Literature and Medicine II

6 The controversy over the Skinner chapter, though heated and litigious, pales in comparison to the debate engendered by Slater’s chapter on David L. Rosenhan’s study, “On Being Sane in Insane Places.” In Rosenhan’s original study, eight volunteers (including Rosenhan himself) made appointments at the admissions offices of various psychiatric hospitals where they complained about hearing voices that said “empty,” “hollow,” and “thud.” This was the only symptom that they feigned, and after gaining admission to the hospital (all were admitted in every instance), each “pseudopatient ceased simulating any symptoms of abnormality” (Rosenhan 251; emphasis in original). Rosenhan’s “pseudopatients” stayed in the hospital for an average of 19 days, with length of stays ranging from 7 to 52 days (252). When they were released, they were released because they were judged to be in “remission” of a mental illness. Despite being “people who do not have, and have never suffered, symptoms of serious psychiatric disorders,” their “sanity” was never detected by doctors or hospital staff (251). Rosenhan began this study with the question, “do the salient characteristics that lead to [psychiatric] diagnoses reside in the patients themselves or in the environments and contexts in which observers find them?” (251). His results suggested that “psychiatric diagnosis betrays little about the patient but much about the environment in which an observer finds him” (251). Furthermore, Rosenhan concluded, “any diagnostic process that lends itself so readily to massive errors of this sort cannot be a very reliable one” (252). Rosenhan’s experiment is well-known, often cited, and has helped to fuel skepticism about the reliability and accuracy of psychiatric diagnoses. As one of Rosenhan’s most vocal critics, Robert L. Spitzer, ruefully noted in 1975, “this single study is probably better known to the lay public than any other study in the area of psychiatry in the last decade” (“More on Pseudoscience” 459).

7 Slater not only echoes Rosenhan’s critique of psychiatry by retelling it; she also reinforces the conclusions of his original study by repeating the experiment itself and reporting similar results. Slater stops showering for five days, visits a psychiatric emergency room, and complains of hearing the word “thud.” Slater writes:

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, of course, I am denied admission—I deny I am a threat and I assure people I am able to do my work and take care of my child—but strangely enough, most times I am given a diagnosis of depression with psychotic features [...]. I am prescribed a total of twenty-five antipsychotics and sixty antidepressants. (88-89)

Slater concludes that “the zeal to prescribe drives diagnosis in our day, much like the zeal to pathologize drove diagnosis in Rosenhan’s day” (90).

8 The number of medications that Slater was prescribed during her experiment was truly shocking: an average of about nine different medications per emergency room visit. In her book, Slater recounts her experiment to Robert L. Spitzer, the very same psychiatrist who was Rosenhan’s critic in the 1970s and who led the American Psychiatric Association task force that created the DSM-III in 1980. [2]The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the official American Psychiatric Association reference manual, listing all mental disorders and the criteria by which these disorders are diagnosed; it is the diagnostic bible of psychiatry. Spitzer was initially both disappointed and a little defensive when he learned of her results: “‘You have an attitude,’ he tells me, ‘like Rosenhan did. You went in with a bias and you found what you were looking for’” (Opening Skinner’s Box 90). After the book’s publication, Spitzer challenged Slater’s findings in a more public, systematic way, by responding to her experiment in a peer-reviewed professional journal. Unlike his previous responses to Rosenhan, which were thoughtful and complex essays that painstakingly critiqued the logic of the original study’s methods, interpretation of the data, and conclusions, [3]Spitzer, “On Pseudoscience in Science” and “More on Pseudoscience in Science.” Spitzer took a different approach to Slater’s experiment: he repeated it. Working together with two colleagues, he created a case study vignette based on Slater’s own description of her emergency room presentation and a series of questions about diagnosing, treating, and prescribing medication which he then distributed to emergency room psychiatrists. Spitzer’s results differed in significant ways from Slater’s results. Of the 73 doctors who responded to Spitzer’s survey, only 6% diagnosed psychotic depression and 34% prescribed antipsychotic medication (Spitzer et al., “Rosenhan Revisited” 737). While Slater reported an average of 6 different prescribed antidepressants per visit in her experiment, none of the doctors in Spitzer’s study prescribed any antidepressants. While acknowledging the distinct differences between Slater’s first-hand experiment and the written survey based on her performance of symptoms, “it strains credulity,” Spitzer and his colleagues wrote, “to contend that Slater’s physical appearance alone was sufficient to account for the discrepancy [in final data] across studies” (738). Slater, furthermore, refused to share “any documentation such as case records (with identification deleted) or hospital bills or to explain puzzling details about her reported experiences, such as how she was prescribed 85 medications on only nine occasions” (738). “Our failure to corroborate Slater’s findings, conjoined with her unwillingness to supply us with any objective documentation, raise troubling questions about the credibility of her study’s findings,” they concluded (738). In other words, they implied, Slater is lying.

9 Spitzer and his colleagues published their findings in The Journal of Nervous and Mental Disease and Slater was invited to respond. The exchange that followed was not the typical academic difference of opinion. Slater’s tone was mocking and irreverent, and she depicted her critics as foolish for even thinking about engaging with her in this venue:

I am a bit at a loss as to how to respond to the “critique” by Spitzer et al. of my Rosenhan “study” because as a trade book writer, I never did such a study; it simply does not exist. This puts me in an awkward position, but probably not as awkward a position as it puts you—the editors and peer reviewers—for accepting for publication before reading the text (my book) toward which the rebuttal is aimed. I’m sure this is not common practice. (743)

“I write for fashion magazines almost exclusively,” claimed Slater, and the personal and eccentric content of her prose should have signaled to them that her writing lies beyond the scope of this form of academic critique:

That Spitzer et al. have chosen to label my work as a study is a silly and troubling mischaracterization; it is a manipulative mischaracterization as well, for of course such esteemed men must know that pet raccoons, dog dandruff, dahlias, and pooper scoopers firmly locate a work in something altogether outside of academia. (“Reply to Spitzer” 743)

These “esteemed men” should know better than to squander time and resources on such a silly attack on her: “I, for one, do not want my tax dollars being spent by men on such poorly conceived and misleading projects” (744). Although she refers to her re-enactment of Rosenhan numerous times as an “experiment” in Opening Skinner’s Box, she claims here that her “use of the word ‘experiment’ is of course vernacular, as in ‘honey, let’s experiment with this recipe tonight’” (743). She’s just a woman writing for fashion magazines and playing around in the kitchen; Spitzer et al. are humorless male bureaucratic scientists who take everything too seriously.

10 Slater’s central defense is to challenge the language that Spitzer depends upon and to strategically reestablish the disciplinary boundaries between the vernacular and the scientific, boundaries that she has previously worked hard to transgress or bridge in her work: Spitzer logically cannot critique a “nonstudy” or a “phantom study.” In addition to rejecting the terms of his critique, she also parodies the scientific method Spitzer deploys by mocking the conventions of experimental research:

Because I am neither an academic nor do I have any university or organizational affiliation, I lacked access to an Institutional Review Board to approve my inquiry, its methods, and underlying ethics. I was able, however, to cobble together my own IRB, which consisted of Dr. McFarland, our hamster’s vet; Yassir Mizra, the owner of the wonderful neighborhood café Sound Bites; Ally Hines, member of our PTA; Andreas Lopez, the used car salesman who sold me the $4000 Subaru with 71,000 miles on it (all-wheel drive); my neighbor, Mr. Smith, who is on parole; and Lorna, our school crossing guard. (743)

Although the primary purpose of such a passage may be to entertain us, at Spitzer’s expense of course, it is worth noting that this comic deflection begins with an acknowledgement of the power relations structuring this debate. Despite her successes as a writer and her graduate degree in psychology, Slater is an outsider, without academic affiliation and without authority. She is at a rhetorical disadvantage here, and her response can be read as a desperate attempt to alter the terms of the debate.  [4]Slater’s status as a former psychiatric patient adds another layer that might undermine her authority to speak. As Catherine Prendergast writes, “to be disabled mentally is to be disabled rhetorically” (57), and Slater herself acknowledges that as a former mental patient she would not qualify as a pseudopatient under Rosenhan’s original criteria. Slater’s rhetorical position is never explicitly pathologized in this dispute, however.