Transcripts For CSPAN QA Susannah Cahalan The Great Pretender 20240713

The hospital, we abandoned our symptom, and we behaved the way we usually behave. The question was, would anyone detect we were sane . The answer was, no. Host your new book, the great pretender, centers around the story of this man. Who is he . Susannah hes a stanford professor who was the architect of this amazing study with the incredible footage you just played, called on being sane in insane places. Just has he has described, he and seven other people reportedly went undercover in Psychiatric Hospitals around the country to test the nature of diagnosis and see if their sanity would be detected. As he said, they were not. The study was done in the early 1970s. Why are you interested in it today . Susannah it came from a very personal place. I had my previous book, my memoir, brain on fire, which targeted my experience that was briefly misdiagnosed as a serious Mental Illness. Originally bipolar disorder and then schizoaffective disorder. After that book came out, i was inundated by emails from the general public, a lot of people who were looking for answers, some of whom actually found answers because of my book, but i also received many emails from people who felt lost within the Mental Health system, who felt they were not being seen and not being heard. It really atrocious stories of their care. Started to question a lot of these issues of diagnosis and misdiagnosis, and the question of what is Mental Illness. This led me specifically to one story that i called my mirror image, and that really had an effect on me. We have a trailer from netflix because your book was made into a movie. I want to show people who didnt read your first book to give a sense of what you went through. [video clip] my stomach hurts and im numb, and i cant feel anything. We tested for every infectious disease. All of the results are negative. The eg is completely normal. Her mri is normal. Its all normal. Her condition continues to regress. Mania, paranoia. First they are saying its schizophrenic, than they are saying its psychotic. We should look at hospitals better equipped to deal with this. You look fine. Host when did this happen to you . Susannah i was 24 at the time. This was 2009. A lot of that time i dont remember. Its always very bizarre to see it recreated in movie form. I wrote about about a time that is very much lost to me, and then it was recreated, so i have very strange feelings about that whole experience. As it was depicted, i experienced very serious signs of Mental Illness, typically associated with serious Mental Illness, psychosis and hallucinations, delusions. I was violent, paranoid, angry. There are various points, doctors had various diagnoses that ran from bipolar disorder, schizoaffective disorder to various others in between. Host how did you get better . Susannah i was very lucky, and that is something i understand now to a greater degree, having done this new book. I chanced upon this amazing, forward thinking, beautiful soul of a doctor who listens to me and my parents, and really took a very indepth patient history, and was able to dig in and discover the cause, which was at that time a very newly discovered autoimmune disease of the brain called autoimmune encephalitis. Host what was the treatment plan . Was it medication, pharmaceuticals that made you better . Susannah it was not. It was the arsenal you would truce to treat any other autoimmune disease. That was steroids, plasma out of your blood in exchange for new plasma, and ivig treatment. That is what cured me. Host is there a chance you will get it again, or are you cured for life . Do you know . Susannah unfortunately, the disease itself was only named in 2007. I was treated in 2009. The Natural History of the illness is not well understood, so there are a lot of question marks. One of those is the relapse rates. It can come back, but i was treated very swiftly and aggressively, another example of my luck. So hopefully those rates are lower, but i do live with the threat that it could return. Host you were out on the btour and kept hearing from people saying maybe my diagnosis is also wrong. How did you get from there to this project . Susannah actually, out on book tour in boston, around that time i actually encountered the story that would haunt me of this young woman. When i was doing proselytizing, i was talking about this illness to whomever would listen to me. I wanted to get the word out that this condition existed. At one point, i found myself in a Psychiatric Hospital presenting to doctors. After my presentation, one of the doctors came up to me and said, we have a woman here. She sounds a lot like you. We are going to test her for your illness. I remember walking through the hall is thinking, is that the person . I remember being moved by the thought that someone could have had what i had. I found out two weeks later this person did have what i have. She fit the same profile and had the same diagnosis, but there was a stark difference between us. I was misdiagnosed for one month. She was misdiagnosed for two years. She had been misdiagnosed with schizophrenia. And unfortunately, her doctor told me she would never fully recover and that she would operate the rest of her life as a permanent child. This really not only angered me, but it galvanized me to continue asking these questions of, what is Mental Illness . I mentioned the story to two neuroscientists who i am friendly with. One of them said to me, you and this woman are kind of like modernday pseudopatients. I had no idea what she meant at what she meant by that. That night, she sent me this study on being sane in insane places. It asked very similar questions to the ones percolating around my mind of, what is Mental Illness . What do these labels mean . Is there validity there . I remember reading that and thinking and feeling really seen, and really relating to it on a deep level. Host you write in the book, the ability to answer this question, what is Mental Illness, shapes everything from how we medicate, treat, and sure, hospitalize, and who we treat treat, ensure, hospitalize, how we police, and who we choose to imprison. Can you talk about why this topic covers so many aspects of society . Susannah the broad general idea what is eccentricity . What is personality trait . What is pathological . These questions are about the self. That touches all of us. In a broader sense, the idea of, what is Mental Illness, does affect if someone behaves in a way during a psychotic experience the labels and context of these diagnoses has an effect on the way we see people who have these illnesses. I think that it is a broad swath of an influence on our culture and society. Host by profession, you are a journalist. How did you use your journalism skills in answering these questions . Susannah i read that study and immediately related to it. I thought, i want to know more. I wanted to know about David Rosenhan, he is a very charismatic man. I wanted to know about these other volunteers. He had seven other people. Who were these people . Why did they put their lives on the line for this assignment . For what reason . So i started to dig. I got access to his unpublished book, his diary entries. Eight bankers boxes worth of correspondence that chronicled his career at stanford. I started to dig. That dig turned into a six year investigation. Host and how far did it take you geographically . Susannah all over the country. Also actually into england as well. But mostly, i hopscotched from the haverford area to stanford. Those were kind of my home turfs, but i went everywhere in between. It was on this wild goose chase for these seven other people and more information about David Rosenhan. Host we know about stanford because thats where he taught. What was the haverford connection . Susannah before he was recruited to stanford based on this study, there were rumors that he was working on Something Big reached stanford. He was working to become a tenured professor. He was previously at swarthmore. It was there that the idea for the study came to him. It was not actually his own idea, which is what i discovered in his unpublished book. It was actually his students. They asked him, we want to see the idea of madness up close. He actually said to them, if you want to see it up close, become a mental patient. Go undercover in a Psychiatric Hospital. They all said, yes, we want to. The problem was, what he actually posed this idea to their parents, none of them approved it. So David Rosenhan decided to go in himself. That is where the germs of this study started. Host i want to get back to the study in a bit, but readers of your book will also get a brief history of how this country and western societies have treated Mental Illness over time. I would like to have you walk us through a little bit of that. Lets say the early part of the 20th century, people who were diagnosed with Mental Illness, what were the options available . Susannah weve had so many different stages in terms of the way we treat and view Mental Illness. I kind of start the book with the story of nelly bly. Thats kind of where i start in terms of the modern history of psychiatry. You can go back to we could go back forever, with ancient egyptians boring holes into peoples skulls to try to release the demons of the mind. These questions have plagued humanity forever. But i started with nelly bly, who was this amazing woman. An original what we call sob sister. They wrote these sob stories, these amazing investigative reporters when women did not do such things. She, and her early 20s, went undercover in a hospital on what is now roosevelt island. It was notorious. It was a hellhole. She went undercover as a psychiatric patient. She was one of the first to do so in this overthetop way. What she found was appalling. Basically, the idea of insanity was a one size fits all. If you were off or different, you would be put into an insane asylum. And there, care did not exist. There was neglect and outright abuse. She chronicled in the two part expose shocked the country. But it was going on all over the place during the turn of the century. Host who paid for those institutions, which were all over the country at that time . Susannah i believe we paid for them at that time. Some of them are private. But there were state institutions. Host technology started coming along. There is something called electroshock therapy. Is that still in use . What does that do . Susannah it is electroconvulsive therapy now. Its very different than it was then. It is still very controversial. It is interesting because in the time that David Rosenhan was going undercover, it was still the kind of scary therapy we think of and associate with movies like one flew over the cuckoos nest. These were therapies that created that a lot of people describe as sledgehammers. We do not know how they work. They send electrical currents to the brain. In the past, they would induce seizures, people would break their backs and bite their tongues. That is no longer the case. It is very different now. But these contributed to the general publics distrust of andhiatric institutions psychiatry at the time. Host theres another thing, you can tell us when it became put into use, but the lobotomy. What is a lobotomy . Susannah that is one of the darkest chapters of the history of medicine and psychiatry in particular. It was first created there was the first test on chimpanzees. It is basically a shutting off of the connections between the prefrontal lobe and the rest of the brain. It is supposed to produce higher functioning. It was intended to treat psychosis and a host this idea of onesizefitsall insanity. It was used to treat homosexuality and psychosis and depression. It was just one of these disgusting sledgehammers we should be ashamed of. Host in 1991, the bbc did a documentary on Mental Health called madness. They have interviews with two people who really popularized, maybe even invented this procedure. We have a clip to show people. Lets watch that. [video clip] that is a picture of me. [laughter] and oswald freeman. [indiscernible] i had no misgivings about him until dr. Friedman began to deliver the lobotomies in his office. One day, i walked in. One day, i walked in as he was doing a look but doing a lobotomy. He is a great man for recording things photographically. He had someone hold the ice pick while he took the photograph. He asked me, will you hold the ice pick while i take the photograph . I did not want to have a picture of me holding an ice pick at a patients head. I said, no, id rather not. Host so it is hard to watch. Susannah it is. Host how long was it practiced . Susannah i am not sure of the exact timeline, but many people in this country, i think hundreds of thousands of people underwent it. The most shocking story for me, or poetic in many ways, was the story of rosemary kennedy, who had a lobotomy done by Walter Friedman and james watts. I read a lot other biographers had done books about rosemary. The passages about her pre and postlobotomy were heartbreaking. Her mother, giving birth, had a difficult birth. There was oxygen deprived to her brain. She had always been a little bit different. She was vivacious and very alive, but very after the strong and beautiful. Lobotomy, one of the writers but very strong and beautiful. After the lobotomy, one of the writers described her as a painting that had been brutally slashed. She could hardly come up with any words. She walked pigeon toed. She would basically be an invalid the rest of her life. It was a travesty. Host so often, we see in this town of washington political figures who have personal stories in their lives use them to galvanize Public Policy efforts. How did the kennedy family, her brother who became president of the united states, incorporate this experience into a view of and work on Mental Health issues . Susannah this was an amazing story, the connection between rosemary and how it affected us in the long term. Jfk was obviously very affected by his sisters story. That 100 had an effect on his policy, which was the community Mental Health care act. He turned away from many of the institutions in a bid to create a Community Care model, which would take people out of these warehouses where people were mistreated and neglected and have people treated in the community. That was the ideal of it. Unfortunately, he died before any of this was actualized. The result was that these Community Care models were not enacted. The money did not follow the patients even though the hospitals did close. Host the second step of that was when Lyndon Johnson came into office with the signing of medicare and medicaid in 1965. What happened with that at that point that affected federal policy on Mental Health . Susannah there is something called the imd exclusion, which eliminated funding for any mental hospitals that had more than 16 beds. That facilitated the mass closure of a lot of these big state institutions that were very broken and needed fixing. They were outright closed without any safety net in place for these people to go. Host so the state versus federal role in treating Mental Health changed as a result of that. What did states they were expecting something from the federal government that never materialized . Susannah i guess they were trying to they knew they werent going to get the funding, so what was the outcome . They would close the institutions. If they were going to be losing money, the result was, if they closed the institution, they would save money. It was really a follow the money story, i think. Host some statistics you mentioned, the Community Care aspect of this never materialized. I found in our archives that they celebrated the 50th anniversary of this act passing as though it had a big impact. Did it have a big impact . Susannah of course it did. I think you walk the streets and see people who are i think it closed a lot of places that were terrible, but i think it left a lot of people who needed our help the most without help. So it had a huge effect on closing very bad places, which is a great thing, but i think it was not fully actualized. I think that there is a lot that could have been done with these ideals. I relate to the idea of treating people within the community. That is a wonderful model, but the money was not there. You can see on your walk for me in new york city, i can see it on my walk to work every day, passing Homeless People who are very sick. Host the stat you have in your book is 90 of the Mental Health beds that were available when jfk signed the bill in 1963 have closed. At the same time, our population has doubled in about that time. So where are these people going . Susannah it is a broad and very complex story. We have many drugs available to treat people. Certainly some of those people would not need to be hospitalized. But there are still very sick people who are not getting the help they need. So we are, at last count there is wonderful work done by someone named dj jaffe who gets into the nittygritty of these statistics. But i believe that last count, we were 96,000 beds short of need. Host when did antipsychotic drugs become part of the equation . Susannah it was discovered in the 1950s, so they had been around for a very long time. Around the time David Rosenhan and his people went undercover, that is when the real story of the antipsychotic medicine changing psychiatry started to come into effect. You added all of these other antipsychotic drugs that would join the marketplace and really change the way psychiatry was practiced. That was all happening in the 1970s. Host we are going to go back and spend a little more time with David Rosenhan and what you found out. Heres another look. You write, in 1969, David Rosenhan walked into the intake room in a hospital in pennsylvania and set off a metaphorical timebomb. Lets listen to him. [video clip] the term we use to describe the experience is dehumanized. Nobody talks to you. Nobody has any contact with you. The average contact of patients with staff was about six and a half minutes a day. Nobody comes to visit. The first time i was in a Psychiatric Hospital on the admissions ward with 41 men, my wife constituted four of the seven visitors on a weekend. Psychiatric hospitals are storehouses for people in society who you really do not want, who you really did not understand, and for whom youve lost a great deal of sympathy. Host was that factor a generalization at that point in time . Susannah at that point in time, i think that was probably the norm. I do. Watching him speak, he is such a beautiful speaker, and a writer. It was one of the reasons i fell in love with the study. He went undercover in a Psychiatric Hospital at haverford state. He spent nine days as a patient. The description of what he experienced, they are gorgeous. I even, in my brief period of being misdiagnosed, related to the dehumanization he described, the feeling of otherness. The idea that doctors see you through a clinical gaze, through a prism of your Mental Illness. These are all things he describes. I believe they were very common at the time and continue to be common today. Host describe how he put the rest of the study together with his students. Susannah after that first experience, the nine days at haverford hospital, he returned and said, students cannot go in. He had a very painful nine days. He was shaken. His colleagues who i interviewed described him as a shaken man, so he put an end to the teaching exercise. The study would have ended there. What i only have to focus on is, in terms of what happened next, was his unpublished book, which became a guiding star for me on how to put this narrative together. He said he was lecturing about his experience in the Psychiatric Hospital, and a husband and wife, a psychologist and psychiatrist, asked if they could go in too. Now, i could not verify that that actually happened. That would end up being one of the many issues that started to emerge with the study that indicated to me that things were not as they appeared in the way that he portrayed them. Host in his unpublished book ultimately, how many people did he say participate in this project . Susannah he said all eight participated. The problem was i could not verify many of his claims, and found inconsistencies along the way. Host how did the study become so important . Susannah the study itself was published in science, which is one of the most esteemed science publications in the world. In many ways, you think, eight people if you think of a data set in terms of number of subjects, it is not a very scientific or rigorous data set. However, the fact that it was in science gave it this feeling of importance of scientific rigorousness that perhaps it did not deserve. That is why the study had this huge effect. Host so then what happened . Susannah after the study was published, there was a huge outcry. There were two differing reactions. On one side, the public read the study, and it was confirmation of what many suspected. It was confirmation of what they were seeing in mass media. At that time, you had movies like snake pit, one flew over the cuckoos nest. You had a litany of exposes about the horrors of Psychiatric Hospitals. The fact that David Rosenhan and his pseudopatients came back misdiagnosed, grossly misdiagnosed, and never discovered as pseudopatients, especially during long stays one person stayed 52 days, according to the study, and was never revealed to be faking her illness these things confirmed what many people already believed. On the others, psychiatry itself was going through an identity crisis. They had issues with the diagnostic system. There were studies showing that, in the u. S. , people were being diagnosed with schizophrenia at higher rates. In the u. K. , the same people were being diagnosed with bipolar disorder. So our terms were fluid and we didnt seem to have a common language. That was very embarrassing, and at the same time, we are moving away from psychoanalysis. Psychiatrys role in the place of medicine was coming under fire. This study went right into that sweet spot at that exact right time, and one dr. , who wrote beautifully about this, described it as a sword plunged into the heart of psychiatry. Host how did those other patients get out of the institutions they were in . Susannah great question. The average stay was 19 days. It ranged from seven to 52 days. All of them, according to the paper, left against medical advice. At various points, they would petition to get out and would not be able to get out because they were not deemed well enough. A major part of the study was that each patient would only you know, who tried to commit themselves based on one symptom alone. I hear a voice that says thud. I hear a voice that says empty. Thats it. Once they were admitted, they were to drop any other pretense. They did not hear any other voices. They were to act as normal as the situation allowed. Host one could simply check yourself out of a hospital if you wanted to . Susannah you could not. In some cases, you would have to get a court order. The Patient Rights Movement change that. That would follow davids study as well. Host so what is happening in society, we have this legislation two important pieces of legislation that are bringing people out of institutions. Weve got this major study, and you mentioned the societal aspects of it. A couple of times youve referenced one flew over the cuckoos nest. I hope everyone who is watching us have seen it come about it wanted to put a clip on screen because its really become an iconic movie. Lets watch a little bit and talk about the impact it had. [video clip] as a matter of fact, they are very few men here who are committed. Theres mr. Tabor, some of the crocs, and to some of the chronics, and you. You are voluntary . Yes, sir. Scanlin . You must be committed, right . No. Jesus, you guys complain about how much you cant stand it in this place, and you dont have the guts to walk out . What do you think you are, crazy or something . Well, youre not. Youre not. Host we still talk about this movie and the characters all these years later. What impact did it have . Are you surprised that Something Like a movie can have such a Cultural Impact . Susannah at the time, it was the book that had a tremendous effect. What it did, both the movie and the book, it really shaped Public Opinion about psychiatry, about not only its limitations but the dangerousness of its power embodied in the nurse ratched character. And i think it had a huge effect on peoples kind of mistrust of psychiatry. And i think that, too, made psychiatry in a lot of ways in response to that general public distrust of its field. Host what happened . How did the field respond . Susannah this is really interesting because the study itself had a very key effect on psychiatrys response, which is embodied in the kind of bible of psychiatry which is called the dsm. The diagnostic statistical manual of mental disorders. During my unearthing of all of these correspondences in David Rosenhans history i found a treasure trove of letters between David Rosenhan and a man named Robert Spitzer who was the creator of the dsm iii, the third edition of the famous manual that affects our lives today. Robert spitzer was very much against this study. And he spoke out very widely about his distaste for the study and his kind of push back against it. In the letters between them i see this back and forth and i realized that Robert Spitzer saw the study as an opportunity. And i confirmed this with his wife. Basically at that time, 1973, he was starting to work on what would become the dsm iii, and which would become basically a medicalization of psychiatry. It would put together a manual that would make everything very prescribed and orderly. People described it disparagingly as a chinese menu approach. It was a way of reclaiming psychiatrys role within medicine and really make it scientifically rigorous, make sure we are all speaking the same language, all using the same diagnoses. One person theyre in arizona would be diagnosed the same as another person in maine. That was a major push of the dsm. And what i found is during the writing and creating of the dsm Robert Spitzer often thought of David Rosenhan and his study. And he would say things, could David Rosenhan and the pseudopatients get past this if we had this criterion . It was amazing to see their interaction and also hear the incredible effect that the study had on the kind of bible of psychiatry. Host as you started to put these pieces together, you are asking yourself the question, what is Mental Illness and how the society understand that . You find out about this, key study that David Rosenhan did that impacted the profession and really the country. So, when did you start asking yourself questions about its validity . Susannah i would say, you know, when i started to dig into those files and actually got access to David Rosenhans medical records, that is when question started to really emerge. In those medical records i found that David Rosenhan did not just exhibit a voice that says thud, as he often said he did. It was a huge part of my paper. He actually exhibited way more severe signs of psychosis that that. In the medical records, i hear repeatedly that he said he put copper pots over his ears to drown out the noises. He had been hearing voices for many months. He had a long history of depression and he was often suicidal. And that, to me, created a far more nuanced and a far more severe portrait of psychotic ailments than, i hear a voice that says hollow. once i got access to that, other things started to not make sense. Maybe things i had been ignoring previously started to fall in line as major issues with the study. Host you set out to find the other people who participated. How did that effort go . Susannah it was a rabbit hole. Unfortunately, i was only able to find one of the original eight. I hired a private investigator and interviewed hundreds of people. And unfortunately could only find one. He was a graduate student at stanford. He was in David Rosenhans class on psychopathology. This is in 1970. He went undercover at agnew State Hospital. I tracked him down at the Austin Hilton and interviewed him and his wife. His experience mirrored that of davids. He had a terrible time at agnew State Hospital which is now in the process of closing. He describes the depersonalization. At one point, he was mistaken for another patient who had diabetes and almost given insulin therapy. At another point, he actually swallowed thorazine because he had been given a thorazine tablet that was a rapid melt tablet, and the idea of cheeking it, what they were trained to do with pills, would not have worked with the rapid melts. He was drugged and in a stupor when his wife visited. It was very traumatic for everybody involved. I found him and felt very positive about that. But through him, i found another person. He was not one of the eight. He was a ninth pseudopatient, a man i call the footnote. Host who was he . Susannah his name is larry landau. He is a professor of psychology at the university of minnesota and he studies smoking cessation. He started also as a graduate student at stanford and actually stuck with psychology. He went for 19 days undercover as a patient at the u. S. Public Health Service hospital. And was misdiagnosed, as david wrote everyone was, with schizophrenia. However, thats where his situation and his experience, the similarities ended. He had described to me that he had a positive experience during his 19 days. He was an unhappy graduate student at the time in an unhappy marriage. He felt lost and isolated. He was in a very competitive atmosphere at stanford. When he admitted himself to the hospital, he felt this tremendous relief. He walked on the wards. He described them as light and bright. The nurses were engaged. No one wore uniforms. They were men and women, they sang peter paul and mary in the hallways. He had a wonderful 19 days. He felt it was a healing environment. This did not match davids thesis at all. This is the opposite of davids thesis in many ways. So therefore he was not included in the final product. Unfortunately, David Rosenhan had passed away before the start of the study, but harry landau believes that his data does not support the thesis that David Rosenhan was writing, so he discarded the data. Host how did he feel about spending his life in a profession where he was part of such a pivotal study and yet had questions about its validity . Susannah it is interesting, because i think when i came to him with my questions and kind of digging this up, i think he went back and looked at it with a gimlet eye. When he was excluded from the study he felt disappointed and he felt angry. He did not know. He learned about it when he read the study in science. I dont think he knew enough to put in to context of there is something fishy here. As i started to present other issues ive found with the study, i think he refrained his experience and thought, ok, maybe i was excluded because he had had a bias. Host as a journalist and digging through all the stuff, what was the point when the scale got tipped for you, when you went from exploring to questioning . Susannah i would say probably harry. The medical records for me were damning. I also, in kind of a lead up to discovering those medical records, i also discovered some discrepancy with data, which, to me, in a scientific paper to have issues with the data was at that point, it tipped me over to really feeling there were some Serious Problems with the paper. And that was found through harry. I had two drafts of the study. One draft had nine pseudopatients. No footnote. The other draft had eight pseudopatients and one footnote, leading me to believe, very fairly, that in the earlier paper he did not remove harry and the later paper he did. And unfortunately, none of the numbers, not one, changed. Still 2100 pills given. Still had down to the decimal number of minutes the psychiatrists on average outside, on the floor or nurses spent out of the cage. Very highly specific numbers. Not one changed. That, to me, was pretty damning. This is beyond sloppiness. There is some kind of willful massaging here. Host once you have an ahha moment that this is not all adding up, what did you do with that . Susannah well, you know, at first i thought the book is done. I really thought i wanted to find the pseudopatients, and the more i dug, i started to doubt if these patients existed at all. What do i do now . I really thought the book was over. Now, in retrospect, i realize it is actually a more interesting book, having to kind of search for this at the time, i thought, what am i going to do with this . I was also very much embedded in David Rosenhans world. Im very close with his Close Friends and close with his son jack. And it made me very uncomfortable because in many ways he was a hero and i loved that study. It was a lesson you do not want to meet your heroes. They might let you down. I felt very let down. Host what about his family . When you had to present the evidence at some point to them that their relative, their close relatives lifes work may have not been valid. How did they react . Susannah it was really difficult. One of the reasons this took six years is i wanted to be sure and i wanted to dig up every single lead i possibly could. I had a confidante who was who is davids very close friend, florence keller. She was kind of a guru going through this. She went through every major reveal with me and, at various points, came to the same conclusions i did. I felt supported by someone who knew him. Very well and some of the things i was finding the hardest person to talk to about this was his son. I took him out to lunch. I remember when i first had an inkling that things were awry and i presented some of these issues to him. And his response of the time was my father was a storyteller. But i dont think he would do anything to mess with his research. That was his stance. Then as the book starting to come together and publication loomed i fact checked the book and made it clear this might not make for pleasant reading. And that the conclusion i came to may not put his father in the best light. Hes a lovely person. Jack rosenhan. He actually called me two days ago after he read the book in full. And he says he actually likes it. He said it was hard to read but in many ways the twinkle that was his father, this charismatic man, this amazing thinker, it still comes across even though there are now questions about the validity of the study. I am happy to hear that he had the response to it. Host how long ago did rosenhan die . Susannah rosenhan died in 2012, a year before i started investigating the study. Host did his publisher answer the question of why his book never got published . Susannah the publisher actually sued him because he never delivered and that was another clue to me that kept haunting me. Why, why didnt he finish this book . He had eight chapters written. Well over 100 pages written. This wouldve been a smash success, the study was huge. He was a media celebrity. Why not publish the book . And that really was an interesting thing. So, i tracked down a lawsuit in 1980 at doubleday, his publisher, and they actually sued him to recoup the advance they have given them, which was a sizable advance. That, to me, was a big question. I still dont know why he did not do the book. I have some ideas, some theories, but i still do not know why he did not finish that book. Host he did not share it with his family. Susannah not that i know. Host what is the implication if rosenhans study was not valid . Susannah because rosenhans study had such a wide influence on so much of what we contend with today, so much of the Mental Health crisis that we see today was touched in some ways by this study and a lot of Public Opinion about psychiatry, about its institutions were in part shaped by this study. So, i think that in questioning it, we have to go back and question some of our assumptions. And i hope that this gives us an opportunity to kind of go back and reassess in a way that moves forward, because we cant move forward on a rotten foundation. If this study was not up to snuff, if it was not legitimate, we really have to rethink some of the conclusions that were presented. Host you told us about the connection between rosenhans study and dsm iii. What does dsm stand for . Susannah im sorry. Diagnostic statistical manual of mental disorders. Host what version are we on now . Susannah five. Host there was a relationship between that and rosenhans study. Was it one where you questioned the dsm . Susannah i do. And i think that most psychiatrists, research psychiatrists who are on the cutting edge, are definitely questioning the dsm. Even the nimh now want their research to use a different criteria than the dsm. The dsm present illnesses and hard line senses. With schizophrenia, bipolar disorder, they are separated. They have different criteria. What people are finding in the Research Side again, these are questions we do not have answers but what they are finding is that genetically there are overlaps. There are more gray areas between these diagnoses than hard lines. I think rosenhan pushed the field to kind of defend itself and say, we are legitimate. This is our criteria. And we are going to be very strident about the terms we use. But unfortunately, in response, it created a black and white system where a lot of it is very gray. Everything that deals with the brain is very gray. And i think that there is a reckoning with that today now too. Host here is another set of statistics that you record in the book that to me seems like a demonstration of having this roadmap of diagnoses. Since this period of time, childhood bipolar diagnosis, disorder diagnoses, increased 40 fold in 15 years. There has been a 57 fold increase in childrens autism spectrum diagnosis from the 1970s to today. Today, 8 of all children in the u. S. Are diagnosed with hyperactivity disorder. And 15 of all High Schoolers are diagnosed with adhd, attention deficit. What should we understand from those numbers . Susannah these are questions i do not have answers to. Hard lines do kind of protect us against over reach. Is it overreach or was it under reach before . These are questions we have to grapple with within the field, as a society. They are difficult ones and i do not have the answer to that. Host we talked earlier about pharmaceuticals. What impact has the growth of the pharmaceutical industry had on how we approach all of these questions in society . Susannah what has been amazing to me, my pursuit of these questions as i learned how much medicine, psychiatry in particular, medicine in general is manmade. We have these you know, guidelines that move and change and adapt and they are moved and changed in adapted by many things and some of them ours pharmaceutical industry interests. And some is changing standards. More understanding about technology and our understanding about the body. There is good and bad with these moving targets. But that was incredibly enlightening to me about how, how manmade, how artificial, how gray a lot of medicine is. And i think the pharmaceutical interest in psychiatry is something that i think the field is starting to come to terms with right now. Host you have been speaking about this before the book was published. To psychiatry groups and the like. What has been the reaction to your question the basic foundational tenants of their profession . Susannah i think the best psychiatrist embraces it because Robert Spitzer, who created the dsm iii, he created that document to be a living, breathing document your he said we do not have an a lot of knowledge yet. We are talking about the brain, an isolated organ. It is impossible to study in real time. We cannot look at it and touch it. The psychiatry deals with very complex issues. Our hope is what we are doing right now will seem primitive in 50 years. I think people are really thinking about these issues and really interrogating them welcome questions. We dont push against that. I hope in this book is that i raise these questions for reasons we can think more critically about some things we take for granted as being just the truth. Host circling back to your own experience with this, where will the questioning come of whether or not this has a biological organic base as opposed to Mental Health . Susannah in terms of . Host people getting diagnosed. Susannah if we have a blood test or objective measure. Host are people beginning to question, could this be something other than a Mental Health issue . Could it have biological origins that, as your experience did. The dsm does not prepare for provide for that. Susannah the dichotomy is false. I think were going to discover there is no difference between organic or inorganic or psychiatric versus neurological. There is so much overlap, and i think eventually down the line, im very optimistic, and i am not a doctor, but this is my hope is that those terms become outdated. That we discard them the more we learn about the brain and the body and interface between the two. Host we are getting close to our hour, but there is one aspect of what is happening in society that we have not referenced. You talked about the number of Homeless People. Some of that is economic of course. Some of it Mental Illness. We dont really know, do we, as a society how many Homeless People have Mental Illness. Susannah there estimates of 100,000 people with serious Mental Illness live on the streets. Host the other thing is pretty putting people in jail with Mental Illness. I have one other piece of video from chicago where a forward thinking cook county official has been trying to introduce these questions into how we put people in jail. Lets watch that. [video clip] an average of 70,000 men and women pass through Cook County Jail each year, many more than once. What percent do you think here really shouldnt be here . I would suggest conservatively that half of the people here in the jail should not be here. The county sheriff says the jail has become a dumping ground for the poor and mentally ill. Host so, another big societal question. Susannah he is amazing to the work he is the reason the work he is doing is incredible. He put his psychologist as a head warden of the jail, coming to terms with the reality many of us do not want to face the fact that we are putting people who are very sick in prison and jails and in places that are not healing, they are punitive. They are opposite of a place they should be. I like that he is at least facing this headon, and he is saying this is the situation and we have to deal with it headon and we have to come to terms with the fact that we are putting sick people, we are imprisoning sick people. And i just really think it is a testament to his kind of, his way of seeing the world. Host so, is washington, right now we are of course very much involved in the impeachment issue, and a lot of policy issues are not being attended to, but are these questions being discussed in washington, d. C. , with federal policymaker or is it local or state policy makers thinking about homelessness and prison populations and their connection to Mental Illness . Susannah i think youre seeing movement or lack thereof on the state side. I think across the board, from my perspective, we are losing this issue. If we have, you know, one of the more forward thinking jails saying half the people do not belong here. Clearly we are not going to correct, we are failing on the federal and state level. But i think that there are some bright spots in my experience. There are some interface between police and Mental Health experts that seem to be, Mental Health courts, that talk to people who are seriously and mental ill people before they get into the prison system. There are some initiatives that seem to be doing something, but i think, in so many ways, we are so behind as a culture. And this is something that i think, it kind of is a wide swath across the political spectrum. Were not doing the right thing for very sick people. Host in your book, you described our Mental Health system as harsh. If we look at other countries, england and canada, are we different in that regard in the way we approach these questions, or is western society all in the same place . Susannah you know, i think we all grapple with similar issues. I think we probably, there are some places that seem to be doing this right. There is actually work thats interesting out of l. A. That is going on right now. They are studying a system in trieste, italy. That is a very communityfocused model. It is not an institution model. It is interesting. Its tiers of care that is provided through the community. And they are trying to adapt that. It is interesting what this small town in italy seems to be doing it right. I visited a place that i thought was doing it correctly in south dakota, and this was a Hospital System there where not only do that have a mobile triage unit that goes to the actual sickest people, the interface with police officers, they have suicide hotlines for farmers manned by farmers. And they have acute care units and longerterm care units, and they have nurses and attendance who really care about their jobs and really care about the people there. In a similar way that harry landau described his experience, the wards were light and bright and airy and it fell healing. I have been to a lot of Psychiatric Hospitals, i would not use those words to describe pretty much any other ones that i saw at the state level. Host you end by saying you believe that psychiatry will one day be deserving of the faith you have in it to adapt. What will get our society there . Susannah as simplistic as this might sound, i think that psychiatry at its best is the art of medicine writ large. It is really relating to the patient, taking deep patient histories, using all five senses in terms of taking in the patient, because we do not have blood tests. We do not have these objective measures. So, you need to really focus on the art of medicine. So, i hope that as we learn more about the body and the brain, the art of medicine will not be discarded and that, as we kind of make these advancements, those would be married and care would be improved. Host the last seven or eight years of your life have been consumed with this question of what is Mental Illness and how do we treat it . You are so passionate about it. Do you think youll be spending more time on the subject . Are there more questions to be asked . Or is it time to put your skills to Something Else . Susannah wow, what a great question. I have to say i am obsessed. I think maybe because it comes from a personal place, but i do not believe i am done talking about these issues. Because there is still so much. The minute you peel that onion, there is more layers. I think im going to be talking about this for a long time. Host thank you for talking with us about it for the past hour. Susannah thank you for having me. [captions Copyright National cable satellite corp. 2020] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] all q a programs are available on our website or as a podcast at cspan. Org. Edisony ford and thomas took highly publicized camping trips together at the height of their fame. President warren g. Harding even joined them on one trip. Next sunday, historian jeff quinn discusses his book about the summer road trips taken between 1914 and 1925. Thats q a next sunday at 8 00 p. M. Eastern and pacific, on cspan. 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They just thought we will disrupt everything and have every hierarchy that we know just come crashing down, and whatever happens next, it will probably be fine, but we dont really know what it is. Retrospect, it was not fine. Into that power vacuum that Silicon Valley created came rushing in these people called the gate crushers, which art nihilist, trolls, bigots, propagandists. Watch monday night at 8 00 Federal Reserve chairman Jerome Powell and treasury secretary Steven Mnuchin testify remotely before the Senate Banking committee about the 2 trillion cares act, which passed in march as part of the governments coronavirus response. Live coverage begins tuesday at 10 00 a. M. Eastern on cspan, cspan. Org or the free cspan radio app. Cspan has unfiltered coverage of the federal response to the coronavirus pandemic with white house briefings, updates from governors and congress, and our daily callin Program Washington journal, hearing your thoughts about the crisis. If you missed any of our live coverage, watch anytime on demand at the span. Org coronavirus at cspan. Org coronavirus. Next, we hear from british Prime Minister Boris Johnson the governments response to the pandemic and the reopening measures for the u. K. We now come to questions to the Prime Minister. I will call the pr