Genre(s): Non-fiction, Psychology
The Great Pretender: The Undercover Mission that Changed Our Understanding of Madness is the author’s personal quest to find out about Dr. Rosenhan’s grand experiment that changed mental health treatment practices. It started in 1973 when Dr. Rosenhan committed himself to a mental hospital and had to prove himself sane. His published findings on the treatment of individuals in these facilities forever changed our reliance on these facilities, as well as how we handle mental health today.
The author, Susannah Cahalan, holds a special connection to this topic. She was nearly incorrectly diagnosed with schizoaffective disorder because of related symptoms but was eventually properly diagnosed with autoimmune encephalitis. Any further delay in this diagnosis and proper treatment would have left her with permanent brain damage, and eventually death. That being said, Dr. Rosenhan’s famous experiment sparked a desire in her to learn more. The study consisted of Dr. Rosenhan and several other students entering psychiatric facilities claiming to be sane, and having to prove their sanity to leave. By performing the steps above, Dr. Rosenhan was able to show the discrepancy/complete inaccuracy in diagnoses, as well as the poor treatment of paitents. However, as Cahalan continues her research of these experiments, she finds that there is a lot missing from the story.
I originally picked up The Great Pretender as a BOTM pick, being drawn to the topic of mental health myself. Near me, there is a massive psychiatric facility that at one point consisted of about 100 buildings. But in the wake of medication as treatment, and other forms of cause and effect described in this book, that massive facility was downsized, and eventually closed and abandoned in 1996. And as someone that is currently being treated for my mental health, sometimes I’ve wondered – if I were born any earlier, would I have ended up in that facility too?
Likely, that answer is yes. Throughout The Great Pretender, Cahalan describes the state of psychiatric facilities, and just how many people fit the bill to be housed in these buildings. There’s a lot of eye-opening information about the progression of diagnoses and treatments during this time, as well as the amount of ease there was to being let into these facilities. However, getting out was another story.
There is a lot of valuable information in this book for those that have interest in learning more about how we’ve viewed mental illness throughout history. There’s also quite a bit about the progression of diagnostic manuals like the DSM. My biggest complaint with this book, however, is that much of the information is scattered about, and in the beginning, the purpose wasn’t very clear.
When picking up The Great Pretender, I was primarily expecting a full account of the experiment itself in a linear progression. Instead, we start from the accounts of another woman who snuck into an asylum for a similar purpose. Then, we learn of the author’s struggle with her own diagnosis and treatment. I ended up finding her story to be very insightful and an example of why mental health should be treated with more attention and care, but I didn’t anticipate her perspective of researching it being a core portion of the book. Much of the book weaves in and out of her perspective as we hear her process in researching this case. She did a great job of this as there is a wealth of citations at the end of the book, but I was expecting more from the perspective of what happened.
Additionally, it takes a long time to actually dive into the study itself. Within the first 100 pages of this book, there were several instances where it seemed clear to me that the next chapter was going to start with Dr. Rosenhan being committed. Instead, the book goes into another direction. This made the whole book feel non-linear in its progression of explaining the experiment and its outcomes, even though it manages to save the long-term impact until the end. And considering the fact that this book has ~100 pages of notes and appendices, ~300 pages does not give a lot of room for explanation of the study. As the book progresses there is a very big reason for this, but I found the haphazard organization of this book to be very distracting.
There’s a turning point in this book that I will consider to be a “spoiler” (despite this being non-fiction, it is told in a narrative style and the information would impact your reading experience the first time). The discovery Cahalan here makes a very interesting topic of discussion, and essentially questions whether Dr. Rosenhan’s impact was the impact that was really needed. The comparisons made between today and what we know from the past is very insightful, and changed my initial feelings during the introduction of the book.
Overall, The Great Pretender serves as a decent introduction to the Rosenhan experiment, a brief history of mental health, and the impact of how we treat those who are in need of it (and those who are not). Despite my three-star rating, I would still recommend this book for those who need an introduction to these topics. There’s a lot to be said about our history of treatment here, and it would become insightful to those who question the need for things such as certain kinds of treatments, why we change how we diagnose individuals, and how we keep these things consistent. My main issues with the book were how it was organized and non-linear, as well as the book being different from my expectations based on the synopsis. Despite this, you’ll find a lot of information that you may find eye-opening.
