The Great Pretender by Susannah Cahalan

How I Read It: Audiobook

Dates Read: 11/20/19-11/24/19

How I Found It: Book of the Month

I’ll be honest, I’m not a psychologist. At all. In fact, I got a C in Intro to Psychology when I took it as a freshman in college. To me, psychology is not that interesting in the abstract, but I find particular case studies interesting. For example, the Stanford Prison Experiment (which was created into a movie in 2015) and Pavlov’s experiments have always interested me. This book discusses a study called Being Sane in Insane Places by David Rosenhan. In this study, Rosenhan gets 8 mentally healthy people to go into an insane asylum and initially convince them they are insane, then trying to prove their sanity to get back out. Within this book, we learn about the people that were involved, especially Rosenhan, and how mental health analysis has changed both in connection to this study and as our view of mental health has changed.

Firstly, let’s start with Cahalan. When she was in her twenties, she was hospitalized with symptoms of schizophrenia. While many people with that diagnosis would be stuck in psychiatric wards, her parents fought for another reason. Eventually, a thoughtful doctor found the illness was autoimmune encephalitis, which is when your body attacks the brain. The disease was caught just in time, and Cahalan was able to fully recover. Another woman had the same disease but it was not caught early enough, and now she is forced to live in a hospital for the rest of her life. Since she could have easily been the woman, Cahalan shared her story in a memoir, called Brain on Fire (which has been adapted into a Netflix movie in 2018).

In Rosenhan’s study, 9 people (including Rosenhan himself) went into a mental hospital intake area saying that they heard voices that said something along the lines of “empty”, “thud”, and “hollow”. According to his results, 8 of the pseudopatients were given a schizophrenia diagnosis, with one pseudopatient receiving a manic depression (now called bipolar disorder) diagnosis. Most stays lasted between 10-30 days, while some pseudopatients stayed in hospitals for as long as 3 months (over multiple stays). According to Rosenhan, all pseudopatients left the hospital against medical advice “in remission”. (One of the pseudopatients was not listed in the original study, but rather in a supplemental report. This supplemental report was important because the patient, according to Rosenhan, could not be counted because he lied about other aspects of his life that could result in a mental health disorder.)

When Rosenhan reported the study in 1973, along with Rosemary Kennedy’s lobotomy, mental health reform came to the US. But this study received A LOT of criticism. One of those problems was the small number of pseudopatients, which causes a lot of extrapolation. Also, Robert Spitzer wrote a response on Rosenhan’s experiment calling it “logic in remission”. He believed that there was misreporting within the study that led to fabricated results.

Cahalan got Rosenhan’s notes from his time on Being Sane in Insane Places after his strokes. Using these notes and his friends from that time period, Cahalan tried to piece together who the pseudopatients were hoping to find out more information about Rosenhan’s study. What she found questions the entire validity of the study, with many of the pseudopatients being impossible to track down, or the ones that can be found giving different testimonies than reported.

I found the book a little repetitive, but I think the amount of research that went into the book is INSANE. I think that there are a lot of things that don’t add up, and sadly, we can’t ask Rosenhan about them. I think that he was a man that wanted to prove his point, and gain notoriety along the way, even if he has to cut corners to get there. But obviously my opinion is slightly biased because I have just listened to 11 hours of one side. So let me know what you guys think and if you think Rosenhan’s study was valid or not.

In terms of rating, I would probably give this one 4.5 out of 5. While completely out of my usual, I did listen to it whenever I had a chance to, which means it is pretty good. There were a few things that bothered me, but otherwise I thought it was easy for someone who didn’t know anything about the study (like me) to be able to read and understand this book.

(P.S. I totally think that a movie called Being Sane in Insane Places needs to happen)

If you guys have any thoughts or ideas, feel free to leave a comment, find me on the social medias at @elizabooksblog, or email me at And as always, I’ll see you all in the next book!

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