The Enduring Impact of Type II Errors in Mental Health and Law
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Chapter 1: Understanding Type II Errors in Psychiatry
Type II errors are more common than one might think. This discussion revisits a 1973 study on misdiagnosis in psychiatric settings, revealing how similar flaws persist in law enforcement practices today.
In a landmark investigation conducted between 1969 and 1972, Dr. David L. Rosenhan, a psychiatrist from Stanford University, sent eight individuals—who had no mental health disorders—into twelve psychiatric hospitals without the staff's knowledge. Across these twelve instances, the participants were wrongly diagnosed with mental illnesses and admitted, with no corrections made during their stays. This study raised significant doubts about the reliability of psychiatric diagnoses.
Before 1973, Dr. Rosenhan aimed to determine whether psychiatrists could reliably distinguish between normal and abnormal psychological conditions. The 1960s had seen increasing skepticism regarding the objectivity and validity of psychiatric diagnoses compared to those in physical medicine. Critics argued that psychiatric assessments often resembled subjective opinions, which could be influenced by biases, even among experienced professionals.
With the goal of fostering a more empathetic understanding, Dr. Rosenhan sought to challenge the norms by having individuals with no significant psychiatric history admitted to hospitals, uncovering transformative insights in the process. He believed that if mental health professionals could consistently identify the absence of abnormal traits, it would provide compelling evidence of their diagnostic capabilities.
In eleven out of twelve cases, patients were diagnosed with schizophrenia, aligning with Dr. Rosenhan's expectations, but they were later discharged with a diagnosis of schizophrenia in remission—something he had not intended. The hospitals should have recognized their diagnostic errors, but they did not. To secure the initial diagnosis, participants reported experiencing auditory hallucinations, describing indistinct voices making nonsensical sounds like "empty," "hollow," and "thud."
Upon their admission, the participants ceased feigning psychiatric symptoms, yet the label persisted. Dr. Rosenhan attributed the initial misdiagnosis to a strong tendency among clinicians to commit type II errors, which occur when one fails to reject a false hypothesis.
Despite the assumption that a skilled clinician would eventually recognize and correct these type II errors, no such corrections were made during any of the hospitalizations. The patients’ normal behaviors went unnoticed. Dr. Rosenhan observed that even individuals without a psychiatric diagnosis might exhibit behaviors deemed abnormal, such as excessive writing, which would be attributed to normal factors like hobbies. He argued that the misattribution of behaviors illustrates the similarities between sane and insane individuals.
The study concluded that both practitioners and patients find themselves in a difficult situation. Mental health professionals often err on the side of caution, leading to a high rate of type II errors at admission, while the likelihood of these errors being identified during treatment remains low. The labeling of patients created a persistent perception, where their actions and statements were consistently interpreted through the lens of schizophrenia, showcasing the significant impact of contextual framing on evaluations.
Statistics 101: Controlling Type II Error using Sample Size
This video explains the concept of Type II errors in statistics and how adjusting sample sizes can help mitigate these errors in research.
Section 1.1: The Consequences of Labeling
Labeling is a powerful tool for social regulation; once assigned, every action and statement of the labeled individual is viewed through that lens. Dr. Rosenhan's findings from the 1970s highlight the inaccuracies in psychiatric evaluations, yet these same misdiagnosis issues are still prevalent in 2024, particularly within the criminal justice system. Once someone is labeled a criminal, they often cannot escape that identity.
Do you believe that law enforcement will ever acknowledge their errors? Probably not, especially when powerful police unions, particularly in large cities like Miami, exert pressure on departments to avoid disciplinary actions, even in cases involving severe misconduct. "When Florida cops are dismissed, they frequently find ways to return to duty."
Consider this: if a police officer suspects you might be intoxicated, even if you haven't had a drink, they may commit a type II error and arrest you.
Moreover, wrongful arrests and malicious prosecutions stemming from these errors occur frequently, yet they often go unrecognized and uncorrected. Many accused individuals feel powerless or lack the resources to contest their charges, leading them to accept pleas or face loss in court, perpetuating a cycle of injustice. Often, they remain incarcerated for so long that when offered a chance at freedom—whether through a guilty plea or probation—they feel compelled to accept, having few alternatives. Police departments are unlikely to admit errors without external pressure, as doing so exposes them to potential legal liabilities.
Just as mentally healthy individuals were misdiagnosed and confined in psychiatric wards in the 1970s, innocent people are similarly trapped within the criminal justice system without significant oversight. The lack of accountability for law enforcement's mistakes, whether intentional or not, is alarming.
Shame on them.
Chapter 2: The Call for Change
Statistics 101: Calculating Type II Error, Concept with Example
This video discusses how to calculate Type II errors in statistical research, providing examples to illustrate the concept.
Will there be change in policing practices? Not as long as powerful police unions remain in place. It may be time for both experienced and new officers to focus on their core mission of "protect and serve," rather than prioritizing their public image and arrest quotas. As it stands, once an individual is labeled as a criminal—much like how psychiatric facilities assigned a type II error diagnosis of schizophrenia—escaping that label is a daunting challenge that can be financially burdensome, emotionally taxing, and time-consuming.
How do you envision change occurring?