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?
Journalist Cahalan (Brain on Fire) sets a new standard for investigative journalism in this fascinating investigation into a pivotal psychological study. In 1973, the mental health system was in trouble, she writes, thanks to weak diagnostic criteria and overburdened hospitals and health-care providers. Stanford psychologist David Rosenhan understood it would take a grand gesture to incite reform such as recruiting seven sane individuals to feign auditory hallucinations. Rosenhan used their accounts of institutionalization to write the 1973 article "On Being Sane in Insane Places," which sparked controversy and led to the widespread reform or closure of institutions and a revision of the DSM. However, his volunteers' identities were never revealed, which to Cahalan raises the question was he hiding anything? Driven by her own traumatizing experience as a misdiagnosed psychiatric patient, Cahalan pours through Rosenhan's notes and lists of his known contacts, attempting to match real people to the study's unnamed subjects, and ultimately is unable to find proof that six out of the seven fake patients really existed. She also discovers the wholesale omission of a volunteer's account that contradicted Rosenhan's argument. Her impeccable inquiry into the shadowy reality of Rosenhan's study makes an urgent case that the psychological and psychiatric fields must recover the public trust that "Rosenhan helped shatter."