The Great Pretender, Susannah Cahalan's first book since Brain on Fire, her 2012 memoir of a rare, difficult-to-diagnose autoimmune disorder, investigates an infamous and groundbreaking 1973 study carried out by psychiatrist David Rosenhan. Rosenhan sent a group of eight healthy "pseudopatients" into mental institutions with the goal of determining whether it was possible for sane people to be admitted merely by faking symptoms of mental illness; namely, could doctors and staff "distinguish sanity from insanity."

"That study, published as "On Being Sane in Insane Places," drastically reshaped psychiatry, and in doing so sparked a debate about not only the proper treatment of the mentally ill but also how we define and deploy the loaded term mental illness."

The more Cahalan delved into what Rosenhan's study entailed, and tried to determine basics like who the pseudopatients actually were, the more complex the story became. This study was revolutionary in its own way; she notes that its publication "would upend the field of psychiatry and fundamentally change the national conversation around mental health". And yet details and information around it, which should be clear and readily available for a scientific study that had such major repercussions, proved scant and elusive, and Rosenhan's own records confusing and secretive.

Not to mention a creeping sensation of something not being quite right. Cahalan's dogged research begins to unpack this, and what the implications may be, as the narrative progresses.

Cahalan was understandably interested in the experiences of the pseudopatients, since she could be identified as one herself, initially labeled schizophrenic during her hospitalization, and she took it as "a challenge, a call to learn more and understand how this study, and the dramatic questions Rosenhan raised almost fifty years ago, could help the untold others whom our health care system still leaves behind."

This reads like a medical detective story, and Cahalan writes from a first person perspective in some sections to better put some of her findings and interviews into context. As in her first book, she's a smart and enjoyable narrator, so her presence in these parts of a history work well. Plus she had that deeply seated personal interest in exploring this story:

"Diseases like the one that set my brain "on fire" in 2009 are called the great pretenders because they bridge medical worlds: Their symptoms mimic the behaviors of psychiatric illnesses like schizophrenia or bipolar disorder, but have known physical causes, such as autoimmune reactions, infections, or some other detectable dysfunction in the body."

Elsewhere, Cahalan retreats and only reports the story, drawing often on the notes that Rosenhan collected from his pseudopatients during their time institutionalized. He went undercover in one location himself, under the name David Lurie, where he was diagnosed schizophrenic like most of the pseudopatients, perhaps because they followed a set list of symptoms and behaviors. As Lurie he wrote constantly to record his experiences, and fellow patients and even doctors asked if he was writing an expose of the hospital but then waved it off themselves. "It was just a joke. Of course David Lurie wasn't writing an expose. That would be crazy." The insights like this are illuminating, and sometimes chilling.

In the course of the investigation, Cahalan fills in back story of medical and psychiatric history, as well as tying it all to the present, including the prevalence of fraud in medical and psychological research: "I notice fraud everywhere now. In the fall of 2018, Cornell University professor Brian Wansink resigned after thirteen of his papers -- including one that showed how serving bowl size increases food consumption -- were retracted and Cornell found he committed "academic misconduct in his research and scholarship..." (Tell that bit about bowl size to this author, please.)

But, much as I love all the side dives this takes, including little stories like the above, it brings me to the problem I had with this book. Cahalan's research is so extensive, so comprehensively no-stone-unturned, that the general thread of the story of the study and Rosenhan's work often gets lost. There are so many additional forays and explorations that it's easy to lose sight of the primary story, or get confused and forget who's doing what where and why. This isn't helped by all the obfuscation and mystery around the study, its participants, and the question of whether at least some of it was fabricated.

It's highly entertaining to read, and well written considering the wealth of information, which is probably why you don't notice immediately that the organization is a mess. I only realized how scattered, and how much of a problem it was, once I started trying to write about it. I can barely articulate what exactly it's about, or coherently explain what trails it veers off on.

So that's worth knowing. It's like a page-turning mystery, you'll learn a lot, including about unexpected areas, but you might get lost and if you're a stickler for organization, good luck. If you're willing to just read it for what it is, it's a compelling, exciting mishmash of psychiatric/medical history, fraud investigation, and detective story.

Thank you NetGalley for allowing me to get an advanced copy of this book.

This book is certainly a heavy nonfiction book, filled with the history of psychology, abnormal psychology, and Susannah’s own research journey as to how one 1970’s psychologist may have significantly impacted the way we understand mental illness nearly a half century later.

While at times, I struggled to get through this book as it is laden with some technical but much needed references - it really made me think and question concepts I thought I understood.

As someone who has degrees in psychology, this book certainly piqued my interest but you certainly don't have to have prior exposure to the studies that influenced today's practices. Anyone interested in mental health, psychology, and how physical diagnoses can often be interpreted as psychological diagnoses will want to pick this book up.

I do have to say this may be a book you want to nurse, it definitely heavy and technical, but also very insightful and may be better read over a period of time to truly appreciate and understand where the field of clinical psychology, mental health, and medicine has come over a few short decades.

The author was initially misdiagnosed as schizophrenic. Instead, she had autoimmune encephalitis, an organic brain disorder often called The Great Pretender for its ability to mimic the signs of psychiatric disease. Even though she was labeled as a mental patient for only a week, wondering what would have happened if the initial diagnosis wasn’t overturned compels her to investigate the US mental health care system. In fact, she finds someone who spent years in the mental health system before being correctly diagnosed with the author’s disease with unfortunate consequences.

“The brain is a physical organ and physical disease occurs within the brain. Why does that make it a ‘ psychiatric condition’ instead of a physical ‘ disease’?”—from a father of a son diagnosed with psychosis quoted in the book

The Great Pretender makes an excellent case that psychiatry is the study of neurological disease for which we have no cause or cure...yet. Both autoimmune encephalitis and syphilis were originally diagnosed as mental disorders. Once a cause and cure were found, they were moved to neurology.

Originally all mental diseases were thought to be caused by the devil. Next, medical science thought it was a weakness in the person’s character, which could be solved by drastic measures like lobotomy and shock therapy. Now, a person’s history is blamed with talk therapy and strong drugs as cures. Who is to say that that is the final solution to psychiatric disease.

The heart of the book concerns the landmark study in 1973 by Stanford professor David Rosenhan, On Being Sane in Insane Places. He and seven of his students and colleagues self-reported symptoms of psychosis to get placed in one of the facilities. Once there, they acted normally until someone released them. The average time to get out was fifteen days. The study’s conclusion was that psychiatry had no clear way to diagnose or cure mental illness. It was unable to separate the sane from the insane. The author finds additional notes from the study’s now-deceased author. She finds one of the living pseudopatients and interviews him. The author also finds a ninth pseudopatient who is mentioned only in a footnote within the study. His story is told in the book.

Currently, four percent of the US have serious mental illnesses. Many will have their lives shortened by ten to twenty years because of their condition. If you, or someone in your life, have one of these issues, you must read this book for a different perspective. Even if you are just interested in psychology, like me, The Great Pretender is highly recommended. 5 stars!

Thanks to Grand Central Publishing and NetGalley for a copy in exchange for my honest review.

As a follow up to her successful memoir, Brain on Fire, Susannah Cahalan explores the world of mental illness. In The Great Pretender, she explores the study done by Stanford psychologist David Rosenhan where he and seven volunteers enter mental hospitals to understand what goes on behind close doors. The only way out is to convince the staff that they are actually sane.

I loved Brain on Fire. I love when nonfiction books read like fiction books and I will have to say that this one was not as easy to read. It's definitely packed with research (as you can tell from the 70 pages of citations in the back of the book) and clinical terms on mental illness. I think Cahalan is an amazing journalist. Based on the title, I expected this book to be about the experiences of the volunteers in the facilities, but it was really an expose on David Rosenhan and his famous study. It's still worth a read to gain a better understanding of the evolution of how we understand and treat mental illness today. 3.5 stars!

Thank you to Grand Central Pub and NetGalley for a copy of this ARC in exchange for my honest review.

The Great Pretender was initially intriguing to me as mental health diagnoses and treatment is a topic I am very passionate about and has also been a part of my life personally. Author Susannah Cahalan shares an in-depth look at a study from the 1970s that I had previously never heard of before but still affects the diagnosis process to this day. It was an eye-opening experience to see how mental health has been treated both historically and some practices that still continue today.

Cahalan's first book, Brain on Fire, was a personal look at her own experiences and I loved that this book was a wonderful follow up to this important and timely topic as a whole. While we have come so far, we still have a way to go when dealing with mental health stigmas and treatment.

Non-fiction books like this are such a powerful and important conversation starter. While this novel was insightful and thought-provoking it wasn't an easy read at times. With that said, sometimes discomfort is what can fuel the fire for change and I am so glad I gave this once a chance.

The second book written by Susannah Cahalan and I was such a fan girl after the first that I was first in line at BookExpo to get a signed copy of this one!

This book is different from the first, but seems like a cousin and a perfect pairing. After Susannah went through her episode and diagnosis that was expertly laid out in her first book Brain on Fire, she took this deep dive into psychiatry and thus this book was born. Cahalan does a ton of research on a big name in psychiatry - David Rosenhan and his study that he did sending in "sane" people into an asylum to test doctors and nurses and the system.

What a journey this book was. I am a novice when it comes to psychiatry and its checkered past, so this book was almost part textbook while I learned the ups and downs of institutions and diagnosing of patients. At first I was hopeful that we had come a long way, but in the end I realized that as a society we are more accepting of mental illness as a true illness, but we haven't come close to making sure that our drugs and therapies are really helping patients.

While I don't have anyone real close who has been impacted by mental illness, I found this book to be so fascinating and heartbreaking all at the same time. I hope that Cahalan can write another book that takes us forward in this field and provides hope that we are treating patients as they need to be.

This was another fantastic book by this author and I maintain my fan girl status!

Wow. This book was so shocking. Cahalan’s writing is fabulous, her research carefully done. I’m definitely going to be talking about this with friends and family. I highly recommend.

The Great Pretender, by Susannah Cahalan, is one of the most extraordinary, best written works of nonfiction I think I’ve ever read. I have so much to say about it that I’m honestly not sure where to begin! This book takes on our existential fear of mental illness, our cultural dread of asylums, and the possibly unsolvable problem of where mental illnesses come from and how to cure them. Cahalan uses all her skills as a journalist to dig deep into a contentious scholarly and societal argument about the the legendary Rosenhan Experiment.

After her own hospitalization and initial misdiagnosis (documented in Brain on Fire), a doctor told her about David Rosenhan and “On Being Sane in Insane Places,” published in Science in 1973. Earlier this year, I read “On Being Sane.” I recall being horrified and struck by the truth of what Rosenhan was saying: that even professionals have a hard time diagnosing mental illness, especially in institutions like the old mental hospitals that existed up to the 1970s. Once the label of mental illness is applied, everything the “patient” does is a symptom of that illness. Thus, once you’re in, it’s hard to prove you’re sane and get out. Cahalan, who turned out to be suffering from autoimmune encephalitis, was labeled as schizophrenic until a doctor spent some more time on her case and figured it out. It’s no wonder that “On Being Sane” resonated with Cahalan.

Initially, Cahalan set out to find the pseudopatients in “On Being Sane,” who volunteered to get themselves committed to various asylums. The article refers to eight pseudopatients (with one thrown out for improvising too much) who presented with claims of auditory hallucinations that riffed on the words thud, empty, and hollow. They then spent various lengths of time before wrangling their way out again. One of the pseudo patients was diagnosed with manic depression (now called bipolar disorder); all the rest were diagnosed with varieties of schizophrenia. When “On Being Sane” was published, it exploded on the discipline like a bomb. Its legacy touched on the development of new editions of psychiatry’s bible, The Diagnostic and Statistical Manual of Mental Disorders, the political dismantling of America’s state mental hospitals, and fueled lingering doubts about the veracity of psychiatry in general.

But when Cahalan starts to dig, she turns up an unexpected and troubling can of worms about Rosenhan’s experiment. I don’t want to say too much because Cahalan’s writing about her investigation is beautiful, subtle, and credible. I started out like Cahalan. I trusted Rosenhan’s “On Being Sane.” It just seemed so true. But there are questions. Why didn’t Rosenhan finish his book about his experiment? He was eventually sued by his publisher to recover the advance. Why is it so hard to find the pseudopatients, even allowing for the passage of time? Like Cahalan, my opinion of Rosenhan started to shift right along with hers as she shared her findings. Cahalan takes us from certainty, to doubt, to a new plane of important, useful questions about mental illness and treatment.

This review barely scrapes the surface of Cahalan’s investigation. And I can’t say enough in praise of The Great Pretender. I loved this so much that I’m going to lobby our behavioral sciences librarian to buy a copy for the library and badger every reader I know who is interested in health and mental health to read this book.

This is an absolutely engrossing and fascinating non-fiction piece about Rosenham's psychological/psychiatric experiments where sane people were placed in asylums to test psychiatric labels and diagnoses. These people had to prove their mental health in order to be released. All eight came out with shocking stories of their treatments, leading a massive changes in the mental health field. It was absolutely appalling the way they were treated! Shocking and disturbing, but something people really should read. Mental health care is always a changing field, and few understand how far treatments have come, as well as how far they still have to go. Cahalan is here to open eyes and minds!

With " Brain on Fire" Susannah Cahalan bravely shared with the world her bought with madness that left her forever changed. In " The Great Pretender" Cahalan delves into the world of mental illness again, following an early study conducted in the early seventies by Dr. David Rosenhan. The study placed Rosenhan and seven other sane volunteers into an asylum. Their intended purpose: to prove their sanity in order to be set free.

Cahalan's investigative nature lends itself to an insightful and thought provoking novel. I found myself engrossed in the history of the study while being pulled further into it's mysterious outcome. What prevailed is a study that forever impacted our modern day mental health system.

As a proponent of mental health awareness, I highly recommend this read for anyone interested in the history of psychiatry and psychology. This book will leave you more educated and empathic. A five star read!