The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness Hardcover – November 5, 2019

“‘Insanity haunts the human imagination. It fascinates and frightens all at once. Few are immune to its terrors,’ wrote sociologist Andrew Scull in his book Madness in Civilization. ‘It challenges our sense of the very limits of what it is to be human.’ It’s undeniable: There is something profoundly upsetting about a person who does not share our reality, even though science shows us that the mental maps we each create of our own worlds are wholly unique. Our brains interpret our surroundings in highly specific ways—your blue may not be my blue. Yet what we fear is the unpredictability of a mentally ill “other.” This fear emerges from the sneaking realization that, no matter how sane, healthy, or normal we may believe we are, our reality could be distorted, too.”In the 1970’s a Stanford psychologist, David Rosenhan, set out to show that anyone could get themselves admitted to an asylum by changing just a few of their answers on an evaluation, and to show how they were treated once admitted even if they acted completely “normal”. The results of his study had a broad impact on the world of psychiatry. But as the author looked deeper into his study, she found that not all may have been as it was presented.This book brings to light questions we should all be asking ourselves about psychiatry. About how patients are diagnosed and treated, and how we should all keep looking for solutions and answers rather than allowing the ones seeming to need treatment to disappear or remain on the outsides of society as other. I really would recommend this book to anyone. It was informative and interesting. It asks the tough questions. I give it 4.5 stars.

The author, Susannah Cahalan, spent five years trying to uncover the truth of psychologist David Rosenhan’s famous research paper. When she sticks to that story, which is only about half of the book, the book is riveting. The other half of the book discusses a wide range of topics that were a bit tangential and could have been handled differently.Cahalan had access to Rosenhan’s unpublished manuscript of a book, and his detailed notes of his own stay as a fake patient on a psychiatric ward in 1969. She tracked down two other fake patients. She uncovered numerous things that Rosenhan fabricated and lies he told. Much of Rosenhan’s famous paper could be neither supported nor discounted because many of the key players have passed away after more than 40 years, but Cahalan makes an interesting case that Rosenhan may have fabricated even more than what she was able to document.She uncovered the fascinating side story about psychiatrist Robert Spitzer, who was perhaps Rosenhan’s fiercest critic. Spitzer obtained a copy of Rosenhan’s hospital record and may have used it to his own advantage towards the development of the revolutionary Diagnostic and Statistical Manual, Third Edition (DSM-III).Weaknesses of the book include how Rosenhan described his experiences and the experiences of other fake patients as almost entirely negative because they felt bored, neglected, and dehumanized. He never seemed to be able to view it from the experiences of real patients who were helped by being hospitalized. The inability to view life from the perspectives of others, and Rosenhan’s know-it-all dismissiveness of other viewpoints, sounds like a narcissist. The author never seemed to question Rosenhan’s one-sided negative view of hospitals. This appears to view real patients as passively allowing themselves to be mistreated. The sections on her own medical illness that was mistaken briefly as a psychiatric illness, the history of insane asylums, and other history about psychiatry placed a focus on the history of psychiatry instead of on Rosenhan’s lies, which made the book feel like two different books. These topics might have been discussed more dispassionately in the context of how easy it is for nefarious things to happen when dealing with the human mind.Cahalan’s disparagement of the DSM is worthy of note. Her criticism of the DSM is naïve for repeating many of the criticisms about how it artificially creates categories, creates too many disorders, and how psychiatrists supposedly blindly embraced the DSM as a bible. Much could be said in response but I think the best response is that despite a lot of smart people criticizing the DSM for years, no one has proposed a better classification system. The DSM was never meant to provide a perfectly unassailable view of the human mind. Criticizing the DSM for not doing everything perfectly seems like criticizing a car because it can’t fly.If Cahalan had stuck to the facts of the Rosenhan story, I may have rated it five stars, but it felt like she could not remove her personal beliefs from the narrative. Cahalan writes well, and she did a good job of investigating and finding perhaps everything that was possible to find after more than 40 years. She found quite a lot. However, even though Rosenhan lied about the most central aspects of his study, the author still seems to find some validity in Rosenhan’s central premise that the doctors in his study were the ones who got it wrong. On her Today Show interview (Nov. 5, 2019), she said, “I still think there is a lot of validity in it (Rosenhan’s study) even though there are problems. He actually identified a lot of true things.” Like what?

Ostensibly a book about the author's search for the story behind psychologist David Rosenhan's study of "pseudopatients" easily gaining admission into mental hospitals (which she discovers may have been a hoax), it's more about the history of psychiatry generally and its record of cruel treatments and repeated failures over the years in dealing with serious psychosis. The writing often reminds me of travel shows that follow the host more than the subject matter per se (realistically, I just want the information that the author or host or guide discovered, not the story of the adventure in obtaining that information) but the information developed here is pretty good. Cahalan does not come across as either rabidly anti-psychiatry or as an apologist for the field - she's got eyes wide open at all times and is evenhanded in her treatment of the subject - but she has good analyses of why the field is so fraught with failures and how efforts to fix psychiatry, even when well-intentioned (such as deinstitutionalization, or to come up with better and more nuanced diagnostic tools) have only resulted in their own failures. A good book about the field for the layman to read, even if the "quest" model for writing the story seems out of place to me.

Como psiquiatra e gestor de saúde mental, esse livro me fez repensar toda minha prática e as bases eóricas e históricas em que embasam nossa disciplina. Ótimo e obrigatório!

David Rosenhan was a psychologist at Stanford University. In 1970 he led an experiment in which eight normal people faked symptoms to secure admission to psychiatric hospital. He concluded that psychiatry could not distinguish sanity and insanity. The results were published in the elite journal Science, then picked up by the media. It was embraced by critics of the mental health system. It is referenced in textbooks today.But was it really what it claimed?Susannah Cahalan has produced an investigation that I can only describe as riveting. She tracked down everyone who knew Rosenhan, everything he wrote. She spoke to family, friends and colleagues. In particular she set her sights on the eight subjects, anonymous in the paper. Were they still alive? Could she locate them? Could she ask for their memory of their experience?The author claimed an interest for her curiosity. She had herself been misdiagnosed with schizophrenia and has written about this. She is not a psychiatrist but is respected in the medical community, frequently lecturing to professional audiences.She addresses the wider questions raised by Rosenhan’s paper. Can we really not tell sanity from insanity? Is there a such a thing as mental illness? Her answer to the second is unequivocal – mental illness is a reality. Closing down hospitals did not solve the problem. Psychiatry has generally failed to offer a solution at least not in the way we manage cancer or heart failure. It has had some success though and we must continue to hope for advances. Her optimism somewhat tempered she concludes the book with “I believe”.It is a great book with a couple of caveats. She puts a lot of her own experience into the account, which we could understand. Her style of writing is a bit free at times – “throw a rock into a crowd in the 1800s and there’s a good chance you’d hit someone who’d spent time in an asylum”.Set against this is the reach of her investigation – determined and detailed. Her background in news helped her to get people to talk about things both personal and painful. How upfront has she been though? It becomes clear that among leading psychiatrists Rosenhan did not command respect. There were doubts about his research, serious questions were raised. By and large these were not publicised. By 2015 most of those who led the field in 1970 had either died [Rosenhan deceased in 2012] or long retired. Was now the time? Did someone drop a hint to the author?

This is a well written and very interesting book, but on several pages it looked like the ink had been smudged when it was printed.

Only missing a star because damaged on arrival!

The subject of this book was extremely interesting to me however I wish I had paid more attention to who the author was before I purchased it. Just like Brain on Fire, this book was a chore to read. The author speaks more about herself and her findings than the actual study itself. Overall feels like it was mislabeled and I was tricked into reading something that wasn’t what was advertised. I did finish the book, but I had to force myself to do so.