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

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

From "one of America's most courageous young journalists" (NPR) comes a propulsive narrative history investigating the 50-year-old mystery behind a dramatic experiment that changed the course of modern medicine. 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...

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Title:The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness
Author:Susannah Cahalan
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Edition Language:English

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

  • Janelle | She Reads with Cats

    Fascinating! Review to come.

  • Annie

    , by Susannah Cahalan, is one of the most extraordinary, best written works of nonfiction I think I’ve ever read. I have so much to say about it that I’m honestly not sure where to begin! This book takes on our existential fear of mental illness, our cultural dread of asylums, and the possibly unsolvable problem of where mental illnesses come from and how to cure them. Cahalan uses all her skills as a journalist to dig deep into a contentious scholarly and societal argument

    , by Susannah Cahalan, is one of the most extraordinary, best written works of nonfiction I think I’ve ever read. I have so much to say about it that I’m honestly not sure where to begin! This book takes on our existential fear of mental illness, our cultural dread of asylums, and the possibly unsolvable problem of where mental illnesses come from and how to cure them. Cahalan uses all her skills as a journalist to dig deep into a contentious scholarly and societal argument about the the legendary Rosenhan Experiment...

  • Susannah

    A writer friend always rates her own books. She explained that if she doesn’t love her own book enough to give it five stars, how can she expect anyone else to do the same? I like this mentality so here I go!

  • Sharon

    I found this a very interesting read, this study led to some major shifts in how mental illness was thought about, diagnosed and treated and so it’s important that the study be real and accurate. This is a well written and well put together account of what happened. If you are interested in psychiatry, then I would encourage you to take the time to read this book.

  • Judy Lesley

    Susannah Cahalan and her family didn't want to accept her diagnosis of schizoaffective disorder even though her symptoms easily fit. Instead they continued to search for what was happening to her, what was causing the symptoms she was living with. Finally she was diagnosed with the medical condition of autoimmune encephalitis, received treatment and recovered. Coming that close to such a huge misdiagnosis caused her to wonder how doctors in the field of psychiatry could tell which patient was

    Susannah Cahalan and her family didn't want to accept her diagnosis of schizoaffective disorder even though her symptoms easily fit. Instead they continued to search for what was happening to her, what was causing the symptoms she was living with. Finally she was diagnosed with the medical condition of autoimmune encephalitis, received treatment and recovered. Coming that close to such a huge misdiagnosis caused her to wonder how doctors in the field of psychiatry could tell which patient was sane and which insane. Friends suggested she might be interested in reading an article published in the journal Science in 1973 titled "On Being Sane in Insane Places" by Stanford University professor David Rosenhan. Reading the article ignited her desire to find out who the "pseudopatients" were that participated in Rosenhan's project, to know how they got themselves admitted to twelve hospitals and, just as interesting, how they managed to convince staff that they were cured or sane enough to be released. Commitments ranged from 7 to 52 days with seven participants plus Rosenhan himself.

    The first portions of this book were not terribly interesting to me but the writing is very well done and the whole question of how to reliably tell sanity from insanity was what had initially triggered my interest so I decided to read on. Once Cahalan began to research who the pseudopatients were and which hospitals they chose the story began to change completely for me and I became thoroughly involved. The research into the questions surrounding Rosenhan's article soon became can't-stop-reading for me, a real life mystery spotlighting not just his article, but the man himself. The answers Cahalan found were unexpected, especially when considering the world wide changes the article had on the field of psychiatry. One man made such a difference to an entire branch of medicine. Find out here how he did it and what the consequences have been.

    I received a review copy of this book.

  • Jennifer ~ TarHeelReader

    Have read Susannah Cahalan’s deeply personal memoir, Brain on Fire? She has followed-up that best-selling book with The Great Pretender, which exposes the suspenseful mystery behind an experiment that shaped modern medicine and mental health as we know it today.

    David Rosenhan and his brave colleagues entered asylums undercover in order to come out diagnosed out the yin-yang, but better able to expose the atrocities and systemic problems in mental health treatment at the time. On top of that,

    Have read Susannah Cahalan’s deeply personal memoir, Brain on Fire? She has followed-up that best-selling book with The Great Pretender, which exposes the suspenseful mystery behind an experiment that shaped modern medicine and mental health as we know it today.

    David Rosenhan and his brave colleagues entered asylums undercover in order to come out diagnosed out the yin-yang, but better able to expose the atrocities and systemic problems in mental health treatment at the time. On top of that, Cahalan exposes the untold mystery within the mystery.

    I received a complimentary copy from the publisher.

    Many of my reviews can also be found on instagram:

  • Julie Ehlers

    Back in the early 1970s, Dr. David Rosenhan published the results of a study wherein he and several other people (so-called “pseudopatients”), none of whom had ever had mental health issues, attempted to get admitted to psychiatric hospitals by showing up and claiming they heard a voice in their head saying “empty,” “hollow,” and “thud.” All of them got admitted on this basis, most of them receiving a preliminary diagnosis of schizophrenia. Once admitted, they behaved like their normal selves,

    Back in the early 1970s, Dr. David Rosenhan published the results of a study wherein he and several other people (so-called “pseudopatients”), none of whom had ever had mental health issues, attempted to get admitted to psychiatric hospitals by showing up and claiming they heard a voice in their head saying “empty,” “hollow,” and “thud.” All of them got admitted on this basis, most of them receiving a preliminary diagnosis of schizophrenia. Once admitted, they behaved like their normal selves, but no one seemed to notice they were actually not mentally ill. The resulting article,

    purported to show that (1) diagnosis of mental health issues was unreliable at best; and (2) patients in psychiatric hospitals were in fact not treated in ways that might actually be therapeutic.

    When Susannah Cahalan heard about this study a few years ago, she was fascinated. Girl, me too. Rosenhan’s study put me in mind of Nellie Bly’s groundbreaking undercover investigation of an asylum, which she published in the 1880s as

    and which I was obsessed with as a kid. Bly’s investigation is detailed in

    , but Cahalan’s own interest was based on something more personal: Her

    of having her brain inflammation misdiagnosed as mental illness. If a determined doctor hadn’t discovered what was actually ailing her, her life may have turned out very differently.

    Cahalan decided to find out everything she could about Rosenhan’s study, talking to his associates and even attempting to track down some of the other “pseudopatients” who took part in it. Without spoiling anything, what she discovered was very interesting, and

    itself should have been similarly interesting. Unfortunately, this book had so many structural problems it was ultimately much more frustrating than fascinating.

    Simply put, Cahalan should have made the Rosenhan study, how it was received, and her investigation into it the main plotline of the book. But she clearly did a ton of research and didn’t want any of it to go to waste, so there are many, many detours, for paragraphs, pages, or even entire chapters, into topics that are peripheral (the history of the Esalen Institute, for example) and/or can’t be discussed adequately here (overdiagnosing; replicability issues in research; imprisoning the mentally ill). Some of these details actually undermine the points she is trying to make—for example, she wants to claim that Rosenhan’s study caused the closure of psychiatric hospitals, resulting in a lack of support for the mentally ill, but a long detour into John F. Kennedy’s efforts to “help” the mentally ill shows that this was a problem well before Rosenhan came on the scene. All of this extra information not only makes the reading experience a slog; it also dulls the impact of the discoveries Cahalan herself makes. I truly wish someone had edited this book with an eye toward making it sharper and more concise; it would have made the book a more informative and memorable reading experience.

    Cahalan understandably takes issue with the vague misdiagnosing that caused the “pseudopatients” to end up hospitalized, but she seems equally opposed to the much more detailed diagnostic criteria provided by DSM volumes that have appeared subsequent to the Rosenhan study. Does Cahalan offer her own solution to these problems? In a word, no—in the penultimate chapter of

    she rails against the psychiatry and psychology professions in a way that’s nearly incoherent, and in the final chapter she purports to offer hope for the future, but some of the “advances” she names seem like quackery and pseudoscience, and the fact that psychiatrists are making more money than ever before hardly seems like the good news she thinks it is.

    The book is also sloppy with facts in a way that gave me pause. She misuses the word “metastasize,” for example, and indicates that mammograms “prevent” breast cancer (they don’t, of course). She also makes much of the fact that Rosenhan published his article in

    rather than a more specialized journal, implying that

    would be less rigorous in its review and that its quick turnaround times necessarily meant its peer-review process cut corners. This implication struck me as irresponsible; it seems equally likely that Rosenhan wanted to be in

    because it was a prestigious and popular journal, and that its faster peer-review process might be a result of its large number of resources compared to other journals. I was left with the feeling that Cahalan, a former

    reporter, didn’t know much about scientific publishing, and it made me wonder what else was mere speculation on her part.

    Some criticisms with the presentation of the book: The Rosenhan article itself wasn’t included here; neither were the responses to the study that other researchers published. Sure, it would have cost money for the publisher to obtain these reprint rights, but it would have made the entire experience of reading

    much more informative. Additionally, Cahalan urges readers to educate themselves on these issues, but she doesn’t include a list of recommended reading; instead readers are expected to wade through the end notes for pertinent material. None of this adds up to a satisfactory learning experience.

    As I said, this topic is fascinating to me, and it saddens me that I can’t recommend this book. In short, the whole thing should have been way more incisive. The less-pertinent info should have been edited way down; Cahalan’s unfocused screeds should have been shortened and made, well, more focused; and more resources should have been provided for the reader. It seems that

    is meant to be some kind of challenge to the field of psychiatry to

    , and while that’s a worthy goal, Cahalan hasn’t done much here besides meet their fuzzy thinking with fuzzy thinking of her own.

    I received this ARC via a Shelf Awareness giveaway. Thank you to the publisher.

  • Nenia ⚡ Aspiring Evil Overlord ⚡ Campbell

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    I was so excited to read this book because I loved her first book, BRAIN ON FIRE, which was her own journalism-style memoir chronicling her experience with autoimmune encephalitis that manifested itself with symptoms similar to schizophrenia. Had she been misdiagnosed, she could have ended up with permanent brain damage-- or dead. Given that close call, it's understandable that the author might have some skepticism about psychology. A lot

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    I was so excited to read this book because I loved her first book, BRAIN ON FIRE, which was her own journalism-style memoir chronicling her experience with autoimmune encephalitis that manifested itself with symptoms similar to schizophrenia. Had she been misdiagnosed, she could have ended up with permanent brain damage-- or dead. Given that close call, it's understandable that the author might have some skepticism about psychology. A lot of people do, and like a lot of sciences, its beginnings seem backwards and barbaric. Of course, since psychology is one of the newer sciences, those beginnings are far more recent than most.

    THE GREAT PRETENDER is about the

    , a study in which volunteers (including the psychologist leading it) pretended to have vague symptoms and see if they would get checked in to a mental health facility. Spoiler: according to the researcher's notes, all of them did, and all of them (except for one) ended up with diagnoses of schizophrenia (the other was diagnosed as borderline, I think, or manic). Also spoiler: they found the conditions pretty horrible, too. Staff were unsympathetic and liable to treat even normal behaviors (such as journaling) as mentally ill.

    Cahalan manages to get access to the psychologist's notes and even interview some of the participants in the study. Her findings, through supplementary research and some historical context, are pretty grim on both sides. Yes, clinical psychologists have, historically, done some pretty awful things in the name of medical science, whether it's treating patients like circus acts (19th century Bedlam) or doing gratuitous surgeries assembly-line style, to those who are willing and not (lobotomies). Cahalan talks about a Victorian journalist who checked herself in to a psychiatric facility and was horrified by the results. Rosenhan and his experimenters, while finding themselves in conditions nowhere near as horrifying, were still shocked at their cold and impartial (and sometimes unhygienic) treatment.

    When the study came out, people immediately sought to riposte it. Psychology is an oft-villainized field and I think there was probably a concern that a distrust in the industry might dissuade people from seeking the treatment they might need. Less philanthropically, I'm sure they were also concerned for their careers and the cash money said careers brought in. As Cahalan notes, the study may not have been as truthful as it could have been, as there were some factual disputes that arose when his data was cross-referenced with interviewees and other sources.

    I wanted to like this book a lot more than I did, being that I was a psychology major in school and actually contributed to active research studies. Supposedly, there's even one floating around out there with my name on it. Initially, I was very interested in the subject of the experiment, but it quickly wore thin as it was much drier than I was expecting and the whole time I was reading, I kept comparing THE GREAT PRETENDER unfavorably to the author's first book. I do think if you want to read a book that goes into depth about what psychiatric clinics are like, as well as the ethics of psychology and treatment, you might enjoy it, but those who aren't interested in psychology and have only scant interest in the topic will be disappointed, as this is hardly titillating and textbook-dry.

    Thanks to the publisher for sending me a copy in exchange for an honest review! 

    2 to 2.5 stars

  • Peter Tillman

    Nature's review:

    Excerpts: Author "Cahalan quotes a former colleague of Rosenhan’s, who notes that he was a good networker, an excellent lecturer and a generally charismatic character. “But some people in the department called him a bullshitter,” Kenneth Gergen says. And through her deeply researched study, Cahalan seems inclined to agree with them. She discovered that the man whom she had initially admired, and who had done so much to change how mental

    Nature's review:

    Excerpts: Author "Cahalan quotes a former colleague of Rosenhan’s, who notes that he was a good networker, an excellent lecturer and a generally charismatic character. “But some people in the department called him a bullshitter,” Kenneth Gergen says. And through her deeply researched study, Cahalan seems inclined to agree with them. She discovered that the man whom she had initially admired, and who had done so much to change how mental illness was perceived, was not all that he had seemed. And neither, she argues, was his famous experiment."

    "When all of the leads from her contacts led to ground, she published a commentary in The Lancet Psychiatry asking for help in finding them — to no avail. Had Rosenhan invented them, she found herself asking?

    In recent years, other heroes of social psychology have been found to have misrepresented their data. The most prominent case is that of Dutch social psychologist Diederik Stapel, who was forced to retract 58 papers. Those who have followed these cases might be appalled by the Rosenhan story, but will not be surprised.

    Cahalan, whose life was saved by front-line medical science in the context of psychiatry, was shocked by what she found. She writes that she cannot be completely certain that Rosenhan cheated. But she is confident enough to call her engrossing, dismaying book

    ."

  • Book of the Month

    Why I love it

    by Maris Kreizman

    Susannah Cahalan was not okay. Over the course of a month she went from being a fully functioning young reporter to suffering from psychosis and hallucinations, a step away from being diagnosed with schizoaffective disorder. In her devastating 2012 memoir,

    , Cahalan details how a neurological disease not only caused her body to attack her brain, but also caused her to question her own sanity.

    Susannah is fully recovered now, but what would have happened

    Why I love it

    by Maris Kreizman

    Susannah Cahalan was not okay. Over the course of a month she went from being a fully functioning young reporter to suffering from psychosis and hallucinations, a step away from being diagnosed with schizoaffective disorder. In her devastating 2012 memoir,

    , Cahalan details how a neurological disease not only caused her body to attack her brain, but also caused her to question her own sanity.

    Susannah is fully recovered now, but what would have happened to her if her diagnosis of mental illness had stuck? This is what she grapples with in

    , an engrossing history of the study of mental illness, centered around an experiment in which a psychiatrist and a group of other healthy people get themselves committed to mental hospitals in the early 1970s. There they experience the dehumanizing, traumatizing nature of the institutions themselves, and ultimately discover firsthand how mental illness diagnoses are biased and arbitrary at best.

    How do we decide who is mentally ill? Drawing on years of archival research as well as her own personal experiences, Cahalan’s gripping account of the history of insanity is a feat of both enjoyable storytelling and skillful reporting.

    Read more at:

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