When, in my rambling way, I told Lee about how my own story led to David Rosenhan’s, he interrupted me.
“I had Guillain-Barré,” he said. “I had hallucinations, too. But I had hallucinations because I was severely sleep-deprived, because I couldn’t close my eyes. They like to say everybody’s about six degrees Fahrenheit from hallucinating.”
(Auditory hallucinations, the symptom most associated with serious mental illness, are actually quite common in the general population—as widespread as left-handedness, some studies say. A host of medical conditions can induce them: high fevers, of course, but also hearing loss, epilepsy, alcohol withdrawal, bereavement, and intense stress. If you do hear voices, you’re joining an esteemed group that includes Socrates, Sigmund Freud, Joan of Arc, Martin Luther King Jr., and Winston Churchill.)
Guillain-Barré syndrome is an autoimmune disease that occurs when the body’s immune system targets nerves, which can sometimes result in paralysis. Lee’s case struck him five years before our meeting, and at one point, he could not swallow or talk. It is hard to imagine a worse fate for a man so interested in conversing with the world. After several months of treatment, hooked up to a respirator and a feeding tube, Lee recovered and the lingering effects are minor, if there are any.
Coincidentally, David Rosenhan had suffered from Guillain-Barré, too. Lee mentioned this as he pointed out the office down the hall where Rosenhan had worked for more than thirty years. That two people who shared the same floor of a small office building had had the same rare autoimmune disease shocked one doctor with whom I shared this information—it’s a one-in-a-billion chance, the doctor said. But it was true: I would later confirm this coincidence with Rosenhan’s family and friends. It was the first of many small, improbable details I would encounter in my investigation.
Before my visit, Lee had set aside a stack of books that had once belonged to Rosenhan and that Lee believed were key to his thinking: The Myth of Mental Illness by Thomas Szasz, Self and Others by R. D. Laing, and Asylums by Erving Goffman—all works associated with the anti-psychiatry movement.
As I thumbed through Rosenhan’s books, Lee told me the origin story of their friendship. They had met in the early 1970s when Rosenhan joined Stanford’s psychology faculty after leaving Swarthmore College. Stanford in those days was home to an all-star roster of psychologists, including Philip Zimbardo, who led the much-publicized Stanford Prison Experiment in 1971. The observational study, which recently spawned a movie, purportedly simulated prison life in the basement of the university’s Jordan Hall with volunteers playing the parts of fake guards and fake prisoners. After a few days, the guards, drunk on their own power, abused the prisoners, who withdrew and grew resigned to their fate. Zimbardo’s study was published in 1973, not long after Rosenhan’s. The Stanford Prison Experiment made Zimbardo a legend the same way “On Being Sane in Insane Places” did for Rosenhan.
Lee and I had been chatting for a few minutes when he casually reached up and removed a box stuffed with papers from the top of his filing cabinet. He fingered through files, stopping at a fat folder bursting with pages.
I blinked. Realizing what it contained, I couldn’t believe my luck—if I was right, this treasure trove would be almost as good as being able to interview Rosenhan himself. Pages peeked out from a folder titled ON BEING SANE and another marked PSEUDOPATIENTS. Papers stuck out in various directions. The files were organized, or rather disorganized, according to how Rosenhan left them—once I started pawing through it I quickly realized that the mess revealed more about his mind than anything sanitized by an archivist. There was something voyeuristic, even indecent, about the digging, but, for better or worse, my years working in a tabloid newsroom weaned me off any shame about going through people’s dirty laundry.
Sometimes the contents corresponded to the description on the folders; often they did not. You’d open up a folder on, say, Rosenhan’s work about altruism in children and you’d find a bill of sale for his Mercedes. There were drafts of “On Being Sane in Insane Places,” which Rosenhan had cut out into sections and pasted back together like an elaborate puzzle, and dozens of pages of handwritten diary entries from his time inside the hospital. A folder marked CRITICISM held brutal comments from his peers: “pseudoscience presented as science,” “unfounded,” “entirely unwarranted.” If this folder was any indication, Rosenhan clearly had pissed off psychiatrists. And he seemed proud enough of it to keep the evidence.
I came to a stack of paper held together by a thick but weathered rubber band. The first page read:
Chapter 1
We never really know why ideas are born. Only how and when. And while origins hardly matter when an idea is fully formed and articulated, they may make something of a difference when it is still being shaped. What stands in tonight’s shadows sometimes mars tomorrow’s path.
I find myself unable to say why this research began in any sense that reveals to me something more about the ideas. Perhaps you, better than I, can infer something more from the circumstances. Let me describe them.
His unpublished book. There were at least two hundred pages here. My heart raced. This was the manuscript that his publisher, Doubleday, had sued him for. These were the pages they fought for but never received—pages the world had never before seen. I tried to look casual as I set it aside and continued my frantic search for information. I wouldn’t be able to rest until I understood the study inside and out, including what led to its creation and the context of its consequences. I wanted to be inside the heads of everyone involved. And here was my chance. I tried to contain my enthusiasm when I opened up the folder marked PSEUDOPATIENTS.
My Rosetta stone. The names of all the pseudopatients.
David Lurie, pseudopatient #1, was a thirty-nine-year-old psychologist who pretended to be an economist and got himself admitted for ten days to Billington State Hospital. He was released with the diagnosis of schizophrenia, schizoaffective type, in remission.
John and Sara Beasley, pseudopatients #2 and #3, husband and wife, psychiatrist and psychologist, went undercover. John went in twice, first at Carter State for three weeks and then at Mountain View for two. John described his time inside as “Kafkaesque.” Sara admitted herself to Westerly County and spent eighteen days inside. Both were released with a diagnosis of schizophrenia in remission.
John’s sister, Martha Coates, pseudopatient #4, was a widow who posed as a housewife. She joined the study after her brother and sister-in-law and spent two weeks at Kenyon State Hospital, where she became the fourth pseudopatient in a row to receive a schizophrenia diagnosis.
Laura and Bob Martin, pseudopatients #5 and #6, followed. Laura, a famous abstract painter, was admitted to the only private psychiatric hospital in the study. She spent a shocking fifty-two days there until she was released with a different diagnosis than the rest: manic depression. Her husband, a pediatrician, admitted himself to a less-than-stellar psychiatric hospital, claiming to be a medical technician. He, too, was diagnosed with schizophrenia.
Carl Wendt, pseudopatient #7, went undercover four times, totaling seventy-six days locked away. His obsession with the study worried Rosenhan, who became concerned that Carl had grown “addicted” to it.
Finally, there was Bill Dixon, #8, Rosenhan’s graduate student, who infiltrated a failing public hospital for seven days and also received a diagnosis of schizophrenia, making the total seven out of eight patients to receive that diagnosis. All twelve hospitalizations had resulted in misdiagnosis.
It didn’t take long to figure out that pseudopatient #1, David Lurie, was really David Rosenhan, which led me to the swift realization that all the names had been changed. There would be no simple, ten-minute internet search for Bill Dixon or Martha Coates. The hospitals, too, had been renamed.
Lee’s voice yanked me back to the present moment in his Stanford office.
“David was in some ways a little hard to know,” he said.
“What do you mean?” I
asked.
“Well…” Lee paused here, choosing his words carefully. “He had secrets, in other words, as most people do. It was the dramatist in him. He was, as that saying goes, a riddle wrapped in a mystery inside an enigma.”
In retrospect, I wish I had asked him exactly what he meant. But in the moment, I was too distracted by the promise of the pages in front of me.
Lee pivoted back to the files. “You may find the answers to your questions in this,” he said, gesturing to the papers. But then he added: “Where’s that one thing?” He searched through the pile, stopped at one folder, removed it, and walked it back to his filing cabinet. “This is personal,” he said. He placed the folder in his cabinet, closed the drawer, and smiled at me. Was this smile an invitation? Or was I reading too much into all of this?
It was only when I walked back to my car that Lee’s words began to circle in my brain: riddle, mystery, enigma.
PART TWO
Felix Unger: I think I’m crazy.
Oscar Madison: If it makes you feel any better, I think so too.
—The Odd Couple, 1968
6
THE ESSENCE OF DAVID
I returned to California six months later to revisit the files, which had been relocated to their intended owner, a clinical psychologist and a close friend of Rosenhan’s named Florence Keller. Florence had saved the files in the frenzied aftermath of Rosenhan’s disabling strokes when Rosenhan was being moved to an assisted living facility a decade before his death in 2012. During the frantic cleanout, Florence managed to salvage a box marked ON BEING SANE. When Florence alerted Rosenhan, he asked that she hold on to it for him.
Florence is trim and attractive, a handsome woman in her early seventies. There is something of Katharine Hepburn in the way she navigates the world—floating with an easy confidence as she swings open the door, welcoming me in with a wide smile. She gave me a tour of her Joseph Eichler–designed Palo Alto midcentury bungalow with its orange and Meyer lemon trees. I noticed two identical New Yorker magazines side by side on the kitchen table.
“Why the two?” I asked.
“It’s the one thing LaDoris and I can’t share,” she said, laughing. LaDoris, her partner for over thirty years, goes by many names—“LD” or “Herself,” as Florence calls her, and “Judge Cordell” to the rest of the world. She’s a Palo Alto celebrity, the first African American female judge to sit on the bench of the Superior Court, who in her retirement now provides legal commentary for the national news and leads protests on all manner of issues, from upholding judicial independence to combating police brutality. If you live in Palo Alto, it’s likely that LaDoris either helped you, married you, or advocated for you.
From the moment I removed my shoes and stepped through her front door, Florence and I became partners in crime. I called her my Rosenhan whisperer. She was one I would rely on at every stage of the investigation, through every increasingly surprising twist. She was the person who had the most insight into Rosenhan’s mind, and his secrets. The two had met at a mutual friend’s party, where she found herself in lively conversation about how almost all curse words aimed at men were really directed at women. The bald man with a glimmer in his eye readily agreed, and the two started listing words that fit her theory.
“Son of a bitch, bastard…”
“Motherfucker…,” he added.
They each rattled off as many epithets as they could, and by the time they’d run out of insults, the two were fast friends.
I asked Florence to help me translate the dozens of pages of Rosenhan’s handwritten notes scrawled out on yellow legal pad paper, written before and during his hospitalization for the study. His handwriting at first had seemed easy and accessible—he had beautiful penmanship—but, strangely, the minute you began to read, you realized that the letters themselves were impossible to decipher. “Echt David,” meaning “the essence of David,” quipped Florence.
Over the coming months, I burrowed into that unpublished manuscript. The study began, I would quickly learn, not with Rosenhan’s plan to challenge psychiatry as he knew it, nor even with a Nellie Bly–inspired curiosity about the conditions inside the asylums, but with a student request in his abnormal psychology honors class at Swarthmore College in 1969.
“It all started out as a dare,” Rosenhan told a local newspaper. “I was teaching psychology at Swarthmore College and my students were saying that the course was too conceptual and abstract. So I said, ‘Okay, if you really want to know what mental patients are like, become mental patients.’”
January 1969
Swarthmore, Pennsylvania
The campus—the whole world, really—seemed to be losing its mind. In the first six months of 1969, there were more than eighty-four incidences of bombings, bomb threats, and arson reported on college campuses. America was mere months away from the national shock of the Manson Family murder spree. Plane hijackings were common. The world had just watched police officers use billy clubs and tear gas on crowds of unarmed protesters at Chicago’s Democratic National Convention as onlookers chanted, “The whole world is watching.” Richard Nixon’s inauguration fell the same week as the start of Swarthmore’s spring semester. Some of Rosenhan’s students had joined the tens of thousands in Washington who cheered and booed, throwing bottles at the presidential motorcade and holding up signs announcing, NIXON’S THE ONE… THE NUMBER ONE WAR CRIMINAL. Nixon, in a moment of inspiration, stuck his head out the top of his limo and made the now infamous V-for-victory sign with his arms. We now know that Nixon’s self-serving political meddling helped prolong the Vietnam War, a personal victory achieved by any means necessary. The nightly news showcased the Vietnam War in real time as casualties hit their peak in 1968. We were in an unwinnable war with an enemy on the other side of the earth killing thousands of young men, for what? In the face of such inexplicable acts on a global scale, madness no longer seemed to be restricted to the asylums. Some young men who had low draft numbers exploited the system by pretending to be out of their minds to get out of the war. Why not, after all? Everything seemed insane.
“It’s easy to forget how intense the ’60s were,” wrote Swarthmore alum Mark Vonnegut (the son of that famous writer) in his memoir The Eden Express, which chronicled his own experience with psychosis during this turbulent time.
In 1969, the concept of mental illness—of madness, of craziness, of deviance—had become a topic of conversation like never before in the history of our country. It became more of a philosophical debate than a medical one. Wasn’t “mental illness,” many argued, just a way of singling out difference? Madness was no longer shameful; it was for the poets, the artists, the thinkers of the world. It was a more enlightened way to live. The young embraced psychoanalyst Fritz Perls’s slogan (popularized by Timothy Leary): “Lose your mind and come to your senses.” Only squares were sane.
And then there were the drugs. Two million Americans had dropped acid by 1970, getting a glimpse of the “other side” and joining the “revolution by consciousness”—convinced, as Joan Didion wrote, “that truth lies on the far side of madness.” They did not want what society (their schools, their parents, President Nixon) needed from them. They believed that they were all a razor wire away from the madhouse—and they may well have been.
Young people moved to utopian communities in the middle of nowhere. One of the country’s most popular bumper stickers was QUESTION AUTHORITY. Growing Up Absurd, written by an openly bisexual anarchist who linked the disillusionment of youth with the rise of corporate America, was a runaway bestseller. The 1966 surrealist film King of Hearts featured a small French town during World War I where the happy denizens of the local asylum take over, prompting the viewer to ask, Who is truly sane in a war-ravaged world gone mad? Ken Kesey’s trippy novel One Flew Over the Cuckoo’s Nest did more than any other book to incite the public against psychiatry. (In a few short years, the 1975 movie starring Jack Nicholson would further outrage viewers.) The power of Kesey’s stor
y has endured. I’m sure that if someone asked you for an example of a “sane” person railroaded by a mental institution, you would immediately cite Cuckoo’s Nest as the classic example. Though the book was intended to critique conformity on a grand scale, the novel will forever be associated with the evils of psychiatry. The book, as one psychiatrist put it, “gave life to a basic distrust of the way in which psychiatry was being used for society’s purposes, rather than the purposes of the people who had mental illness.”
Kesey, a star athlete and the son of a dairy farmer, found his revelatory moment while working nights as an aide at Menlo Park Veterans Hospital. He enrolled in a government-sponsored experiment at the same hospital, where researchers dosed him with a series of drugs—including mescaline, Ditran, IT-290, and his favorite, lysergic acid diethylamide (LSD).
These experiences birthed the ultimate antihero, Randle Patrick McMurphy, who fakes his way onto a ward to get out of serving a prison sentence. “If it gets me outta those damn pea fields I’ll be whatever their little heart desires, be it psychopath or mad dog or werewolf,” McMurphy says.
Once free of his prison sentence, McMurphy causes as much trouble as he can on the ward and in doing so discovers that his fellow patients aren’t so different from him after all: “Hell, I been surprised how sane you guys all are,” McMurphy tells the other patients. “As near as I can tell you’re not any crazier than the average asshole on the street.” The big difference, McMurphy is shocked to find, is that the other men shackled themselves to the institution voluntarily. They chose to be there.
The Great Pretender Page 6