What if you entered a psychiatric hospital under false pretenses? What if the symptoms you presented—a voice that said the words thud, empty and hollow—were false? You’ve seen how easy it is to be diagnosed with a mental illness. From inside, you’ll be able to observe how medical staff interacts with patients. Once you convince the hospital to release you, you’ll share your findings with the professor who arranged the study.
But even then, what if it wasn’t all as it seemed?
Susannah Cahalan, the bestselling author of Brain on Fire, was enchanted by the work of psychologist and Stanford University professor David Rosenhan, who created just such an experiment. Cahalan could relate to the pseudo-patients in his study. As she recounts in her first book, Cahalan was misdiagnosed with schizoaffective disorder, a psychiatric illness, before doctors eventually identified that she was suffering from autoimmune encephalitis, an illness with a known physical cause. Such diseases are called “the great pretenders.”
In the people who participated in Rosenhan’s study, Cahalan found another collection of pretenders and a window into psychiatric treatment. A psychologist introduced her to “On Being Sane in Insane Places,” Rosenhan’s account of the pseudo-patient study, which became widely known after its January 1973 publication in the journal Science. (Half of all intro-to-psychology textbooks referenced it by 1976.) In her growing fascination, she studied how Rosenhan’s work affected modern psychiatry, including hospitals that were shut down as a result of the study and revisions that were made to the Diagnostic and Statistical Manual of Mental Disorders.
But the deeper she dug, the more questions Cahalan had. The pseudo-patients were difficult to identify, even with access to the professor’s notes. In some cases, details didn’t match, and Cahalan questioned the study’s veracity.
The Great Pretender is an account of Cahalan’s own research. In addition to Rosenhan’s study, she weaves in glimpses of other similar experiments, such as Nellie Bly’s well-documented experience as a journalist going undercover in a psychiatric hospital. The book is a detailed examination of psychiatry in the decades since the publication of Rosenhan’s groundbreaking, if elusive, study.
