness. That said, much suffering has been eliminated and a greater understanding of the mind and it's operations has occurred over the last 40 years.

Critics of psychology like Tom Cruise do not have this in mind when when they suggest that psychologists cannot tell the difference between sane persons and the insane. The critics of insanity would suggest that there are no mind illnesses just the labeling of behavior; however, even the most strident critic of psychology must admit to the reality of "damaged brains" leading to mental and behavioral abnormalities.

In a famous experiment in 1973, sociologist David Rosenhan, designed a study to examine the the social construction of the "mentally ill" label. I will use this experiment because it is purported to disprove the notion that psychiartrists can tell the difference between the mentally ill and normal people.

Rosenhan's experiment used eight healthy "pseudopatients" who were admitted to twelve psychiatric inpatient units in five states by feigning psychotic auditory hallucinations — hearing unfamiliar voices of the same sex saying "empty", "hollow" and "thud". None had a history of mental illness. After being admitted, the experimental subjects acted normally and did not display any obvious psychopathology. Subjects were to remain as inpatients until they were discharged by the staff at their hospitals, who were not privy to the experiment and believed the subjects to be real psychiatric patients. Their stays ranged from 7 to 52 days and the average was 19 days, all being discharged as schizophrenic "in remission."

That sounds terrible right? But the truth is that schizoid cases only rarely remit(about 1% of the time). The fact that all of these patients were "hearing" things is unusual in itself and and it's not at all that odd to rely on patient complaints and self reports to help diagnose disease. Doctors are taught that people know when something is wrong about their bodies or feeings and take these reports seriously. Doctors in general are more likely to find something wrong with you than find you healthy regardless of whether they look at your body or mind.

When you think about it, who wouldn't want people, who were so alarmed by the fact that they are "hearing voices" they checked themselves into a clinic, to be "looked at" a while? But the critics of psychology and the sociologists who ran this study thought it odd that patient complaints would be validated so easily.

The suggestion that the doctors do not distinguish between sanity and insanity does not bear out. If a person came to you complaining of voices in his head you would take it as a sign that all is not well. So quite prudently the medical profession investigated. And all of the patients where released, most after just a brief stay.

And all of them were found to be sane again (though in remission.) Of course this does bring us in to issues that go beyond the scope of this blog entry like
malingering and the stigma of mental illness labels, but these issues have nothing to do with the correspodence of mental illness as phenomenon to reality. The Rosenhan experiment in no way invalidates mental illness as a reality, but rather provides a cautionary tale about expectations and the consequences of medical practice.

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