The Great Pretender

by Susannah Cahalan

  Harding, one of the patients, explains why: “I discovered at an early age that I was—shall we be kind and say different?… I indulged in certain practices that our society regards as shameful. And I got sick. It wasn’t the practices, I don’t think, it was the feeling that the great, deadly, pointing forefinger of society was pointing at me—and the great voice of millions chanting, ‘Shame. Shame. Shame.’” He wasn’t sick in the biological sense, but was made sick by the world around him.

  Even more pointedly, the narrator, Chief “Broom” Bromden, pretends he can’t hear or speak, but documents everything and gets away with it because the institution sees him only as a crazy man with a broom, and so he is invisible. In the end, McMurphy’s battle is lost. The authoritative powers of the institution—embodied by the monstrous Nurse Ratched—converge on McMurphy, who is lobotomized for the sake of convenience, never again to be a problem on Ratched’s ward.

  Suffice it to say, in the early 1970s, psychiatric hospitals were not getting a good rap.

  On top of it all, Cold War paranoia touched everyone, as stories of men and women interned in Soviet psychiatric hospitals for political reasons reached the US. Thousands of dissenters in the USSR were hospitalized against their will, including one outspoken general named Pyotr Grigorenko, who served in the Red Army before he began to question the policies of the Communist Party. He was diagnosed with “paranoid development of the personality with reformist ideas rising in the personality, with psychopathic feature of character, and the presence of symptoms of arteriosclerosis of the brain” (a Russian nesting doll of a sentence if I ever heard one). He spent five years in one of the worst Soviet “psycho-prisons” until he was finally released and allowed to immigrate to the US.

  Which was scarier: using psychiatric labels as a tool of oppression, or the possibility that many of these Soviet psychiatrists actually believed that someone who didn’t support Communism must be crazy?

  And yet this exploitation of psychiatry was also happening in America—by the White House, in particular. To discredit Daniel Ellsberg, the man who leaked the Pentagon Papers to the New York Times, former CIA agent Howard Hunt sent the “plumbers” (men who did the White House’s dirty work) to his psychoanalyst’s office to find information there to discredit him.

  The most famous person singled out for his mental health history was Republican presidential candidate Barry Goldwater, whom psychiatrists (without personally examining him) called unfit to serve, describing him as, among other things, “a dangerous lunatic” in a 1964 Fact magazine article titled “1,189 Psychiatrists Say Goldwater Is Psychologically Unfit to Be President!” The American Psychiatric Association, embarrassed by the resulting fallout (and Goldwater’s successful libel suit against Fact), implemented the Goldwater rule in 1973, an ethical principle banning psychiatrists from making armchair diagnoses of public figures they have not examined, which continues even in the face of opposition today.1 A cardiologist, they argue, wouldn’t dare diagnose someone they saw only on TV, so neither should psychiatrists. This rule suggests that psychiatry should be held to the same standards as other medical specialties, a defensiveness that is revealing: “Psychiatrists are medical doctors; evaluating mental illness is no less thorough than diagnosing diabetes or heart disease,” the APA wrote.

  At the same time, the lay public continued to wonder, Does madness even exist? This might seem like an absurd question to anyone who has lived with mental illness—either personally or through a loved one—but in a time when people were labeled “mentally ill” simply for their attraction to people of the same sex, it was a legitimate debate. The emerging anti-authority movement questioned so many of our assumptions, arguing that all madness was a social construct. They quoted French philosopher-historian Michel Foucault’s Madness and Civilization as proof that psychiatric institutions had, from the very beginning, used confinement as a tool for domination. Sociology professors taught the labeling theory, which presented mental illnesses as self-fulfilling prophecies hoisted upon us by society’s own need to classify and stereotype “deviants.”

  If this sounds familiar, it is because these are the same impossible questions (in different contexts) that we’ve been circling as long as we could reason. And Rosenhan would crystallize all of this in his blockbuster study.

  Meanwhile, the growing anti-psychiatry movement launched critical attacks from within the academy’s own ranks. R. D. Laing, a Scottish psychiatrist, offered arguments that were most appealing to the counterculture. He theorized that insanity was a sane response to an insane world. Schizophrenia, Laing would write, was a super sanity—a kind of insight only those with truly open minds could achieve—and he believed that one day, “They will see that what we call schizophrenia was one of the forms in which, often through quite ordinary people, the light began to break through the cracks in our all-too-closed minds.”

  In 1967, he wrote, “Madness need not be all breakdown. It may be breakthrough.” Students carried dog-eared copies of his books The Divided Self (1960) and The Politics of Experience (1967)—two of his most popular and groundbreaking works—in their back pockets, a badge of honor advertising their cynicism about the societal judgments imposed on the mind, proclaiming their higher consciousness about the self, about sanity, about society. But it was easy to poke fun at him. “Schizophrenics were the true poets,” Erica Jong would joke in Fear of Flying. “Every raving lunatic was Rilke.” Soon enough, reports of rampant drug use at Laing’s asylum-style London house called Kingsley Hall emerged. Alongside his rise as a guru, Laing seemed to grow into a caricature of kookiness as he flirted with “rebirthing” sessions and other bogus ’70s-era treatments, along with copious drugs and alcohol. (I’ll never be able to purge the sight of Laing, red-faced and perspiring as he mimed pushing himself through “his mother’s birth canal” on a patterned couch, captured on video and screened for me by his former cameraman.)

  Hungarian-American psychiatrist Thomas Szasz called mental illness a “myth” and said that the concept of mental illness was “scientifically worthless and socially harmful.” The opening of his most famous book, The Myth of Mental Illness, reads, “There is no such thing as mental illness,” and the book relegates psychiatry to the realm of alchemy and astrology. Psychiatrists used medical jargon, he argued, without having any real credibility. “If you talk to God, you are praying; if God talks to you, you have schizophrenia. If the dead talk to you, you are a spiritualist; if you talk to the dead, you are a schizophrenic,” he wrote. Institutional psychiatry in particular was an instrument of oppression to control troublesome or morally deviant characters, whom he called “parasites.” Psychiatry wasn’t just oppressive, it also enabled the worst among us, he argued. At least for a time, Szasz’s arguments were compelling to intellectuals in and outside the field. (According to Rosenhan’s private notes, he was far more inspired by Szasz’s view of mental illness than Laing’s—at least at first. In later retellings, however, as Szasz fell out of favor he would credit Laing with inspiring his famous study.)

  The anti-psychiatry movement made not-so-strange bedfellows with the civil rights movement. Both were united against a common enemy: the power of “the institution” that decided what was “normal” or “acceptable” in society.

  This spirit fully permeated Rosenhan’s Swarthmore College, an ivory tower liberal enclave with Quaker roots, surrounded by blue-collar, conservative, meat-and-potatoes Delaware County, Pennsylvania. In the spring semester of 1969, the campus had never been so politicized. Though typical university controversies still existed—like whether the admissions office should maintain its ban on students with beards working as tour guides—now they were conducted alongside contentious debates over whether or not to allow naval recruiters on campus.

  In the midst of these protests, the Swarthmore Afro-American Student Society (SASS) staged sit-ins and walkouts calling for greater representation of black students on the campus that had opened its doors to them only two decades ea
rlier, and whose minuscule numbers had barely hit double digits. With tactics that included hunger strikes, the SASS successfully delayed the opening of Swarthmore’s spring semester, resulting in a week of canceled classes dubbed “The Crisis of 1969,” which ended only when President Courtney Smith suffered a fatal heart attack in a campus stairwell. One writer suggested that President Smith died “from a broken heart.” The campus mourned the popular president’s death, and the Afro-American Student Society’s terms were back-burnered. Swarthmore became known as “the place where the students killed the president”; Vice President Spiro Agnew is said to have nicknamed it “the Kremlin on the Crum” (the Crum are the woods that surround the college). Needless to say, the atmosphere on campus that spring was electric.

  And these trade winds helped steer a delegation from David Rosenhan’s abnormal psych seminar to approach him in his smoky lab in the basement of Swarthmore’s Martin Hall at the start of the spring semester in 1969—a meeting that would set in motion a chain of events that would change the world.

  7

  “GO SLOWLY, AND PERHAPS NOT AT ALL”

  Professor David Rosenhan may have only just arrived the previous semester, but in his tweed jacket with leather elbow pads, he arrived at Swarthmore looking like he belonged there. Some students joked that his big bald dome of a head must mean he had a big brain. Colleagues recalled his hip-swishing swagger as he’d amble through the campus with his hands clasped behind his back, the walk of a guy who owned the place.

  Rosenhan’s previous position had been as a lecturer at Princeton’s Department of Psychology and a research psychologist at Educational Testing Service, a group of test makers that helped shape the SAT into the test we know today. The Educational Testing Service gave its researchers a wide latitude to explore nearly any subject. It was a perfect situation for Rosenhan, who had an agile mind that tended toward backflips, always ready to vault over and around obstacles in his path. (He nimbly employed psychological tricks even in grade school. Rosenhan was a scrawny kid who loved wrestling, and he figured out a way to use his weakness as an advantage. To break an opponent, he’d set the other boy’s expectations low by purposefully tripping on the way to the mat.)

  The elastic nature of his mind reveals itself in the subjects he pursued: He wrote papers on dream analysis, on hypnosis, and on contemporary social issues like the motivations of Freedom Riders, black and white civil rights advocates who traveled on buses together in the South to challenge segregation. He replicated Stanley Milgram’s 1963 study on obedience, showing the extreme lengths that his subjects would go to when following orders. Milgram had created a fake shock box with levers marked with voltages that ranged from 15 V to “XXX,” the latter’s abstraction meant to imply that it was so high it could be deadly. Milgram’s results stunned the world: The study’s volunteers showed themselves ready and willing to administer high levels of electric shocks to strangers, just because they were asked to (in Milgram’s sample, 70 percent would shock their cohorts at the XXX level), which struck an uncomfortable chord in the aftermath of World War II. The son of two Eastern European Jews, Milgram had grown up in the shadow of the Holocaust, as had Rosenhan, and this was never far from their minds. “A number of us here are interested in extending your work,” Rosenhan wrote to Milgram in 1963. “Needless to say, we feel you’ve discovered a remarkable phenomenon.”

  Rosenhan’s current passion—and the interest funded by the National Institute of Mental Health—was studying pro-social behaviors in children, specifically testing “young children’s unprompted concern for others,” which he called his “search for values.” In other words, do you become a good or bad person, or are you born that way? This was an animating question for social psychologists at the time—one that Milgram and his shock machine and later Zimbardo and his prison experiment both grappled with.

  Rosenhan set up his lab to resemble a miniature bowling alley, with marbles used as bowling balls. He rigged the study so that he could control whether a child would win or lose, and then documented how the child’s altruistic behavior, like donating money to charity, changed depending on whether or not adults were present. Rosenhan’s research assistant Bea Patterson remembers cringing at his instructions to tell the children that they were “duds” if they didn’t win, knowing full well that the results were randomly assigned. Sometimes the losing kids would cry. More often they would cheat, pushing over the tiny pins. In an unanticipated turn of events, Rosenhan and Patterson discovered that cheating, as much as winning, increased the likelihood that children would donate their money. Other researchers may have thrown in the towel, but Rosenhan, as any good scientist would, turned his study on its head and published another, more interesting paper about the role of confidence in cheating behavior, an example of his backflipping brain at work.

  His intellectual range was boundless. He devoted a good deal of interest to abnormal psychology, and he wrote two textbooks on the subject with close friend and psychologist Perry London. He explained his attraction to the topic in a letter to a colleague and friend: “Abnormal psychology is a painfully complicated psychological area. It implicates biology, chemistry and genetics heavily. It implicates social perception. And it implicates the experience of any of us who has been depressed, anxious, or worse. The need to bring simplicity and understanding to an apparently complicated area challenges me.”

  But Rosenhan’s real talent was teaching. Rosenhan had a way with people, a seductive quality. His baritone voice could easily transfix a packed auditorium. Ex-students of his called it a gift. One described him as being able to “rivet a group of two to three hundred students with dynamic lectures that are full of feeling and poetry and personal anecdotes.”

  It was no wonder, then, that Rosenhan’s first abnormal psychology class was such a hit that Swarthmore tapped him to run an honors seminar devoted to the same subject. I wish I could have been there in the moment to hear him on that very first day, but instead, I was able to track down a few tapes of Rosenhan’s later lectures. His deep and resonant golden voice, which sounds a bit like Orson Welles’s, boomed through my computer speakers: “We are here in this spring quarter to see if we can understand the mind through its abnormalities,” he said. His Talmudic cadence—the way he elongated words, pausing and stressing them for dramatic effect—must have been carved in him during a youth spent singing and training to be a cantor. It was the kind of voice that projected authority and made you want to lean in, focus, and listen.

  “The question is… What is abnormality?… What are we here for?” he asked. “Some things will be black… Others will be white. But be prepared for shades of gray.”

  I had no idea how shaded that gray would become.

  It was likely late morning when his students approached him in his office. They had come to complain, he explained in his unpublished manuscript, “that the course had had two shortcomings. First, I had avoided case histories of psychiatric patients. And second, I had pointedly refused to allow students to visit psychiatric hospitals.” He went on:

  We sometimes forget that psychiatric patients are people too. They have their dignities, their shames, and their vulnerability like the rest of us. It seemed unfair, an invasion of the privacy of people who were helpless to defend themselves, to encourage students to visit such hospitals. Would you want to be exposed to young inquisitive strangers, however well intentioned, if you were there?…

  For their part however, the students had a case and they pressed it vigorously. We do not appreciate abstractions, they argued, without direct experience with the substances that form them. How does one assess… say, schizophrenia, without knowing directly some schizophrenics? Without having been exposed immediately and concretely, to their thoughts, their feelings, the way they perceive the world? Isn’t it a bit like trying to understand the value of a dollar without knowing what the dollar will buy?

  I was caught then, clearly and unpleasantly, between appreciating their views and being con
vinced by my own. As the issues became clearer, the argument took on vigor. Finally, it seemed to me that I saw a compromise between these two seemingly irreconcilable positions.

  “Look,” I blurted, “if you really want to know what psychiatric patients are all about, don’t waste your time on case histories or in simply visiting hospitals. Why don’t you simply check into a psychiatric hospital as a patient?”

  “When?” they asked.

  When? Not why. Not how, or where, or even “hey wait a minute.” But when. Bless their cockiness.

  As his students made their case, Rosenhan recalled an undergraduate course at Yeshiva University on minority groups, which required each student to rent a bed in a Spanish Harlem boardinghouse to experience poverty firsthand. Living with ten others in an apartment meant for four people had made a deep impression on Rosenhan, even as the son of Polish Jewish immigrants in Jersey City who survived on his father’s meager living as a door-to-door salesman. The memory rekindled an enthusiasm he recognized from his own student days.

  Energized, he decided to reframe the students’ pitch as a teaching exercise and began to plan. First they’d have to find a psychiatric hospital willing to let them in. Luckily a colleague worked at Haverford State Hospital just fifteen minutes away, and he promised to bring it up with the hospital’s superintendent, Jack Kremens. Rosenhan couldn’t believe his luck. Kremens, who had worked during World War II as an agent in the Office of Strategic Services (a precursor to the CIA), would be the perfect point person to approach for something so bold. And he had every reason to think Kremens would be interested, too, since the students’ undercover exercise would allow them to report back, from the ground, about internal operations at the hospital. Rosenhan and his students could document any gap between the set of regulations regarding patient care and the day-to-day realities. Kremens had been specifically concerned about the possibility of illegal drugs floating around his facility, and he needed to know if they were coming from someone on the inside. Rosenhan’s project offered an opportunity to do some spying.