Susannah Cahalan’s The Great Pretender is a gripping work of detection into the 1973 experiment that changed the course of psychiatry
The Great Pretender
Susannah Cahalan Canongate £16.99
It was an audacious hoax that delivered a deeper truth. In 1973, the esteemed journal Science carried an article revealing that eight individuals had approached psychiatric institutions in America and reported a single symptom. All of them claimed to hear a voice saying the words: ‘thud, empty, hollow’.
On the basis of that claim, all eight were admitted and became psychiatric patients. Having been found mad, they were treated as mad. Everything they did was interpreted as evidence of madness by the professionals supposedly caring for them. The individuals – now patients – began to think of themselves as mad as they submitted to the regimes of the asylums.
The study was initiated by psychologist David Rosenhan, who was also one of the pseudopatients, and it became one of the most influential articles in the history of mental health, an act of bravery in the service of whistleblowing. This, at any rate, was the version of Rosenhan’s study that author Susannah Cahalan first heard.
The Great Pretender by Susannah Cahalan investigates the Rosenhan experiment of 1973. Above: In The Madhouse, wood engraving by Ernst Ludwig Riepenhausen (1762-1840)
The question of who is mad and who is not, and how that line is divined, is one of personal interest to Cahalan. Her first book, Brain On Fire, tells how she was diagnosed with schizophrenia and would have been left to institutionalised decline had it not been for the intervention of one physician who recognised her symptoms as the result of a brain inflammation and brought her back to health.
Was Rosenhan a forerunner of Cahalan’s saviour? His paper underlined the insight that ‘medicine frequently operates more on faith than certainty’. When she started to investigate his research, she saw him as a hero. But the more she learned, the more she suspected.
By the Seventies, asylums had acquired a reputation for brutality. There was also a belief that mental health professionals were simply making up their diagnoses. Rosenhan’s work justified large-scale hospital closures. But his notes leave few traces of who his pseudopatients actually were.
He claimed that was to protect their identities, but there was another possibility: did they even exist? The few that Cahalan was able to identify raised even more questions. She discovered the study that changed the course of psychiatry was based on suppressions, distortions and some outright fabrications.
The Great Pretender is a gripping work of detection. But Cahalan is too generous to make a simple villain of Rosenhan. ‘Rosenhan’s paper,’ she writes, ‘as exaggerated, and even dishonest, as it was, touched on truth as it danced around it.’