A review of The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness by Susannah Cahalan
“All of the little things—the wig, the lying about his hospitalization dates, the exaggeration in his medical records, the playing with numbers, the dismissal of Harry’s information, the unfinished book, his never tackling the subject again—all of these piled up. Rosenhan does not seem to be the man I’d believed in.” (269-70)
You can say that again.
David Rosenhan (1929-2012) was the Stanford psychologist whose sensational “pseudopatient study” shook psychiatry to its foundations. Published to worldwide acclaim in 1973, it saw eight sane people fake their way into mental hospitals, get misdiagnosed as schizophrenic, and have trouble getting back out. Five decades later it is still regularly cited, taught, and invoked as proof that psychiatric diagnoses lack validity.
In this new book, journalist Susannah Cahalan makes a strong case that Rosenhan pretty much made it all up.
The Great Pretender is the book of the decade. Assuming Cahalan’s research is sound, it will force a retraction by the journal Science, and every psychology and psychiatry textbook in the world will have to be rewritten. It’s also a gripping detective story and a terrific read. Cahalan’s documentation is rich, her research seemingly exhaustive, and she thanks a fact-checker in her acknowledgments.
As Cahalan tells it, Rosenhan’s study is nothing but one lie or exaggeration after another: most of the “pseudopatients” never existed; there were only two, besides Rosenhan himself, and one actually enjoyed his experience in the hospital.
Rosenhan lied when he wrote that his sole presenting symptom was hearing a voice say “empty,” “hollow,” and “thud.” Not so, as Cahalan shows in a bombshell screenshot of his admission file:
He has felt that he is "sensitive to radio signals and hear what people are thinking." He realized that these experiences are unreal but cannot accept their reality. He has tried to insulate out the noises by putting "copper over my ears". One reason for coming to the hospital was because things "are better insulated in a hospital". He has also had suicidal thoughts.
Worse, Cahalan discovers that Rosenhan didn’t “gain admission” to the hospital. His wife had him committed.
After going home, Rosenhan then leveraged his “experiment” to (apparently) lie his way to fame and fortune. He landed a lucrative double appointment at Stanford, where he spent the rest of his career.
Alas, that career can only have been utterly miserable, because that is where his lies evidently caught up to him. The hospital he’d stayed in had leaked his file, and it found its way to psychiatrist Robert Spitzer, the architect of the DSM-III. Cahalan doesn’t use the word “blackmail,” but she does suggest Spitzer cowed Rosenhan into silence forever after while he pursued his own agenda of revising, expanding, and medicalizing the diagnoses of the DSM.
The irony of this whole sorry mess is that of all people, a psychologist should know that living a lie is the chief obstacle to achieving serenity, inner peace, or—as we call it now—mental health.
I take a great interest in these affairs because I met or spoke with Rosenhan, Spitzer, and the psychiatrist Thomas Szasz about the Rosenhan experiment just before their deaths, right around the time Cahalan found her own way to it.
Cahalan came by way of a misdiagnosis she’d been given (the topic of her previous book, Brain on Fire).
My own interest was purely academic. In 2011, I'd discovered a startling similarity to Rosenhan’s experiment in a stage comedy from ancient Rome titled The Menaechmus Brothers. As I realized, the central theme of that play is exactly the same that Rosenhan raised in the famous first sentence of his article: “If sanity and insanity exist, how shall we know them?” (Read my paper here alongside pages 83-93 of The Great Pretender.) It was eerie.
Flush and out of my element, I contacted Rosenhan, Spitzer, and Szasz for their thoughts. None of them knew the play, but their reactions were quite different. Szasz, who had published a critique of the Rosenhan Experiment, was eager to discuss my paper and sent me some immediate impressions. Spitzer professed himself uninterested in hearing more. Through his caretaker, Rosenhan initially expressed interest—especially in the title, which I chose to honor him—but he never got back to me. Since he was ailing and died shortly after, I’ll never know why.
With The Great Pretender, Susannah Cahalan will go down in history. Like her great predecessors—Dorothea Dix, Lady Rosina, Elizabeth Packard, Nelly Bly—she digs deep, investigates, and works to expose the psychiatric charades and charlatans of our times. If the facts are indeed as she presents them—and I call on Stanford to digitize and publish the materials she quotes from—then we all owe her a debt of gratitude.