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

Susannah Cahalan

Nov 2019 · Sold by Grand Central Publishing

About this ebook

Shortlisted for the 2020 Royal Society Insight Investment Science Book Prize

Named a Best Book of 2020 by The Guardian * The Telegraph * The Times

"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?

Ratings and reviews

Susannah Calahan is the author of the bestselling memoir Brain on Fire: My Month of Madness, in which she describes an amazing ordeal in which she was misdiagnosed with a mental illness that was actually autoimmune encephalitis that caused extreme psychotic symptoms. This experience sparked a curiosity about psychiatric assumptions and the validity of the studies upon which they are based. The Great Pretender is the result of her obsession with a famous study conducted by David Rosenhan in the 1970s. Rosenhan and other individuals went “undercover” as pseudopatients in mental hospitals, ostensibly to test out their diagnostic systems and evaluate their treatment methodologies. The results and conclusions of this study, published in Science in 1973, had a profound impact on the practice of psychiatry and called into question many of its essential tenets. The study remains very controversial: the subjects were kept secret and their notes undisclosed; there are doubts about the tactics used to gather the data, and the conclusions drawn are regarded by many to be faulty. Calahan explains how her own attempts to clarify what Rosenhan and his other subjects experienced in the institutions only resulted in more ambiguity. It became apparent to the author that there could be some serious issues about Rosenhan’s ethics and motives. The Great Pretender also describes the development of psychiatry as a specialty that had branched off from other biologically-based medicine after Freud, only to be re-integrated recently with the advent of psychopharmacology and advances in brain research. Calahan additionally provides a re-examination of other pivotal psychological research studies and evaluates their extensive influence within a branch of medicine that has been traditionally judged as more palliative than curative. Calahan understandably approaches this subject with a good degree of skepticism about the fallibility of psychiatry and its practices given her own personal experience. As a result, this book remains very personal as she struggles with frustration in her search for underlying information about Rosenhan’s work and her questions about his integrity as a scientist. Fascinating as both an historical overview and a critique of psychological research, The Great Pretender can be viewed both an educational text and a compelling mystery as well. Thanks to the author and Grand Central Publishing for an advance copy of this book in exchange for an unbiased review.

Excellent book! Susannah's Book Interview on 11/10/2019 by C-Span also gave her outstanding Analysis! Personally, we should scrape the word Mental Health, and replace it with what should be America's new MH, that is "Mentorship Helps". Like how America learned to adopt new words after the American Disabilities Act, such as invaled to disabled and other reprehensible words to now more appropriate ones, like frail, elderly, neurologically challenged. Susannah took her own deeply personal tragedies, and she intelligently was able to articulate America's truths about the DSM. I care emencely about this issue, growing up with a very violent father, who till the day he died at age 75 constantly threatened to do harm to my mother, my brothers and myself. With today's worst threats of mass shootings, the opioid crisis, veteran suicides, while healthcare is gutted daily to benefit the rich...more courageous women, like Susannah Calahan are needed.

Great when she's chasing down the details about Rosenhan's study. Terrible when she strays from that and tries to talk about the wider context. And the book is an absolute bore when she talks about her experience in the inpatient mental health system.

About the author

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.