Hallucination. Psychosis. Cognitive decline. Susannah Cahalan had all of these symptoms. Doctors concluded that she was schizoaffective, and the words “TRANSFER TO PSYCH” began to creep into her medical file. Through a series of events, it was revealed that Susannah had autoimmune encephalitis. It wasn’t a mental illness at all.
How would her story have been different if she had simply been relegated off to the psych ward? Why do we treat mental illnesses differently than other conditions. Her journey led her to a Stanford psychologist named David Rosenhan. In the 1970s, Rosenhan began his search for the answer to these questions. Do we know how to treat mental illness? Do we know how to diagnose it? Do we even know what it is?
In order to find the answer, Rosenhan and seven other people went undercover into asylums around the United States to find out if psychiatrists could tell the difference between sanity and insanity. The only way out would be to prove their sanity.
Rosenhan’s findings were published by the journal Science in 1973 under the title “On Being Sane in Insane Places.” According to Rosenhan, he and other “pseudopatients” were diagnosed with mental illness and admitted to various psychiatric hospitals. After presenting with auditory hallucinations to gain admittance, the pseudopatients acted normally. “Yet from the moment of admittance, clinicians viewed all behaviors through the prism of the pseudopatients’ presumed mental illness.” According to Rosenhan’s study, it was 30 percent of the actual patients that noticed something was awry.
Many critics denounced the study as a farce, but the damage to the field of psychiatry was overwhelming. Susannah searched for clues that might lead her to one of the other pseudopatients, but they all lead to a dead end. The files Rosenhan kept and the findings of his study didn’t exactly match up.
Asylums are, for the most part, a thing of the past; mental illness is still very much an issue. Today many people diagnosed with mental illness are housed in jails or prisons. Is this really the solution to the problem?
My thoughts: It was an interesting dive into mental illness, how it was treated in years past, and some of the problems we face today. Many of the quotes from the book left a lasting impression on me. Susannah once described her plight by saying, “My illness appeared as if it was a psychiatric condition, but it was not a psychiatric condition – it was a physical condition.” A father with a mentally ill son felt betrayed by this answer and said, “The brain is a physical organ and physical disease occurs within the brain. Why does that make it a ‘psychiatric condition’ instead of a physical ‘disease’? What am I missing?” Maybe we should try to answer the same question.
Ricky Statham is director at Oneonta Public Library. Visit the library Monday and Thursday from 9 a.m. to 7 p.m.; Tuesday, Wednesday, and Friday from 9 a.m. to 5 p.m.; and Saturday from 9 a.m. to 2 p.m., to check out this or another great book.
The Great Pretender
by Susannah Cahalan