The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness

by Susannah Cahalan

Overview

Shortlisted for the 2020 Royal Society Insight Investment Science Book Prize

Named a Best Book of 2020 by The Guardian * The Telegraph

"One of America's most courageous young journalists" and the author of the #1 New York Times bestselling memoir Brain on Fire investigates the shocking mystery behind the dramatic experiment that revolutionized modern medicine (NPR).

Doctors have struggled for centuries to define insanity—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, healthy, 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 in this real-life detective story, very little in this saga is exactly as it seems. What really happened behind those closed asylum doors?

Product Details

ISBN-13:	9781538715277
Publisher:	Grand Central Publishing
Publication date:	07/14/2020
Pages:	416
Sales rank:	400,525
Product dimensions:	5.20(w) x 7.90(h) x 1.20(d)

About the Author

Susannah Cahalan is the award-winning, New York Times bestselling author of Brain on Fire: My Month of Madness, a memoir about her struggle with a rare autoimmune disease of the brain. She writes for the New York Post. Her work has also been featured in the New York Times, Scientific American Magazine, Glamour, Psychology Today, and other publications. She lives in Brooklyn.

Table of Contents

Preface xv

Part 1

1 Mirror Image 3

2 Nellie Bly 12

3 The Seat of Madness 22

4 On Being Sane in Insane Places 33

5 A Riddle Wrapped in a Mystery Inside an Enigma 42

Part 2

6 The Essence of David 53

7 "Go Slowly, and Perhaps Not at All" 63

8 "I Might Not Be Unmasked" 75

9 Committed 83

10 Nine Days Inside a Madhouse 86

Part 3

11 Getting In 111

12 … And Only the Insane Knew Who Was Sane 122

13 W. Underwood 131

14 Crazy Eights 135

15 Ward 11 148

16 Soul on Ice 156

17 Rosemary Kennedy 162

Part 4

18 The Truth Seeker 173

19 "All Other Questions Follow from That" 182

20 Criterionating 192

21 The SCID 199

Part 5

22 The Footnote 213

23 "It's All in Your Mind" 230

24 Shadow Mental Health Care System 236

25 The Hammer 247

26 An Epidemic 265

27 Moons of Jupiter 279

Epilogue 295

Acknowledgments 301

Reading Group Guide 307

Notes 315

Index 375

Permissions 389

Editorial Reviews

…absorbing…It's the kind of story that has levels to it, only instead of a townhouse it's more like an Escher print. On one level: A profile of Rosenhan and his study. On another: Cahalan's own experience of researching the book. And on a third: The fraught history of psychiatry and the pursuit of scientific knowledge…The Great Pretender reads like a detective story, with Cahalan revealing tantalizing clues at opportune moments so we can experience the thrills of discovery alongside her. Her voice is warm and often charming…Without Cahalan's intrepid reporting, the truth of Rosenhan and his paper might have been lost.

The New York Times - Jennifer Szalai

09/30/2019

Journalist Cahalan (Brain on Fire) sets a new standard for investigative journalism in this fascinating investigation into a pivotal psychological study. In 1973, the mental health system was in trouble, she writes, thanks to weak diagnostic criteria and overburdened hospitals and health-care providers. Stanford psychologist David Rosenhan understood it would take a grand gesture to incite reform—such as recruiting seven sane individuals to feign auditory hallucinations. Rosenhan used their accounts of institutionalization to write the 1973 article “On Being Sane in Insane Places,” which sparked controversy and led to the widespread reform or closure of institutions and a revision of the DSM. However, his volunteers’ identities were never revealed, which to Cahalan raises the question—was he hiding anything? Driven by her own traumatizing experience as a misdiagnosed psychiatric patient, Cahalan pours through Rosenhan’s notes and lists of his known contacts, attempting to match real people to the study’s unnamed subjects, and ultimately is unable to find proof that six out of the seven fake patients really existed. She also discovers the wholesale omission of a volunteer’s account that contradicted Rosenhan’s argument. Her impeccable inquiry into the shadowy reality of Rosenhan’s study makes an urgent case that the psychological and psychiatric fields must recover the public trust that “Rosenhan helped shatter.” Agent: Larry Weissman, Larry Weissman Literary. (Nov.)

Publishers Weekly

"Cahalan is a gifted and dogged investigative reporter, and her work on this study is vital. The questions and concerns she raises about Rosenhan's research are long overdue."—Paste

From the Publisher

Narrator Christie Moreau strikes just the right balance of seriousness, empathy, and a detective’s curiosity in this fascinating investigation of the world of psychiatry. In 1973, Dr. David Rosenhan published an article in SCIENCE titled “On Being Sane in Insane Places” after eight healthy people, including Rosenhan himself, faked their way into psychiatric hospitals. Susannah Cahalan tries to find those pseudopatients. What she learns casts doubt on Rosenhan’s data and conclusions. In a thoughtful and charming narration, Moreau reveals the odd note of whimsical humor. She is also appropriately sensitive to Cahalan’s own brush with psychiatric misdiagnosis, when a rare autoimmune disease attacked her brain, presenting as schizophrenia. A.B. © AudioFile 2020, Portland, Maine

MARCH 2020 - AudioFile

★ 2019-08-03
A sharp reexamination of one of the defining moments in the field of psychiatry.

"There are not, as of this writing, any consistent objective measures that can render a definitive psychiatric diagnosis," writes New York Post journalist Cahalan (Brain on Fire: My Month of Madness, 2012) at the beginning of this gripping account of a study that rocked the foundational concepts of how we judge sanity. In the early 1970s, David Rosenhan, a Stanford professor of psychology, sent eight sane people into hospitals for the insane in an experiment involving diagnostics and conditions for the mentally ill. The eight participants told the intake doctors that they were experiencing aural hallucinations, and they were all admitted for varying lengths of time. The resulting article, which appeared in Science, is credited with helping to change both diagnostic and hospitalization procedures. At first, Cahalan approaches the article, "On Being Sane in Insane Places" (1973), with a level of awe and appreciation and treats readers to a tour of the miseries that patients endured—most notably, isolation and dehumanization—as well as a review of her own misdiagnosis of schizophrenia. Eventually, doubts start to creep into the author's investigation, discrepancies that a purportedly scientific article should not have contained: lying about hospitalization dates, exaggerating medical records, playing with numbers, and more. Cahalan follows all the leads like a bloodhound, in particular trying to uncover the identities of the patients. Her pursuit reads like a well-tempered mystery being picked apart, with tantalizing questions for which many of the answers are just out of reach. While "On Being Sane" may have been partially fabricated, it was also an important force in the deinstitutionalization of care for the mentally ill. Cahalan draws a vivid and critical picture of Rosenhan and the ramifications of his most prominent work.

A well-told story fraught with both mystery and real-life aftershocks that set the psychiatric community on its ear.

Kirkus Reviews