Book Review: The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness by Susannah Cahalan

In her twenties, Susannah Cahalan went crazy. She was just a regular young journalist in New York City who got paranoid and manic and depressed and eventually ended up at the hospital. Because she was middle class, educated, white, and had very involved and educated parents, her parents were able to convince doctors to continue to treat her as a medical patient instead of a mental health patient, and lo and behold, she was eventually diagnosed with an autoimmune disorder that was in fact causing her insanity, and when it was treated she became herself again, albeit missing a few weeks of her life. That's the story she tells in her memoir, Brain on Fire. 

After that experience and after that book came out (and went on to become a New York Times bestseller!), Susannah started giving a lot of talks about mental health. Along the way, she learned about a famous study done in the late 1960s that changed the state of mental health treatment forever. A psychologist, David Rosenhan, and about a dozen people he recruited, went undercover as mental health patients at a variety of hospitals around the country. They presented completely normally, but said they had auditory hallucinations of the words "empty," "hollow," and "thud." All of them were committed, all of them were given the diagnosis of schizophrenia but one, and all stayed for anywhere from two weeks to two months without any of the professionals figuring out they really weren't insane. Basically they were recreating Nellie Bly's famous undercover bit, but in a more scientific way. Afterwards, the study was a scandal, showing how psychiatrists couldn't tell they were sane, the hospitals were horrible (this was the era of One Flew Over the Cuckoo's Nest), and there was almost no treatment. The horror! It led directly to the revision of the DSM, and has been cited for decades. In fact, I remember learning about it, and that could only have been in my college Psych 101 class.

Ms. Cahalan decided to look into this study further, since she found it and Professor Rosenham so important and influential. She wanted to know more about it, and in particular she was hoping to track down all the pseudo patients and talk to them about their experiences. What she found out was not at all what she was expecting. 

I don't want to give too much more away, as the reveal was fascinating and unexpected. Suffice it to say, for his own sake it's good that Prof. Rosenham has passed away as he would not like dealing with the aftermath. It's also not what Ms. Cahalan wanted, so she didn't go in trying to undermine him but quite the opposite--she fought her ultimate conclusion until the evidence was just too overwhelming.

Along the way, you learn all about the trajectory of mental health care in the 20th century. It's made several turns but never been very good, unfortunately, at least not for the severely ill. I am a big proponent of therapy and think it's incredibly helpful, but I also have had two relatives diagnosed with schizophrenia and the options are limited. I do hope that we're on a better track now, but it's not as much better as you would have hoped in 1968.

I borrowed this digital audiobook from my library via Libby/Overdrive.