“What I’ve come to think about with David and this whole thing is his twinkle,” Florence said. “You could imagine him saying, Well, if I had completed this study, it would have been exactly as I described it.”
Florence’s acceptance of the possibility that Rosenhan’s work may not have been completely legitimate opened something inside Lee. “There is a certain shadowy quality when you probe into David’s work and life,” Lee Ross said. “It’s just that feeling of you can’t quite pin things down. Things don’t quite add up sometimes. And I think he… I don’t want this to have more connotations than it does. There is a way in which he kind of led multiple lives. And by that I just mean I think he was a somewhat different person in somewhat different contexts.” I couldn’t help but smile a little—that was, after all, one takeaway from Rosenhan’s paper: that we’re never all one way, that insane people are never always crazy, nor are sane people always rational. Lee continued: “I would be surprised, not unbelieving, but very surprised and very unhappy to learn [that he lied]. It would make me even more feel that David was struggling for a place in the sun.”
Though I had to wonder: Was he struggling not for but with his place in the sun?
Rosenhan, with his twinkle and shadowy quality, managed to expose truths—even if those truths contained problematic fictions—and created something that we still debate, pillory, celebrate, and investigate nearly half a century later. The study may have “proved” something that people believed was true, and, for better or worse, that was enough to change everything. Maybe it’s as Chief Bromden says in One Flew Over the Cuckoo’s Nest: “It’s the truth even if it didn’t happen.”
There were no lines around the block to attend Rosenhan’s funeral. No national newspaper covered his passing. The sparse attendance was partially due to how inured Rosenhan’s community had grown to their grief. A series of tragedies hit the aging professor with such senseless brutality that people could not help but make comparisons to Job. It started with his daughter Nina’s death in 1996 in a car accident, followed by Mollie’s lethal lung cancer diagnosis, followed by Rosenhan’s first stroke—a small TIA that would likely have gone unnoticed if Rosenhan had not insisted that he be checked out. Florence noticed a slight difference in her friend after that first scare. With a mind so nimble, he was good at hiding it, but there was a new hesitation, a few seconds of delay that had never existed before. Mollie died in her bed at home in 2000, around the time that Rosenhan suffered a massive stroke from which he would never recover. The stroke and the other illnesses that had befallen him had damaged his vocal cords so that the familiar baritone voice faded into silence. The man who took daily multi-mile walks around Stanford’s Dish, the professor who made you feel truly seen, the warm, approachable raconteur, turned into a shell of himself. He lost his ability to walk and moved into a nursing home. The stalwarts—among them his friend and caretaker Linda Kurtz; his son, Jack; and Florence—came frequently to check on him. Otherwise, people forgot about him. When I contacted his former friends and colleagues, many of whom had attended parties at his house for years, they inquired about how he was because they had not heard about his death.
At his funeral, Rosenhan’s close friend Lee Shulman, who spent many hours studying the Talmud with Rosenhan in a study group, gave a speech that perfectly captured Rosenhan:
David’s fame was based on many accomplishments, but one stands out as a powerful beacon. His essay in Science, “On Being Sane in Insane Places,” begins with an opening sentence that should be intoned in the register of the yeshiva student whom he would always remain: “If… sanity and insanity exist… how shall we know them?”…
If you have never actually read that article, or it’s been a long while, you just may have forgotten its rhetorical power… It is a proclamation, a moral outcry, a scream of pain and a demand that the world bear witness.
David Rosenhan is no clearer a figure to me now, even after my years of relentless digging into his personal and professional past, than he was the day I first heard Dr. Deborah Levy talk about his study. He was, as Lee Ross said, “a somewhat different person in somewhat different contexts”; depending on what kind of light you cast on him, you could view him as a hero or a villain, a scoundrel or a rascal, a charlatan or a Cassandra, a selfless leader or a selfish opportunist.
But there’s one story that sums him up for me, as a thinker, as a father, and as a human.
Jack was thirteen when his father invited him to join him on a trip to New York City to meet with an editor and discuss the pseudopatient book that he would never publish. The two were walking through the crowded streets of downtown Manhattan when they noticed an open grate on the sidewalk. Through the hole you could see below to a whole hidden world. They nearly gasped when a huge dump truck drove by underfoot.
“Don’t say a word, just follow me,” Rosenhan said, leading his son to one of the hardhats manning an elevator that led belowground.
He introduced himself as David Rosenhan, professor of engineering at Stanford University. In a flash, Rosenhan and Jack were fitted for hard hats and boots. Zoom! They were in an elevator headed underground to see the building of the infrastructure of the New York City subway system firsthand. Their guide seemed impressed by Rosenhan and his credentials and gave them the full tour. Jack kept worrying that they’d be busted. Just one complicated engineering question and we’re toast, he thought. But Rosenhan seemed as cool and confident as always, carrying himself as if he belonged there, as if he were the king of the underground, a world invisible to the people who walked in droves above them. This simple fact blew Jack’s young mind: His father could so easily become someone else.
He was the great pretender.
ACKNOWLEDGMENTS
Five years ago, when I started researching this book, Dr. E. Fuller Torrey wrote me an email after our first meeting: “It is a good project for a layperson because you come to it with a fresh outlook, not contaminated by the revered wisdom of the professionals who may, but often do not, know what they are talking about.” I like the sentiment (the email hangs above my desk)—and though I have come across many professionals who do not know what they’re talking about, I’ve encountered many more who do. This is a list, by no means definitive, of the many generous people who took time out of their busy lives to help me write this book.
First and foremost, a heartfelt thank-you to Florence Keller and LaDoris Cordell, the Wonderful Women of Wilkie Way, who held my hand throughout years of researching and writing, providing support, wisdom, and counsel. You two have brought so much to my life and I’m forever grateful that David brought us all together. I could not have written this book without you.
This was not the book I initially intended to write. While researching it, however, I got to spend time with David Rosenhan’s son, Jack, and his wife, Sheri, two supremely kind and generous people. I am grateful for your time—it is a joy to know you.
I so enjoyed the hours spent with Bill and Maryon Underwood. It was such a blast walking down memory lane. And to Harry Lando—the great footnote—thank you for being so open and honest. I hope I did your experiences justice.
It takes a small army to get what’s on my laptop ready for public consumption. Thank you to agent duo Larry Weissman and Sascha Alper, who helped shepherd this project and find its perfect home. Thank you to the magnificent Millicent Bennett: You are a gift sent from writer heaven, and I cherish the day our paths crossed. Thank you for your tireless support, your brilliant mind, and your steadfast belief in this project. Thank you to Carmel Shaka for keeping us on track during a serious time crunch. Thank you to the dream team at Grand Central Publishing for championing this book, especially Michael Pietsch, Ben Sevier, fellow Hilltopper Brian McLendon, Karen Kosztolnyik, and Beth deGuzman. Thank you also to the powerhouse publicity team led by Matthew Ballast with help from Kamrun Nesa and Jimmy Franco and social media maven Alana Spendley. Thank you to the sales team—Ali Cutrone, Alison Lazarus, Chris Murphy, Karen
Torres, Melissa Nicholas, and Rachel Hairston—for their early enthusiasm (even after I babbled at them with twin newborn “mom brain”). Thank you to the supertalented art and production team—Albert Tang, Kristen Lemire, Erin Cain, Carolyn Kurek, Laura Jorstad, and a special shout-out to Tareth Mitch, who, late one Friday, saved the day.
Thank you to my early readers: Dr. Dominic Sisti for his nuanced look at diagnosis and the role of institutions (as well as his support throughout the writing); Dr. Andrew Scull for helping me understand Rosenhan’s place in history and his infectious enthusiasm for the research; Dr. Will Carpenter for his perspective on the biological side of psychiatry; Dr. Len Green for his perspective on the history of psychology and the replication crisis; Dr. Michael Meade for his general wisdom; Dr. Craig Haney for taking time to help me understand the range of horrors happening in jails and prisons. Thank you to Dr. Belinda Lennox, who read an early draft and urged me to be a bit softer on the field; and thank you to the brilliant Maureen Callahan, who pushed me to be a bit harder on it. Ada Calhoun and Karen Abbott, my beloved Sob Sisters, provided support and enthusiasm when I needed it most. Panio Gianopoulos, combination superman and mensch, helped me to control the chaos of the first drafts, and Karen Rinaldi helped me keep my head straight. Thank you to Dr. Niall Boyce for introducing me to the concept of a microhistory and to Allen Goldman for his unerring support and clarity during the book’s final stages. Thank you to Hannah Green for her take on the complexities of the criminal justice system, and to Dr. Heather Croy, whose help with the twins made it possible for me to finish this book. Thanks also to Shannon Long and Emmett Berg for their help with research, and especially to the remarkable Glyn Peterson, who went above and beyond with her eagle-eyed fact-checking.
A special hat tip to Dr. Deborah Levy and Dr. Joseph Coyle for setting me off on this mission—who would have ever guessed that an offhand comment made in a crowded restaurant would consume the next five years of my life? Thank you also to Dr. Lee Ross, who helped stoke an early interest in Rosenhan and his famous study.
Thank you to the staff of Stanford University’s Special Collections and Swarthmore College for letting me camp out and dig into the research. Haverford Hospital’s lead researcher Margaret Schaus supplied me with a treasure trove of primary sources, as did the Historical Society of Pennsylvania. Thank you to the Treatment Advocacy Center, especially to E. Fuller Torrey and Maree Webster, who gave me a tour of the Stanley Medical Research Institute’s brain bank. Thank you also to the Center of Inquiry for hosting a strange and fun research trip. Thank you also to Emilie David at Science for her help in tracking down documents, and thank you to DJ Jaffe for taking time out to school me on all the facts.
And to the staff and patients at the following hospitals, thank you for hosting me: McLean Hospital (especially Dr. Bruce Cohen, Dr. Dost Ongur, and Dr. Joseph Stoklosa), Santa Clara Valley Medical Center, Zucker Hillside Hospital and the staff of the Early Treatment Program, and University of Pennsylvania’s PEACE program (especially Dr. Irene Hurford).
There are mind-blowing museums across the country devoted to the history of psychiatry, but many are hidden away from the general public. Thank you to social worker and historian Dr. Anthony Ortega for his unforgettable tour of the Patton State Hospital Museum, and to Bethlem Hospital and the Institute of Living for allowing me to visit their collection.
Thank you to Dr. Michael First for being such a good sport; to Dr. Nancy Horn for her passionate perspective; to Dr. Janet Williams for bringing Dr. Robert Spitzer to life; to Mary Bartlett and Claudia Bushee for embracing my intrusive questions about your family. Thank you to Dr. Allen Frances for his perspective on the DSM; to Dr. Gary Greenberg and Dr. Ian Cummins for helping me figure this story out; to Drs. Ken and Mary Gergen for giving me my aha moment; to Dr. Karen Bartholomew for going above and beyond; thank you to Dr. Jeffrey Lieberman for the four-part history lesson; thank you to Dr. Matthew State and Dr. Steven Hyman for making me excited about the future of the field; thank you to Dr. Chris Frith and Dr. Thomas Insel for answering my many stupid questions with such patience. Thank you to IBM’s Watson team (especially to Guillermo Cecchi) for inviting me to your headquarters. I am indebted to Ron Powers for his beautiful No One Cares About Crazy People and the perfectly inscribed copy of Good Night Moon. I’m so grateful to Justen Ahren and the Noepe community for giving me a place in the most beautiful corner of the earth to write.
For their perspectives on Rosenhan, the man, thank you to: Dr. Edith Gelles, Dr. Helena Grzegolowska-Klarkowska, Abbie Kurinsky, Linda Kurtz, Dr. Miv London, Vivian London, Pamela Lord, Harvey Shipley Miller, Dr. Kenneth P. Monteiro, Hank O’Karma, and Dr. Lee Shulman.
For their perspective on David Rosenhan, the psychologist, thank you to: Robert Bartels, Dr. Daryl Bem, Dr. Gordon Bower, Dr. Bruno Breitmeyer, Dr. Allen Calvin, Dr. Gerald Davison, Dr. Thomas Ehrlich, Dr. Phoebe Ellsworth, Drs. Raquel and Ruben Gur, Dr. Eleanor Maccoby, Dr. David Mantell, Bea Patterson, Dr. Henry O. Patterson, Dr. Robert Rosenthal, Dr. Peter Salovey, Dr. Barry Schwartz, Dr. Martin Seligman, Dr. Ervin Staub, and Dr. Philip Zimbardo.
For their perspectives on the study, thank you to: Dr. Matthew Gambino, Dr. Peter Gray, Dr. Benjamin Harris, Dr. Voyce Hendrix, Dr. Marc Kessler, Dr. Alma Menn, Dr. John Monahan, Dr. Gina Perry, and Dr. Christopher Scribner.
For their perspective on psychiatry’s past, present, and future, thank you to: Richard Adams, Dr. Justin Baker, Dr. Gary Belkin, Dr. Richard Bentall, Dr. Carol Bernstein, Claire Bien, Dr. Joel Braslow, Dr. Cheryl Corcoran, Dr. Philip Corlett, Dr. Anthony David, Dr. Lisa Dixon, Mark Gale, Dr. Steven Hatch, Dr. Robert Heinssen, Dr. John Kane, Dr. Ken Kendler, Dr. Richard Lamb, Dr. Robert McCullumsmith, Kerry Morrison, Dr. Souhel Najjar, Dr. Stephen Oxley, Dr. Roger Peele, Dr. Thomas Pollack, Dr. Steven Sharfstein, Dr. Kate Termini, Dr. Jim van Os, Dr. Mark Vonnegut, and Bethany Yeiser.
Thank you most of all to Stephen Grywalski. The past four years were intense—a marriage, a run-in with Marie Laveau, an ileus, a move—you are my tireless advocate and you’ve given me the greatest gift of all: our twins, Genevieve and Samuel. Without you, none of this.
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ABOUT THE AUTHOR
@ Shannon Taggart
Susannah Cahalan is the award-winning, New York Times bestselling author of Brain on Fire: My Month of Madness, a memoir about her struggle with a rare autoimmune disease of the brain. She lives in Brooklyn.
Also by Susannah Cahalan
Brain on Fire: My Month of Madness
Reading Group Guide
Discussion Questions
1. Discuss the book’s title. Does the term “the great pretender” change meaning for you over the course of the book, and if so, how? What different things does it represent to you by the end of the book versus the beginning?
2. In chapter 1, Susannah encounters a woman whose disease was similar to her own, but her fate was drastically different. She begins to refer to her as her “mirror image.” How does this figure—and the author’s awareness of her background presence—help shape the rest of the book? What would such a person look like in your own life?
3. Why do you think “On Being Sane in Insane Places” hit such a nerve in American culture in 1973, and caused such a sea change in the history of psychiatry? How was it different from the work done by Nellie Bly and other brave pseudopatients and reporters in previous decades?
4. Try to imagine what mental health care in this country would look like now if Rosenhan had never published his work. Would we be in a better place? A worse one? Why?
5. Dr. Levy described Susannah as a ninth pseudopatient. In what ways do you feel that Susannah fills this role in the book?
6. The central mystery of the book propels Susannah down a number of rabbit holes, and to a frustrating series of dead ends, before she discovers the truth. Once she does, she
realizes that the answer has been staring her in the face the whole time. How did you feel about this revelation? Have you had any experiences in your own life that have been similarly surprising?
7. From the beginning, psychiatry has struggled with identifying the divide between the body and the mind, between the biological and the psychological, between the “real” and the idea that something is “all in your head.” Do you agree that this line needs to be drawn, and if so, where would you draw it and why? Is there a better system of diagnosis than the one we have currently?
8. If you had to write policy for revamping the mental health care system in this country, what would you tackle first? What approach do you feel is the most likely to succeed long term?
9. What was the most exciting, dramatic twist, or piece of evidence, that stuck with you over the course of the book?
10. Susannah describes herself as in awe of Dr. Rosenhan, early in the book, and her drive to understand his study is fueled by her admiration for him; his students frequently describe him as “charismatic” and “charming.” But of course the secrets she uncovers considerably complicate her—and our—portrait of him as a man and a scientist. Have you had any experiences in your own personal or professional life with the fall of a hero, someone you admired who, in one way or another, failed to live up to your expectations? Discuss.
11. If you were Rosenhan’s student and he recruited you to participate as a pseudopatient in the study, would you have done it? Why or why not?
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