4/30/2020

ON BEING SANE IN INSANE PLACES : PSYCHIATRY REVIEW


A detective in the corridors of the mind : ''The Great Pretender'' : The Undercover Mission That Changed Our Understanding of Madness.

Books about mental illness often reflect on how reality is experienced. in addition to the standard questions - What do we know, and how do we know it? - is another layer of inquiry : What do we know about our own minds, and what if it isn't true?

In her first book, ''Brain on Fire,'' Sussanah Cahalan, described her horrifying experience of presenting symptoms of mental illness that looked like schizophrenia but turned out to be an autoimmune disease.

She eventually received the treatment she needed, but the tortuous ordeal disrupted her assumptions about the medical profession and her sense of self.

Her next promised to be straightforward by comparison : She would use her skills as an investigative journalist to write about somebody else a scientist and his pathbreaking study.

In 1973, a psychologist David Rosenhan published ''On Being Sane in Insane Places''in the journal Science, helping to upend the field of psychiatry.

He had recruited healthy volunteers to feign symptoms of mental illness and get admitted to hospitals, thereby showing how easily ''sane'' people could be ''institutionalized'' by a profession that had enormous confidence in its diagnoses and  had accumulated a vast amount of power.

Cahalan decided to track down these volunteers, or ''pseudopatients.'' She had lander a puzzle that seemed to be missing only a few pieces.

What she unearthed turned out to be far stranger, as documented in her absorbing book, ''The Great Pretender.'' It's the kind of story that has levels to it, only instead of townhouse it's more like an Escher Print.

One one level : A profile of Rosenhan and his study; on another Cahalan's own experience of researching the book. And on a third : the fraught history of psychiatry and the pursuit of scientific knowledge.

Rosenhan's paper has been one of the most reprinted and cited papers in psychiatric literature. An anti-psychiatric movement was growing throughout the 1960s, promoted by books like:

Thoma Szasz's ''The Myth of Mental Illness'' and  Erving Goffman's ''Asylums''; what Rosenhan's experiment provided was reassuring buttress. Cahalan writes, of ''scientific certainty.''

His influence was real and lasting. Psychiatric hospitals closed, while an embarrassed profession tried to reinvent itself, eventually overhauling its diagnostic manual. Gone were the fuzzy psychoanalytic references, which were replaced by a more biological and standardized approach.

But this isn't just a case of a journalist uncovering the details of an important story, Calahan was intrigued by Rosenhan's study because it resonated with her own experience.

Reading ''One Being Sane in Insane Places,'' she realized that that the pseudopatients were like her  "mirror image'', if it hadn't been for the doctor's who identified the inflammation in her brain that was masquerading as a mental illness, Cahalan, like Rosenhan's volunteers, might have been swept  ''inside any broken mental health system.''

So she set out to find the eight volunteers, all of them unnamed in the paper and identified only by pseudonyms in Rosenhan's notes.

She soon learned that the pseudopatient named ''David Lurie'' was Rosenhan himself, who died in 2012, after a series of debilitating strokes.

She eventually met with the other two volunteers. Only one of them was included in the study, the second was excluded for having ''falsified aspects of his personal history,'' Rosenhan wrote.

The honor and serving of the latest Global Operational Research on great scientific work and journalists, continues. The World Students Society thanks review author, Jennifer Szalai.

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