The Great Pretender

by Susannah Cahalan

  In the fall of 1970, Harry enrolled in a graduate seminar called Psychopathology. He didn’t recall many specifics from Rosenhan’s lectures except the awe he inspired. At one point, Rosenhan invited the eight students in the class over to his house. Mollie’s food was in top form that night—Greek egg soup, lemony and creamy—and while the students devoured it, Rosenhan made his pitch. Harry was so blown away by the food, by the house, by the Meyer lemon and pomegranate trees, by the black-bottomed pool in the backyard, by Rosenhan, that, he said, he would have signed on any dotted line: “It was kind of like, Wow, this is exciting.” Rosenhan had set his hooks in him and he was intrigued by the thought of going undercover. It’s not in Harry’s nature to overanalyze, but it seems clear that he joined the study because Rosenhan gave him an opportunity to belong to something. Thanks to scheduling conflicts and other halfhearted excuses, however, none of the other students ended up going through with hospitalization except Bill Underwood.

  Harry chose the name “Harry Jacobs,” which he said just popped into his head, and Rosenhan and his research assistant gave him a fake address that was near their target hospital, Langley Porter, the University of California at San Francisco’s psychiatric hospital, the oldest one in California. Like Bill, Harry did not recall that Rosenhan prepped them beyond a tutorial on how to cheek pills. “That kind of surprised me. I felt like we had pretty minimal coaching. I met with Rosenhan the day before. He said something in class about ‘empty, thud, and hollow,’ the voices, existential psychosis, but really I got maybe fifteen minutes of coaching, and it really made me nervous because, you know… having not been a clinical psychology student, having grown up with the ideas that people who are mentally ill are just really off the wall, right? So I almost felt like I was going into the lion’s den here. I mean, what would the patients be like?”

  Harry had remembered a PSA from his childhood, which warned children that they should be kind to people with mental illness because it could happen to you. These ads scared the daylights out of little Harry, who developed a phobia that he would one day be boarded up in an insane asylum and “catch” mental illness. Now here he was nearly two decades later volunteering to enter one.

  It was late November, after Thanksgiving, a perfect autumn morning in San Francisco. Harry put on his slacks and a dress shirt (he was not of the hippie clique, didn’t have a mustache, hadn’t grown out his hair). He carried very little money, enough to get him to the hospital and a little extra pocket change, and no identification just in case they searched him.

  He took a bus to the admissions office in San Francisco’s Langley Porter. A nurse there asked if he had an appointment. He replied that he didn’t, but that his psychologist, Dr. David Rosenhan, had referred him. When Harry told them his address, the nurse replied that he would have to go to San Francisco General Hospital because Langley Porter was not in his (fake) address’s catchment area. The nurse gave him bus route directions and sent him on his way. Harry left the hospital and went to a phone booth to call San Francisco General. The operator debated if they would take him given his address, took his number, and told him that someone would call him back. Harry, now thoroughly unnerved, phoned Rosenhan’s research assistant, the study’s point of contact, a young woman whose name escaped him, and delivered the bad news. She sounded disappointed but told him to hang tight.

  Seconds later the phone rang. Harry was rattled when a strange voice introduced himself as a psychiatrist from yet another hospital. How did this psychiatrist get the phone booth number? Who had contacted him? What hospital was he calling from? And what exactly transpired in this phone call? Harry couldn’t remember, though he was sure he delivered his practiced script—thud, empty, hollow. Still, something about his story or the way he was telling it made the doctor think that Harry was a suicide risk. I pressed Harry repeatedly to explain why the doctor might feel that way, but Harry could not come up with any reason for it.

  “You’re forcing my hand,” the doctor kept repeating, as Harry recalled. “You’re forcing my hand. You need to come to the hospital.”

  Harry boarded another bus and tried to tamp down the growing unease. This was not a vetted hospital. He had no clue about how this hospital worked or what kind of patients it treated.

  He was heading straight into the great unknown.

  Harry didn’t remember walking in. Somehow he ended up on the fourth floor in a private room, an office, where a psychiatrist sat behind a big desk with some personal touches, a few family photos, a book or two. The psychiatrist asked Harry to sit in the seat opposite him. Harry felt sweat staining his undershirt, but the funny thing was, he didn’t feel nervous. It was as if he was observing the anxiety from a great distance. It felt like a schoolyard game, like he was up to bat, about to take a swing for the fences. The words flowed: He was Harry Jacobs, a Berkeley grad (he changed his school from Stanford to his wife’s school), who had begun to hear voices just a few weeks before, that said, “It’s empty. Thud. It’s all hollow.” All parts of the approved script.

  There were amendments, Harry admitted. He told the psychiatrist that he lived alone off campus, leaving out the fact that he lived with his wife off campus—which, Rosenhan would write, gave evidence of isolation that could spell out trouble for someone presenting with a severe psychiatric symptom (even though Bill had done exactly the same thing and left Maryon out of the narrative). Harry then told a more significant lie. He said that he had no close family since his parents were killed in a car accident a year before (in reality his parents were alive and well). Why did he do this? Even Harry didn’t have an answer, but he did insist that Rosenhan approved the changes to his biography prior to going to the hospital. Rosenhan’s notes (he used the pseudonym “Walter” for Harry in some scrap notes, and because he did not indicate that Walter was the footnote, I had assumed at the time that Rosenhan had used another pseudonym for one of his original eight) tell another story: “Just why Walter changed his script was never clear, but I strongly suspect that it was because he wanted very much to be hospitalized, and like the rest of us, expected that he would not be admitted on the basis of such a slender set of symptoms… These alterations of script made it impossible for me to include his data in the study, since I could not know what impact the changes had on the staff’s perceptions.” And yet, again, we know too well the distortions Rosenhan made to his own script.

  Either way, once admitted, Harry became an interesting case. About fifteen minutes into his intake interview, the psychiatrist asked if he could bring in two other psychiatrists to consult. Harry felt flattered by the doctor’s interest. When they asked about how he spent his days, Harry answered honestly: the bleakness of holing himself up in his apartment watching television, the endless studying, the hypercompetitive atmosphere at school, the absence of close friends. Harry spoke about his feelings of worthlessness and self-doubt. It wasn’t until this moment when he was pretending to be Harry Jacobs in front of three psychiatrists that he realized how truly miserable he was. “I was not a very happy graduate student, and at the time being unhappily married didn’t really help the situation. But part of it… is a lot of self-doubt, being with these famous people in the department, you know… There was this feeling of isolation.” He may not have lost his parents or lived alone, but the heartsickness was genuine; only the cause was fabricated. Was this really worse than Rosenhan’s own insistence that he put copper over his ears to drown out the noises?

  After forty-five minutes, Harry was admitted to U.S. Public Health Service Hospital.1

  “I felt like I passed a test.”

  The word that best describes Harry’s first impression of the ward is light. A bank of windows in the dayroom let in cascades of natural illumination that made the ward seem impossibly uplifting. Christmas decorations, wreaths and handmade ornaments, and a tree strung with lights gave the ward a festive, joyous feel. Was this really the horror house he’d imagined in his youth?

  Men and women shared the
unlocked floor and were free to roam around as they pleased. The nurse took him on a tour (this in itself was unusual; it didn’t happen with Rosenhan or Bill) and explained that there were wake-up and sleep times, but what you did in between was up to you. And there were no uniforms! The staff wore street clothes. Harry got them mixed up with patients more than once, especially in the beginning. Perhaps the differences could be chalked up to the fact that Harry’s hospital was an acute psychiatric facility, intended to provide short-term care with a focus on releasing patients to their homes, outpatient facilities, or, if necessary, state hospitals. This was neither a place of last resort nor a custodial care center into which people would disappear for months or years. The hospital wanted you in and out, and in the process tried to make your experience as pleasant as possible.

  In our conversation, Harry didn’t remember much about that first night. Rosenhan wrote that Harry’s first meal was “eaten in total silence,” a reflection of his early uneasiness, though Harry said that his silence might have been a result of the surprise at how tasty his fillet of beef was. His medical file acknowledged this nervous energy: “He engages in finger-cracking,” according to Rosenhan’s notes.

  Like Rosenhan, Harry spent the early days avoiding his fellow patients. Once he started attending group therapy sessions, however, he had no choice but to interact. The patients were mostly around his age, a few younger and a few his parents’ age, but none older than that. Some fit the stereotype of a Bay Area hippie circa 1970. Some ended up there after a suicide attempt—newspapers at the time frequently reported people being talked down from the Golden Gate Bridge. One kid, a former member of the Coast Guard, spent eight months on a tiny island in the Pacific, flipped out, and ended up there, guitar in hand. Harry felt a special fondness for that cracked guardsman, who reminded Harry of his brother. Once he plugged into the floor’s energy, he realized that he was part of a love-in—people sat in groups, singing, crying, laughing, all part of a community of people who had lived through some heavy stuff.

  Pretty much everyone on the ward was against the war, even the nurses. When news of war casualties aired on TV, a nurse commented: “I’m moving to the North Pole,” which cracked everyone up. Nearly everyone, anyway. John, a Korean War vet, took an instant dislike to Harry and harangued the whole group for their antiwar views, repeating: “Anybody who is against the war should be shot.”

  This didn’t scare Harry; John seemed like a curmudgeon, not the kind of mental patient you saw ranting in the movies. Harry recalled that the “craziest” person on the ward was a suicide risk named Ray. He was the only patient who wore a hospital gown intended to prevent escape. Before his hospitalization, he had jumped out of a fourth-floor window and survived. He had a few broken bones to prove it. Still, Harry found him to be a pretty rational guy, if a touch blue.

  If Ray was blue, Harry was red. Harry described himself as positively amped up those first few days. He had a fire lit inside him that had been absent since he’d moved to Stanford. He wrote nonstop, filling pages in his notebook. (Up until he found them days before this book went into production, Harry was convinced that he had thrown his notes out in a rabid spring cleaning years before I contacted him. Harry does not recall if Rosenhan received a copy of these pages.) The staff noticed. Several approached Harry about his writing and asked him if he was a writer.

  Harry presented with enough psychotic symptoms for doctors to prescribe him daily doses of Thorazine. Trouble was, the drugs were not in pill form, but liquid. Liquid Thorazine was introduced in the 1960s as a response to the pervasive problem of patients cheeking pills. The ad campaign in the 1960s read: “Warning! Mental Patients are Notorious DRUG EVADERS.”

  Harry thought, Okay, David, what do I do now? and hesitated for just a moment before he swallowed the unpleasant syrup, grimacing as it slid down his throat, bracing himself for the drug to take effect. Hours later, nothing had happened. “I think that tells you something about my mental state,” he said now. Either the dose was so low that it hardly had an effect or he was so unsettled by the environment that the antipsychotic soothed him. Later the doctors switched him to pills that he could cheek so he wouldn’t have to test this assumption out.

  Harry spent the early days observing, asking questions, but rarely speaking—a behavior that prompted one of the younger, more attractive nurses (on whom Harry had developed a crush) to push him to share more of himself, suggesting that the sublimation of his own feelings was a sign of his suffering. This was an astute observation. He did detach—especially at home with his wife. “This really touched me,” Harry said.

  To Harry’s eye, the staff just seemed as though they really enjoyed their jobs. They spoke to patients as equals, engaged them in games and gossip, and even joined their sing-along groups, the sounds of Peter, Paul and Mary filling the ward. When one young female patient was released without a place to call home or any money, one of the nurses took her in until she got on her feet. “The hospital seemed to have a calming effect. Someone might come in agitated and then fairly quickly they would tend to calm down. It was a benign environment,” Harry said.

  But Harry was still a patient—and he was reminded of this distinction during a meeting with the ward’s clinical psychologist, who asked him to draw stick figures, which Harry recognized from the “Draw a Figure” test, a popular psychological test originally designed for children. Harry studied it in graduate school as a tool to assess perception and cognition. Drawing was not one of Harry’s talents, and he felt self-conscious. Even though this was make-believe, he still wanted to impress the psychologist—the same way I had wanted to impress First while taking the SCID—and he tried hard to hide his spatial limitation. “I wanted to do the best I could, just as much as if I had been in a ‘real situation,’” he told me.

  Eventually he asked the psychologist: “Should I continue trying or should I give up?”

  The psychologist responded, “It’s up to you.” He remembered that response was exactly what he’d been trained to say when faced with that question from a patient. “Having that thrown back at me wasn’t entirely pleasant,” he admitted.

  Early in his stay, a nurse handed Harry his own medical file—an unusual moment in any hospital, let alone a psychiatric one—and told him to walk it to another floor to get an EEG. The minute the CONFIDENTIAL file hit Harry’s hands, he knew it was as good as gold. Harry thumbed through the files as he walked. Time was of the essence. They would notice his absence from the appointment if he took too long, but he needed to get this information to Rosenhan. How? A phone! He paced the hallways in search of one, ducking into an empty office, his hands shaking as he picked up the receiver and dialed Rosenhan’s number. He didn’t remember speaking to Rosenhan, but believed he made contact with Rosenhan’s pretty research assistant.

  The file confirmed that he was taking antipsychotic medication. Another line read: “Unfit for military service.” He couldn’t help but think, Man, this could be helpful. But then three words jumped out at him: “Chronic, undifferentiated schizophrenia.” Rationally he knew that to be hospitalized he was likely diagnosed with something—but to see it written out in black-and-white still stunned him.

  A new woman joined the group therapy session the next day and turned her back to the room, refusing to talk. The other patients devoted the session to cajoling her into engaging. “We wish you’d join us,” they’d say. Eventually their kindness broke her down and she began to communicate with the group, telling them that God had damned her. One of the patients quoted Bible passages to her that expressed God’s love and forgiveness. “It’s hard to convey the sense of the beingness of the environment, and how the patients, I mean, how the patients supported each other. I mean they cared,” Harry said. “I’m getting emotional just thinking about this… What struck me is just how human and I guess vulnerable the patients seemed.”

  While Rosenhan had the experience of wanting to expose himself as a “sane person” (“I am Profess
or Rosenhan!”), Harry wanted to confess for entirely different reasons: “I felt this guilt that they were making such an effort to help me with my problems, and they were taking time with me that could have been spent otherwise. I felt this guilt that I was in the hospital when I didn’t need to be. And these were good people… I wanted to confess my sins.”

  A little less than a week in, the ward arranged for a day trip out of the hospital to the beach. The group boarded a shuttle bus and headed forty minutes down the coast. The sea air must have smelled magical, potent with possibility, as they disembarked and made their way onto the beach to enjoy the warm early-December afternoon. Did people whisper, They’re from the loony bin? If they did, Harry didn’t notice. He was too happy. He sunbathed and chatted. It was so much more fun than grading papers in graduate school. All that seemed so far off now. A female patient grasped his hand and whispered: “Let’s stay here. Let’s not go back.”

  “I felt less de-individualized, more actualized in the hospital with those patients than I did as a graduate student, honestly,” he said.

  On Rosenhan’s notes about Harry’s stay, the professor scrawled “HE LIKES IT” on the side of the paper, as if he couldn’t imagine such a thing.

  By the second week in, Harry had transformed from a shy loner into a ward leader. His peers seemed to respect him. They looked at him for approval and for advice. He leaned into this newfound position of authority and even dropped little hints that he knew a bit more about psychology than he had let on, offering to administer ad hoc psychotherapy to his fellow patients. Rosenhan interpreted this as trying to differentiate himself from the group. Harry agreed—but saw it in a more aspirational way. “I, of course, imagined myself as McMurphy,” he said, channeling the hero from One Flew Over the Cuckoo’s Nest. “I just got the feeling that patients were looking up to me, and that meant a lot… I felt like I could be a positive influence and support for other patients.”