Booby Hatches: The Crisis in Psychiatric Hospitalization

“I’m talking about the booby hatch,” the guy on the phone said. “You know, straitjackets. Padded rooms. Not stuff that happens to people like us.”

The guy was an insurance agent, telling me the one thing his suspiciously cheap policy didn’t cover. It was psychiatric hospitalization.

I thought of him when I read that the family of Irvo Otieno reached an $8.5 million settlement in September, just this week. The young Black patient was asphyxiated while he was pinned to the floor in a psychiatric hospital.

I wish this case were an outlier. But it isn’t.

Money Grabs, Neglect, and Abuse

A 2019 article in the Los Angeles Times found almost 100 preventable deaths in California facilities, including by restraint. In 2016, BuzzFeed reported on the largest chain of private psych hospitals in the country, Universal Health Services. It cited pressure to fill beds, even with people who didn’t need them. Understaffing, choking, and wrongful death.

Two hospitals near me have been charged with holding patients unnecessarily to grab money—as the Seattle Times put it in a 2019 story, “Free to Check in But Not to Leave.” In 2022 one lost the right to accept underage patients. Neglected teens had been victimized by another patient.

More simply, a family member told CBS News Seattle’s Western State Hospital was like “going into hell.” She’d found her mother’s room full of trash, and fungus growing on her feet.

The Rosenhan Experiment: A Long History of Abuse

In 1969, a man named David Rosenhan went to a psychiatric hospital and told the doctor he heard voices. He was a psychologist and pseudopatient who wanted to see hospitals from the inside. He called himself David Lurie. Said voices may have been this doctor’s least interesting of all time: male, unfamiliar, they said only hollow, empty, and thud.

Rosenhan wondered how meaningful a psychiatric diagnosis was—and if it could include the concept of well. Or, as I’d put it, different but well.

“Lurie” made it clear to the intake doctor that he managed a demanding job, and had a spouse and children. He lived a fulfilled and functional life. Nevertheless, he was admitted with a diagnosis of schizophrenia.

Rosenhan spent nine days at Haverford State Hospital. Haverford was a new and fancy state hospital—it even had a bowling alley. But he came out of those nine days so shaken his students and assistant could see the change: he seemed darker, as one put it, “distressed, worn out, somewhat older than before."

After his stay, Rosenhan recruited seven more people to play pseudopatients. They also used as symptoms his three words. All but one was diagnosed with schizophrenia; that one was called bipolar. All were declared sick enough to be held for long periods, though after a few days, pseudopatients said their symptoms had gone away.

Rosenhan published his study results in a paper titled “On being sane in insane places” in the journal Science in 1972.

“Neither anecdotal nor ‘hard’ data,” wrote Rosenhan, “can convey the overwhelming sense of powerlessness that invades the individual as he is continually exposed to the depersonalization of the psychiatric hospital.”

Rosenhan had to strip in front of a half-open door. One nurse adjusted her bra in front of a roomful of patients, handling her breasts.

Nurses, staff, and doctors often only spent just minutes a day with patients. Some toilets overflowed with waste. Rosenhan observed patients being called motherf*ckers, even being hit and physically assaulted.

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Rosenhan was not an anti-psychiatrist and believed mental illness was real. He also believed our diagnoses may not be “as substantive as we think them to be.” And that once a psychiatric label is attached to someone, particularly one like schizophrenia or bipolar, it’s next to impossible to remove.

Too often, once the labeling begins, the dehumanization begins. And those we dehumanize, we can hurt.

Rosenhan’s notes were messy, and when a journalist looked for the pseudopatients several decades after the fact, found only two. One pseudopatient had experiences like Rosenhan’s, the other had found his hospital fairly benign. That pseudopatient’s daughter would land in a psych hospital, one she described as a prison that pumped her with drugs.

The possibility that “being insane” couldn't be proven after the fact led to a lot of unfortunate cheering about the whole story, in and out of the psych community. That’s missing the point. No one questions Rosenhan’s traumatic nine days.

A psychiatrist who worked at Haverford then called it a “dark, foreboding cave.” A nurse’s whistleblowing about the period 1967 to 1972 included charges of mis-medicating, absent medical staff, and ignoring or allowing sexual abuse. Haverford finally closed.

The Ultimate Gaslight

If hospitalized cancer patients were treated like the neurodivergent, reporting on it would spark angry and sustained public protest. It doesn’t, because of attitudes like that of my insurance guy. Most people think the booby hatch has nothing to do with them. Should they have a bad experience, these attitudes about booby hatches will make it shameful to talk about.

Let’s face it: Psychiatric professionals have the ultimate gaslight if they choose to use it. Universal Health Services ducked responsibility for dozens of reports, many from former staff, by saying psychiatric patients were unable to make the “same judgments” as non-psychiatric patients.

I told my insurance agent that “lots of us are going to spend time in a psych hospital.” I didn’t mention that I have. As have those I love. For me and someone close to me, these rank as the worst experiences of our lives. As they did for David Rosenhan.

At least we survived them.

PS: I once asked an assortment of people to tell me how they think. Not what; how. The basic architecture of thinking, which in different people ranged from inner governments to elevators stopping at the floors of different mental topics. How about you?