[Ebook] ↠ The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness Author Susannah Cahalan – Reliableradio.co.uk

The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness From One Of America S Most Courageous Young Journalists NPR Comes A Propulsive Narrative History Investigating The Year Old Mystery Behind A Dramatic Experiment That Changed The Course Of Modern Medicine 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 S 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 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 When I read Brain on Fire, Susannah Cahalan s memoir about her experience with psychosis, I became a little obsessed with it The Netflix adaptation was disappointing, as the clever hook in the book was her investigating her own illness from an outside perspective, something she could do as she lost most of her memory from when she was sick The film just follows it straight But that s a digression Brain on Fire is an extremely readable memoir about a very scary and rare thing that happened When I read Brain on Fire, Susannah Cahalan s memoir about her experience with psychosis, I became a little obsessed with it The Netflix adaptation was disappointing, as the clever hook in the book was her investigating her own illness from an outside perspective, something she could do as she lost most of her memory from when she was sick The film just follows it straight But that s a digression Brain on Fire is an extremely readable memoir about a very scary and rare thing that happened to Cahalan Especially since the extremely rare illness she was diagnosed with anti NMDA receptor encephalitis, an autoimmune disease that at the time had only been diagnosed in a couple hundred people, ever is a kind of disorder that is sometimes called a great pretender, meaning it mimics the symptoms of other diseases and is thus hard to diagnose In this case, Cahalan s body was attacking her brain, but doctors believed she was mentally ill After recovering from her illness, Cahalan became obsessed with what could have been, or the people she began to call her mirror images One woman in particular was diagnosed with the same rare disorder after her doctor attended a lecture that Cahalan gave, but she had been suffering with the condition for years at that point, and even after treatment, would never be able to fully recover as Cahalan was able to, because she was incredibly lucky and diagnosed so early Cahalan s is full of encounters like this now, as talking about mental illness with strangers has become a regular occurrence When an acquaintance brought up David Rosenhan s infamous study from the 1970s, where he sent eight pseudopatients undercover into psychiatric hospitals to test out psychiatry s ability to tell the sane from the insane, and to question the efficacy of psychiatric diagnosis, Cahalan immediately wanted to learn everything she could Rosenhan s study became a phenomenon when it was published, crossing over into the mainstream media, and altering the practice of psychiatry in pretty significant ways.Cahalan began digging into the story, determined to learn about Rosenhan, track the effects of the study, and maybe track down the pseudopatients themselves they were given pseudonyms in the published paper, which was titled On Being Sane in Insane Places But as she starts her digging, she gradually comes to realize there are enormous holes in the story, and Rosenhan and his study were not what they seemed I don t want to saythan that, because it s fun to watch her chase down clues, and uncover what actually happened.Cahalan also uses the investigation into the study to look into the history of psychiatry itself This was one of the main things I m ambivalent about with the book At times it felt scattered, as other reviewers have pointed out, she follows a lot of tangents I keep going back and forth about whether those tangents were actually tangents at all, but instead purposeful insights into a greater picture that Cahalan was trying to present But it was still a little messy and confused in execution I think I would have appreciatedclarity But I do think it was a necessity for her to not write about this study in a bubble You need to know about a lot of it to understand the impact the study had on the field, and why it feels like such an urgent topic still today to Cahalan.It was very unsettling throughout the book to realize just how much we still don t know about mental illness, as one psychiatrist she quotes in the book says, all we have are signs and symptoms, and though other reviewers have accused Cahalan of an anti psychiatry bias, I don t think that s what s going on here at all She s certainly in favor of psychiatry practices that don t dehumanize patients, and in favor of science that advances our understanding of the brain and how it works She s also not afraid to bring up sticky questions, like how the mental illness stigma and cognitive bias often leads to misdiagnosis, and how disorders that have a physical cause in the body are taken so muchseriously than the murkier conditions like bipolar or schizophrenia, or even clinical depression She definitely is advocating for an approach that eliminates the distinction between a medical diagnosis and a mental one she argues that mental diagnoses are medical, even if we don t yet understand the causes Her own case is pretty damning she says the way she was treated was markedly different after she received her medical diagnosis, as compared to how she was treated when doctors thought she might have schizoaffective disorder, or maybe she was just partying too much One of the things I found fascinating about the book was that even as Rosenhan s study exposed flaws in the system, and produced massive change a new standardized approach to diagnosis in the DSM III for one thing , it also had massive consequences for the future of institutionalized psychiatry There was already a growing anti psychiatry movement in full swing by the time the study was published, one of the reasons it hit so big, and afterwards, many hospitals were closed, and those that are now left are massively underfunded The need for psychiatric beds, according to Cahalan, is at minimum 95,000 heads in the USA It is easier to get into Harvard in some cases than to get a bed and treatment when it is needed Something I didn t know before this was that JFK s sister, Rosemary, had a developmental disorder due to oxygen deprivation at birth, and what ended up happening to her was so horrific, JFK decided to devote himself to the idea of ending barbaric practices on patients like lobotomies and to promote community care with government funding aholistic approach that focuses on humanizing patients But because he was assassinated, the only part of his plan to be put into effect was the closing of hospitals, and the funding for different types of programs never materialized.Despite it s scattered ness, I m really glad I read this, and I hope people who can make a difference in our mental health care system will also read it 3.5 stars, rounding up A writer friend always rates her own books She explained that if she doesn t love her own book enough to give it five stars, how can she expect anyone else to do the same I like this mentality so here I go Back in the early 1970s, Dr David Rosenhan published the results of a study wherein he and several other people so called pseudopatients , none of whom had ever had mental health issues, attempted to get admitted to psychiatric hospitals by showing up and claiming they heard a voice in their head saying empty, hollow, and thud All of them got admitted on this basis, most of them receiving a preliminary diagnosis of schizophrenia Once admitted, they behaved like their normal selves, b Back in the early 1970s, Dr David Rosenhan published the results of a study wherein he and several other people so called pseudopatients , none of whom had ever had mental health issues, attempted to get admitted to psychiatric hospitals by showing up and claiming they heard a voice in their head saying empty, hollow, and thud All of them got admitted on this basis, most of them receiving a preliminary diagnosis of schizophrenia Once admitted, they behaved like their normal selves, but no one seemed to notice they were actually not mentally ill The resulting article, On Being Sane in Insane Places, purported to show that 1 diagnosis of mental health issues was unreliable at best and 2 patients in psychiatric hospitals were in fact not treated in ways that might actually be therapeutic.When Susannah Cahalan heard about this study a few years ago, she was fascinated Girl, me too Rosenhan s study put me in mind of Nellie Bly s groundbreaking undercover investigation of an asylum, which she published in the 1880s as Ten Days in a Mad House, and which I was obsessed with as a kid Bly s investigation is detailed in The Great Pretender, but Cahalan s own interest was based on somethingpersonal Her harrowing experience of having her brain inflammation misdiagnosed as mental illness If a determined doctor hadn t discovered what was actually ailing her, her life may have turned out very differently.Cahalan decided to find out everything she could about Rosenhan s study, talking to his associates and even attempting to track down some of the other pseudopatients who took part in it Without spoiling anything, what she discovered was very interesting, and The Great Pretender itself should have been similarly interesting Unfortunately, this book had so many structural problems it was ultimately muchfrustrating than fascinating.Simply put, Cahalan should have made the Rosenhan study, how it was received, and her investigation into it the main plotline of the book But she clearly did a ton of research and didn t want any of it to go to waste, so there are many, many detours, for paragraphs, pages, or even entire chapters, into topics that are peripheral the history of the Esalen Institute, for example and or can t be discussed adequately here overdiagnosing replicability issues in research imprisoning the mentally ill Some of these details actually undermine the points she is trying to make for example, she wants to claim that Rosenhan s study caused the closure of psychiatric hospitals, resulting in a lack of support for the mentally ill, but a long detour into John F Kennedy s efforts to help the mentally ill shows that this was a problem well before Rosenhan came on the scene All of this extra information not only makes the reading experience a slog it also dulls the impact of the discoveries Cahalan herself makes I truly wish someone had edited this book with an eye toward making it sharper andconcise it would have made the book ainformative and memorable reading experience.Cahalan understandably takes issue with the vague misdiagnosing that caused the pseudopatients to end up hospitalized, but she seems equally opposed to the muchdetailed diagnostic criteria provided by DSM volumes that have appeared subsequent to the Rosenhan study Does Cahalan offer her own solution to these problems In a word, no in the penultimate chapter of The Great Pretender she rails against the psychiatry and psychology professions in a way that s nearly incoherent, and in the final chapter she purports to offer hope for the future, but some of the advances she names seem like quackery and pseudoscience, and the fact that psychiatrists are makingmoney than ever before hardly seems like the good news she thinks it is.The book is also sloppy with facts in a way that gave me pause She misuses the word metastasize, for example, and indicates that mammograms prevent breast cancer they don t, of course She also makes much of the fact that Rosenhan published his article in Science rather than aspecialized journal, implying that Science would be less rigorous in its review and that its quick turnaround times necessarily meant its peer review process cut corners This implication struck me as irresponsible it seems equally likely that Rosenhan wanted to be in Science because it was a prestigious and popular journal, and that its faster peer review process might be a result of its large number of resources compared to other journals I was left with the feeling that Cahalan, a former New York Post reporter, didn t know much about scientific publishing, and it made me wonder what else was mere speculation on her part.Some criticisms with the presentation of the book The Rosenhan article itself wasn t included here neither were the responses to the study that other researchers published Sure, it would have cost money for the publisher to obtain these reprint rights, but it would have made the entire experience of reading The Great Pretender muchinformative Additionally, Cahalan urges readers to educate themselves on these issues, but she doesn t include a list of recommended reading instead readers are expected to wade through the end notes for pertinent material None of this adds up to a satisfactory learning experience.As I said, this topic is fascinating to me, and it saddens me that I can t recommend this book In short, the whole thing should have been wayincisive The less pertinent info should have been edited way down Cahalan s unfocused screeds should have been shortened and made, well,focused andresources should have been provided for the reader It seems that The Great Pretender is meant to be some kind of challenge to the field of psychiatry to do better, and while that s a worthy goal, Cahalan hasn t done much here besides meet their fuzzy thinking with fuzzy thinking of her own.I received this ARC via a Shelf Awareness giveaway Thank you to the publisher Have read Susannah Cahalan s deeply personal memoir, Brain on Fire She has followed up that best selling book with The Great Pretender, which exposes the suspenseful mystery behind an experiment that shaped modern medicine and mental health as we know it today David Rosenhan and his brave colleagues entered asylums undercover in order to come out diagnosed out the yin yang, but better able to expose the atrocities and systemic problems in mental health treatment at the time On top of that, Ca Have read Susannah Cahalan s deeply personal memoir, Brain on Fire She has followed up that best selling book with The Great Pretender, which exposes the suspenseful mystery behind an experiment that shaped modern medicine and mental health as we know it today David Rosenhan and his brave colleagues entered asylums undercover in order to come out diagnosed out the yin yang, but better able to expose the atrocities and systemic problems in mental health treatment at the time On top of that, Cahalan exposes the untold mystery within the mystery.I received a complimentary copy from the publisher.Many of my reviews can also be found on instagram www.instagram.com tarheelreader

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