The Great Pretender

August 15, 2019
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.

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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.

October 1, 2019
Following her bestselling memoir, Brain on Fire (2012), about how an unknown pathogen caused brain inflammation, seizures, and paranoia, journalist Cahalan tackles a larger medical mystery that also raises profound questions about the field of psychiatry. Her quest: to figure out the true story behind an influential 1973 article in Science, On Being Sane in Insane Places, that changed the national conversation about mental health. Psychologist David Rosenhan and seven other sane, healthy people pretended to hear voices and committed themselves to psychiatric institutions to see if doctors and staff could distinguish between individuals who were genuinely ill versus the undercover pretenders. But Cahalan began wondering if the now deceased Rosenhan, who never revealed the volunteers' real names, might have made it all up? She notes that the study contributed to the shuttering of psychiatric hospitals, and to important disclosures about how depersonalized mentally ill patients felt and how psychiatric conditions were often dismissed as less legitimate than physical ones. Cahalan's compelling and provocative investigation raises many questions about our attitudes toward mental illness and psychiatry.(Reprinted with permission of Booklist, copyright 2019, American Library Association.)

October 1, 2019

Seven years after the million-plus-copy best seller Brain on Fire, an account of the previously unknown autoimmune disease that brought Cahalan to psychosis, she chronicles a key event in the history of mental illness. In the 1970s, Stanford psychologist David Rosenhan and seven colleagues posed as patients in asylums nationwide and emerged, after having to prove themselves sane, with surprising diagnoses and harrowing stories of treatment. The experiment led to institutional closings and radical change in the field of psychiatry, but Calahan reveals that events were not as they initially appeared. With a 150,000-copy first printing.

Copyright 2019 Library Journal, LLC Used with permission.

Starred review from October 1, 2019

Employing her journalistic research skills and intensely personal experience with misdiagnosis and the psychiatric profession, Cahalan (Brain on Fire: My Month of Madness) investigates legendary psychological researcher David Rosenhan. Psychology students will immediately recognize Rosenhan as the author of the seminal study "On Being Sane in Insane Places," an experiment in which mentally sound investigators infiltrated psychiatric hospitals by feigning symptoms suggestive of schizophrenia. Rosenhan hypothesized that psychiatric diagnosis was so imprecise that doctors could not readily differentiate the sane from the insane. Thus, while undercover investigators easily gained admission to hospitals, it was extremely challenging to get released, despite their behaving normally. Rosenhan's study helped revamp our entire mental health system, resulting in the mass closure of hospitals. But was Rosenhan correct? This is the fundamental question explored in Cahalan's brilliant book, in which she diligently traces and interviews people associated with the study, the circumstances of which became increasingly suspect. In the end, she provides a convincing argument that Rosenhan largely fabricated his research. VERDICT Indispensable reading for aficionados of Cahalan's Brain on Fire and Merve Imre's The Personality Brokers. [See Prepub Alert, 4/22/19.]--Lynne Maxwell, West Virginia Univ. Coll. of Law Lib., Morgantown

Copyright 2019 Library Journal, LLC Used with permission.

June 1, 2019

Seven years after the million-plus-copy best seller Brain on Fire, an account of the previously unknown autoimmune disease that brought Cahalan to psychosis, she chronicles a key event in the history of mental illness. In the 1970s, Stanford psychologist David Rosenhan and seven colleagues posed as patients in asylums nationwide and emerged, after having to prove themselves sane, with surprising diagnoses and harrowing stories of treatment. The experiment led to institutional closings and radical change in the field of psychiatry, but Calahan reveals that events were not as they initially appeared. With a 150,000-copy first printing.

Copyright 2019 Library Journal, LLC Used with permission.