by AB Morgan
‘Ah yes. The antipsychiatry movement. They seem to be made up of these so called survivor patients of mental health services, but also of psychologists, social commentators and indeed psychiatrists. They, as a group or groups, assert that our psychiatric facilities are bulging at the seams with people who either shouldn’t be there, or for whom medication is not the answer.
‘It appears that people are abandoning their drug treatments, and in most cases, but not all, they are becoming unwell again and therefore needing readmission to psychiatric wards. This has created pressure and apparent indignity and suffering. In effect we may in the UK have exchanged large asylums for lots of smaller oppressive ones. Let me explain in more detail how we believe we can demonstrate this one way or the other.’
Prof Hugo had the room’s attention, although not purely because of the content of the information. Most of the journalists were watching his every entertaining move, and their faces were lit up, like those of children at a circus.
‘In the 1970s in the USA there was a famous experiment carried out by a psychologist who was also a university professor by the name of David Rosenhan. He set out to determine how valid psychiatric diagnoses were. At that time there was, and still is, a lot of criticism of how the mentally ill were diagnosed and treated, so Rosenhan set up an experiment to test this, by sending pretend patients into various psychiatric hospitals across a number of states in America. The pretend patients were instructed to report that they were hearing voices in order to gain admission to those hospitals if possible.’
Linda interrupted. ‘If this one-flew-over-the-cuckoo’s-nest research has been done before, why are we considering doing this again? It’s hardly newsworthy to repeat it.’ Mark agreed. As funny as the presentation was, he was not on board with the proposed assignment.
‘I appreciate your question, and I hope that things will become clear, as I go through the detail. There will be ample time for questions once I have set the scene, as it were.’
Prof Hugo held Linda’s gaze briefly as he floundered for a few seconds fiddling with his notes, and there was a considerable delay before he proceeded. ‘Where was I? Oh yes. In the 1970s. The Rosenhan Experiment. Which was famous by the way. Now then, when the pretend patients arrived unannounced at the various hospitals, they reported that they were hearing voices. Have I said that bit yet?
‘Anyway, they had to describe their voice-hearing experiences in the same way. They told the psychiatrists in each case that they had unclear voices, which said the words “hollow”, “empty”, and “thud”. There were twelve of these pretend patients, and they gained admission to hospitals across the USA. No other psychiatric symptoms were reported or described by them in any way, and they gave false names and fake information as to their occupation and such like. Are you with me so far?’
Prof Hugo outlined that the pretend patients in this experiment were instructed to behave normally after they were admitted, and they were also instructed to report to staff that they were no longer experiencing any hallucinations. So in effect, the pretend patients had only reported hallucinations for a brief period of time, and these voice-hearing reports, on their own, would not necessarily indicate the presence of a mental illness.
‘However, in each case they were all given a diagnosis of a mental illness, and they were all prescribed medication. Most surprisingly each one of them had to admit to having a mental illness and agree to continue on prescribed medication before they could secure their discharges from the hospitals.
‘I emphasise again that … that,’ stuttered Prof Hugo, ‘this was in every case. Professor Rosenhan had taken part in the experiment himself, you know. He was stuck in hospital for weeks.’
According to Prof Hugo, while the pretend patients were in the hospitals, no one had challenged them or even identified them as imposters. ‘I need to make it clear that the pretend patients did not actually take the medication; they pretended to do so, and flushed it down the toilet, taking care not to get caught. And the contact the patients had with doctors, who, remember, are the professionals in control of decisions, was for an average of six point eight minutes per day, shocking, when you think about it.’
Now the professor informed the listening audience that, while these were alarming outcomes in themselves, there was actually a second and more surprising part to Rosenhan’s experiment. One of the hospitals where the first part of the experiment had taken place, was offended by the initial research findings, and Rosenhan was challenged to send further pseudo-patients. The hospital in question believed that their staff would be able to detect any imposter. A timescale was agreed during which 193 new patients were seen. Of these, the staff at this particular hospital identified forty-one as potential pretend patients, with nineteen being suspected as such by a psychiatrist and at least one other member of staff.
‘That seems pretty impressive, doesn’t it?’ challenged Prof Hugo who was at last getting to grips with the use of the overhead projector. ‘But ladies and gentlemen, how many pretend patients had Rosenhan sent to that hospital?’
There was a long pause. Mark was interested enough to listen intently for the answer.
‘None. Not one!’ announced the professor proudly. ‘Rosenhan then, would you believe, wholeheartedly upset the psychiatric profession by concluding in his research that they, the psychiatrists that is, could not distinguish the sane from the insane in their hospitals. Much of the psychiatric profession was outraged when he published the full findings. So then where does this lead us?’
Mark perked up. Finally, we get to the point!
‘Well,’ revealed the professor, ‘we are aiming to repeat a version of part one of the experiment. It would be anticipated that things have improved and moved forward since the 1970s, but as I said earlier, the evidence we have to-date does not seem to indicate that this is the case.
‘We have approached you, the journalists around the table, because of your backgrounds and reputation. Most of you have careers in which you have had to give factual accounts, where you have borne witness to extraordinary events, and you have the capacity to file clear thoughtful and accurate reports in the middle of turmoil. This should therefore be easy for you. However, you may need to call on your personal resources, as we are making one or two changes to the Rosenhan experiment.’
Prof Hugo paused again, carefully observing each of the journalists around the room. ‘Any immediate questions?’
Mark was still in a state of mild disbelief. He had spent the last few months in the Lebanon, in Israel, and in Palestine. He had been in Gaza at the beginning of July when Yasser Arafat returned after twenty-seven years in exile. After which there were real hopes that the Middle East would settle down with the political scenery looking rosier. Mark had anticipated being less busy as a result, however he was not expecting his next assignment to be this. It could be a really nice change, he thought, to spend a few days in a nut house, or conversely he could be bored witless. He had one simple question at that point.
‘If the hospitals in this country are bursting at the seams, just how are we going to get ourselves admitted without being bonkers for real? Let’s face it, if we behave normally and get discharged, then this is not going to be very fruitful for either the paper as far as copy, or for your research,’ Mark offered.
The prof nodded, appreciating the question. ‘That is a consideration, and if the results indicate an improvement in care and treatment, then we have to question the whole anti psychiatry movement and its political motives. But you do raise a good point about the potential challenge of achieving admission. This brings me neatly onto the different approach we will be using in comparison to Rosenhan. We are going to base our experiment on behaviour rather than voice hearing or reported symptoms of any kind. This effectively negates the criticism that Rosenhan received. After publication of his findings it was proposed by the world of psychiatry, that because the pretend patients in his experiment had actually described mental illness symptoms,
this created enormous bias towards diagnosis of a mental illness.
‘So … you are all going to devise a plan for admission based on bizarre or irrational behaviour in order to gain admission if you can. Additionally you will remain silent, mute, or at least wordless for the first few days. The plan is that you will then return to normal behaviour but not speak to the doctors or staff initially. The project can then be managed in the same way as the Rosenhan team by giving false names and occupations, but not admitting to any symptoms or feelings or behaviour that you do not normally experience.’
Bloody hell, thought Mark, We’re going in. Undercover. How on earth is that going to work?
‘Once you have settled in, you should be able to access a telephone to contact one of us who are leading the research project to confirm your admission. That will be, John Starkey, Lewis James who you will meet shortly, and myself. There will be no need to make any written reports until the end of the experiment. However, you need to be aware that any one of you could end up under a Section of the Mental Health Act, which is why we have invited our local neighbourhood lawyer, Lewis here, to clarify this possibility.
‘That’s enough talking and listening for now. Let’s take a break and have a coffee, a cup of tea, a cigarette break, or whatever you need. Please remember not to discuss this in public areas. We will be asking for complete silence. Have a good chat with each other though, and be back round the table in twenty minutes, if that is okay?’
The room remained silent and still for a couple of seconds before Charlie piped up. ‘How’s Linda going to manage without her fags and gin in a hospital? That’s a bit cruel.’
Linda was lightening-quick with her riposte. ‘There speaks Charlie who spends his entire working life in the Foreign Correspondent’`s Club in Hong Kong, drinking, smoking and extracting stories from people who actually do the job they are paid for. Or, when he’s back in dear old Blighty, he can be found shagging their wives for the same reason. Perhaps you should pretend you feel guilty about this and want to jump from a bridge, a high one.’
Charlie smiled cockily, and returned the compliment using fairly ripe language that made Linda laugh and then cough. Much to Mark’s irritation, she lit up her fifteenth cigarette of the day.
With the room buzzing from the noise of chattering excitement, everyone could let out the laughter that they had been painfully holding onto for so long.
Mark remained reflective. He had been struck by what Prof Hugo had insinuated. He had seen people with incredible resilience in war zones, but also witnessed the demise of many who cracked under the strain, including a handful of his colleagues in recent years. He wondered about Charlie, who, on the face of it, appeared charming and full of his usual flirtatious energy and childish enthusiasm, but who was going to great pains to avoid active frontline war zone journalism. Linda’s comment about him leeching information from other journalists had been remarkably truthful. Mark could see why Charlie needed to absent himself from the on-the-ground reporter role, because the truth of it was that most of them didn’t survive long. Many returned to a desk job or ended up drug and alcohol fuelled shadows of their former selves. Of course he had also lost a few close colleagues altogether, as the death toll amongst foreign war correspondents was notoriously high given the nature of their work. Mark found himself on one hand relieved that he was not off to Bosnia, and on the other, tempted and intrigued by this experiment and assignment. He wasn’t too worried about the risks. What was the worst that could happen? He’d get found out and thrown out of hospital, which would hardly come as a surprise, because he was well aware that psychiatric wards were generally no-go areas for journalists. Still, it would be a free hotel bed for a few nights, in the company of other interesting guests. Maybe it was time to retire from the Middle East front line for a while at least. For now, he wanted to get a lungful or two of fresh air away from Linda and her foul cigarette smoke.
He stepped into the polluted London air.
16
The Sharp-dressed Lawyer Speaks
The serious-looking lawyer, not previously recognised by either Charlie or Mark, stood back from the head of the table. He waited for the assembled group to settle again and sit with pens at the ready for round two.
He had lost the serious expression, and was smiling and relaxed. Before speaking, he gave a broad grin exhibiting a fine set of even white teeth. Tall and dark featured, he was sharply dressed in an obviously costly suit, which fitted perfectly. John Starkey, wearer of the crumpled suit look, and the editor of the Daily Albion, introduced this smiling man as Lewis James, ‘a barrister with a specialism covering mental health law and civil rights.’
It turned out that Lewis James was not a serious character.
‘Hello to you lovely journalistic sensation-seekers, and research boffins. Yes, I am Lewis James.’ His clear and resonant mellow voice with a noticeable Northern accent echoed around the room. Mark found that it was not easy to work out whether this was a Yorkshire or Lancashire accent, but it was intriguing and rather unexpected. The man himself looked too London-executive posh, for a down-to-earth northerner. The effect was curiously incongruous.
Lewis James did a passable impression of Tommy Cooper. ‘Lewis James, James Lewis … just like that, shushuum. Please try not to get the names the wrong way round, as you may have need of my services in the coming weeks, and it is important that you have my name and my contact number indelibly etched on your brains and in your memories. Although you may find it hard to believe, I originally worked as a mental health nurse. Yes indeed, that was years ago, and it may explain why I don’t sound like a barrister, or sometimes behave like one. I’m also married to a consultant psychiatrist.
‘Aha, I see I have your attention. Yes, she’s a wonderful woman and a dedicated doctor, so I’m taking a tidy risk by joining this research project as legal advisor. Now then, because I cannot discuss this with my wife in any shape or form, things could become awkward. I’m sure she will suspect that I’m up to no good, as she’s remarkably perceptive. Having said that, confidentiality rules okay in our house, and she’s used to me not being able to discuss important cases. So I’m safe enough for now. I suppose it depends how long you and I are going to carry on this clandestine relationship.’
Lewis James meandered around as he spoke, carefully catching the eye of each of those seated around the table, occasionally tugging at his cuffs and flashing his pearly white teeth as he did so.
‘I’m here to dispel and debunk a few myths, and also to guide you through the “shoulds” and “coulds” of this project. By that I mean, what should happen to you when you attempt your admission to hospital, and then also to help look at what could happen to you, in order for us to consider necessary contingencies.’
Mark was relieved to hear that here, at last, was a man in the know. This idea for research was all well and good, but he was damn sure that no one else in the room actually had experience of what it was like inside a psychiatric ward.
Sensibly, Lewis began with the basics, and he outlined that once each of the volunteers had decided on a suitable false identity – including a plan for admission and back-story – they would be temporarily registered with an out of area GP. In fact they would be as far away from their home territory as was reasonable, to avoid bumping into someone they knew, or who knew them.
‘When and how you give information about your false selves and your temporary GPs is up to you, but as you will be newly registered as temporary patients, the GP practice will have no past history to give to the hospitals when they ring for background information about you.’
One of the journalists by the name of Jock, a ferret of a man with a strong Scottish accent, put his hand in the air, and was invited to ask his question with a nod and a wave from Lewis James. ‘Aye, what aboot an address? Surely we will need one to register?’
‘Correct, yes, you will be given one of those too. The road names and postcode will exist but the house number will
not. In effect my friends, you will become a finely tuned group of undercover agents by the time you enter the hospital environment.’
‘Now you’re talking,’ muttered Mark. At last there seemed to be evidence of organisation. Mark stopped doodling, and instead gave his full attention to what was being said.
Lewis James clarified that the research project would be confined to English hospitals only.
‘Scottish mental health law is different,’ Lewis explained. ‘We did consider Wales but they speak Welsh far too often, so we thought better of that idea. Anyway, what should happen is, whichever your route in, you will more than likely end up being assessed by an on-call doctor. You have been asked to remain silent or at least wordless, but I would suggest that you make the odd noise, or hum or wail. Whatever you do, your behaviour must be a cause for concern enough to warrant an admission. If you get it right, then you may succeed in raising anxieties purely by the method you choose to get you to the point of assessment. For example, the idea of jumping off a bridge is pretty good, as long as you don’t actually launch yourself into the Thames.’
Lewis James had quickly picked up on the reference made by Linda to Charlie about jumping from a bridge, and he became more animated as his descriptions went on.
‘Now then, let’s imagine your admission raises an unhealthy amount of concern, and that a decision is made to assess you under the Mental Health Act. Don’t worry. Remember that the medical staff and the approved social workers are trained to carry out this role, and they have to act in the interests of you as the patient, and the wider public. If this does happen, you will only be placed under a Section 2, which allows for assessment where necessary for up to twenty-eight days. I repeat: up to twenty-eight days. It doesn’t mean you’ll be in for a whole month. A Section 2 is used because you do not have an established diagnosis, and even if you do in real life, you now have a false name, so they don’t know if you are already a little bonkers. Which, quite frankly, you must be to sit here at least considering whether or not to take part in this outrageously adventurous experiment.‘ He laughed.
