User Reviews
Rating: really liked it
A writer friend always rates her own books. She explained that if she doesn’t love her own book enough to give it five stars, how can she expect anyone else to do the same? I like this mentality so here I go!
Rating: really liked it
Back in the early 1970s, Dr. David Rosenhan published the results of a study wherein he and several other people (so-called “pseudopatients”), none of whom had ever had mental health issues, attempted to get admitted to psychiatric hospitals by showing up and claiming they heard a voice in their head saying “empty,” “hollow,” and “thud.” All of them got admitted on this basis, most of them receiving a preliminary diagnosis of schizophrenia. Once admitted, they behaved like their normal selves, but no one seemed to notice they were actually not mentally ill. The resulting article, “On Being Sane in Insane Places,” purported to show that (1) diagnosis of mental health issues was unreliable at best; and (2) patients in psychiatric hospitals were in fact not treated in ways that might actually be therapeutic.
When Susannah Cahalan heard about this study a few years ago, she was fascinated. Girl, me too. Rosenhan’s study put me in mind of Nellie Bly’s groundbreaking undercover investigation of an asylum, which she published in the 1880s as “Ten Days in a Mad-House,” and which I was obsessed with as a kid. Bly’s investigation is detailed in
The Great Pretender, but Cahalan’s own interest was based on something more personal: Her harrowing experience of having her brain inflammation misdiagnosed as mental illness. If a determined doctor hadn’t discovered what was actually ailing her, her life may have turned out very differently.
Cahalan decided to find out everything she could about Rosenhan’s study, talking to his associates and even attempting to track down some of the other “pseudopatients” who took part in it. Without spoiling anything, what she discovered was very interesting, and
The Great Pretender itself should have been similarly interesting. Unfortunately, this book had so many structural problems it was ultimately much more frustrating than fascinating.
Simply put, Cahalan should have made the Rosenhan study, how it was received, and her investigation into it the main plotline of the book. But she clearly did a ton of research and didn’t want any of it to go to waste, so there are many, many detours, for paragraphs, pages, or even entire chapters, into topics that are peripheral (the history of the Esalen Institute, for example) and/or can’t be discussed adequately here (overdiagnosing; replicability issues in research; imprisoning the mentally ill). Some of these details actually undermine the points she is trying to make—for example, she wants to claim that Rosenhan’s study caused the closure of psychiatric hospitals, resulting in a lack of support for the mentally ill, but a long detour into John F. Kennedy’s efforts to “help” the mentally ill shows that this was a problem well before Rosenhan came on the scene. All of this extra information not only makes the reading experience a slog; it also dulls the impact of the discoveries Cahalan herself makes. I truly wish someone had edited this book with an eye toward making it sharper and more concise; it would have made the book a more informative and memorable reading experience.
Cahalan understandably takes issue with the vague misdiagnosing that caused the “pseudopatients” to end up hospitalized, but she seems equally opposed to the much more detailed diagnostic criteria provided by DSM volumes that have appeared subsequent to the Rosenhan study. Does Cahalan offer her own solution to these problems? In a word, no—in the penultimate chapter of
The Great Pretender she rails against the psychiatry and psychology professions in a way that’s nearly incoherent, and in the final chapter she purports to offer hope for the future, but some of the “advances” she names seem like quackery and pseudoscience, and the fact that psychiatrists are making more money than ever before hardly seems like the good news she thinks it is.
The book is also sloppy with facts in a way that gave me pause. She misuses the word “metastasize,” for example, and indicates that mammograms “prevent” breast cancer (they don’t, of course). She also makes much of the fact that Rosenhan published his article in
Science rather than a more specialized journal, implying that
Science would be less rigorous in its review and that its quick turnaround times necessarily meant its peer-review process cut corners. This implication struck me as irresponsible; it seems equally likely that Rosenhan wanted to be in
Science because it was a prestigious and popular journal, and that its faster peer-review process might be a result of its large number of resources compared to other journals. I was left with the feeling that Cahalan, a former
New York Post reporter, didn’t know much about scientific publishing, and it made me wonder what else was mere speculation on her part.
Some criticisms with the presentation of the book: The Rosenhan article itself wasn’t included here; neither were the responses to the study that other researchers published. Sure, it would have cost money for the publisher to obtain these reprint rights, but it would have made the entire experience of reading
The Great Pretender much more informative. Additionally, Cahalan urges readers to educate themselves on these issues, but she doesn’t include a list of recommended reading; instead readers are expected to wade through the end notes for pertinent material. None of this adds up to a satisfactory learning experience.
As I said, this topic is fascinating to me, and it saddens me that I can’t recommend this book. In short, the whole thing should have been way more incisive. The less-pertinent info should have been edited way down; Cahalan’s unfocused screeds should have been shortened and made, well, more focused; and more resources should have been provided for the reader. It seems that
The Great Pretender is meant to be some kind of challenge to the field of psychiatry to
do better, and while that’s a worthy goal, Cahalan hasn’t done much here besides meet their fuzzy thinking with fuzzy thinking of her own.
I received this ARC via a Shelf Awareness giveaway. Thank you to the publisher.
Rating: really liked it
Have read Susannah Cahalan’s deeply personal memoir, Brain on Fire? She has followed-up that best-selling book with The Great Pretender, which exposes the suspenseful mystery behind an experiment that shaped modern medicine and mental health as we know it today.
David Rosenhan and his brave colleagues entered asylums undercover in order to come out diagnosed out the yin-yang, but better able to expose the atrocities and systemic problems in mental health treatment at the time. On top of that, Cahalan exposes the untold mystery within the mystery.
I received a complimentary copy from the publisher.
Many of my reviews can also be found on instagram: www.instagram.com/tarheelreader
Rating: really liked it
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I was so excited to read this book because I loved her first book, BRAIN ON FIRE, which was her own journalism-style memoir chronicling her experience with autoimmune encephalitis that manifested itself with symptoms similar to schizophrenia. Had she been misdiagnosed, she could have ended up with permanent brain damage-- or dead. Given that close call, it's understandable that the author might have some skepticism about psychology. A lot of people do, and like a lot of sciences, its beginnings seem backwards and barbaric. Of course, since psychology is one of the newer sciences, those beginnings are far more recent than most.
THE GREAT PRETENDER is about the Rosenhan experiment, a study in which volunteers (including the psychologist leading it) pretended to have vague symptoms and see if they would get checked in to a mental health facility. Spoiler: according to the researcher's notes, all of them did, and all of them (except for one) ended up with diagnoses of schizophrenia (the other was diagnosed as borderline, I think, or manic). Also spoiler: they found the conditions pretty horrible, too. Staff were unsympathetic and liable to treat even normal behaviors (such as journaling) as mentally ill.
Cahalan manages to get access to the psychologist's notes and even interview some of the participants in the study. Her findings, through supplementary research and some historical context, are pretty grim on both sides. Yes, clinical psychologists have, historically, done some pretty awful things in the name of medical science, whether it's treating patients like circus acts (19th century Bedlam) or doing gratuitous surgeries assembly-line style, to those who are willing and not (lobotomies). Cahalan talks about a Victorian journalist who checked herself in to a psychiatric facility and was horrified by the results. Rosenhan and his experimenters, while finding themselves in conditions nowhere near as horrifying, were still shocked at their cold and impartial (and sometimes unhygienic) treatment.
When the study came out, people immediately sought to riposte it. Psychology is an oft-villainized field and I think there was probably a concern that a distrust in the industry might dissuade people from seeking the treatment they might need. Less philanthropically, I'm sure they were also concerned for their careers and the cash money said careers brought in. As Cahalan notes, the study may not have been as truthful as it could have been, as there were some factual disputes that arose when his data was cross-referenced with interviewees and other sources.
I wanted to like this book a lot more than I did, being that I was a psychology major in school and actually contributed to active research studies. Supposedly, there's even one floating around out there with my name on it. Initially, I was very interested in the subject of the experiment, but it quickly wore thin as it was much drier than I was expecting and the whole time I was reading, I kept comparing THE GREAT PRETENDER unfavorably to the author's first book. I do think if you want to read a book that goes into depth about what psychiatric clinics are like, as well as the ethics of psychology and treatment, you might enjoy it, but those who aren't interested in psychology and have only scant interest in the topic will be disappointed, as this is hardly titillating and textbook-dry.
Thanks to the publisher for sending me a copy in exchange for an honest review!
2 to 2.5 stars
Rating: really liked it
This is the year where I have gotten to learn that so many of the social psychology experiments I’d always assumed to have been completely above board are actually anything but. The Milgram, the Stanford prison, those experiments on the effect of plate size on how much you eat, and even the great marshmallow of delayed gratification – the real story behind each of these being somewhat different from the marketing hype. And learning that has proven to be deeply disturbing, because people have made real-world choices and decisions on the marketed version of those experiments. Decisions that have had lasting consequences on many, many people’s lives.
This book is also about one of these big experiments – Here’s the short version.
Being a social psychology experiment, of course, it involves deception. That fact alone makes me uneasy with the whole field, but let’s trudge along regardless. A group of people turn up at mental institutions across the country and claim that they can hear voices. The voices aren’t particularly nasty or anything. They say a group of words that imply emptiness. This is all the potential clients claim – they don’t claim to want to have sex with their mum or anything like that, just voices saying no more than “Thud, Empty, Hollow”. They are all admitted to hospital for various (and surprisingly long) times and they all left with a diagnosis of schizophrenia or depression. The paper that came out of this experiment spoke of how easy it is to fool the ‘doctors’ working in this field of diagnosis.
But it turns out that the ‘patients’ might not have merely said they were hearing voices. They might have said that they were considering suicide. They might have had the voices saying other things. They might have actually acted much more insane than was written up in the paper following this experiment. Still, the problem remains of a little craziness having very, very large consequences.
We have all seen the films – Who Flew Over the Cuckoo’s Nest – say, and we’ve all been outraged by how impossible it is to prove you are sane once you have been marked as insane. Goffman (something of a hero of mine) discusses this in a couple of his books too – Asylum and Stigma – and he gets mentioned here too, along with Foucault’s A History of Madness. I’ve read that too. I found it a bit uncomfortable reading this and feeling my perspective change on some of these questions. I guess like many other people, I’ve often thought of mental institutions as a close approximation to hell-on-earth. Needlessly cruel, acting out unspeakable inhumanity, the sorts of places that could reasonably have a sign above the door with ‘abandon all hope all ye who enter’ written on it. Closing them down was one of the truly liberating actions of the later part of the 20th Century – good riddance, and all that…
This book has made me aware of some shades of grey. It certainly isn’t that we need to reopen such hospitals and pump people full of drugs to keep them chemically restrained. Or to lacerate their brains to pacify them, or to give them electro-convulsive therapy to see what happens. The problem is that we closed these hospitals down and then dumped people with mental illness onto the street and left them mostly to care for themselves. The one constant in this story seems to be society’s utter lack of care for these incredibly vulnerable people. We saw a terrible situation, one where those who were being badly treated were concentrated in one place, and so we dispersed them, making it easier for us to pretend we couldn’t see what was going on anymore. Or we then put them into prisons – where we could define them in ways that made us their victims, rather than the other way around.
Obviously, Rosenhan’s experiment can’t be held solely responsible for all of this – no one event or person ever really is – but the experiment was clearly a sign of the times and the sort of clear example that made arguing against it seem to be about vested interests or akin to being the moral equivalent of pure evil. What I found most interesting is that Rosenhan had his paper published in Science – a generalist publication – but the author says that it would have been very unlikely to ever have been published in a specialist journal. This is because his evidence was so thin. In fact, the author suspects that a lot of his evidence was actually made up. That he only sent a couple of people into these hospitals and mostly just made up the rest of his data. We might never know if this is the case or not, but it seems possible given some strange facts about the data.
There was also the problem with one of the people she was able to track down who had been part of the experiment. His data hadn’t been included, it seems, because he was treated really well in the hospital he went to and he felt they couldn’t have been more helpful. Needless to say, normally in science you don’t dump results that go against your hypothesis, in fact, the whole point of an experiment is to disprove your hypothesis.
And this wasn’t the only problem with the experiment. It seems that the whole ‘we only said one thing and got dumped into the snake pit’ was a bit of an exaggeration too. It seems that rather than just saying ‘I’ve been hearing voices’ – they also said that their lives were falling apart, that they had been contemplating suicide and had even been socially isolating. Rather than the experiment being about how easy it is to get into a mental hospital, as Seymour Kety is quoted, rather colourfully, as saying of the experiment: “If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood, the behavior of the staff would be quite predictable. If they labeled and treated me as having a bleeding ulcer, I doubt that I could argue convincingly that medical science does not know how to diagnose the condition.”
I really liked this book. What I liked most about it is that it is a couple of books in one. I don’t think the point is to come away from this book saying, ‘Bloody Rosenhan – made the whole damn thing up’ – but rather to see that some ideas are imminent, but that science ought to strive to be above what is in the air. I’m not entirely convinced it ever really can get beyond this, but I do think more of an effort could be expended than was clearly done here. Rosenhan is one of a largish group of scientists who have ‘known’ the truth and have been prepared to bend their data to make it conform. As the author also makes clear, many of those who knew his results were a bit smelly, still used them for their own ends.
I don’t want this to be a review that says, look at how we have been fooled by what this one man did. The point is, we wanted to be fooled. The ultimate fact is that if we want to know what we really think of the mentally ill, just look around at how we continue to treat them. Foucault says in his History of Madness that madness came into being as leprosy was being Irradicated in Europe. And we had these large hospitals and no one to put into them. That might be going too far, or it might not be. It is always hard to tell with the past. However, we are certainly overdue a new experiment to shame us again over our treatment of the mentally ill.
Rating: really liked it
Why I love it
by Maris Kreizman
Susannah Cahalan was not okay. Over the course of a month she went from being a fully functioning young reporter to suffering from psychosis and hallucinations, a step away from being diagnosed with schizoaffective disorder. In her devastating 2012 memoir,
Brain On Fire, Cahalan details how a neurological disease not only caused her body to attack her brain, but also caused her to question her own sanity.
Susannah is fully recovered now, but what would have happened to her if her diagnosis of mental illness had stuck? This is what she grapples with in
The Great Pretender, an engrossing history of the study of mental illness, centered around an experiment in which a psychiatrist and a group of other healthy people get themselves committed to mental hospitals in the early 1970s. There they experience the dehumanizing, traumatizing nature of the institutions themselves, and ultimately discover firsthand how mental illness diagnoses are biased and arbitrary at best.
How do we decide who is mentally ill? Drawing on years of archival research as well as her own personal experiences, Cahalan’s gripping account of the history of insanity is a feat of both enjoyable storytelling and skillful reporting.
Read more at: https://bookofthemonth.com/the-great-...
Rating: really liked it
Very disappointing. This book is rather poorly written and its approach is exceedingly scattered. In my opinion, the author is not really qualified by either education or experience to write about the topics discussed. The actual purpose of the work remains elusive to the reader. Cannot recommend either the purchase or taking the time to read this.
Rating: really liked it
If you’re going into this book expecting an in-depth rehashing of the Rosenhan experiment and its conclusions, you may be disappointed. I hold a BA in psychology, so I was already somewhat familiar with this study going into the book. While I did get some new information from The Great Pretender, it was not nearly as much as I’d hoped. Part of the reason for this is that the focus of the book is not super specific. The synopsis from the publisher gave me an impression of a very different book than I read.
Another reviewer (who enjoyed the book a lot less than I did) made the comment that it felt like Cahalan did a lot of research on peripheral topics for this book and didn’t want it to go to waste. Consequently, it all gets included. While I get where this person is coming from, I disagree. A lot of the history of psychology included in this leads directly into David Rosenhan’s reasoning for conducting his famous experiment. He sent healthy “pseudo-patients” into mental hospitals for two major reasons: to expose the hazy nature of psychological diagnostic criteria as they existed at the time, and to provide witnesses who would be palatable to the general public who could relay the treatment the mentally ill were receiving in these institutions. The historical backdrop did not feel superfluous.
Cahalan also delves into several other famous experiments, again in more detail than I would have expected given the blurb’s focus on Rosenahn. These major experiments are also relevant, albeit in a tangential way, because of the controversy surrounding them. The Stanford Prison Experiment (Philip Zimbardo) and Stanley Milgram’s experiment on obedience to authority. These experiments also share some thematic similarities with Rosenhan’s work; all of them explore the darker side of human nature in varying respects. Zimbardo purported to show that the overwhelming majority of people are capable of horrifically abusive behaviors towards another person in dehumanizing, institutional settings like prisons. Milgram’s experiment had an authority figure in a lab coat asking participants to administer electric shocks to people as part of an experiment on the effects of punishment on learning. The “teaching experiment” was actually a smokescreen, and the true purpose was to see how many people would agree to shock someone who was in pain, and to what degree.
All three of these experiments (Rosenhan’s, Zimbardo’s, and Milgram’s) have faced sharp criticism of their methodology, with Zimbardo facing probably the most scrutiny. Issues vary from the potentially inappropriate level of manipulation on the participants from the researcher to outright deceit.
Cahalan’s book explores a variety of issues surrounding psychiatry in a good amount of detail, some only tangentially related to the experiment referenced in the title. If your interest in this book is primarily out of a desire to understand Rosenhan’s research, you may end up feeling like you are wading through a lot of unneeded information in order to get it. However, if you have a more general interest in psychology and psychiatry, this may be an excellent book for you.
You can read all of my reviews on my blog, Jenna Bookish!
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Rating: really liked it
2.5 Stars - rambling and poor organization mitigated the impact of her research findings If sanity and insanity exist ... how shall we know them?
- David Rosenhan
These questions not only began Rosenhan's seminal study, they shaped the bulk of Cahalan's
The Great Pretender. Rosenhan was a Stanford professor of psychology and law when he published "On Being Sane in Insane Places" (OBSIP) in 1973 in
Science. He described how eight healthy adults presented themselves as having auditory hallucinations and were committed into eight different psychiatric hospitals across the US. The hospital intake psychiatrists diagnosed seven of these pseudo-patients with schizophrenia and one with manic depression. After an average stay of 19 days, these pseudo-patients were discharged with the diagnoses that their disorders were in remission and not cured. Rosenhan's conclusions that the field of psychiatry was unable to recognize sanity and the depersonalizing treatment from the hospitals inflicted severe blows on a medical discipline which has had a shaky reputation since its inception.
The author presented a loose history of the treatment of the mentally ill in order to illustrate how America has just about come full circle. For most of history, there's been a "unitary psychosis" designation - if you acted crazy, you were assumed to be crazy. In biblical times, the causes were believed to be either demonic possession or that a person "had been touched by God." In the 1800s in the US, a "crazy" person would typically be institutionalized until death at an insane asylum and though the cause was no longer attributed to demonic forces, the origin was still unknown. "Insanity" was broadly defined as the label could be thrown onto people who contravened societal norms - from suffragettes who wanted the vote to black slaves who repeatedly made escape attempts.
Cahalan focused on reform efforts in the late 1800s. In particular, she described journalist Nellie Bly's undercover work at the Women's Lunatic Asylum on New York's Blackwell Island in 1887. Blackwell Island was notorious for its filthy and overcrowded conditions. During Bly's 10 days inside, she saw a woman wearing a straight jacket as she gave birth and punishment in which the patient would be confined within a tomb-like crib. After Bly's article was published, there was an investigation, some of the worst practices were cleaned up, and the asylum's budget was increased by 60 percent.
The care and treatment of the mentally ill in America has not been something to boast about. Between 1907 and 1937, the eugenics philosophy was adopted by 32 states as they passed laws forcing the sterilization of the insane. This low point in US history inspired Nazi Germany to sterilize 300,000 psychiatric patients from 1934 to 1939 and to kill more than 200,000 mentally ill persons by 1945.
Cahalan described additional treatment trends, such as the rise of psychoanalysis in response to PTSD cases which were more prevalent than physical injuries among the returning WWII veterans. Monumental changes began in the early 1960s as federal policies created unintended consequences. President Kennedy wanted to move the mentally ill out of vast impersonal institutions and into much smaller home-like facilities. President Johnson created Medicare and Medicaid with restrictions on mental healthcare payments to continue JFK's policy. But since federal funding didn't materialize for these smaller care homes and states realized that the funding rules had changed, many states began shutting down their psychiatric hospitals without first creating alternative homes.
This was the climate in which Rosenhan's "OBSIP" was published. Public opinion of the psychiatric field diminished further and the closure rate of psychiatric hospital accelerated. This trend contributed to not only today's homelessness but to the high incarceration rate of people with diagnoses of mental health disorders.
The Great Pretender title originated with Cahalan's personal brush with insanity. She was afflicted with autoimmune encephalitis which produced symptoms exactly like those for schizophrenia. Her doctor diagnosed and treated her correctly before she would have been permanently committed to a psychiatric hospital. Her interest was piqued by Rosenhan's "OBSIP" case, especially since the pseudo-patients mimicked schizophrenia and the study had been widely influential. More than half of her book is Cahalan's research into Rosenhan and her mostly unsuccessful efforts to uncover the identities of all the pseudo-patients. It turns out that there's more than one "great pretender" in her book. (view spoiler)
[ Cahalan asserted that Rosenhan had exaggerated and falsified the "OBSIP" study. That there were not 8 participants but only 3. Of the 3, one pseudo-patient's results were suppressed because it contradicted Rosenhan's thesis. (hide spoiler)]I like psychology and I found the history of mental healthcare interesting. I recognize what Cahalan accomplished with her investigation into Rosenhan. It wasn't a small issue that she unearthed. (view spoiler)
[ But as to her belief that a truthful representation of Rosenhan's study would have led to a different outcome, I don't agree. The financial reimbursement structure had been made and that was the most significant cause of deinstitutionalization. (hide spoiler)] I agreed with her overall point that the state of mental health care is reprehensible and does not appear far advanced from Bly's days more than a century ago.
My low rating is due to the book's organization, or lack thereof, and the level of rambling was truly excessive in the last fifth of the book. It felt as though Cahalan was losing energy but still wanted to include as many of her research findings as possible. Also for a work of investigative journalism, Cahalan inserted herself into the narrative far too much and to the detriment of the book's impact.
Rating: really liked it
I love non-fiction. I love psychology. I thought I was going to love this book. I was wrong.
I hate that I found this book so very disappointing. The author states the book is about Rosenhan and his pseudopatient study which I was excited to learn more about after it was mentioned briefly during my undergrad degree. Maybe 1 1/2 chapters is about Rosenhan’s experience in a psychiatric hospital along with a few experiences mentioned by the other pseudopatients. This book is mostly a history of psychiatry which is okay, but most definitely not what the author claimed it to be about.
The writing is also hard to follow. The author starts a paragraph on one topic and then follows several rabbit trails, going on rants and in depth discussion on another semi-related matter before finally finishing the original paragraph three page later.
Unfortunately, I really can’t recommend this book to anyone and I’m sad I wasted a Book of the Month credit on it.
Rating: really liked it
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Filed Under: SCHIZOPHRENIA
Before you go into reading this book, you must first understand the true premise. It is NOT a history of psychiatry and psychiatric hospitals, though those things are discussed to fully understand what Dr. David Rosenhan was doing. But this book is almost totally about Dr. David Rosenhan and his study from the 1970s that looked to expose how psychiatry was functioning away from public knowledge.
I admit I was kind of disappointed once Nellie Bly was discussed for only a couple of paragraphs because that is the shit I showed up for. I was expecting a novel that discussed people like Bly more in-depth. I was expecting something a bit more sinister and historical. Like, give me some Geraldo Rivera at Willowbrook kind of drama.
But alas, it wasn’t meant to be.
Once I got past my assumptions, I did get into this nonfiction work, but not as much as I was hoping I would. It’s a pretty dense read, full of medical jargon, medical history (seriously, you go through the creation of all the DSM volumes) and a complete dissection and recounting of Dr. Rosenhan’s study,
On Being Sane in Insane Places.The gist is this: David Rosenhan, a psychologist and Stanford University professor, was not all in on his profession and saw psychiatry as having taken a dangerous path. He believed people were over-diagnosed, over-medicated and that the definitions of mental health issues were too broad and unreliable.
He conceived of his experiment as a way to test that reliability, checking himself into a mental ward undercover, claiming to hear voices and have other hallucinations. He wanted to see if the doctors, nurses and staff would be able to figure out he was lying. They couldn’t. He was instead diagnosed as schizophrenic and heavily medicated – like the drooling and not able to talk kind of medicated (He only ever swallowed the meds once, on accident.)
After he was discharged, Rosenhan expanded the study, bringing on seven other “pseudo-patients” to go undercover, all at different psych hospitals and wards. Rosenhan came to the conclusion that psychiatrists and psychiatric hospitals were completely unable to sort the insane patients from the sane ones.
Once someone was deemed to be “insane,” all of their actions, even if perfectly normal behaviours, were seen as crazy because everything was being viewed through the lens of being “formally diagnosed.”
The study was published by the journal Science in 1973 and effectively caused the entire psychiatric field to reevaluate, take sides and come under scrutiny.
Without giving anything away, despite this not being what I thought the majority of the book was going to be about, the story of David Rosenhan’s experiment was hella interesting and has a few shocking little twists.
Basically, it all comes down to an Oprah-style moment of YOU GET SCHIZOPHRENIA! YOU GET SCHIZOPHRENIA! EVERYONE GETS SCHIZOPHRENIA!
But like I said, this book is dense with information, and it’s not only information about Rosenhan’s study and Cahalan’s complete investigation into every aspect of it. Any time a point is raised, Cahalan takes a detour and pours out all her research into that detour topic. It’s very clear she completely immersed herself into everything having to do with psychiatry and its history and current status, and that she didn’t want to edit out any of it. She found a spot for every last quote and topic, causing the narrative to sometimes feel like Cahalan was jamming a square peg of information into the round hole of the timeline.
The Esalen Institute, JFK’s family history and his dedication to ending barbaric psychiatric practices like lobotomies; issues of replicability in research and using prisons as defacto psych wards for criminals who should really be in genuine psych wards – these are all topics that we meander onto at some point. It’s all worth the brainpower to read, I feel like I learned a lot even if I can’t say it totally stuck for recall.
My main takeaway from this is that we basically still know jackshit about mental health and how to treat it. It’s a sobering, scary and frustrating topic to delve so deeply into, but despite its scattered flow, Cahalan did a hell of a job getting me to read something through to the end that I would normally have abandoned because I hate learning things or whatever.
⭐⭐⭐⭐ | 4 stars
Rating: really liked it
When I read
Brain on Fire, Susannah Cahalan's memoir about her experience with psychosis, I became a little obsessed with it. (The Netflix adaptation was disappointing, as the clever hook in the book was her investigating her own illness from an outside perspective, something she could do as she lost most of her memory from when she was sick. The film just follows it straight. But that's a digression.)
Brain on Fire is an extremely readable memoir about a very scary and rare thing that happened to Cahalan. Especially since the extremely rare illness she was diagnosed with—anti-NMDA receptor encephalitis, an autoimmune disease that at the time had only been diagnosed in a couple hundred people, ever—is a kind of disorder that is sometimes called a "great pretender," meaning it mimics the symptoms of other diseases and is thus hard to diagnose. In this case, Cahalan's body was attacking her brain, but doctors believed she was mentally ill.
After recovering from her illness, Cahalan became obsessed with what could have been, or the people she began to call her "mirror images." One woman in particular was diagnosed with the same rare disorder after her doctor attended a lecture that Cahalan gave, but she had been suffering with the condition for years at that point, and even after treatment, would never be able to fully recover as Cahalan was able to, because she was incredibly lucky and diagnosed so early. Cahalan's is full of encounters like this now, as talking about mental illness with strangers has become a regular occurrence. When an acquaintance brought up David Rosenhan's infamous study from the 1970s, where he sent eight "pseudopatients" undercover into psychiatric hospitals to test out psychiatry's ability to tell the "sane" from the "insane," and to question the efficacy of psychiatric diagnosis, Cahalan immediately wanted to learn everything she could. Rosenhan's study became a phenomenon when it was published, crossing over into the mainstream media, and altering the practice of psychiatry in pretty significant ways.
Cahalan began digging into the story, determined to learn about Rosenhan, track the effects of the study, and maybe track down the pseudopatients themselves (they were given pseudonyms in the published paper, which was titled "On Being Sane in Insane Places"). But as she starts her digging, she gradually comes to realize there are enormous holes in the story, and Rosenhan and his study were not what they seemed. I don't want to say more than that, because it's fun to watch her chase down clues, and uncover what actually happened.
Cahalan also uses the investigation into the study to look into the history of psychiatry itself. This was one of the main things I'm ambivalent about with the book. At times it felt scattered, as other reviewers have pointed out, she follows a lot of "tangents." I keep going back and forth about whether those tangents were actually tangents at all, but instead purposeful insights into a greater picture that Cahalan was trying to present. But it was still a little messy and confused in execution; I think I would have appreciated more clarity. But I do think it was a necessity for her to not write about this study in a bubble. You need to know about a lot of it to understand the impact the study had on the field, and why it feels like such an urgent topic still today to Cahalan.
It was very unsettling throughout the book to realize just how much we still don't know about mental illness, as one psychiatrist she quotes in the book says, all we have are "signs and symptoms," and though other reviewers have accused Cahalan of an anti-psychiatry bias, I don't think that's what's going on here at all. She's certainly in favor of psychiatry practices that don't dehumanize patients, and in favor of science that advances our understanding of the brain and how it works. She's also not afraid to bring up sticky questions, like how the mental illness stigma (and cognitive bias) often leads to misdiagnosis, and how disorders that have a physical cause in the body are taken so much more seriously than the murkier conditions like bipolar or schizophrenia, or even clinical depression. She definitely is advocating for an approach that eliminates the distinction between a medical diagnosis and a mental one; she argues that mental diagnoses are medical, even if we don't yet understand the causes. (Her own case is pretty damning; she says the way she was treated was markedly different after she received her medical diagnosis, as compared to how she was treated when doctors thought she might have schizoaffective disorder, or maybe she was just "partying too much.")
One of the things I found fascinating about the book was that even as Rosenhan's study exposed flaws in the system, and produced massive change (a new standardized approach to diagnosis in the
DSM-III for one thing), it also had massive consequences for the future of institutionalized psychiatry. There was already a growing anti-psychiatry movement in full swing by the time the study was published, one of the reasons it hit so big, and afterwards, many hospitals were closed, and those that are now left are massively underfunded. The need for psychiatric beds, according to Cahalan, is at minimum 95,000 heads in the USA. It is easier to get into Harvard in some cases than to get a bed and treatment when it is needed. Something I didn't know before this was that JFK's sister, Rosemary, had a developmental disorder due to oxygen deprivation at birth, and what ended up happening to her was so horrific, JFK decided to devote himself to the idea of ending barbaric practices on patients (like lobotomies) and to promote community care with government funding (a more holistic approach that focuses on humanizing patients). But because he was assassinated, the only part of his plan to be put into effect was the closing of hospitals, and the funding for different types of programs never materialized.
Despite it's scattered-ness, I'm really glad I read this, and I hope people who can make a difference in our mental health care system will also read it.
[3.5 stars, rounding up]
Rating: really liked it
The Great Pretender by Susannah Cahalan
My Rating: 2/5 stars
Let me start by saying I typically tend to enjoy an non-fiction reads. I love learning and the plot of this book was so interesting to me. I mean it claims to be the real story of eight people who went undercover as psych patients into asylums in the 1970s. It sounds so exciting and enlighting. Well the most exciting part was the summary on the back cover.
The writing style of this book is awful. It’s like a drunk aunt or a wild college professor who was telling me a story and continually forgetting the point. It’s full of wild tangents and unnecessary author bias.
Don’t get me wrong Susannah Cahalan’s story where her actual illness was diagnosed as a mental disorder. But she wrote a Memoir called Brain on Fire: My Month of Madness. Did she really need to rehash that story in this book as well?
Parts of this book were really interesting but they got lost in the rest of the book. This book could have been shorter and better organized and I think this could have been a really powerful piece. The plot is really intriguing but it falls flat.
The Bottom Line: There are so many good books in the world, don’t waste your time with this one.
I received a review copy of this book from Grand Central Publishing and Shelf Awareness in exchange for an honest review. Thank you for allowing me to review this book.
Rating: really liked it
Cahalan questions the validity of David Rosenhan’s undercover psychiatric study. I’m skeptical of this book’s purpose. It just seems like a platform to further shout her disdain for psychiatry. Perhaps this could’ve been a worthwhile article, but as a book, it lacks the sagacity of Brain on Fire.
Rating: really liked it
There is sanity in every insane person, and there is insanity in every sane,” says the inaccurate quote from the book ‘The Great Pretender: The Undercover Mission that Changed Our Understanding of Madness.’ In her second book, Susannah Cahalan, who merely escaped being locked for a long, or perhaps, for a life-long, term in a psychiatric ward after a misdiagnosis, explores the possibilities of psychiatry. If a person can be misdiagnosed with modern cutting-edge technologies, what other faults may psychiatry contain? Does the flaw lie in the general approach or in the foundations of the field? In search of answers, the author digs into the groundbreaking research called ‘On Being Sane in Insane Places,’ published in the journal ‘Science’ in 1973 by Professor David Rosenhan. The professor and seven other people conducted an experiment, infiltrating into psychiatric wards under the premise of having hearing hallucinations. Their aim was to collect scientific data about conditions and care provided for mentally ill patients. According to the study, all infiltrations were successful, and the main concern for all participants was not to go insane in the debilitating environment. But were the results really accurate to the fact? Susannah Cahalan leads a reader through chapters containing her personal breakthroughs, dead ends, and doubts to find the truth that can shake modern psychiatry to the core.
The book deserves praise in many aspects. The author’s journalistic background ensures vivid descriptions, rich language, and accurately stressed paragraphs. Tactful curiosity and kindness, brought in by the author’s experience in a hospital, do not allow sensationalism to break into the narrative. All findings are backed up by a broad range of data and facts. The author uses archives, interviews with friends/family/colleagues, and David Rosenhan’s unpublished book to source the material.
The only minus, understandable and irrelevant compared to its massive-scale advantages, is the book’s focus on Cahalan's birth country, America. Though the author traces the origins of the field across different countries, she goes deeper into current psychiatry’s flaws and accomplishments on American soil in the last chapter. Her goal is to revolutionize the existing American healthcare system that unfairly divides and treats 'physical' and mental illnesses.
