The Great Pretender

The Undercover Mission That Changed Our Understanding of Madness

By: Susannah Cahalan

Narrated by: Christie Moreau, Susannah Cahalan

Length: 11 hrs and 3 mins

Publisher's summary

A Literary Hub Most Anticipated Books of 2019 Pick

From "one of America's most courageous young journalists" (NPR) comes a propulsive narrative history investigating the 50-year-old mystery behind a dramatic experiment that changed the course of modern medicine.

For centuries, doctors have struggled to define mental illness - 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, normal, 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, very little in this saga is exactly as it seems. What really happened behind those closed asylum doors, and what does it mean for our understanding of mental illness today?

PLEASE NOTE: When you purchase this title, the accompanying PDF will be available in your Audible Library along with the audio.

©2019 Susannah Cahalan (P)2019 Hachette Audio

Critic reviews

"Breathtaking! Cahalan's brilliant, timely, and important book reshaped my understanding of mental health, psychiatric hospitals, and the history of scientific research. A must-read for anyone who's ever been to therapy, taken a brain-altering drug, or wondered why mental patients were released in droves in the 1980s. And a thrilling, eye-opening read even for those who thought they weren't affected by the psychiatric world." (Ada Calhoun, author of St. Marks Is Dead and Wedding Toasts I'll Never Give)

"A well-told story fraught with both mystery and real-life aftershocks that set the psychiatric community on its ear." (Kirkus)

"Susannah Cahalan has written a wonderful book that reflects years of persistent and remarkable historical detective work. The Great Pretender is an extraordinary look at the life of a Stanford professor and a famous paper he published in 1973, one that dramatically transformed American psychiatry in ways that still echo today. The book is fast-paced and artfully constructed - an incredible story that constitutes a tribute to Cahalan's powers as both a writer and a sleuth." (Andrew Scull, author of Madness in Civilization: A Cultural History of Insanity)

"The Great Pretender is a tight, propulsive, true-life detective story which somehow also doubles as a sweeping history of our broken mental health-care system. Cahalan herself has experienced this system as both a patient and a reporter, and her background informs every fascinating page of this dogged investigative odyssey. It is an amazing achievement, and there is no question it will go down as the definitive account of one of the most influential psychology experiments of all time." (Luke Dittrich, New York Times best-selling author of Patient H.M.)

"Cahalan researched The Great Pretender over the course of five years, but the pages practically turn themselves. It's absorbing, sometimes sobering, sometimes seriously funny. Cahalan's narration makes the reading great fun, with an urgency occasionally akin to a thriller." (Shelf Awareness)

Important story of fraud really well told

If you teach psychology, practice psychology, or have ever been tested by a therapist of any sort this is an absolute must read. I am a Ph. D. In experimental ( cognitive and social) psychology and now a generalist teaching undergraduates. For years my main area of teaching was research methods and statistics so I am up to date and very interested in the “ replication crisis”. I’ve also been in therapy and have friends who are psychiatrists, clinical psychologists and clinical social workers. I also have a close relative who was at one point diagnosed as schizophrenic though later that diagnosis was corrected and today he is a completely “ normal” college professor. So I’m interested in this story from about every angle except actually practicing diagnosis myself. But I was not expecting the story to be told in such a well told and compelling manner! I highly recommend this book to absolutely anyone. It is thorough, gives a really interesting history of psychiatry, institutional treatment of people diagnosed with osychiatruc disorders and the pivotal role the ultimately fraudulent experiment that is the focus of this book played in changing the dominant model of disorders to a medical model and how that changed institutional treatment. It also covers the history of fraud in psychology in general including “ the replication crisis” as well as new methods of treatment and new models of disorders. Oh and it also tells a very good detective story around this pivotal piece of research done decades ago.

What’s the Takeaway?

Imagine being a passenger in a car and the driver is talking to you about New York the whole ride, so you assume that’s where you’re headed. But then just as you’re about to reach New York he hops off the highway and turns toward Pennsylvania, and it turns out you’re actually going there… Or maybe not. Hard to know because the car just kind of slows to a stop in the middle of nowhere.

I’m just not sure what I was supposed to gain from this when all was said and done. The message seemed crystal clear for the first ~75-80% of the book, and then took a turn in an entirely different direction. It’s like okay, interesting twist, but where does it leave things?

Boring and biased

I felt compelled to listen to the very end, waiting for this book to redeem itself, but it didn’t. The author does not possess the appropriate background (medical or psychological), training, or credentials to be able to appropriately interpret her data and draw meaningful conclusions. Much of the book is her opinion and while she is likely an excellent researcher, her opinion is not really valid in areas well outside her expertise.
Furthermore, the content was simply not that interesting. There were a few stories about patients living in asylums that were morbid enough to be interesting and a handful of studies that were worth learning about but I felt the majority of the book was quite boring. This was a surprise to me, given the topic. I was disappointed.

Impostors evaluate the mental health system

Self proclaimed mental health expert writes a slobbering tribute to a then unknown psychologist (non-MD ) who unethically convinced a small group of politically charged undergrads (from an elitist east coast university) to infiltrate the mental health system in order to "critically evaluate" their care. None of them were heath care experts nor had any training in the mental health system at all but subsequently lied and cheated their way into a very small number of facilities to provide an "objective" account of life on the "inside". This paper gained surprising recognition primarily because it was published in the magical journal Science. Today it wouldn't get published in People magazine. The authors words drip with intrigue at every turn and bore us with her endless interpretations of every dishonest moment. This is a pathetic attempt by a "journalist" at enlightening the uninformed masses about the current state of mental health in America, based on a 50 year-old report with limited data. Don't waste your time.

Slow going but got better.

I was excited to read this because I tore through Brain on Fire so fast. I knew this was going to be different but I had high hopes.it was slow going and boring at first but it got more interesting after the first few chapters. The story telling is great and I get why people say it reads like a mystery but at times it gets boring going off on tangents and statistics and lost interest.

pretty boring

struggled to finish, she repeats herself over and over and doesn't really have a clear path or plot.

Muddy presentation of subject marred by mispronunciations

I’ve never before asked to return a book I’ve purchased, but I will this one.

The author’s position on “mental” versus “physical” illness and health was difficult to discern. At first it appeared that she was arguing for a dichotomy separating mind and brain/body. Her initial dismay at “transfer to psych” reinforces a stigma against which she seems to argue. Hard to follow.

There are many other books by neurologists and psychologists and psychiatrists (as well as lay people) that present more poignant and compelling pictures of the struggle of “mental” versus “physical” illness. See for example anything written by Oliver Sachs; An Unquiet Mind by Kay Redfield Jamison; The Center Cannot Hold by Elyn R Saks; Darkness Visible by William Styron; The Noonday Demon by Andrew Solomon; or The Spirit Catches You and You Fall Down by Anne Fadiman.

The narration was marred by mispronunciations of words well-known in the professional community. Questioning my own pronunciation and concerned that a colloquial and idiosyncratic accent might have biased my appreciation of the narration, I “googled” several and confirmed my suspicions: the acCENT was often on the wrong syLLAble.

Overall a great book

I think this book is fascinating. Anybody who is interested in mental health should read it. The story feels a little Monday night and gets off-track and goes on tangents sometimes. Also I found it really odd at it distracting it to have a different narrator for the very last chapter. The main narrator is great, but the other narrator is not

Wonderfully researched, surprising and enlightening

Susannah Cahalan has done a wonderful job in writing this engaging, enlightening, funny and depressing account of mental health care and academic fraud. It reads like a mystery as we explore her research with her. She brings to light sides of the story that paint the article and author, of which this book is based, that make us see it in a new context. I loved this and her previous book and look forward to any future works from this author and great investigative journalist.

I’m thrilled people are talking about mental health

I loved Susannah Cahalan’s first book And while this one is more technical. The world needs to start reading and researching and finding answers to why some people are touched with mental illness and why some are not. Is it the inability to process folic acid, Is it a slight swelling in the brain due to immune issues, is it Harmons?? I am so hopeful that we are closer to understanding. I praise Susannah For her dedication to this topic. She was the right person to be touched with insanity and recover from it. Thank you.