10 ms·

This is basically the premise of the book "One Flew Over The Cuckoo's Nest". The major question of the book was: "Who was really crazy, the inmates or the Syst

This is basically the premise of the book "One Flew Over The Cuckoo's Nest". The major question of the book was: "Who was really crazy, the inmates or the System?" It's kind of frightening that views haven't changed in the 40+ years since the book was written. I guess the difference is that they will simply overmedicate rather than lobotomize.

JonnieCache 15y ago
Firstly, things have changed massively since one flew over the cuccoos nest was written. It wasn't even representative at the time. As I understand, it's more an allegory for the wider society and about institutions. A modern psychiatric hospital is utterly unlike the place in that book in every respect. They still use electroshock therapy, because it has been proven to work. Now they do it under general anaesthetic and it's an altogether less messy affair. Watch this moving TED talk if you don't believe me: http://www.youtube.com/watch?v=oEZrAGdZ1i8 http://www.youtube.com/watch?v=oEZrAGdZ1i8 Secondly, closely related to this is the famous Rosenhan experiment. http://en.wikipedia.org/wiki/Rosenhan_experiment http://en.wikipedia.org/wiki/Rosenhan_experiment The really relevant bit is this paragraph: For example, one nurse labeled the note-taking of one pseudopatient as "writing behavior" and considered it pathological. The patients' normal biographies were recast in hospital records along the lines of what was expected of schizophrenics by the then-dominant theories of its etiology. I also remember that one participant had their habit of standing around outside the cafeteria waiting for it to open for lunch noted down by a nurse as "neurotic behaviour around eating and food" and again framed as part of their disorder and used as a reason to keep them there. Remember though that this was in america in the 70s, and things have changed a lot since then. Partly as a direct result of that study, which made a huge impact on the profession and caused a lot of soul searching. Someone repeated it, I think in the 90s, and they were all just put on pills rather than being committed. The crucial difference being that one can choose not to take pills.
- lifeisstillgood 15y ago
  Isn't this the "all politicians are untrustworthy" problem. Politicians are not any more untrustworthy or criminal than the general populace, they are just more closely watched. And the same is obviously true of those 'under observation' - psychiatric disorders or not. I am not sure just how many of my strange habits would be diagnosed under the DSM - but enough to worry me :-)
  - JonnieCache 15y ago
    >I am not sure just how many of my strange habits would be diagnosed under the DSM - but enough to worry me That is exactly why doctors don't diagnose just using the DSM checklists. Obviously if they did, we'd all be mad as hatters. There are a whole load of other criteria which must be met, for example, the behaviours have to be detrimental to your life or to the lives of others around you. They also must be abnormal within your culture, which is why religious people aren't all immediately locked up and sedated. I really wish I could remember/find the name of this other set of assessments that doctors make but alas I cannot. Also my knowledge is based on the UK system, where incidentally they use the ICD-10, which is like the european version of the DSM. Things may very well be different in the states or elsewhere.
    - SimHacker 15y ago
      Our culture would benefit greatly if religious people were immediately locked up and sedated. They ARE crazy and harmful to those around them, and humoring them is bad for society.
      - anti-atheist 15y ago
        yeah, it would be much better if instead of 'thou shalt not kill' we taught our children 'do unto others before they do unto you'. Don't conflate the failings of a minority with the actual religion.
  - mikeash 15y ago
    I'm really curious about your politicians statement. Has it been studied and found that politicians match the population in this area, or is that just your supposition?
    - ImprovedSilence 15y ago
      I decided to look this up, and I'm actually impressed with the overview from Snoops: http://www.snopes.com/politics/crime/congress.asp http://www.snopes.com/politics/crime/congress.asp [tl:dr, they really didn't come to any conclusion]
- Alex3917 15y ago
  "Firstly, things have changed massively since one flew over the cuccoos nest was written. [...] A modern psychiatric hospital is utterly unlike the place in that book in every respect." Why do you say this? From everything I've read I don't think there have been many changes at all.
  - JonnieCache 15y ago
    I've seen the inside of (admittedly only one of) them, although not as a patient. My father is a psychiatrist. I admit that they probably bear some similarities in the patterns of procedure and behaviour that take place in them, but they are not the stark, inhumane, prisonlike environments portrayed in that book/film. You're right though, "utterly unlike in every respect" is probably too strong.
    - nknight 15y ago
      > I've seen the inside of (admittedly only one of) them, although not as a patient. My father is a psychiatrist. So you lack first-hand knowledge, and your argument is easily seen as a biased defense of a family member -- an authority figure, even. I don't think you're helping your cause any.
  - cgoddard 15y ago
    http://en.wikipedia.org/wiki/Deinstitutionalization http://en.wikipedia.org/wiki/Deinstitutionalization Granted letting people fend for themselves on the streets and be poor and destitute through financial marginalization isn't always a lot better.
- c1sc0 15y ago
  I can report firsthand (well, nearly) on the effectiveness of correctly administered electroshock therapy. My mother has been treated successfully with modern electroshock therapy for major depression. It is entirely painless and the only debilitating side-effect is memory loss. For many patients this approach is more valid than the lengthy trial-and-error approach of finding the right mix of andtidepressants. Disclaimer: my father is a biological psychiatrist, so she may have received better-than-average treatment. What blew me away was the effectiveness: it was like rebooting a system. After the treatment an entirely different person came back.
  - noduerme 15y ago
    Sorry if this is rude, but... was there at any point a discussion about the ethics involved in having one's wife rebooted and turned into an entirely different person?
    - brazzy 15y ago
      Have you ever had to deal with someone suffering from clinical depression? It is not a condition likely to have the ethics of an effective therapy doubted by anyone, including the patient.
      - noduerme 15y ago
        Ah, so if the ends justify the means then there's no one qualified to question the method? Why not diagnose demonic possession and write a prescription for drowning? Who's to doubt the ethics of the method if it's "effective"? And "effective" by whose measure, anyway? A husband who wants his wife to "act normal"? The health establishment? You?
        jff 15y ago
        You're right, he should have let his wife be herself and just commit suicide.
        15y ago
- dkarl 15y ago
  Someone repeated it, I think in the 90s, and they were all just put on pills rather than being committed. And they were probably just given pills because that's what doctors to do make their customers happy. The "anti-authoritarian" diagnoses are also demand-driven. Parents want a mental health diagnosis to explain why their kids aren't the perfect overachievers they wanted them to be, and then they want pills to make it better. The elastic definitions of mental disorders make it possible for the customer to always be right. Nothing brings out authoritarianism like parenthood.
- napierzaza 15y ago
  So it's a big pat on the back for prescribing pills? I'm not sure where you're coming from on this. But I think the person your responding to understood it as an allegory, and getting on the psych defense is missing the point.
zackzackzack 15y ago
And Catch-22. The only way for Yossarian to be sane and avoid death was to do things that most people considered crazy.
noduerme 15y ago
I think it's even more frightening than that. As a sociopolitical program, mass-diagnosing and mass-medicating nonconformists to tone down their nonconformity is one of the basic premises of Brave New World. The ability to delegitimize an individual's arguments by labeling his point of view a "disease" is a power accorded only to mental health professionals, and the closest historical analogs are the labels of "anti-American", "counter-revolutionary" and "heretic" (and now, maybe, "terrorist"). What these labels have in common is that they not only confer on the authorities the public's blessing to treat or re-educate the non-conformist, they also carry a freight of social stigma and fear of open association that's sufficient to scare other people away from openly sympathizing with the now-isolated individual - making it impossible to determine from that point forward whether the charges were accurate, or if the individual was targeted solely for being anti-authoritarian. In fact, making an example of one non-conformist pays dividends for the authorities running the inquisition, by cowing the rest of the population further into submission, while forcing the most vehement of the other non-conformists to expose themselves in defense of whatever is said to be "indefensible". As counter-revolutionary thought was considered contagious under Mao and Stalin, and as people were terrified to even ask where their relatives had disappeared under Pinochet, so defending a non-compliant individual becomes socially unacceptable once the labels and drugs have been applied. There's no reason to think this principle doesn't operate at the level of psychiatrist and patient, since that relationship (other than the individual's relationship to mass culture through television) is exactly where most people with the financial means to effectively contest authority are actually presented with ideas of what constitutes "healthy" conformist and consumerist behavior.

JonnieCache 15y ago

Firstly, things have changed massively since one flew over the cuccoos nest was written. It wasn't even representative at the time. As I understand, it's more an allegory for the wider society and about institutions. A modern psychiatric hospital is utterly unlike the place in that book in every respect. They still use electroshock therapy, because it has been proven to work. Now they do it under general anaesthetic and it's an altogether less messy affair. Watch this moving TED talk if you don't believe me: http://www.youtube.com/watch?v=oEZrAGdZ1i8 http://www.youtube.com/watch?v=oEZrAGdZ1i8 Secondly, closely related to this is the famous Rosenhan experiment. http://en.wikipedia.org/wiki/Rosenhan_experiment http://en.wikipedia.org/wiki/Rosenhan_experiment The really relevant bit is this paragraph: For example, one nurse labeled the note-taking of one pseudopatient as "writing behavior" and considered it pathological. The patients' normal biographies were recast in hospital records along the lines of what was expected of schizophrenics by the then-dominant theories of its etiology. I also remember that one participant had their habit of standing around outside the cafeteria waiting for it to open for lunch noted down by a nurse as "neurotic behaviour around eating and food" and again framed as part of their disorder and used as a reason to keep them there. Remember though that this was in america in the 70s, and things have changed a lot since then. Partly as a direct result of that study, which made a huge impact on the profession and caused a lot of soul searching. Someone repeated it, I think in the 90s, and they were all just put on pills rather than being committed. The crucial difference being that one can choose not to take pills.

lifeisstillgood 15y ago
Isn't this the "all politicians are untrustworthy" problem. Politicians are not any more untrustworthy or criminal than the general populace, they are just more closely watched. And the same is obviously true of those 'under observation' - psychiatric disorders or not. I am not sure just how many of my strange habits would be diagnosed under the DSM - but enough to worry me :-)
- JonnieCache 15y ago
  >I am not sure just how many of my strange habits would be diagnosed under the DSM - but enough to worry me That is exactly why doctors don't diagnose just using the DSM checklists. Obviously if they did, we'd all be mad as hatters. There are a whole load of other criteria which must be met, for example, the behaviours have to be detrimental to your life or to the lives of others around you. They also must be abnormal within your culture, which is why religious people aren't all immediately locked up and sedated. I really wish I could remember/find the name of this other set of assessments that doctors make but alas I cannot. Also my knowledge is based on the UK system, where incidentally they use the ICD-10, which is like the european version of the DSM. Things may very well be different in the states or elsewhere.
  - SimHacker 15y ago
    Our culture would benefit greatly if religious people were immediately locked up and sedated. They ARE crazy and harmful to those around them, and humoring them is bad for society.
    - anti-atheist 15y ago
      yeah, it would be much better if instead of 'thou shalt not kill' we taught our children 'do unto others before they do unto you'. Don't conflate the failings of a minority with the actual religion.
- mikeash 15y ago
  I'm really curious about your politicians statement. Has it been studied and found that politicians match the population in this area, or is that just your supposition?
  - ImprovedSilence 15y ago
    I decided to look this up, and I'm actually impressed with the overview from Snoops: http://www.snopes.com/politics/crime/congress.asp http://www.snopes.com/politics/crime/congress.asp [tl:dr, they really didn't come to any conclusion]
Alex3917 15y ago
"Firstly, things have changed massively since one flew over the cuccoos nest was written. [...] A modern psychiatric hospital is utterly unlike the place in that book in every respect." Why do you say this? From everything I've read I don't think there have been many changes at all.
- JonnieCache 15y ago
  I've seen the inside of (admittedly only one of) them, although not as a patient. My father is a psychiatrist. I admit that they probably bear some similarities in the patterns of procedure and behaviour that take place in them, but they are not the stark, inhumane, prisonlike environments portrayed in that book/film. You're right though, "utterly unlike in every respect" is probably too strong.
  - nknight 15y ago
    > I've seen the inside of (admittedly only one of) them, although not as a patient. My father is a psychiatrist. So you lack first-hand knowledge, and your argument is easily seen as a biased defense of a family member -- an authority figure, even. I don't think you're helping your cause any.
- cgoddard 15y ago
  http://en.wikipedia.org/wiki/Deinstitutionalization http://en.wikipedia.org/wiki/Deinstitutionalization Granted letting people fend for themselves on the streets and be poor and destitute through financial marginalization isn't always a lot better.
c1sc0 15y ago
I can report firsthand (well, nearly) on the effectiveness of correctly administered electroshock therapy. My mother has been treated successfully with modern electroshock therapy for major depression. It is entirely painless and the only debilitating side-effect is memory loss. For many patients this approach is more valid than the lengthy trial-and-error approach of finding the right mix of andtidepressants. Disclaimer: my father is a biological psychiatrist, so she may have received better-than-average treatment. What blew me away was the effectiveness: it was like rebooting a system. After the treatment an entirely different person came back.
- noduerme 15y ago
  Sorry if this is rude, but... was there at any point a discussion about the ethics involved in having one's wife rebooted and turned into an entirely different person?
  - brazzy 15y ago
    Have you ever had to deal with someone suffering from clinical depression? It is not a condition likely to have the ethics of an effective therapy doubted by anyone, including the patient.
    - noduerme 15y ago
      Ah, so if the ends justify the means then there's no one qualified to question the method? Why not diagnose demonic possession and write a prescription for drowning? Who's to doubt the ethics of the method if it's "effective"? And "effective" by whose measure, anyway? A husband who wants his wife to "act normal"? The health establishment? You?
      - jff 15y ago
        You're right, he should have let his wife be herself and just commit suicide.
        15y ago
dkarl 15y ago
Someone repeated it, I think in the 90s, and they were all just put on pills rather than being committed. And they were probably just given pills because that's what doctors to do make their customers happy. The "anti-authoritarian" diagnoses are also demand-driven. Parents want a mental health diagnosis to explain why their kids aren't the perfect overachievers they wanted them to be, and then they want pills to make it better. The elastic definitions of mental disorders make it possible for the customer to always be right. Nothing brings out authoritarianism like parenthood.
napierzaza 15y ago
So it's a big pat on the back for prescribing pills? I'm not sure where you're coming from on this. But I think the person your responding to understood it as an allegory, and getting on the psych defense is missing the point.

zackzackzack 15y ago

And Catch-22. The only way for Yossarian to be sane and avoid death was to do things that most people considered crazy.

noduerme 15y ago

I think it's even more frightening than that. As a sociopolitical program, mass-diagnosing and mass-medicating nonconformists to tone down their nonconformity is one of the basic premises of Brave New World. The ability to delegitimize an individual's arguments by labeling his point of view a "disease" is a power accorded only to mental health professionals, and the closest historical analogs are the labels of "anti-American", "counter-revolutionary" and "heretic" (and now, maybe, "terrorist"). What these labels have in common is that they not only confer on the authorities the public's blessing to treat or re-educate the non-conformist, they also carry a freight of social stigma and fear of open association that's sufficient to scare other people away from openly sympathizing with the now-isolated individual - making it impossible to determine from that point forward whether the charges were accurate, or if the individual was targeted solely for being anti-authoritarian. In fact, making an example of one non-conformist pays dividends for the authorities running the inquisition, by cowing the rest of the population further into submission, while forcing the most vehement of the other non-conformists to expose themselves in defense of whatever is said to be "indefensible". As counter-revolutionary thought was considered contagious under Mao and Stalin, and as people were terrified to even ask where their relatives had disappeared under Pinochet, so defending a non-compliant individual becomes socially unacceptable once the labels and drugs have been applied. There's no reason to think this principle doesn't operate at the level of psychiatrist and patient, since that relationship (other than the individual's relationship to mass culture through television) is exactly where most people with the financial means to effectively contest authority are actually presented with ideas of what constitutes "healthy" conformist and consumerist behavior.