56 Time November 18, 2019
Cahalan’s second book, The Great PretenderEven so, the accuracy of Rosenhan’s
study comes to matter less than its
consequences. After its publication,
psychiatric hospitals all over the U.S.
closed down. In tracing the
history of psychiatric care
in America, Cahalan charts
how prisons have become
the primary replacement for
asylums—what she calls the
“shadow mental-health care
system”—and reminds us
of the worrying influence of
Big Pharma on the way we
diagnose certain conditions.
The book has the urgency of a call
to action: the U.S. is at least 95,000
public psychiatric beds short of need,
and at least 20% of people in jails fit
the criteria for serious mental illness.
Having described the horrors of
19th century asylums, Cahalan delivers
a bold verdict: “Today, it’s worse,”
she writes. “We don’t even pretend
the places we’re putting sick people
aren’t hellholes.” □“if SaniTy and inSaniTy
exist, how shall we know them?”
So begins a landmark 1973 study
by Stanford psychology professor
David Rosenhan, who persuaded
eight healthy people to feign hal-
lucinations and commit them-
selves to mental asylums. Once
inside, they would have to prove
their sanity to get out. The study’s
impact was explosive, demonstrat-
ing that even trained profession-
als struggled to tell the difference
between the mentally ill and the
mentally healthy. It was so pivotal
in reshaping our understanding and
diagnosis of madness that 46 years
later, it is still taught widely.
In The Great Pretender, journalist
Susannah Cahalan turns her inves-
tigative skills to this famous experi-
ment. Her interest in the trauma of
being labeled insane is personal: at 24,
she was hospitalized with symptoms
including seizures, hallucinations and
psychosis—an experience she recounted
in her 2013 best seller, Brain on Fire. She
was misdiagnosed with bipolar disorder
before it emerged that she
had a rare auto immune dis-
ease of the brain. “For every
miracle like me, there are...
a thousand rotting away in
jails or abandoned on the
streets for the sin of being
mentally ill,” she writes, “a
million told that it’s all in
their heads, as if our brains
aren’t inside those heads.”
A gripping, insightful read, The Great
Pretender probes the gaps that medi-
cal science has yet to fill when it comes
to understanding mental illness. After
recovering from her own condition,
Cahalan spent five years exploring psy-
chiatry. Rosenhan died in 2012, but
Cahalan gained access to his notes. As she
delved into them and searched for par-
ticipants from the study, she discovered
troubling inconsistencies in the work.
BOOKS
Dark dreamsIn the first pages of her
new memoir, Carmen Maria
Machado confesses she never
reads prologues. If the text is
so important, she asks, why
include it before the story
begins? But turn the page, and
she’s titled her next chapter
“Dream House as Prologue.”
Each section of In the
Dream House uses a different
narrative trope to explore
a toxic relationship in the
home Machado shared
with a past partner, one she
paints as explosive and
fearsome. Through the book’s
sections—“Erotica,” “Choose
Your Own Adventure” and so
on—Machado describes the
trauma she endured. She
blends examples from history
and academia into the work,
pointing to a larger problem
about the lack of attention
paid to abuse in same-sex
relationships.
This structure could easily
feel forced, but Machado, a
2017 National Book Award
finalist, is a nimble writer. Her
prose is clean and urgent,
written primarily in the second
person as she asks a younger
version of herself questions
that have haunted her for
years. But the “you” serves
another purpose too, placing
readers directly into the
discomfort of the story.
—Annabel GuttermanBOOKS
A journey into
the nature of
sanity
By Naina Bajekal
TimeOff Reviews
‘If sanity and
insanity exist,
how shall we
know them?’
DAVID ROSENHAN,
psychology professor at
Stanford University