Sunday, February 22, 2004
Into the cuckoo's nest
Guardian Unlimited : "I call back Robert Spitzer at Columbia's Institute for Biometrics.

'So what do you predict would happen if a researcher were to repeat the Rosenhan experiment in this day and age?' I ask him.

'The researcher would not be admitted,' Spitzer replies.

'But would they be diagnosed? What would the doctors do about that?'

'If they only said what Rosenhan and his confederates said?' he asks.

'Yeah,' I say.

'They would be given a diagnosis of deferred.'

'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, 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.'"

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