Book of the week
The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness
(Grand Central, $28)
In 1973, psychologist David Rosenhan published a paper that “shook the world of psychiatry to its core,” said Michael Schaub in NPR.org. Rosenhan had assembled eight accounts of healthy subjects who had presented themselves at mental hospitals throughout the country and been held for days and even weeks. The resulting uproar led to the closing of many mental institutions, and when journalist Susannah Cahalan learned of the episode years later, she was inclined to trust the famous exposé. But Cahalan, who is both a dogged reporter and an “absolutely incredible” writer, discovered as she examined the details that little of Rosenhan’s study could be backed up. Because of a misdiagnosis in her own past, Cahalan is passionate about this story, but she’s channeled her outrage into a book that “reads, in parts, like a suspense novel” while urging serious reform in how we treat the mentally ill.
At first, Cahalan’s research went smoothly, said Emily Eakin in The New York Times. Rosenhan, who died in 2012, had left his files, including a 200-page incomplete manuscript, with a colleague. But troubling discrepancies in Rosenhan’s work quickly emerged. His study said that each pseudopatient had complained of a single symptom: hearing voices that said “hollow,” “empty,” and “thud.” But his own medical file indicated that when he was admitted into a suburban Philadelphia mental hospital, he’d reported a series of more troubling symptoms. Some statistics in the study had no backup reporting. And most worryingly, she was able to identify two other study participants: one whose positive experience was excluded and another whose experience was more positive than Rosenhan reported. Cahalan concludes it’s possible that all six other subjects were invented.
“Even so, the accuracy of Rosenhan’s study comes to matter less than its consequences,” said Naina Bajekal in Time. In the wake of its alarmist claims and the resulting shuttering of mental hospitals, the number of patients in such institutions fell by half nationwide within a decade. Cahalan writes that today the U.S. has 95,000 fewer beds for mental patients than are needed, and that many of our mentally ill have wound up in prisons. Though her descriptions of 19th-century asylums are disturbing, “Today, it’s worse,” she writes. “We don’t even pretend the places we’re putting sick people aren’t hellholes.” Had Rosenhan never published his study, perhaps our mental health system would be both more effective and more humane. ■