The Great Pretender (edition 2020)

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 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." ( )

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 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. ( )

An extremely detailed examination of the evolution of the profession of psychiatry, especially the ways in which we recognize and diagnose insanity. The author was once herself diagnosed as psychotic, a misreading of her symptoms that was eventually corrected, allowing her to seek treatment and eventually recover. This event shook up her life and put her on a path to better understand those diseases that are known as the "great pretenders" because they mimic psychotic symptoms.

Her journey into this research eventually led her to a controversial figure, David Rosenhan, a Stanford psychologist who became famous for running an experiment where perfectly sane individuals set out to have themselves committed to asylums. The results of this famous study would have untold impacts on the field of psychiatry and the asylum system. Fascinated by the concept, the author of this book would begin pursuing these "pseudo patients" who spent time undercover in state facilities. What she began to realize, however, was that most of these people could not be found, and the ones that could often had stories that differed from Rosehan's.

How much of this study was actually true and accurate? And is this type of fraud common? This author's investigation is unnerving in its ability to throw into question so much about what we have taken for granted. A delicious deep-dive into research methods, madness, and the human mind. ( )

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 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. ( )

this is absolutely fascinating, and cahalan writes this in an engaging and compelling way. i was riveted, almost from the first paragraph, and there is nary a lull in the entire book. both the story of david rosenhan's study where "pseudo-patients" went undercover into psych wards, and the revealing of that study as possibly fraudulent, were so interesting and well described. i was so engrossed the entire time.

"There are, at last count in 2014, nearly 10 times more seriously mentally ill people who live behind bars than in psychiatric hospitals. The largest concentration of the seriously mentally ill resides in Los Angeles County, New York's Riker's Island, and Chicago's Cook County, jails that are in many ways now defacto asylums."

"'The big fat manual that is the DSM should be condensed to not more than 10 diagnoses,' Dr. van Os told me. Umbrella terms, like psychosis syndrome and anxiety syndrome, with gradients of symptoms, he argues." ( )