The Great Pretender by Susannah Cahalan may not seem a logical choice for a book review on a website about old, unsolved cases. However, her book is exactly that.
Cahalan wrote a book about the Rosenhan Experiment in which unknown people posed as patients in unknown medical facilities. There are indications of truth, lies, fraud, and deception.
Nobody got murdered but those who posed as pseudo-patients, seem to be missing. Not literally, but their true identities are not clear. So, why were some people used as pseudo-patients and why is Cahalan searching for the exact timeline?
Cahalan got autoimmune encephalitis that temporarily, robbed her of her sanity. Autoimmune encephalitis refers to a group of conditions that occur when the body’s immune system mistakenly attacks healthy brain cells, leading to inflammation of the brain. People with autoimmune encephalitis may have various neurological and/or psychiatric symptoms.
As long as the doctors were convinced that Cahalan’s behavior was rooted into a mental illness, she and her family felt that she was not taken serious. She was acting crazy so they just saw a schizophrenic person. Until there was evidence of brain-targeting auto-antibodies.
As soon as Cahalan’s ordeal became a physical illness, her treatment changed of course, but, more important, she felt that everyone’s perception of her had changed. She wrote about it in her book Brain on Fire. There she ponders the differences between physical disorders and psychiatric conditions, perception, and all the implications.
Prove your sanity
How do you define sanity and most importantly, can you prove that you are sane? Could you get yourself admitted to a mental institution based on a lie, get diagnosed, and then get discharged because you do are sane? It sounds like a horrible dare as so many things can go wrong. But is happened. This is the Rosenhan Experiment. So, what is the story behind it?
Elizabeth Jane Cochrane Seaman (May 5, 1864 – Jan 27, 1922) aka Nellie Bly, was an American journalist. She was internationally renowned for her record-breaking trip around the world in 72 days. That resulted in Jules Verne’s fictional character, Phileas Fogg. But she is equally known for her undercover work to investigate mental institutions under her pen name. Bly feigned to have a mental illness to get admitted to the Women’s Lunatic Asylum on Blackwell Island (NY) to experience how the patients were treated. The asylum opened in 1839 and closed in 1894. You can read about it in her book “Ten days in a madhouse.”
Cahalan heard of Dr. David Rosenhan‘s study, knew about Bly, and had first-hand experience with the perception of insanity. Rosenhan’s experiment was an extended version from Bly’s. Not one person and one institution but several people as pseudo-patients would explore several institutions. You can find the report about that experiment here. The Rosenhan study builds on the idea that insanity is in the eye of the beholder. Are people perceived by others to be insane because they are in an asylum or, because there is an objective diagnoses?
While Cahalan was trying to get more information about the report and the people involved, she kept “running into sloppiness that seemed unprofessional and possibly unethical” and this is where the book starts to grab you. It is in the methodology, the information gathering, the time line, the exact number of days that pseudo-patients were inside an institution, what exactly their diagnosis was, how they got discharged, whether they were at any point in danger, what safety measures were in place to get them out, which authority figures knew about the experiments so they could intervene, etc.
Cahalan started to dissect the report line by line, case by case. She found that Rosenhan had taken precautions for his safety such as letting the institution’s superintendent know in advance about the experiment and he took a tour of the facility before staying there. Cahalan found that this wasn’t the case for the other pseudo-patients which poses a tremendous threat for their safety. She also found that after the report came out, there was a lot of criticism from peers in prominent places who published that critique in prominent scientific magazines.
Cahalan’s book describes the journey she had to take to find the truth about the Rosenhan Experiment, the report, the data, the pseudo-patients, what they really said during their intake, what they really observed, what eventually got them discharged, and how they coped with the consequences of the study.
The author takes you through the debate to rethink psychiatric diagnosis, whether we needs some standards of symptoms that all patients must exhibit before their freedom can be taken away from them, the standardized treatment, observation days, etc. and make it uniform around the USA.
Pay attention to Chapter 22. It deals with the pseudo-patient who became a footnote just because his findings and data did not match Rosenhan’s thesis “that institutions are uncaring, ineffective, and even harmful places.”
There is a chapter dedicated to Rosemary Kennedy. How she was born, what treatments she had to endure, and what eventually became of her. It is a heartbreaking chapter. This part also describes what would eventually become the basis for Medicare and Medicaid.
Cahalan has written a book that rips to shreds a scientific report that was at first heralded as the new milestone. But just like in true crime, a scientific report and its findings are only as good as the people involved and their truthful handling of data. The author went through pages of information, seeking details, trying to complete the time lines, to see if she reaches the same conclusions as others had before her. And then she wrote this book about it.
“The Great Pretender” is a marvelous book that you need to pick up if ethics in reporting, scientific data, and the fields of psychiatry are of interest to you. Highly recommended reading! My other book reviews are here.