Review: The Great Pretender – The Undercover Mission That Changed Our Understanding of Madness by Susannah Cahalan

“Psychiatry at its best is what all medicine needs more of—humanity, art, listening, and empathy—but at its worst it is driven by fear, judgment, and hubris.”



Grand Central Publishing | 2019

Filed Under: Up to your eyeballs in FACTS.

Before you go into reading this book, you must first understand the true premise. It is NOT a history of psychiatry and psychiatric hospitals, though those things are discussed to fully understand what Dr. David Rosenhan was doing. But this book is almost totally about Dr. David Rosenhan and his study from the 1970s that looked to expose how psychiatry was functioning away from public knowledge.

I admit I was kind of disappointed once Nellie Bly was discussed for only a couple of paragraphs because that is shit I showed up for. I was expecting a novel that discussed people like Bly more in-depth. I was expecting something a bit more sinister and historical. Like, give me some Geraldo Rivera at Willowbrook kind of drama.

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But alas, it wasn’t meant to be.

Once I got passed my assumptions, I did get into this nonfiction work, but not as much as I was hoping I would. It’s a pretty dense read, full of medical jargon, medical history (seriously, you go through the creation of all the DSM volumes) and a complete dissection and recounting of Dr. Rosenhan’s study, On Being Sane in Insane Places.

The gist is this: David Rosenhan, a psychologist and Stanford University professor, was not all in on his profession and saw psychiatry as a having taken to a dangerous path. He believed people were over-diagnosed, over-medicated and that the definitions of mental health issues were too broad and unreliable.

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He conceived of his experiment as a way to test that reliability, checking himself into a mental ward undercover, claiming to hear voices and have other hallucinations. He wanted to see if the doctors, nurses and staff would be able to figure out he was lying. They couldn’t. He was instead diagnosed as schizophrenic and heavily medication – like, the drooling and not able to talk kind of medicated (He only ever swallowed the meds once, by accident.)

After he was discharged, Rosenhan expanded the study, bringing on seven other “pseudo-patients” to go undercover, all at different psych hospitals and wards. Rosenhan came to the conclusion that psychiatrists and psychiatric hospitals were completely unable to sort the insane patients from the sane ones.

Once someone was deemed to be “insane,” all of their actions, even the perfectly normal behaviour, were seen as crazy because everything was being viewed through the lens of being “formally diagnosed.”

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The study was published by the journal Science in 1973 and effectively caused the entire psychiatric field to reevaluate, take sides and come under scrutiny.

Without giving anything away, despite this not being what I thought the majority of the book was going to be about, the story of David Rosenhan’s experiment was hella interesting and has a few shocking little twists.

Basically, it all comes down to an Oprah style moment of YOU GET SCHIZOPHRENIA! YOU GET SCHIZOPHRENIA! EVERYONE GET SCHIZOPHRENIA!

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But like I said, this book is dense with information, and it’s not only information about Rosenhan’s study and Cahalan’s complete investigation into every aspect of it.

Any time a point is raised, Cahalan takes a detour and pours out all her research onto that detour topic. It’s very clear she completely immersed herself into everything having to do with psychiatry and it’s history and current status, and that she didn’t want to edit out any of it. She found a spot for every last quote and topic, causing the narrative to sometimes feel like Cahalan was jamming a square peg of information into the round hole of the plotline.

The Esalen Institute, JFK’s family history and his dedication to ending barbaric psychiatric practices like lobotomies; issues of replicability in research and using prisons as defacto psych wards for criminals who should really by in genuine psych wards – these are all topics that we meander onto at some point. It’s all worth the brainpower to read. I feel like I learned a lot even if I can’t say it totally stuck enough for me to recite it. But the reading experience as a whole can feel like a slog to get through with so much constant information being piled on.

My main takeaway from this is that we basically still know jack-shit about mental health and how to treat it. It’s a sobering, scary and frustrating topic to delve so deeply into, but despite it’s scattered flow, Cahalan did a hell of a job getting me to read something through to the end that I would normally have abandoned because I hate learning things or whatever.


For centuries, doctors have struggled to define mental illness-how do you diagnose it, how do you treat it, how do you even know what it is? In search of an answer, in the 1970s a Stanford psychologist named David Rosenhan and seven other people — sane, normal, well-adjusted members of society — went undercover into asylums around America to test the legitimacy of psychiatry’s labels. Forced to remain inside until they’d “proven” themselves sane, all eight emerged with alarming diagnoses and even more troubling stories of their treatment. Rosenhan’s watershed study broke open the field of psychiatry, closing down institutions and changing mental health diagnosis forever.

But, as Cahalan’s explosive new research shows, very little in this saga is exactly as it seems. What really happened behind those closed asylum doors, and what does it mean for our understanding of mental illness today?

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