Review: The Great Pretender by Susannah Cahalan

Title: The Great Pretender: The Undercover Mission that Changed our Understanding of Madness

Author: Susannah Cahalan

Published: February 2020, A&U Canongate

Status: Read February 2020 courtesy Allen & Unwin


My Thoughts:

“No one can improve without the bare minimum—shelter, clothing, and food—but they also need care: intelligent medical intervention, personal contact, community, and meaning.”

If you ever developed a passing interest in psychology, you have likely learned about David Rosenhan’s watershed study published in 1973 “On Being Sane in Insane Places”. Rosenhan, a psychology (and law) professor at Stanford University, and eight other ordinary, well adjusted people faked symptoms of mental illness in order to be committed to mental asylums across America. Rosenhan was essentially looking to prove that psychiatry had no reliable way to tell the sane from the insane, and the results of the experiment appeared to confirm his theory.

The eight subjects (one having been excluded from the results), including Rosenhan, told the same story -they were hearing voices- and, all but one who was labelled with manic depression, were committed with a diagnosis of schizophrenia. The eight pseudopatients were then required to stay until they were medically released. The length of hospitalization, Rosenhan reported, ranged from seven to fifty-two days, with an average stay of nineteen days.

Rosenhan’s paper appeared to be a damning indictment of the psychiatric field, not only were these pseudopatients incorrectly diagnosed they were, by and large, subject to ill-treatment while in the ‘care’ of these institutions. “On Being Sane in Insane Places” became a major factor in changes to the psychiatric discipline going forward, contributing to public distrust of the field, the widespread closure of hospitals for the mentally insane, and the 1974 update of the Diagnostic and Statistical Manual of Mental Disorders.

The author of The Great Pretender, Susannah Cahalan has herself made a major contribution to the discipline of psychiatry. At the age of 24 Susannah, a journalist, suddenly began exhibiting signs of acute mental illness, and was variously diagnosed with bipolar and schizoaffective disorders until a neurologist discovered that Susannah’s brain was under attack from a rare autoimmune disease resulting in her psychotic behaviours. Treatment of the disease resolved any sign of mental illness. Cahalan wrote about her ordeal in Brain on Fire (later adapted by Netflix as a feature film).

Cahalan’s experience of being wrongly diagnosed with a mental illness is what prompted her interest in Rosenhan’s study. Cahalan’s investigation and research appears meticulous and exhaustive but the results are disturbing. It seems likely that Rosenhan, was a ‘Great Pretender’ in that he manipulated and/or fabricated much of the data, and therefore the conclusions he presented in “On Being Sane in Insane Places”. I was convinced by Cahalan’s discoveries, and shocked by the implications of Rosenhan’s fraud.

“That’s where David Rosenhan and his paper come in. Rosenhan’s study, though only a sliver of the pie, fed into our worst instincts: For psychiatry, it bred embarrassment, which forced the embattled field to double down on certainty where none existed, misdirecting years of research, treatment, and care. For the rest of us, it gave us a narrative that sounded good, but had appalling effects on the day-to-day lives of people living with serious mental illness.”

While I remained absorbed in the story of The Great Pretender, I did think that Cahalan’s occasional sidestep into related, but not perhaps not particularly relevant, areas drew focus from the main narrative, though I did find them interesting in their own right.

I found The Great Pretender to be an accessible and compelling read. I imagine that the psychiatry field will not be pleased to learn that yet another ‘breakthrough’ thesis is probably fraudulent, and I’ll be curious to learn what, if any, effect this may have on the future of mental health care (and if Rosenhan’s study will be removed from textbooks).

“And this fraud, played out every day in our academic journals and our newspapers (or more likely our social media feeds), breeds an anti-science backlash born of distrust.”


Available from Allen & Unwin

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9 Comments (+add yours?)

  1. whatsnonfiction
    Feb 16, 2020 @ 01:19:55

    What a wonderful and thorough take on this one! I was fascinated by the story as well. I did get a little lost at times, perhaps because there was just so much information in general but maybe also because it veered off in different directions at times. Still learned so much from it. Great review!

    Liked by 1 person


  2. Kim (Sophisticated Dorkiness)
    Feb 16, 2020 @ 05:09:09

    I just checked this one out from the library! I was excited to pick it up already, but this review made me even more interested.

    Liked by 1 person


  3. Helen Murdoch
    Feb 16, 2020 @ 07:55:04

    I would be terrified to get put in an institution for fear that I would not be released!

    Liked by 2 people


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  5. curlygeek04
    Feb 17, 2020 @ 03:12:35

    This sounds fascinating and disturbing. Thanks for the review!

    Liked by 1 person


  6. Athira
    Feb 24, 2020 @ 13:05:27

    Have you read Ten Days in a Madhouse? In 1887, a woman reporter did something similar – pretend to be insane just to get admitted into a “madhouse”. I hadn’t heard of Rosenham’s study but I’ll have to look it up. I’ve enjoyed Susan Cahalan’s previous book so this one is also on my list.



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