Publication
Grand Central Publishing (2019), 400 pages
Description
For centuries, doctors have struggled to define mental illness--how do you diagnose it, how do you treat it, how do you even know what it is? In search of an answer, in the 1970s a Stanford psychologist named David Rosenhan and seven other people--sane, normal, well-adjusted members of society--went undercover into asylums around America to test the legitimacy of psychiatry's labels. Forced to remain inside until they'd "proven" themselves sane, all eight emerged with alarming diagnoses and even more troubling stories of their treatment. Rosenhan's watershed study broke open the field of psychiatry, closing down institutions and changing mental health diagnosis forever. But, as Cahalan's explosive new research shows, very little in this saga is exactly as it seems. What really happened behind those closed asylum doors, and what does it mean for our understanding of mental illness today?… (more)
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Media reviews
The Great Pretender (Canongate) was also inspired by a personal story. Its author, Susannah Cahalan, was diagnosed as having schizophrenia and almost got lost in the mental health system, until a persistent doctor found a physical diagnosis for her condition and she was cured. Her subsequent
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questioning of the division between "mental" and "physical" illness led her to uncover a famous study from 1973, in which a group of mentally healthy researchers presented themselves at psychiatric hospitals, complaining they could hear voices, and were diagnosed as having serious psychiatric illnesses. The experiment rocked the world of psychiatry, but Cahalan's research suggests that all was not as it seemed. The book is a fantastic scoop, a fascinating history of psychiatry and a powerful argument for why science is often about challenging accepted wisdom. Show Less
User reviews
LibraryThing member Darcia
If sanity and insanity exist, how shall we know them?
I want to talk in depth about all aspects of this book, but this is a review and not a discussion, so I'll keep it brief. This book is thought-provoking. Read it.
Susannah Cahalan takes a look at one doctor's psychiatric study; a study that helped
The writing is engaging and conversational. The topic is compelling. When we start labeling people as "other," we need to be clear on the dividing line. This book proves we're a long way from getting it right.
I want to talk in depth about all aspects of this book, but this is a review and not a discussion, so I'll keep it brief. This book is thought-provoking. Read it.
Susannah Cahalan takes a look at one doctor's psychiatric study; a study that helped
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catapult psychiatric patients out of institutions; a study that Cahalan discovers is flawed in ways we'll never fully unravel. While seeking the facts, Cahalan uncovers just how easy it was and still is to be labeled as mentally ill. We also see the disturbing truth about research studies and the "facts" they produce. The writing is engaging and conversational. The topic is compelling. When we start labeling people as "other," we need to be clear on the dividing line. This book proves we're a long way from getting it right.
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LibraryThing member shelleyraec
“No one can improve without the bare minimum—shelter, clothing, and food—but they also need care: intelligent medical intervention, personal contact, community, and meaning.”
If you ever developed a passing interest in psychology, you have likely learned about David Rosenhan’s watershed
The eight subjects (one having been excluded from the results), including Rosenhan, told the same story -they were hearing voices- and, all but one who was labelled with manic depression, were committed with a diagnosis of schizophrenia. The eight pseudopatients were then required to stay until they were medically released. The length of hospitalization, Rosenhan reported, ranged from seven to fifty-two days, with an average stay of nineteen days.
Rosenhan’s paper appeared to be a damning indictment of the psychiatric field, not only were these pseudopatients incorrectly diagnosed they were, by and large, subject to ill-treatment while in the ‘care’ of these institutions. “On Being Sane in Insane Places” became a major factor in changes to the psychiatric discipline going forward, contributing to public distrust of the field, the widespread closure of hospitals for the mentally insane, and the 1974 update of the Diagnostic and Statistical Manual of Mental Disorders.
The author of The Great Pretender, Susannah Cahalan has herself made a major contribution to the discipline of psychiatry. At the age of 24 Susannah, a journalist, suddenly began exhibiting signs of acute mental illness, and was variously diagnosed with bipolar and schizoaffective disorders until a neurologist discovered that Susannah’s brain was under attack from a rare autoimmune disease resulting in her psychotic behaviours. Treatment of the disease resolved any sign of mental illness. Cahalan wrote about her ordeal in Brain on Fire (later adapted by Netflix as a feature film).
Cahalan’s experience of being wrongly diagnosed with a mental illness is what prompted her interest in Rosenhan’s study. Cahalan’s investigation and research appears meticulous and exhaustive but the results are disturbing. It seems likely that Rosenhan, was a ‘Great Pretender’ in that he manipulated and/or fabricated much of the data, and therefore the conclusions he presented in “On Being Sane in Insane Places”. I was convinced by Cahalan’s discoveries, and shocked by the implications of Rosenhan’s fraud.
“That’s where David Rosenhan and his paper come in. Rosenhan’s study, though only a sliver of the pie, fed into our worst instincts: For psychiatry, it bred embarrassment, which forced the embattled field to double down on certainty where none existed, misdirecting years of research, treatment, and care. For the rest of us, it gave us a narrative that sounded good, but had appalling effects on the day-to-day lives of people living with serious mental illness.”
While I remained absorbed in the story of The Great Pretender, I did think that Cahalan’s occasional sidestep into related, but not perhaps not particularly relevant, areas drew focus from the main narrative, though I did find them interesting in their own right.
I found The Great Pretender to be an accessible and compelling read. I imagine that the psychiatry field will not be pleased to learn that yet another ‘breakthrough’ thesis is probably fraudulent, and I’ll be curious to learn what, if any, effect this may have on the future of mental health care (and if Rosenhan’s study will be removed from textbooks).
“And this fraud, played out every day in our academic journals and our newspapers (or more likely our social media feeds), breeds an anti-science backlash born of distrust.”
If you ever developed a passing interest in psychology, you have likely learned about David Rosenhan’s watershed
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study published in 1973 “On Being Sane in Insane Places”. Rosenhan, a psychology (and law) professor at Stanford University, and eight other ordinary, well adjusted people faked symptoms of mental illness in order to be committed to mental asylums across America. Rosenhan was essentially looking to prove that psychiatry had no reliable way to tell the sane from the insane, and the results of the experiment appeared to confirm his theory. The eight subjects (one having been excluded from the results), including Rosenhan, told the same story -they were hearing voices- and, all but one who was labelled with manic depression, were committed with a diagnosis of schizophrenia. The eight pseudopatients were then required to stay until they were medically released. The length of hospitalization, Rosenhan reported, ranged from seven to fifty-two days, with an average stay of nineteen days.
Rosenhan’s paper appeared to be a damning indictment of the psychiatric field, not only were these pseudopatients incorrectly diagnosed they were, by and large, subject to ill-treatment while in the ‘care’ of these institutions. “On Being Sane in Insane Places” became a major factor in changes to the psychiatric discipline going forward, contributing to public distrust of the field, the widespread closure of hospitals for the mentally insane, and the 1974 update of the Diagnostic and Statistical Manual of Mental Disorders.
The author of The Great Pretender, Susannah Cahalan has herself made a major contribution to the discipline of psychiatry. At the age of 24 Susannah, a journalist, suddenly began exhibiting signs of acute mental illness, and was variously diagnosed with bipolar and schizoaffective disorders until a neurologist discovered that Susannah’s brain was under attack from a rare autoimmune disease resulting in her psychotic behaviours. Treatment of the disease resolved any sign of mental illness. Cahalan wrote about her ordeal in Brain on Fire (later adapted by Netflix as a feature film).
Cahalan’s experience of being wrongly diagnosed with a mental illness is what prompted her interest in Rosenhan’s study. Cahalan’s investigation and research appears meticulous and exhaustive but the results are disturbing. It seems likely that Rosenhan, was a ‘Great Pretender’ in that he manipulated and/or fabricated much of the data, and therefore the conclusions he presented in “On Being Sane in Insane Places”. I was convinced by Cahalan’s discoveries, and shocked by the implications of Rosenhan’s fraud.
“That’s where David Rosenhan and his paper come in. Rosenhan’s study, though only a sliver of the pie, fed into our worst instincts: For psychiatry, it bred embarrassment, which forced the embattled field to double down on certainty where none existed, misdirecting years of research, treatment, and care. For the rest of us, it gave us a narrative that sounded good, but had appalling effects on the day-to-day lives of people living with serious mental illness.”
While I remained absorbed in the story of The Great Pretender, I did think that Cahalan’s occasional sidestep into related, but not perhaps not particularly relevant, areas drew focus from the main narrative, though I did find them interesting in their own right.
I found The Great Pretender to be an accessible and compelling read. I imagine that the psychiatry field will not be pleased to learn that yet another ‘breakthrough’ thesis is probably fraudulent, and I’ll be curious to learn what, if any, effect this may have on the future of mental health care (and if Rosenhan’s study will be removed from textbooks).
“And this fraud, played out every day in our academic journals and our newspapers (or more likely our social media feeds), breeds an anti-science backlash born of distrust.”
Show Less
LibraryThing member jnmegan
Susannah Calahan is the author of the bestselling memoir Brain on Fire: My Month of Madness, in which she describes an amazing ordeal in which she was misdiagnosed with a mental illness that was actually autoimmune encephalitis that caused extreme psychotic symptoms. This experience sparked a
Thanks to the author and Grand Central Publishing for an advance copy of this book in exchange for an unbiased review.
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curiosity about psychiatric assumptions and the validity of the studies upon which they are based. The Great Pretender is the result of her obsession with a famous study conducted by David Rosenhan in the 1970s. Rosenhan and other individuals went “undercover” as pseudopatients in mental hospitals, ostensibly to test out their diagnostic systems and evaluate their treatment methodologies. The results and conclusions of this study, published in Science in 1973, had a profound impact on the practice of psychiatry and called into question many of its essential tenets. The study remains very controversial: the subjects were kept secret and their notes undisclosed; there are doubts about the tactics used to gather the data, and the conclusions drawn are regarded by many to be faulty. Calahan explains how her own attempts to clarify what Rosenhan and his other subjects experienced in the institutions only resulted in more ambiguity. It became apparent to the author that there could be some serious issues about Rosenhan’s ethics and motives. The Great Pretender also describes the development of psychiatry as a specialty that had branched off from other biologically-based medicine after Freud, only to be re-integrated recently with the advent of psychopharmacology and advances in brain research. Calahan additionally provides a re-examination of other pivotal psychological research studies and evaluates their extensive influence within a branch of medicine that has been traditionally judged as more palliative than curative. Calahan understandably approaches this subject with a good degree of skepticism about the fallibility of psychiatry and its practices given her own personal experience. As a result, this book remains very personal as she struggles with frustration in her search for underlying information about Rosenhan’s work and her questions about his integrity as a scientist. Fascinating as both an historical overview and a critique of psychological research, The Great Pretender can be viewed both an educational text and a compelling mystery as well.Thanks to the author and Grand Central Publishing for an advance copy of this book in exchange for an unbiased review.
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LibraryThing member LynnB
Susannah Cahalan was misdiagnosed with bipolar and schizoaffective disorder as a result of an autoimmune disease. I really enjoyed and learned a lot from her book, Brain on Fire.
In this book, Ms. Cahalan examines the work of Dr. Rosenhan who, in the 1970s, got himself and several pseudo-patients
In this book, Ms. Cahalan examines the work of Dr. Rosenhan who, in the 1970s, got himself and several pseudo-patients
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committed to variousl mental health facilities in the U.S. He then wrote a highly influential article, On Being Sane in Insane Places, published in Science magazine. Ms. Cahalan sets out to learn more about his work and attempts to find the pseudo-patients. Her book also looks into historic treatment for mental illness and examines what it means to be "insane" or "sane". Solid research, well written, and again, I learned a lot from her writing. Show Less
LibraryThing member MarianneAudio
About the classic experiment when a professor arranged for volunteers to go undercover in psych hospitals.
LibraryThing member KimMeyer
3.5 stars. The core of this book is about Cahalan's investigation into a study, and that part is very interesting. She also takes many, many detours into many subjects peripherally related to psychiatry and mental health with a lot of research, and I think you might need to be deeply interested in
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this subject in order to not find this part to be a slog. I am, so for me this was a solid pick. Show Less
LibraryThing member Romonko
This was a DNF for me. I got about 1/4 of the way though and realized that it wasn't for me. I think that Ms. Cahalan did a great job of depicting the morass that psychology is today, and I appreciate her sharing her experiences with her readers, but, for me, this book was a non-starter. I didn't
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get engaged. Show Less
LibraryThing member AliceaP
I just finished The Great Pretender by Susannah Cahalan and IT WAS SO GOOD. I don't know why I am surprised by how much I truly enjoy reading an excellent nonfiction book but it's always such a delight especially when they're as engrossing as this one. You might recognize Susannah Cahalan as the
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author of Brain On Fire about her experiences being misdiagnosed with psychosis (for a MONTH) before a doctor determined it was actually autoimmune encephalitis. From that experience, Cahalan became a kind of spokesperson for this disease as well as an advocate for a more nuanced and structured diagnostic process. She learns about a well-known study conducted in the early 70s by David Rosenhan which explored the (pseudo)science of psychiatric diagnosis and the environment of psychiatric hospitals. And thus her passion was truly ignited as she worked to track down as much information about this study as possible. The explosive (and controversial) results of this landmark study had a profound effect on the field of psychiatry and how we view and treat mental illness in the United States. Cahalan gives a comprehensive overview of psychiatry and her journey to uncover the identities of those that participated in the original study. The end result was this book which I frankly keep raving about to anyone who will stop long enough to listen to me. Go forth, dear reader! 10/10 Show Less
LibraryThing member IonaS
The author of this book was previously ""violent, paranoid and delusional" but her problems turned out to be caused by autoimmune encephalitis. She was cured and became interested in psychiatry.
Psychiatrist David Rosenhan presented the thesis that psychiatry had no reliable way of distinguishing
The study tested whether or not the institutions admitted these sane individuals.
All these "pseudopatients" were diagnosed with serious mental illnesses, in all cases but one, with schizophrenia; in the remaining case the diagnosis being manic depression.
The length of hospitalization ranged from seven to fifty-two days with an average of nineteen days.
Once inside the institution it was up to themselves to get out.
We get the stories of the various pseudopatients including Rosenhan's, though as far as I recall, Rosenhan didn't quite follow the rules in some way.
There's a chapter entitled "Only the insane knew who was sane", which was accurate - interesting!
There was a disturbing chapter about John Kennedy's sister Rosemary, though it was not really relevant to the subject on hand.
The book is well-written and I found the first half absorbing, but towards the end it became a bit complicated and I couldn't keep on with it.
Psychiatrist David Rosenhan presented the thesis that psychiatry had no reliable way of distinguishing
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the sane from the insane. Eight people, Rosenhan himself and seven others, volunteered to go undercover in twelve institutions (how could they do that?) on the East and West Coasts of the USA and present with the same limited symptoms. They would tell the doctors that they heard voices that said "thud, empty, hollow".The study tested whether or not the institutions admitted these sane individuals.
All these "pseudopatients" were diagnosed with serious mental illnesses, in all cases but one, with schizophrenia; in the remaining case the diagnosis being manic depression.
The length of hospitalization ranged from seven to fifty-two days with an average of nineteen days.
Once inside the institution it was up to themselves to get out.
We get the stories of the various pseudopatients including Rosenhan's, though as far as I recall, Rosenhan didn't quite follow the rules in some way.
There's a chapter entitled "Only the insane knew who was sane", which was accurate - interesting!
There was a disturbing chapter about John Kennedy's sister Rosemary, though it was not really relevant to the subject on hand.
The book is well-written and I found the first half absorbing, but towards the end it became a bit complicated and I couldn't keep on with it.
Show Less
LibraryThing member arosoff
In the early 1970s, David Rosenhan, a psychology professor at Stanford, published an article in Science about being able to fake being mentally ill and get admitted to mental hospitals. The article was enormously influential--I learned about it in psychology classes decades later. But Rosenhan
It turns out that the story of that study is a lot more complicated than Rosenhan ever let on, and Cahalan does an interesting job of trying to track down all the paths--some with more success than others. I won't go into more details here because it was fun seeing it unspool, and I don't want to spoil it.
In between is sandwiched some background on mental hospitals, and the long term impact of Rosenhan's work--which came at the same time that the antipsychiatry movement was ascendant and contributed to major changes in both mental hospitals and the process of psychiatric diagnosis. This is interesting, but since it's been extensively covered elsewhere, is less compelling than the original research. It gets a little bit messy and overly general, but is nonetheless interesting.
Cahalan is a journalist, not a psychologist, which is an asset when it comes to approaching Rosenhan's work as a kind of detective story. It's well told and engaging and her experience as a layperson makes her well suited to translating the details. The sections on the development of diagnosis and the DSM are a bit less gripping--there are many interesting philosophical questions raised by the process of diagnosis, but it's not the time to get into it. To her credit she doesn't try to delve too deeply; she's trying to strike a balance between providing enough context to understand Rosenhan's work and getting too far into another topic. Overall she does a good job with it; a little bit of editing might have smoothed it out, but I can't argue too much.
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never built on his work. It turns out that the story of that study is a lot more complicated than Rosenhan ever let on, and Cahalan does an interesting job of trying to track down all the paths--some with more success than others. I won't go into more details here because it was fun seeing it unspool, and I don't want to spoil it.
In between is sandwiched some background on mental hospitals, and the long term impact of Rosenhan's work--which came at the same time that the antipsychiatry movement was ascendant and contributed to major changes in both mental hospitals and the process of psychiatric diagnosis. This is interesting, but since it's been extensively covered elsewhere, is less compelling than the original research. It gets a little bit messy and overly general, but is nonetheless interesting.
Cahalan is a journalist, not a psychologist, which is an asset when it comes to approaching Rosenhan's work as a kind of detective story. It's well told and engaging and her experience as a layperson makes her well suited to translating the details. The sections on the development of diagnosis and the DSM are a bit less gripping--there are many interesting philosophical questions raised by the process of diagnosis, but it's not the time to get into it. To her credit she doesn't try to delve too deeply; she's trying to strike a balance between providing enough context to understand Rosenhan's work and getting too far into another topic. Overall she does a good job with it; a little bit of editing might have smoothed it out, but I can't argue too much.
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LibraryThing member asukamaxwell
I sped through it because I really couldn't put it down. The only reason I couldn't give it 5 stars is because it felt like the story wasn't quite finished. I want to save that final star for when that happens. It's not the author's fault of course, there's still so much mystery behind this
This book also includes a host of anecdotes in the history of psychology. I knew of course of Nellie Bly and read of Rosemary Kennedy in 2019, but was introduced this time to Lady Rosina, Elizabeth Packard, the Goldwater Rule, changes in the DSM and those involved, and even Rosenhan's connection to Soteria House! Furthermore, Cahalan thoroughly explains why, after the Medicare and Medicaid bill passed in 1965, asylums and mental institutions shut down left and right. Without beds, the mentally ill were thrown into hospitals, and when hospitals ran out of room, they ended up in prisons. A shameful practice that continues today and how David Rosenhan's experiment played a role in all of it.
"When the promises of community care - first championed by JFK - never materialized, thousands of people were turned out from hospitals and had nowhere to go...There are at last count in 2014, nearly 10 times more seriously mentally ill people behind bars than in psychiatric hospitals."
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impactful (and embellished?) experiment and David Rosenhan himself. But you'll have to read the book to know what I mean!This book also includes a host of anecdotes in the history of psychology. I knew of course of Nellie Bly and read of Rosemary Kennedy in 2019, but was introduced this time to Lady Rosina, Elizabeth Packard, the Goldwater Rule, changes in the DSM and those involved, and even Rosenhan's connection to Soteria House! Furthermore, Cahalan thoroughly explains why, after the Medicare and Medicaid bill passed in 1965, asylums and mental institutions shut down left and right. Without beds, the mentally ill were thrown into hospitals, and when hospitals ran out of room, they ended up in prisons. A shameful practice that continues today and how David Rosenhan's experiment played a role in all of it.
"When the promises of community care - first championed by JFK - never materialized, thousands of people were turned out from hospitals and had nowhere to go...There are at last count in 2014, nearly 10 times more seriously mentally ill people behind bars than in psychiatric hospitals."
Show Less
ISBN
1538715287 / 9781538715284