The author was initially misdiagnosed as schizophrenic. Instead, she had autoimmune encephalitis, an organic brain disorder often called The Great Pretender for its ability to mimic the signs of psychiatric disease. Even though she was labeled as a mental patient for only a week, wondering what would have happened if the initial diagnosis wasn’t overturned compels her to investigate the US mental health care system. In fact, she finds someone who spent years in the mental health system before being correctly diagnosed with the author’s disease with unfortunate consequences.
“The brain is a physical organ and physical disease occurs within the brain. Why does that make it a ‘ psychiatric condition’ instead of a physical ‘ disease’?”—from a father of a son diagnosed with psychosis quoted in the book
The Great Pretender makes an excellent case that psychiatry is the study of neurological disease for which we have no cause or cure…yet. Both autoimmune encephalitis and syphilis were originally diagnosed as mental disorders. Once a cause and cure were found, they were moved to neurology.
Originally all mental diseases were thought to be caused by the devil. Next, medical science thought it was a weakness in the person’s character, which could be solved by drastic measures like lobotomy and shock therapy. Now, a person’s history is blamed with talk therapy and strong drugs as cures. Who is to say that that is the final solution to psychiatric disease.
The heart of the book concerns the landmark study in 1973 by Stanford professor David Rosenhan, On Being Sane in Insane Places. He and seven of his students and colleagues self-reported symptoms of psychosis to get placed in one of the facilities. Once there, they acted normally until someone released them. The average time to get out was fifteen days. The study’s conclusion was that psychiatry had no clear way to diagnose or cure mental illness. It was unable to separate the sane from the insane. The author finds additional notes from the study’s now-deceased author. She finds one of the living pseudopatients and interviews him. The author also finds a ninth pseudopatient who is mentioned only in a footnote within the study. His story is told in the book.
Currently, four percent of the US have serious mental illnesses. Many will have their lives shortened by ten to twenty years because of their condition. If you, or someone in your life, have one of these issues, you must read this book for a different perspective. Even if you are just interested in psychology, like me, The Great Pretender is highly recommended. 5 stars!
Thanks to Grand Central Publishing and NetGalley for a copy in exchange for my honest review.