If you think that psychiatry and psychology are"hard" sciences, I strongly suggest you take the time to read this illuminating and disturbing two-part article by psychologist Lauren Slater. She begins by recounting a now-famous experiment, a"trick" if you will, that took place 30 years ago:

In 1972, David Rosenhan, a newly minted psychologist with a joint degree in law, called eight friends and said something like,"Are you busy next month? Would you have time to fake your way into a mental hospital and see what happens?"

Surprisingly, so the story goes, all eight were not busy the next month, and all eight - three psychologists, one graduate student, a paediatrician, a psychiatrist, a painter and a housewife - agreed to take the time to try this treacherous trick, along with Rosenhan himself, who could hardly wait to get started. ...

Rosenhan instructed his confederates very, very carefully. Five days prior to the chosen date, they were to stop shaving, showering and brushing their teeth. And then they were, on the appointed date, to disperse to different parts of the country, east to west, and present themselves at various psychiatric emergency rooms. Some of the hospitals Rosenhan had chosen were posh and built of white brick; others were state-run gigs with urine-scented corridors and graffiti-scratched walls. The pseudopatients were to present themselves and say words along these lines:"I am hearing a voice. It is saying thud." Rosenhan specifically chose this complaint because nowhere in psychiatric literature are there any reports of any person hearing a voice that contains such obvious cartoon angst.

Upon further questioning, the eight pseudopatients were to answer honestly, save for name and occupation. They were to feign no other symptoms. Once on the ward, if admitted, they were immediately to say that the voice had disappeared and that they now felt fine.

When the experiment was concluded, Rosenhan published his findings:

Rosenhan's paper describing his findings, On Being Sane In Insane Places, was published in Science, where it burst like a bomb on the world of psychiatry. Early in the article, Rosenhan lays it on the line. He claims that diagnosis is not carried within the person, but within the context, and that any diagnostic process that lends itself so readily to massive errors of this sort cannot be a very reliable one. The paper generated a flood of fluorescent missives....

And consider this remarkable revelation of the depths of hatred unleashed by anyone who dares to challenge" conventional wisdom":

Robert Spitzer, one of the 20th century's most prominent psychiatrists and a severe critic of Rosenhan, wrote a 1975 article in the Journal Of Abnormal Psychology, in response to Rosenhan's findings."Some foods taste delicious but leave a bad aftertaste. So it is with Rosenhan's study," he said. ... Spitzer later says, in a phone conversation with me,"And this whole business of thud. Rosenhan uses that as proof of how ridiculous psychiatrists are because there had never been any reports before of 'thud' as an auditory hallucination. So what? As I wrote, once I had a patient whose chief presenting complaint was a voice saying, 'It's OK, it's OK.' I know of no such report in the literature. This doesn't mean there isn't real distress."

I don't want to challenge Spitzer, but a voice saying,"It's OK" sounds pretty OK to me.

Spitzer pauses."So how is David Rosenhan?" he finally asks.

"Actually, not so good," I say."He's lost his wife to cancer, his daughter Nina in a car crash. He's had several strokes and is now suffering from a disease they can't quite diagnose. He's paralysed."

That Spitzer doesn't say, or much sound, sorry when he hears this reveals the depths to which Rosenhan's study is still hated in the field, even after 30 years."That's what you get," he says,"for conducting such an inquiry."

For me, the following identifies the genuinely significant aspect of this experiment:

Rosenhan's experiment, like, perhaps, any piece of good art, is prismatic, powerful and flawed. You can argue with it, as in all of the above. Nevertheless, there are, it seems to me, some essential truths in his findings. Labels do determine how we view what we view. Psychiatry is a fledgling science, if it is a science at all, because to this day it lacks firm knowledge of practically any physiological basis for mental illness, and science is based on the body, on measurable matter. Psychiatrists do jump to judgment - not all of them, but a lot of them - and they can be pompous, probably because they're insecure. In any case, Rosenhan's study did not help this insecurity. The experiment was greeted with outrage, and then, at last, a challenge."All right," said one hospital, its institutional chest all puffed up."You think we don't know what we're doing? Here's a dare. In the next three months, send as many pseudopatients as you like to our emergency room and we'll detect them. Go ahead."

Now, Rosenhan liked a fight. So he said,"Sure." He said in the next three months he would send an undisclosed number of pseudopatients to this particular hospital, and the staff were to judge, in a sort of experimental reversal, not who was insane, but who was sane. One month passed. Two months passed. At the end of three months, the hospital staff reported to Rosenhan that they had detected, with a high degree of confidence, 41 of Rosenhan's pseudopatients. Rosenhan had, in fact, sent none. Case closed. Match over. Psychiatry hung its head.

Since Rosenhan, psychiatry has tried admirably to locate the physiological origins of mental disease - mostly in vain. Much of the current research is a knowing or unknowing response to Rosenhan's challenge and to the inherent anxieties it raises in"soft" scientists.

The unpleasant Spitzer also said,""that experiment could never be successfully repeated. Not in this day and age."

So Lauren Slater did it again -- now:

It's a little fun, going into ERs and playing this game, so over the next eight days I do it eight more times, nearly the number of admissions Rosenhan arranged. Each time, I am denied admission, but, strangely enough, most times I am given a diagnosis of depression with psychotic features, even though, I am now sure, after a thorough self-inventory and the solicited opinions of my friends and my physician brother, I am really not depressed. (As an aside, but an important one, a psychotic depression is never mild; in the DSM, it is listed in the severe category, accompanied by gross and unmistakable motor and intellectual impairments.)

I am prescribed a total of 25 antipsychotics and 60 antidepressants. At no point does an interview last longer than 12 and a half minutes, although at most places I needed to wait an average of two and a half hours in the waiting room. No one ever asks me, beyond a cursory religious-orientation question, about my cultural background; no one asks me if the voice is of the same gender as I; no one gives me a full mental status exam, which includes more detailed and easily administered tests to indicate the gross disorganisation of thinking that almost always accompanies psychosis. Everyone, however, takes my pulse.

Spitzer's reaction to Slater's repeat of the experiment is instructive:

"OK," I say."Let me tell you, I tried this experiment. I actually did it."

"You?" he says, and pauses."You're kidding me." I wonder if I hear defensiveness edging into his voice."And what happened?" he says.

I tell him. I tell him I was not given a deferred diagnosis ["a special category that allows clinicians to do just that, officially put off a diagnosis due to lack of information"], but almost every time I was given a diagnosis of psychotic depression plus a pouch of pills.

"What kind of pills?" he asks.

"Antidepressants, antipsychotics."

"What kind of antipsychotics?" he asks.

"Risperdal," I say.

"Well," Spitzer says - and I picture him tapping his pen against the side of his skull -"that's a very light antipsychotic, you know?"

"Light?" I say."The pharmacological rendition of low-fat?"

"You have an attitude," he tells me,"like Rosenhan did. You went in with a bias and you found what you were looking for."

"I went in," I say,"with a thud, and from that one word a whole schema was woven and pills were given, despite the fact that no one really knows how or why the pills work or really what their safety is."

Spitzer clears his throat."I'm disappointed," he says, and I think I hear real defeat, the slumping of shoulders, the pen put down."I think," he says slowly, and there is a raw honesty in his voice now,"I think doctors just don't like to say, 'I don't know'."

"That's true," I say,"and I also think the zeal to prescribe drives diagnosis in our day, much like the zeal to pathologise drove diagnosis in Rosenhan's day, but, either way, it does seem to be more a product of fashion, or fad."

I am thinking this: in the 1970s, American doctors diagnosed schizophrenia in their patients many times more than British doctors did. And now, in the 21st century, diagnoses of depression have risen dramatically, as have those of post-traumatic stress disorder and attention deficit hyperactivity disorder. It appears, therefore, that not only do the incidences of certain diagnoses rise and fall depending on public perception, but also the doctors who are giving these labels are still doing so with perhaps too little regard for the DSM criteria the field dictates.

Some things are certainly much better today: as Slater reports, and in great contrast to Rosenhan's findings,"every single medical professional was nice" to her. One wouldn't think that would need to be noted as a great improvement, but compared to 30 years ago, it does.

I have much more to say about this subject, and I hope to get to some of it soon. But for now, I recommend you read Slater's article, which provides many more details -- and think about its implications. And remember that psychiatry is a"fledgling science, if it is a science at all." Any purported"science" which"lacks firm knowledge of practically any physiological basis for mental illness" is, of necessity, all too likely to be"a product of fashion, or fad."

And, as I have done before, I recommend you visit Thomas Szasz's site, for a great deal of additional information on this important subject.

(Cross-posted at The Light of Reason.)