EDITOR’S COLUMN How To Assassinate a Medical Specialty by Edward C. Leonard, Jr., MD, DLFAPA
The best thing that ever happened to Susannah Cahalan was having seizures when she was delusional and hallucinating ten years ago. That neurological sign encouraged her doctor to get a newly developed test that showed autoimmune encephalitis, which was treated successfully. Since publishing Brain on Fire, her memoir about this psychotic episode, Cahalan has made many presentations encouraging clinicians to search for causative medical conditions in all who present with mental symptoms. Ensuing discussions with mental health professionals introduced her to David Rosenhan’s 1973 article in Science, “On Being Sane in Insane Places,” which reported what happened to eight healthy women and men who essentially sought psychiatric hospital admission only for hearing voices saying “thud, empty, hollow.”
chart given him by the admitting psychiatrist who was troubled by the article’s lies. Cahalan is cautious in drawing conclusions, but the thrust of the evidence points to deliberate falsification of research in what now seems to be Rosenhan’s gleeful vilification of psychiatry. Seen as a hoax that continues to defame psychiatrists, this article may be the single worst thing that ever happened to our field. It was used by politicians to justify closing mental hospitals, by insurance companies to refuse treatment to suffering patients, by lawyers to challenge psychiatric diagnosis in court and commitment hearings, and it turned countless numbers of college students away from considering careers in our specialty. Everyone interested in how psychiatry got to where it is today must read Susannah Cahalan’s Great Pretender.
In her new book, The Great Pretender: The undercover mission that changed our understanding of madness, she suggests that Robert Spitzer felt that the attack on psychiatric diagnoses in Rosenhan’s article was the best encouragement his DSM project ever received. Cahalan notes that, by never publishing the additional symptoms Rosenhan reported to Haverford State Hospital, Spitzer protected his research from deserved disparagement. The medical record includes Rosenhan saying that the hallucinations were longstanding, troubled him enough to try putting a copper pot over his ears to dampen them, and resulted in suicidal ideas. In addition, not mentioned in “On Being Sane in Insane Places,” the admitting psychiatrist had asked two other psychiatrists to talk with Rosenhan to confirm his need for admission. Cahalan’s access to David Rosenhan’s files encouraged her to search for the other seven pseudo-patients in his study. She only found one. However, she did find a “ninth” pseudo-patient who was mentioned only in a footnote excluding him from the study because he reported more symptoms than a voice saying thud, empty, and hollow. She then found a draft of Rosenhan’s article, which included the ninth pseudo-patient. Comparison with a later draft with only eight pseudo-patients showed the published quantitative data was faked. Her book is a magnificent example of how a thorough reporter investigates her subject, but all psychiatrists should be grateful to Rosenhan’s son for gifting Cahalan permission to publish excerpts from the medical record that no psychiatrist could have quoted during Rosenhan’s life. Spitzer had an unauthorized copy of the
P E N N S Y L V A N I A P S Y C H I A T R I S T | J U LY 2 0 2 0
3
