The Great Pretender

September 30, 2019
Journalist Cahalan (Brain on Fire) sets a new standard for investigative journalism in this fascinating investigation into a pivotal psychological study. In 1973, the mental health system was in trouble, she writes, thanks to weak diagnostic criteria and overburdened hospitals and health-care providers. Stanford psychologist David Rosenhan understood it would take a grand gesture to incite reform—such as recruiting seven sane individuals to feign auditory hallucinations. Rosenhan used their accounts of institutionalization to write the 1973 article “On Being Sane in Insane Places,” which sparked controversy and led to the widespread reform or closure of institutions and a revision of the DSM. However, his volunteers’ identities were never revealed, which to Cahalan raises the question—was he hiding anything? Driven by her own traumatizing experience as a misdiagnosed psychiatric patient, Cahalan pours through Rosenhan’s notes and lists of his known contacts, attempting to match real people to the study’s unnamed subjects, and ultimately is unable to find proof that six out of the seven fake patients really existed. She also discovers the wholesale omission of a volunteer’s account that contradicted Rosenhan’s argument. Her impeccable inquiry into the shadowy reality of Rosenhan’s study makes an urgent case that the psychological and psychiatric fields must recover the public trust that “Rosenhan helped shatter.” Agent: Larry Weissman, Larry Weissman Literary.

March 1, 2020

A former reporter for the New York Post, Cahalan was institutionalized for a month because doctors believed she had a psychiatric illness, though she actually had an autoimmune type of encephalitis. When she recovered, Cahalan became interested in the process of how she came to be misdiagnosed and treated. Cahalan discovered a 1970s study, "On Being Sane in Insane Places" by Stanford's David Rosenhan, which purported to determine the effectiveness of psychiatric diagnosis through the introduction of false, sane, patients into psychiatric hospitals. His study affected government support of psychiatric hospitals and the way the Diagnostic and Statistical Manual of Mental Disorders defined specific illnesses. The resulting changes still affect mental health care in the U.S. today, though Cahalan dug deeper into Rosenhan's research and came to the conclusion that most of his data was fabricated. Though ably narrated by Christie Moreau and by the author, a pronunciation error or two stand out. VERDICT Will be of interest to those seeking to learn about the U.S. mental health system and/or psychology.--Cheryl Youse, Norman Park, GA

Copyright 2020 Library Journal, LLC Used with permission.

Narrator Christie Moreau strikes just the right balance of seriousness, empathy, and a detective's curiosity in this fascinating investigation of the world of psychiatry. In 1973, Dr. David Rosenhan published an article in SCIENCE titled "On Being Sane in Insane Places" after eight healthy people, including Rosenhan himself, faked their way into psychiatric hospitals. Susannah Cahalan tries to find those pseudopatients. What she learns casts doubt on Rosenhan's data and conclusions. In a thoughtful and charming narration, Moreau reveals the odd note of whimsical humor. She is also appropriately sensitive to Cahalan's own brush with psychiatric misdiagnosis, when a rare autoimmune disease attacked her brain, presenting as schizophrenia. A.B. � AudioFile 2020, Portland, Maine