The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness, by Susannah Cahalan (Review)

The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness
by Susannah Cahalan

Genre: Nonfiction, Psychology

Length: 400 Pages

Release date: November 5, 2019

Publisher: Grand Central Publishing


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?


If you’re going into this book expecting an in-depth rehashing of that experiment and its conclusions, you may be disappointed. I hold a BA in psychology, so I was already somewhat familiar with this study going into the book. While I did get some new information from The Great Pretender, it was not nearly as much as I’d hoped. Part of the reason for this is that the focus of the book is not super specific. The synopsis from the publisher gave me an impression of a very different book than I read.

Another reviewer (who enjoyed the book a lot less than I did) made the comment that it felt like Cahalan did a lot of research on peripheral topics for this book and didn’t want it to go to waste. Consequently, it all gets included. While I get where this person is coming from, I disagree. A lot of the history of psychology included in this leads directly into David Rosenhan’s reasoning for conducting his famous experiment. He sent healthy “pseudo-patients” into mental hospitals for two major reasons: to expose the hazy nature of psychological diagnostic criteria as they existed at the time, and to provide witnesses who would be palatable to the general public who could relay the treatment the mentally ill were receiving in these institutions. The historical backdrop did not feel superfluous.

Cahalan also delves into several other famous experiments, again in more detail than I would have expected given the blurb’s focus on Rosenahn. These major experiments are also relevant, albeit in a tangential way, because of the controversy surrounding them. The Stanford Prison Experiment (Philip Zimbardo) and Stanley Milgram’s experiment on obedience to authority. These experiments also share some thematic similarities with Rosenhan’s work; all of them explore the darker side of human nature  in varying respects. Zimbardo purported to show that the overwhelming majority of people are capable of horrifically abusive behaviors towards another person in dehumanizing, institutional settings like prisons. Milgram’s experiment had an authority figure in a lab coat asking participants to administer electric shocks to people as part of an experiment on the effects of punishment on learning. The “teaching experiment” was actually a smokescreen, and the true purpose was to see how many people would agree to shock someone who was in pain, and to what degree.

All three of these experiments (Rosenhan’s, Zimbardo’s, and Milgram’s) have faced sharp criticism of their methodology, with Zimbardo facing probably the most scrutiny. Issues vary from the potentially inappropriate level of manipulation on the participants from the researcher to outright deceit.

Cahalan’s book explores a variety of issues surrounding psychiatry in a good amount of detail, some only tangentially related to the experiment referenced in the title. If your interest in this book is primarily out of a desire to understand Rosenhan’s research, you may end up feeling like you are wading through a lot of unneeded information in order to get it. However, if you have a more general interest in psychology and psychiatry, this may be an excellent book for you.


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Thank you for reading! What was the last book you read that subverted your expectations in the a big way? How did it impact your reading experience?


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