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Summary
Summary
Shortlisted for the 2020 Royal Society Insight Investment Science Book Prize
Named a Best Book of 2020 by The Guardian * The Telegraph * The Times
"One of America's most courageous young journalists" and the author of the #1 New York Times bestselling memoir Brain on Fire investigates the shocking mystery behind the dramatic experiment that revolutionized modern medicine in this international bestseller (NPR ).
Doctors have struggled for centuries to define insanity--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, healthy, 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 in this real-life detective story, very little in this saga is exactly as it seems. What really happened behind those closed asylum doors?
Author Notes
Susannah Cahalan is the award-winning, New York Times bestselling author of Brain on Fire : My Month of Madness, a memoir about her struggle with a rare autoimmune disease of the brain. She writes for the New York Post. Her work has also been featured in the New York Times, Scientific American Magazine, Glamour, Psychology Today, and other publications. She lives in Brooklyn.
Reviews (5)
Publisher's Weekly Review
Journalist Cahalan (Brain on Fire) sets a new standard for investigative journalism in this fascinating investigation into a pivotal psychological study. In 1973, the mental health system was in trouble, she writes, thanks to weak diagnostic criteria and overburdened hospitals and health-care providers. Stanford psychologist David Rosenhan understood it would take a grand gesture to incite reform--such as recruiting seven sane individuals to feign auditory hallucinations. Rosenhan used their accounts of institutionalization to write the 1973 article "On Being Sane in Insane Places," which sparked controversy and led to the widespread reform or closure of institutions and a revision of the DSM. However, his volunteers' identities were never revealed, which to Cahalan raises the question--was he hiding anything? Driven by her own traumatizing experience as a misdiagnosed psychiatric patient, Cahalan pours through Rosenhan's notes and lists of his known contacts, attempting to match real people to the study's unnamed subjects, and ultimately is unable to find proof that six out of the seven fake patients really existed. She also discovers the wholesale omission of a volunteer's account that contradicted Rosenhan's argument. Her impeccable inquiry into the shadowy reality of Rosenhan's study makes an urgent case that the psychological and psychiatric fields must recover the public trust that "Rosenhan helped shatter." Agent: Larry Weissman, Larry Weissman Literary. (Nov.)
Guardian Review
What does it take to be thought of as mentally ill? According to one of the most famous studies in psychiatry, very little. In 1973, the journal Science published "On Being Sane in Insane Places" by the Stanford psychologist David Rosenhan. The paper recounted how he and seven other researchers had gone separately to different psychiatric hospitals and presented a single symptom: hearing voices that said "thud, empty, hollow". Based on this, they were all committed, most being diagnosed with schizophrenia, and spent an average of 19 days institutionalised against their wills. "We now know," the paper alarmingly concluded, "that we cannot distinguish insanity from sanity." The paper made Rosenhan a celebrity and fed into the wider anti-psychiatry movement in the culture of the time: One Flew Over the Cuckoo's Nest, RD Laing's The Divided Self, and so forth. The message that the psychiatric emperor had no clothes spurred other researchers in a grand attempt to put the discipline back on a strictly scientific footing with the compilation of the first DSM (Diagnostic and Statistical Manual) for mental illness. Rosenhan, meanwhile, received a handsome book advance to expand on his research - but, oddly, he never finished that potentially very lucrative project. Which was the first clue to the big problem in this whole story: that, according to Susannah Cahalan's brilliant detective work detailed in this book, very little in the paper had happened in the way Rosenhan said it had. Some of his colleagues had suspected all along that the charismatic lecturer was also a "bullshitter". One of the surviving "pseudopatients" tracked down by Cahalan was eliminated from the study because during his hospital stay he was treated very well and enjoyed the experience (partly because, he now guesses, he really was depressed at the time). Another had false details inserted in his account. And the rest, she concludes, were probably wholly fabricated. This story is fascinating enough in itself, but as Cahalan points out, it also has relevance to the current "replication crisis" in psychology, where many celebrated findings have dissolved once other researchers attempt to repeat the experiments. But does it have anything to teach us specifically about psychiatry as it is practised today? Cahalan's own view of the discipline has been coloured by her experience, detailed in her previous book Brain on Fire, of being treated as schizophrenic before it was discovered that she instead had an autoimmune inflammation of the brain, and from this unpleasant experience she has derived critical opinions of what she calls "the whole system" that treats mental illness. She argues that the paper revealed a truth (about the unreliability of psychiatric diagnosis back then) even though it was fraudulent, and in some sense this is right, but it's notable that she spices up her narrative with horrible stories from psychiatry's dubious past (including the devastating lobotomy imposed on JFK's sister Rosemary), without ever going into comparable detail about its numberless anonymous successes. Indeed, the most damning revelation of Rosenhan's fraud, as she shows, is actually an example of psychiatry working exactly as we wish it should. Rosenhan got himself committed by going much further than sticking to the one symptom he describes having offered in his paper - voices saying "thud, empty, hollow"; he also told the admitting psychiatrist, Frank Bartlett, that he was sensitive to radio waves and could hear what people were thinking, and - most seriously - that he was suicidal. Cahalan discovered this by digging up Bartlett's own notes of their first interview. As it turns out, committing Rosenhan was the only thing a responsible doctor could have done - and could still do today. As Cahalan herself comments: "Dr Bartlett wasn't a bad doctor who made a bad decision ¿ He was a good doctor who made the best call given the information he received." By the end of the book, she has adopted a more optimistic view, looking forward to new brain-scanning technologies and genetic research that might enhance our understanding of what can go wrong within the brain, the most complex object in the known universe. She does also finally concede that modern psychiatry helps untold numbers of ordinary people: psychiatric drugs "help many people lead full and meaningful lives", she writes. "It would be folly to discount their worth." But by the time of this grudging admission, pages from the end, this book might have been happily seized on by cultists and fearmongers who want to dismiss the discipline as a conspiracy cooked up by Big Pharma and the authoritarian state. The truth is that psychiatry, along with medicine in general, remains a highly imperfect science - but the book's polemical implication that it has not moved on much since 1973 has the potential to be truly harmful to anyone thinking about seeking help now.
Kirkus Review
A sharp reexamination of one of the defining moments in the field of psychiatry."There are not, as of this writing, any consistent objective measures that can render a definitive psychiatric diagnosis," writes New York Post journalist Cahalan (Brain on Fire: My Month of Madness, 2012) at the beginning of this gripping account of a study that rocked the foundational concepts of how we judge sanity. In the early 1970s, David Rosenhan, a Stanford professor of psychology, sent eight sane people into hospitals for the insane in an experiment involving diagnostics and conditions for the mentally ill. The eight participants told the intake doctors that they were experiencing aural hallucinations, and they were all admitted for varying lengths of time. The resulting article, which appeared in Science, is credited with helping to change both diagnostic and hospitalization procedures. At first, Cahalan approaches the article, "On Being Sane in Insane Places" (1973), with a level of awe and appreciation and treats readers to a tour of the miseries that patients enduredmost notably, isolation and dehumanizationas well as a review of her own misdiagnosis of schizophrenia. Eventually, doubts start to creep into the author's investigation, discrepancies that a purportedly scientific article should not have contained: lying about hospitalization dates, exaggerating medical records, playing with numbers, and more. Cahalan follows all the leads like a bloodhound, in particular trying to uncover the identities of the patients. Her pursuit reads like a well-tempered mystery being picked apart, with tantalizing questions for which many of the answers are just out of reach. While "On Being Sane" may have been partially fabricated, it was also an important force in the deinstitutionalization of care for the mentally ill. Cahalan draws a vivid and critical picture of Rosenhan and the ramifications of his most prominent work.A well-told story fraught with both mystery and real-life aftershocks that set the psychiatric community on its ear. Copyright Kirkus Reviews, used with permission.
Booklist Review
Following her bestselling memoir, Brain on Fire (2012), about how an unknown pathogen caused brain inflammation, seizures, and paranoia, journalist Cahalan tackles a larger medical mystery that also raises profound questions about the field of psychiatry. Her quest: to figure out the true story behind an influential 1973 article in Science, On Being Sane in Insane Places, that changed the national conversation about mental health. Psychologist David Rosenhan and seven other sane, healthy people pretended to hear voices and committed themselves to psychiatric institutions to see if doctors and staff could distinguish between individuals who were genuinely ill versus the undercover pretenders. But Cahalan began wondering if the now deceased Rosenhan, who never revealed the volunteers' real names, might have made it all up? She notes that the study contributed to the shuttering of psychiatric hospitals, and to important disclosures about how depersonalized mentally ill patients felt and how psychiatric conditions were often dismissed as less legitimate than physical ones. Cahalan's compelling and provocative investigation raises many questions about our attitudes toward mental illness and psychiatry.--Karen Springen Copyright 2010 Booklist
Library Journal Review
A former reporter for the New York Post, Cahalan was institutionalized for a month because doctors believed she had a psychiatric illness, though she actually had an autoimmune type of encephalitis. When she recovered, Cahalan became interested in the process of how she came to be misdiagnosed and treated. Cahalan discovered a 1970s study, "On Being Sane in Insane Places" by Stanford's David Rosenhan, which purported to determine the effectiveness of psychiatric diagnosis through the introduction of false, sane, patients into psychiatric hospitals. His study affected government support of psychiatric hospitals and the way the Diagnostic and Statistical Manual of Mental Disorders defined specific illnesses. The resulting changes still affect mental health care in the U.S. today, though Cahalan dug deeper into Rosenhan's research and came to the conclusion that most of his data was fabricated. Though ably narrated by Christie Moreau and by the author, a pronunciation error or two stand out. VERDICT Will be of interest to those seeking to learn about the U.S. mental health system and/or psychology.--Cheryl Youse, Norman Park, GA
Table of Contents
| Preface | p. xi |
| Part 1 | |
| 1 Mirror Image | p. 3 |
| 2 Nellie Bly | p. 12 |
| 3 The Seat of Madness | p. 22 |
| 4 On Being Sane in Insane Places | p. 33 |
| 5 A Riddle Wrapped in a Mystery Inside an Enigma | p. 42 |
| Part 2 | |
| 6 The Essence of David | p. 53 |
| 7 "Go Slowly, and Perhaps Not at All" | p. 63 |
| 8 "I Might Not Be Unmasked" | p. 75 |
| 9 Committed | p. 83 |
| 10 Nine Days Inside a Madhouse | p. 86 |
| Part 3 | |
| 11 Getting In | p. 111 |
| 12 ... And Only the Insane Knew Who Was Sane | p. 122 |
| 13 W. Underwood | p. 131 |
| 14 Crazy Eights | p. 135 |
| 15 Ward 11 | p. 148 |
| 16 Soul on Ice | p. 156 |
| 17 Rosemary Kennedy | p. 162 |
| Part 4 | |
| 18 The Truth Seeker | p. 173 |
| 19 "All Other Questions Follow from That" | p. 182 |
| 20 Criterionating | p. 192 |
| 21 The SCID | p. 199 |
| Part 5 | |
| 22 The Footnote | p. 213 |
| 23 "It's Ail in Your Mind" | p. 230 |
| 24 Shadow Mental Health Care System | p. 236 |
| 25 The Hammer | p. 247 |
| 26 An Epidemic | p. 265 |
| 27 Moons of Jupiter | p. 279 |
| Epilogue | p. 295 |
| Acknowledgments | p. 301 |
| Notes | p. 307 |
| Index | p. 367 |
| Permissions | p. 381 |
