The Great Pretender

"There is an interesting and important backstory here. The author previously wrote a book titled Brain on Fire , which is about her experience of being misdiagnosed with schizophrenia. She was about to be institutionalised but, fortunately, just before this was to happen it was found that she in fact had autoimmune inflammation of the brain. This was a biological problem for which there was a cure. So the attitudes to her changed. In this book, she focuses on a famous experiment by David Rosenhan, a psychologist who published a paper in Science in 1973 that came to be regarded as a watershed study in the history of psychiatry. It reported how Rosenhan and other researchers had presented themselves at different psychiatric hospitals all saying they were experiencing the same symptoms, which is that they were hearing voices that said ‘thud, empty, hollow.’ The paper reported they were all diagnosed with schizophrenia and institutionalised for a period varying from days to weeks. It concluded that the hospitals could not distinguish insanity from sanity. According to Cahalan, this paper had a profound impact on psychiatry and how it was perceived, and led to the standardisation of criteria for psychiatric diagnosis, and the withdrawal of funding for many psychiatric homes. Rosenhan wrote a book about his research but he never finished it. Get the weekly Five Books newsletter In The Great Pretender, Cahalan embarks on a fascinating investigation and tracks down Rosenhan’s colleagues and others who had known him, including the ‘pseudo-patients’ who had gone into the psychiatric homes and their families and friends. She ultimately found the first 200 pages of his unfinished book, and concluded that much of the content of the paper in Science was fabricated. She wrote to Science but did not get a response. According to a note that she unearthed, Rosenhan got himself committed by going way beyond the agreed ‘thud, empty, hollow’ strategy. He told the psychiatrist he was sensitive to radio waves, that he could hear what people were thinking and that he was suicidal. In other words, the doctor had no option but to admit him, and the system worked. It’s an intriguing and well-written detective story. It embraces the history of psychiatry and brings in a range of examples—including the very unfortunate lobotomy of John F Kennedy’s sister Rosemary, who was a very pretty, lively girl until she had her lobotomy. It challenges the field as not having developed since the 1970s, although Cahalan does concede that modern psychiatry does help people. It is a controversial and challenging book."