January 7, 2020

Colleges and universities are well-known for having "Great Read" programs (sometimes called a "common read"), cross-curricular initiatives that have students, faculty and staff all read the same book, building the book's themes into class content and/or using those themes for non-classroom discussions. SMC is participating in Michigan's Great Read program this year, using What The Eyes Don't See, a book about Flint's water crisis, as the focus of discussion across more than just college communities. I have yet to read the book (our panel discussion will occur this March) but am really excited by the conversations it should create.

As is usually the case, though, I have read something over the Christmas and New Year's break that I would love to recommend:  Susannah Cahalan's The Great Pretender. I had read Cahalan's memoir Brain On Fire, which captured the living nightmare that was her debilitating autoimmune disorder repeatedly misdiagnosed as a mental illness, usually schizophrenia. It is a sobering, eye-opening, and in the end inspiring book. So her next book was guaranteed to be on my wish list.

The Great Pretender evolved from her on-going concern about how others (her "mirror image") might still be misdiagnosed as insane, but ended up as a chronicle of her obsessive journey to discover the truths behind a famous 1973 study led by psychologist David Rosenhan that revealed, perhaps, the harsh treatment patients in mental health institutions endured.

And that's all I want to say about the book specifically.  I couldn't do the nuances justice if I wanted to, so others intrigued by the premise should just go buy the damn book (full information at the bottom).  For my sake, the book reveals everything that a good academic should remember.  If we do a Great Read using The Great Pretender, it will be for the faculty and staff in higher education.  Probably the best thing for students would be to have them read it, then sit back and observe how their educational leaders react to it.

What are the "big" truths The Great Pretender provides academia:

1) We get a necessary reminder that obsessive intellectual curiosity is what we should embody, promote and teach.  Cahalan is relentless in her pursuit of details related to Rosenhan's research, of relatives of relatives of the figures associated with the 1973 study, and for some kind of comfort with the treatment of mental illness.  Most importantly, it is a curiosity rooted in compassion and humanity. Without giving away too much of the ending, I would note the fact that since she doesn't find a lot of what she is searching for, she leads us to the second "big" truth.

2) Answers to our intellectual questions are rarely definitive.  About halfway through her odyssey, she admits that "certainty was a luxury that I could no longer afford" (p. 173).  Many of us are graced with such luxuries in our disciplines, and that eventually is what dooms our fields.  Most academics, I believe, know that truth is grey, but too easily cast our specific palettes as black and white. 

3) Beyond the destruction of certainty, The Great Pretender reveals that our search for truth can be measured in a series of hard stops and starts. Numerous times Cahalan believes she is approaching a definitive moment, only to have that turned on its head. As she finds herself believing more and more in the new perspective, it gets turned on its head again, as if she is on the staircase in an M.C. Escher painting, unsure of which way to step.

4) The anti-science bent in our country today can be blamed partially on ourselves. As Pogo says, "we have met the enemy and he is us."  Cahalan's book thrives mostly on her narrative's momentum, but when she stops and summarizes research or historical events, she never sacrifices the momentum. This balance works perfectly in the late chapter "An Epidemic," which aptly summarizes a world of academic research beset by sketchy research, poor peer review process, and outright fraud, which she rightly notices gets "played out every day in our academic journals and our newspapers (or more likely our social media feeds)" and thus "breeds an anti-science backlash born of distrust" (p. 273).  Mind you, Cahalan goes well out of her way to point out that this questionable research is not just in the area of psychology/psychiatry.

5) Goodness, sometimes the most educated of us are the most boorish.  Cahalan describes the arrogance of experts, the insensitivity of those who should know better, and at times the snark that seems embedded in the academy.  Frankly, I am dying to read the complete set of argumentative letters between Rosenhan and Robert Spitzer, let alone Spitzer's article, described by Cahalan as "delicious in its biting bitchiness . . . the drollest piece of academic literature . . . mean . . . [and] funny" (p. 176).

6) The book also serves as an indictment of how public policy can be shaped by academic research, good or bad.  The perception about the evils of mental institutions led to the closing of many such institutions, but with no back-up plan, or at least financial plan, to compensate for those millions of people still needing help.  As Cahalan points out, and which many of us know too well, the mentally ill are ending up in prisons: "We don't even pretend the places we're putting sick people aren't hellholes" (p. 243).

7) Ultimately, at a time when "mental illness" becomes a defining characteristic of college students, her warnings about how society views mental illness are ever poignant for those of us who want to dismiss a current crop of students.  As Cahalan notes about how psychiatrists characterized her during her "month of madness" (the subtitle of Brain on Fire), "it's hard to ignore the judgment that comes with those kinds of labels" (p. 39).

If I wasn't afraid of the social science faculty feeling too picked on, I would implement this book as an immediate read at Southwestern Michigan College.  Yet, I know "picking on" the social sciences is not Cahalan's point. She actually ends the book with lots of hope and optimism, even when one of the so-called experts tells her to "give [him] ten years" (p. 278) to come up with a positive story about how we are handling the mentally ill.  She doesn't think we can wait that long. I don't think it is possible.  Perhaps my cynicism is now too deeply ingrained in me.

Cahalan's book might as well be about expertise:  We are all pretending.  Those of us who are smart enough, though, need to stop being so great at it.

Cahalan, Susannah.  The Great Pretender. New York: Grand Central Publishing, 2019.  READ IT!