Book Review: The Great Pretender – The Undercover Mission That Changed Our Understanding of Madness by Susannah Cahalan


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E-Galley (Grand Central Publishing), Rating: 🍕🍕🍕 🍕(4/5 Slices)

Disclosure: I received a copy of this book through NetGalley and the publisher in exchange for my honest review.

Before I get into the review of The Great Pretender, it’s important to talk a bit about Susanah Cahalan’s first book, Brain on Fire: My Month of Madness, which I read recently (and loved). Brain on Fire is the harrowing first-hand account of Cahalan’s struggle with Autoimmune Encephalitis. This disease attacks the brain, causing symptoms which can present much like those of other very serious mental illnesses such as schizophrenia. This book read a bit like a living nightmare of roller coaster emotions and events that led to her month-long hospitalization. Her doctors’ struggle to find the correct diagnosis and treatment led her to ask tough questions about mental illness and resulted in her second book, The Great Pretender.

The Great Pretender focuses on mental illness and how the understanding and treatment of the mentally ill has evolved. Cahalan paints a portrait of contrast between her experience as a patient whom doctors, nurses and family thought was suffering from mental illness, and her time as a patient correctly diagnosed with an autoimmune disorder. While it appeared her condition was psychiatric, she felt the behavior towards her (even by doctors and nurses) was overly harsh and even unacceptable. Once diagnosed, that changed, softening considerably.

After publication of Brain on Fire, she became an advocate, speaking at medical conferences, book signings and public events, connecting with others affected by similar experiences. After one such speaking event, the father of a young man suffering from mental illness took issue with Cahalan’s differentiation between mental illness and physical malady. He was taken aback by a statement she made about her condition being not a psychiatric, but rather, a physical condition.  After all, wasn’t the brain an organ just like the rest of the body? And if so, doesn’t that mean that mental illness is a disease just like those affecting other organs? The combination of her personal experience and the undeniable truth from this father, moved Cahalan to dig deeper into the field of mental health and investigate the events that led to its current condition.

What she found was fascinating. In the 1970s a Stanford Professor, David Rosenhan, conducted a study where he sent in seven “pseudo-patients,” (volunteers who pretended to be suffering from mental illness) into different asylums. His mission was to study the actual treatment patients receive in these institutions. When he released his findings, published in the scientific journal Science in 1973, it shook the field and was one of the main causes of widespread closings of insane asylums in this country.

I will not say much more as I believe in a “no spoilers” approach to book reviewing, but I will say this: it is not what you think. She uncovers some pretty unbelievable things about the study that I did not expect. The writing is very similar to Brain on Fire although she does delve more into the technical aspects of mental illness and especially research in the field in general. I was continually fascinated, shocked and appalled at the events that lead to where we are today. Obviously, we have come pretty far in our understanding of many aspects of these horrible diseases, but we still have so far to go and that was never as apparent to me as after reading this book.

At the crux of the issue in this book, Cahalan also looks at and comments on the history of research and medical studies and their connection with public opinion and perception of an issue. Not to mention how the science community responds to them. Scientific research across pretty much all fields are the foundation of our understanding of the world and so much is riding on them but they are not always above-board. (One she mentions is the widely touted and completely debunked study connecting the measles vaccine to cases of autism published in 1998 by Dr. Andrew Wakefield that fuels the anti-vaccine community still today.)

This is an issue that has been troubling me for a very long time as I believe we should base our opinions in scientific fact and make decisions from evidence found in sound scientific studies. However, what happens when the very studies we are basing so many important decisions on are incorrect or worse, fraudulent? Cahalan calls into question a significant portion of our research community with many important examples of where they have failed and why the public does not always trust their findings. (THIS is the direction I hope Cahalan goes next in her writing endeavors.)

For those of you who loved Brain on Fire, I think this one might be a little too deep a dive into the technical aspects of the mental illness field for you to enjoy quite as much. However, I do think if you can get through those parts, Cahalan has touched on an issue that is permeating our culture right now. How do we improve the current situation and successfully and compassionately treat patients with mental illness? She does not really answer this question but she provides the roadmap for how we got where we are today and that is truly an important start.    

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