An interesting look at the history of mental illness treatment in the United States. Cahalan investigates the 1970's study by David Rosenhan of Stanford, for which eight "sane" individuals went undercover in psychiatric hospitals to determine if doctors could really differentiate between sane and insane behaviors.

There is a lot of good here, and the book is worth reading, but it was too long, and I became especially bored when Cahalan described her research process, dead-end leads, etc. It seemed like filler.

Also, the author uses some profanity, which I always find unprofessional, and her political views come across pretty strongly (liberal, far left), so some readers, like myself, may be annoyed by that. ( )

The author spends A LOT of time talking about herself and plugging her previous book (which is also about herself). If I cared about that stuff then I would have read that book, but I don't so I didn't. I resent having to wade through all the self promotion in order to learn about the experiment that is supposedly the topic of this book. At 60 pages in, with no mention of the book's topic in sight, I am giving up.

I sped through it because I really couldn't put it down. The only reason I couldn't give it 5 stars is because it felt like the story wasn't quite finished. I want to save that final star for when that happens. It's not the author's fault of course, there's still so much mystery behind this impactful (and embellished?) experiment and David Rosenhan himself. But you'll have to read the book to know what I mean!

This book also includes a host of anecdotes in the history of psychology. I knew of course of Nellie Bly and read of Rosemary Kennedy in 2019, but was introduced this time to Lady Rosina, Elizabeth Packard, the Goldwater Rule, changes in the DSM and those involved, and even Rosenhan's connection to Soteria House! Furthermore, Cahalan thoroughly explains why, after the Medicare and Medicaid bill passed in 1965, asylums and mental institutions shut down left and right. Without beds, the mentally ill were thrown into hospitals, and when hospitals ran out of room, they ended up in prisons. A shameful practice that continues today and how David Rosenhan's experiment played a role in all of it.

"When the promises of community care - first championed by JFK - never materialized, thousands of people were turned out from hospitals and had nowhere to go...There are at last count in 2014, nearly 10 times more seriously mentally ill people behind bars than in psychiatric hospitals." ( )

In the early 1970s, David Rosenhan, a psychology professor at Stanford, published an article in Science about being able to fake being mentally ill and get admitted to mental hospitals. The article was enormously influential--I learned about it in psychology classes decades later. But Rosenhan never built on his work.

It turns out that the story of that study is a lot more complicated than Rosenhan ever let on, and Cahalan does an interesting job of trying to track down all the paths--some with more success than others. I won't go into more details here because it was fun seeing it unspool, and I don't want to spoil it.

In between is sandwiched some background on mental hospitals, and the long term impact of Rosenhan's work--which came at the same time that the antipsychiatry movement was ascendant and contributed to major changes in both mental hospitals and the process of psychiatric diagnosis. This is interesting, but since it's been extensively covered elsewhere, is less compelling than the original research. It gets a little bit messy and overly general, but is nonetheless interesting.

Cahalan is a journalist, not a psychologist, which is an asset when it comes to approaching Rosenhan's work as a kind of detective story. It's well told and engaging and her experience as a layperson makes her well suited to translating the details. The sections on the development of diagnosis and the DSM are a bit less gripping--there are many interesting philosophical questions raised by the process of diagnosis, but it's not the time to get into it. To her credit she doesn't try to delve too deeply; she's trying to strike a balance between providing enough context to understand Rosenhan's work and getting too far into another topic. Overall she does a good job with it; a little bit of editing might have smoothed it out, but I can't argue too much. ( )

The author of this book was previously ""violent, paranoid and delusional" but her problems turned out to be caused by autoimmune encephalitis. She was cured and became interested in psychiatry.

Psychiatrist David Rosenhan presented the thesis that psychiatry had no reliable way of distinguishing the sane from the insane. Eight people, Rosenhan himself and seven others, volunteered to go undercover in twelve institutions (how could they do that?) on the East and West Coasts of the USA and present with the same limited symptoms. They would tell the doctors that they heard voices that said "thud, empty, hollow".

The study tested whether or not the institutions admitted these sane individuals.

All these "pseudopatients" were diagnosed with serious mental illnesses, in all cases but one, with schizophrenia; in the remaining case the diagnosis being manic depression.

The length of hospitalization ranged from seven to fifty-two days with an average of nineteen days.

Once inside the institution it was up to themselves to get out.

We get the stories of the various pseudopatients including Rosenhan's, though as far as I recall, Rosenhan didn't quite follow the rules in some way.

There's a chapter entitled "Only the insane knew who was sane", which was accurate - interesting!

There was a disturbing chapter about John Kennedy's sister Rosemary, though it was not really relevant to the subject on hand.

The book is well-written and I found the first half absorbing, but towards the end it became a bit complicated and I couldn't keep on with it. ( )