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The Great Pretender by Susannah Cahalan
Narrative nonfiction

The Great Pretender

by Susannah Cahalan

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Quick take

Rips back the curtain on mental health treatment. You'll be rightfully shaken, outraged, or both.

Good to know

  • Illustrated icon, Icon_HeavyRead

    Heavy read

  • Illustrated icon, Icon_400

    400+ pages

  • Illustrated icon, Icon_SocialIssues

    Social issues

  • Illustrated icon, Icon_Creepy

    Creepy

Synopsis

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?

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Content warning

This book contains many scientific concepts and ideas, as well as themes of violence and abuse.

Free sample

Get an early look from the first pages of The Great Pretender.
The Great Pretender

Preface

The story that follows is true. It is also not true.

This is patient #5213’s first hospitalization. His name is David Lurie. He is a thirty-nine-year-old advertising copywriter, married with two children, and he hears voices.

The psychiatrist opens the intake interview with some orienting questions: What is your name? Where are you? What is the date? Who is the president?

He answers all four questions correctly: David Lurie, Haverford State Hospital, February 6, 1969, Richard Nixon.

Then the psychiatrist asks about the voices.

The patient tells him that they say, “It’s empty. Nothing inside. It’s hollow. It makes an empty noise.”

“Do you recognize the voices?” the psychiatrist asks.

“No.”

“Are they male or female voices?”

“They are always male.”

“And do you hear them now?”

“No.”

“Do you think they are real?”

“No, I’m sure they’re not. But I can’t stop them.”

The discussion moves on to life beyond the voices. The doctor and patient speak about Lurie’s latent feelings of paranoia, of dissatisfaction, of feeling somehow less than his peers. They discuss his childhood as a son of two devout Orthodox Jews and his once intense relationship with his mother that had cooled over time; they speak about his marital issues and his struggle to temper rages that are sometimes directed at his children. The interview continues on in this manner for thirty minutes, at which time the psychiatrist has gathered nearly two pages of notes.

The psychiatrist admits him with the diagnosis of schizophrenia, schizoaffective type.

But there’s a problem. David Lurie doesn’t hear voices. He’s not an advertising copywriter, and his last name isn’t Lurie. In fact, David Lurie doesn’t exist.

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Why I love it

Susannah Cahalan was not okay. Over the course of a month she went from being a fully functioning young reporter to suffering from psychosis and hallucinations, a step away from being diagnosed with schizoaffective disorder. In her devastating 2012 memoir, Brain On Fire, Cahalan details how a neurological disease not only caused her body to attack her brain, but also caused her to question her own sanity.

Susannah is fully recovered now, but what would have happened to her if her diagnosis of mental illness had stuck? This is what she grapples with in The Great Pretender, an engrossing history of the study of mental illness, centered around an experiment in which a psychiatrist and a group of other healthy people get themselves committed to mental hospitals in the early 1970s. There they experience the dehumanizing, traumatizing nature of the institutions themselves, and ultimately discover firsthand how mental illness diagnoses are biased and arbitrary at best.

How do we decide who is mentally ill? Drawing on years of archival research as well as her own personal experiences, Cahalan’s gripping account of the history of insanity is a feat of both enjoyable storytelling and skillful reporting.

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Member ratings (5,817)

  • Luiz B.

    New York , NY

    The book is at its best when it’s about the study itself, which is roughly 65% of it? The remaining, despite being interesting, informative & incredibly infuriating, isn’t as “thrilling” of a read.

  • Melissa Y.

    Dyersburg, TN

    I’m not sure what I expected, but this was very different. This book had me captivated from the beginning, however, it did take me a little longer to read than normal. I wanted to research everything!

  • Amanda L.

    Bethesda, MD

    This was an eye—opening look at the way mental health care has been shaped over the years, and how difficult it can be for people to find the help they need. I enjoued the author’s thorough research

  • Allison M.

    poquoson, VA

    After reading Susannah’s amazing book “brain on fire” i was looking forward to delving even further into the world of mental health. She did not disappoint. This is well researched . ❤️❤️

  • Dylan D.

    Westminster , CO

    WOW. As a mentally ill woman with lots of mentally ill loved ones, this really hit home. This should be required reading for anyone who’s been involved in or affected by the inadequacy of psychiatry.

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