The Great Pretender by Susannah Cahalan
Updated: Feb 14
Summary: In the 1970s, psychiatry was at a turning point when Stanford professor David Rosenhan convinced several pseudopatients to check themselves into mental hospitals in order to expose the mistreatment and inefficacy. The resulting article "On Being Sane in Insane Places" drastically changed the mental health world, and perhaps not in a good way.
Review: “Insanity is doing the same thing over and over again, but expecting different results.” A quote often attributed to Albert Einstein is exactly what popped into my mind when reading The Great Pretender and thinking about the mental health crisis in our country.
When I was 13 I was first diagnosed with major depressive disorder and generalized anxiety disorder. It cropped up again after having my son as post-partum depression and even later as seasonal affective disorder. When I was in my early 20s I had attention-deficit disorder added to that list. I have been on and off medications like Prozac, Lexapro, Adderall, and many more. While trying to find something that worked, I was briefly on Wellbutrin that caused paranoia, suicidal ideations, and delusions. It was the most bizarre experience of my life knowing logically what was real and yet still feeling as though my car could fly if I drove up a hill or that I could put my hand through a table.
There were even a few times when I considered seeking help by voluntarily committing myself to the psychiatric ward of the hospital. Which leads me to the profound nature of this book.
I knew the story of Nellie Bly who, in the 1880s, committed herself to an insane asylum and then wrote about the atrocities she witnessed and experienced, however, I had not heard of David Rosenhan's similar study in the 1970s. The Great Pretender begins by exploring the impact that the study "On Being Sane in Insane Places" published in the journal Science had on the world of psychiatry. Not only did it show the deplorable conditions of many mental hospitals, but also concluded that psychiatrists had no idea who was sane and who wasn't.
If Cahalan had ended it there, it still would have been enough to question the way we see mental health, but that was only one part of the story. When researching this historic study and its genius author, Cahalan ran into some disturbing realizations and deadends. Rosenhan's notes and anecdotes didn't match what was published and only two of the pseudopatients appeared to exist. A study that had is widely referenced even today and praised for its scientific process may have been more fiction than facts. This is very troubling since it sparked the closing of institutions across the country, forcing the mentally ill out onto the streets or into prisons, and influenced the DSM-III.
Anyone working with those diagnosed with a mental illness or themselves have a mental illness should read this book. Politicians would also benefit from this as they make policies, finalize budgets, and have the greatest influence in the future of mental health care.