Cover image for The great pretender : the undercover mission that changed our understanding of madness
Title:
The great pretender : the undercover mission that changed our understanding of madness
ISBN:
9781538715284
Edition:
1st ed.
Physical Description:
xiii, 382 pages ; 24 cm.
Personal Subject:
Summary:
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 answer, in the 1970s a Stanford psychologist named David Rosenhan and seven other people--sane, normal, well-adjusted members of society--went undercover into asylums around America to test the legitimacy of psychiatry's labels. Forced to remain inside until they'd "proven" themselves sane, all eight emerged with alarming diagnoses and even more troubling stories of their treatment. Rosenhan's watershed study broke open the field of psychiatry, closing down institutions and changing mental health diagnosis forever. But, as Cahalan's explosive new research shows, very little in this saga is exactly as it seems. What really happened behind those closed asylum doors, and what does it mean for our understanding of mental illness today?
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Summary

Summary

"One of America's most courageous young journalists" and the author of the #1 New York Times bestselling memoir Brain on Fire investigates the shocking mystery behind the dramatic experiment that revolutionized modern medicine (NPR ).

Doctors have struggled for centuries to define insanity--how do you diagnose it, how do you treat it, how do you even know what it is? In search of an answer, in the 1970s a Stanford psychologist named David Rosenhan and seven other people--sane, healthy, well-adjusted members of society--went undercover into asylums around America to test the legitimacy of psychiatry's labels. Forced to remain inside until they'd "proven" themselves sane, all eight emerged with alarming diagnoses and even more troubling stories of their treatment. Rosenhan's watershed study broke open the field of psychiatry, closing down institutions and changing mental health diagnosis forever.

But, as Cahalan's explosive new research shows in this real-life detective story, very little in this saga is exactly as it seems. What really happened behind those closed asylum doors?


Author Notes

Susannah Cahalan is the award-winning, New York Times bestselling author of Brain on Fire : My Month of Madness, a memoir about her struggle with a rare autoimmune disease of the brain. She writes for the New York Post. Her work has also been featured in the New York Times, Scientific American Magazine, Glamour, Psychology Today, and other publications. She lives in Brooklyn.


Reviews 4

Publisher's Weekly Review

Journalist Cahalan (Brain on Fire) sets a new standard for investigative journalism in this fascinating investigation into a pivotal psychological study. In 1973, the mental health system was in trouble, she writes, thanks to weak diagnostic criteria and overburdened hospitals and health-care providers. Stanford psychologist David Rosenhan understood it would take a grand gesture to incite reform--such as recruiting seven sane individuals to feign auditory hallucinations. Rosenhan used their accounts of institutionalization to write the 1973 article "On Being Sane in Insane Places," which sparked controversy and led to the widespread reform or closure of institutions and a revision of the DSM. However, his volunteers' identities were never revealed, which to Cahalan raises the question--was he hiding anything? Driven by her own traumatizing experience as a misdiagnosed psychiatric patient, Cahalan pours through Rosenhan's notes and lists of his known contacts, attempting to match real people to the study's unnamed subjects, and ultimately is unable to find proof that six out of the seven fake patients really existed. She also discovers the wholesale omission of a volunteer's account that contradicted Rosenhan's argument. Her impeccable inquiry into the shadowy reality of Rosenhan's study makes an urgent case that the psychological and psychiatric fields must recover the public trust that "Rosenhan helped shatter." Agent: Larry Weissman, Larry Weissman Literary. (Nov.)


Kirkus Review

A sharp reexamination of one of the defining moments in the field of psychiatry."There are not, as of this writing, any consistent objective measures that can render a definitive psychiatric diagnosis," writes New York Post journalist Cahalan (Brain on Fire: My Month of Madness, 2012) at the beginning of this gripping account of a study that rocked the foundational concepts of how we judge sanity. In the early 1970s, David Rosenhan, a Stanford professor of psychology, sent eight sane people into hospitals for the insane in an experiment involving diagnostics and conditions for the mentally ill. The eight participants told the intake doctors that they were experiencing aural hallucinations, and they were all admitted for varying lengths of time. The resulting article, which appeared in Science, is credited with helping to change both diagnostic and hospitalization procedures. At first, Cahalan approaches the article, "On Being Sane in Insane Places" (1973), with a level of awe and appreciation and treats readers to a tour of the miseries that patients enduredmost notably, isolation and dehumanizationas well as a review of her own misdiagnosis of schizophrenia. Eventually, doubts start to creep into the author's investigation, discrepancies that a purportedly scientific article should not have contained: lying about hospitalization dates, exaggerating medical records, playing with numbers, and more. Cahalan follows all the leads like a bloodhound, in particular trying to uncover the identities of the patients. Her pursuit reads like a well-tempered mystery being picked apart, with tantalizing questions for which many of the answers are just out of reach. While "On Being Sane" may have been partially fabricated, it was also an important force in the deinstitutionalization of care for the mentally ill. Cahalan draws a vivid and critical picture of Rosenhan and the ramifications of his most prominent work.A well-told story fraught with both mystery and real-life aftershocks that set the psychiatric community on its ear. Copyright Kirkus Reviews, used with permission.


Booklist Review

Following her bestselling memoir, Brain on Fire (2012), about how an unknown pathogen caused brain inflammation, seizures, and paranoia, journalist Cahalan tackles a larger medical mystery that also raises profound questions about the field of psychiatry. Her quest: to figure out the true story behind an influential 1973 article in Science, On Being Sane in Insane Places, that changed the national conversation about mental health. Psychologist David Rosenhan and seven other sane, healthy people pretended to hear voices and committed themselves to psychiatric institutions to see if doctors and staff could distinguish between individuals who were genuinely ill versus the undercover pretenders. But Cahalan began wondering if the now deceased Rosenhan, who never revealed the volunteers' real names, might have made it all up? She notes that the study contributed to the shuttering of psychiatric hospitals, and to important disclosures about how depersonalized mentally ill patients felt and how psychiatric conditions were often dismissed as less legitimate than physical ones. Cahalan's compelling and provocative investigation raises many questions about our attitudes toward mental illness and psychiatry.--Karen Springen Copyright 2010 Booklist


Library Journal Review

Employing her journalistic research skills and intensely personal experience with misdiagnosis and the psychiatric profession, Cahalan (Brain on Fire: My Month of Madness) investigates legendary psychological researcher David Rosenhan. Psychology students will immediately recognize Rosenhan as the author of the seminal study "On Being Sane in Insane Places," an experiment in which mentally sound investigators infiltrated psychiatric hospitals by feigning symptoms suggestive of schizophrenia. Rosenhan hypothesized that psychiatric diagnosis was so imprecise that doctors could not readily differentiate the sane from the insane. Thus, while undercover investigators easily gained admission to hospitals, it was extremely challenging to get released, despite their behaving normally. Rosenhan's study helped revamp our entire mental health system, resulting in the mass closure of hospitals. But was Rosenhan correct? This is the fundamental question explored in Cahalan's brilliant book, in which she diligently traces and interviews people associated with the study, the circumstances of which became increasingly suspect. In the end, she provides a convincing argument that Rosenhan largely fabricated his research. VERDICT Indispensable reading for aficionados of Cahalan's Brain on Fire and Merve Imre's The Personality Brokers. [See Prepub Alert, 4/22/19.]--Lynne Maxwell, West Virginia Univ. Coll. of Law Lib., Morgantown


Table of Contents

Prefacep. xi
Part 1
1 Mirror Imagep. 3
2 Nellie Blyp. 12
3 The Seat of Madnessp. 22
4 On Being Sane in Insane Placesp. 33
5 A Riddle Wrapped in a Mystery Inside an Enigmap. 42
Part 2
6 The Essence of Davidp. 53
7 "Go Slowly, and Perhaps Not at All"p. 63
8 "I Might Not Be Unmasked"p. 75
9 Committedp. 83
10 Nine Days Inside a Madhousep. 86
Part 3
11 Getting Inp. 111
12 ... And Only the Insane Knew Who Was Sanep. 122
13 W. Underwoodp. 131
14 Crazy Eightsp. 135
15 Ward 11p. 148
16 Soul on Icep. 156
17 Rosemary Kennedyp. 162
Part 4
18 The Truth Seekerp. 173
19 "All Other Questions Follow from That"p. 182
20 Criterionatingp. 192
21 The SCIDp. 199
Part 5
22 The Footnotep. 213
23 "It's Ail in Your Mind"p. 230
24 Shadow Mental Health Care Systemp. 236
25 The Hammerp. 247
26 An Epidemicp. 265
27 Moons of Jupiterp. 279
Epiloguep. 295
Acknowledgmentsp. 301
Notesp. 307
Indexp. 367
Permissionsp. 381