THE GREAT PRETENDER

A sharp reexamination of one of the defining moments in the field of psychiatry.

“There are not, as of this writing, any consistent objective measures that can render a definitive psychiatric diagnosis,” writes New York Post journalist Cahalan (Brain on Fire: My Month of Madness, 2012) at the beginning of this gripping account of a study that rocked the foundational concepts of how we judge sanity. In the early 1970s, David Rosenhan, a Stanford professor of psychology, sent eight sane people into hospitals for the insane in an experiment involving diagnostics and conditions for the mentally ill. The eight participants told the intake doctors that they were experiencing aural hallucinations, and they were all admitted for varying lengths of time. The resulting article, which appeared in Science, is credited with helping to change both diagnostic and hospitalization procedures. At first, Cahalan approaches the article, “On Being Sane in Insane Places” (1973), with a level of awe and appreciation and treats readers to a tour of the miseries that patients endured—most notably, isolation and dehumanization—as well as a review of her own misdiagnosis of schizophrenia. Eventually, doubts start to creep into the author’s investigation, discrepancies that a purportedly scientific article should not have contained: lying about hospitalization dates, exaggerating medical records, playing with numbers, and more. Cahalan follows all the leads like a bloodhound, in particular trying to uncover the identities of the patients. Her pursuit reads like a well-tempered mystery being picked apart, with tantalizing questions for which many of the answers are just out of reach. While “On Being Sane” may have been partially fabricated, it was also an important force in the deinstitutionalization of care for the mentally ill. Cahalan draws a vivid and critical picture of Rosenhan and the ramifications of his most prominent work.

A well-told story fraught with both mystery and real-life aftershocks that set the psychiatric community on its ear.