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The Great Pretender

I made it halfway through Susannah Cahalan’s new book The Great Pretender, and found myself a bit wary of diving into the second half. After 150 pages of Susannah’s captivating storytelling, detailing a wild story set in the world of psychiatric asylums, where could things possibly go? What else could happen? The second half, it turned out, was even more incredible than the first.

Susannah’s meticulous research into one of the psychiatry world’s most prolific journal articles and its author highlights the sheer brokenness of the American mental health system. “On Being Sane in Insane Places,” written by Stanford psychology professor David Rosenhan in the early 1970’s, sought to answer the question, “If...sanity and insanity shall we know them?” Rosenhan recruited seven other volunteers to, under the cover of slightly altered identities, check themselves into American mental institutions. Their goal? To determine whether the mental health professionals working there could suss out the “pseudopatients” from the truly “insane.”

The author, Susannah Cahalan

It turned out that each and every volunteer was, quickly and without rigorous questioning, determined to have some degree of mental illness, from schizophrenia to manic depression. They were then cast off into a sad, lonely and often frightening existence among the institutionalized, until they could figure out how to get themselves released. The uproar created after Rosenhan’s study was published lead to the closure of most of the asylums housing the mentally ill and an upending of the entire psychiatric world.

However, Susannah’s research, including conversations with some of Rosenhan’s volunteers, concluded that much of the data Rosenhan collected was fabricated, embellished, or thrown away when it didn’t suit his end goal. I won’t go any more into the details of the story, because it’s just too good to spoil.

The Great Pretender is profound in its revelations about the sorry state of the mental health industry in America today, and that can be owed, in large part, to the lasting legacy of Rosenhan’s study. The criminalization of mental illness, the lack of beds in psychiatric facilities, the publishing of studies based on flawed and altered data, and the overall deficiency in understanding of the cause of mental illness has created a medical industry that relies on outdated, often subjective information.

Susannah's memoir, Brain on Fire

I read Susannah’s first book, her memoir called Brain on Fire, a few years ago, and was blown away by her courage to tell such a painful and personal story of her struggle with a dangerous auto-immune disease, which was incorrectly diagnosed as schizoaffective disorder. Her story makes the impact of The Great Pretender all the more powerful. Most patients aren’t as fortunate as Susannah, who was able to find a doctor who saw through her temporary mania to the root cause, anti-NMDA receptor encephalitis, and compassionate care is something Susannah and other progressive psychology professionals advocate heavily for today.

As someone who suffers from often debilitating bouts of anxiety, and has spent way too much time navigating our broken industry to get myself help, I am so thankful that there are educators like Susannah who are pushing through the red tape of the system to advocate for those who cannot speak for themselves. I highly recommend reading Susannah’s newest book, as well as her memoir, if you’re interested in mental health. We have a long way to go in fixing a broken system, but there is hope!

If you or someone you know is in need of help, please see below for resources:

For those of you in Portland, Susannah will be speaking at Powell’s on Tuesday, November 19 at 7:30 PM. I would love to see you there! For additional US tour dates, click here.

*Thank you to Susannah for sending me a copy of your book. I truly enjoyed reading it and am looking forward to lending out my copy!*

Happy reading!


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