By Susan Cahalan
Cahalan, S. (2019). The great pretender: The undercover mission that changed our understanding of madness. Grand Central, New York, N.Y.
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In her follow-up to the acclaimed Brain on Fire, Susannah Cahalan tackles the infamous 1970s study “On Being Sane in Insane Places.” In this study, David Rosenhan and seven volunteers checked themselves into mental health care facilities to see if the mental health care workers could determine who had a mental illness from those who did not. Cahalan begins with a history of asylums and efforts to improve the conditions and treatment of individuals. In some cases, individuals were held against their will in these facilities. She cites that many individuals living in these asylums reported the ease of getting admitted but the difficulty of getting out. Cahalan’s interest in this study stems from her misdiagnosis with schizophrenia and time in a mental health ward, even though her disorder stemmed from brain inflammation.
Calahan recounts the familiar story of the Rosenhan study, in which eight people (three women and five men, including Rosenhan) checked themselves into mental health care facilities reporting that they were hearing the words, “thud, empty, and hollow.” Once the pseudopatients were admitted, they no longer displayed any symptoms and acted normally. Patients spent on average four and one-half minutes per day with doctors. The doctors and staff in many facilities treated patients rudely and often ignored their requests or questions. The pseudopatients had stays that ranged from 17-51 days. While it took the staff a long time to determine that the pseudopatients were sane, many other patients identified the pseudopatients as being a journalist or a professor quickly after their arrival.
The study has often been cited as addressing the problem of labeling people with disorders and the need to develop clear criteria for diagnosis. Rosenhan also wanted to address the need for more time with the staff who work in the facilities. Cahalan obtained the original files from a good friend of Rosenhan (who died in 2012), Lee Ross. Ross was a good friend of Rosenhan and a well-respected social psychologist. As the author searched to find more of the pseudopatients, she runs into many inconsistencies in Rosenhan’s notes, which nobody can quite work out. Rosenhan used aliases for all of the patients, and Cahalan quickly determined that Rosenhan was David Lurie. She finds evidence and speaks to a number of those involved with the study, and she is even able to work out who one of the pseudopatients was and get a direct account of their experiences. The others were harder to track down, and in continuing her research, she begins to question if the remainder of the pseudopatients ever took part in the study. She finds much misinformation in Rosenhan’s notes to demonstrate that many of the pseudopatients were highly embellished if not made up entirely. Callahan is not convinced that all the participants were real. She finds evidence that in some cases, the events and characteristics attributed to one participant were a conglomeration of the experiences of others who in some cases were from outside of the study. She finds credible evidence that one pseudopatient had the characteristics of a good friend of Rosenhan, and that other patients in the wards were depictions of some of his own patients. Rosenhan had a book deal to write a full report about the study but never completed the manuscript and was sued by the publisher.
While she cannot conclude decisively that many of the pseudopatients were falsified, she does create a credible case that this study has some fatal flaws. This book comes as yet another hit to some of the most famously cited studies in psychology and calls into question the legitimacy of one of the most often cited studies in the field of abnormal psychology.
Psychological Figures and Concepts
Borderline personality disorder
Cognitive behavioral therapy
NPR Interview with Susannah Callahan
Susannah Callahan discusses The Great Pretender
Being Sane in Insane Places: Science
David Rosenhan on being Sane in Insane Places