5

A RIDDLE WRAPPED IN A MYSTERY INSIDE AN ENIGMA

I had so many questions for David Rosenhan: about his experiences, about the pseudopatients, about the creation of and the challenges in implementing the study. But he had died in 2012, in those same months when I was preparing for the release of my own Brain on Fire. I searched eagerly for more of his work, but with the exception of one companion piece, where Rosenhan clarified some of the points made in his original study, and a short personal reference to the study in an introduction to his abnormal psychology textbook, he never again published on the topic. He had even secured a book deal, I learned, but ended up never delivering the manuscript and was later sued by the publisher for it. He had walked away from this subject that so desperately needed a champion. What had happened to silence him?

Unfortunately, I would not learn the answer easily. Google searches and basic digging led me nowhere in understanding more about the creation of “On Being Sane in Insane Places.” A news clip search revealed no further details. It seemed there was little else to find beyond the original premise—eight anonymous pseudopatients, twelve hospitals, “thud, empty, hollow.” None of the pseudopatients had gone public, their names never released. Nor had anyone revealed the identities of the hospitals they infiltrated. Rosenhan had remained tight-lipped his whole life about the identities of the hospitals (with one exception—he did reassure the superintendent of Delaware State Hospital that despite rumors, he had not sent pseudopatients there). He was determined to protect their privacy, he wrote, because he didn’t blame the individual doctors and hospitals themselves so much as the system overall. Given how groundbreaking the study was, it was startling that such a large part of it remained a mystery almost five decades later.

Secrecy or no, the study had clearly touched a nerve, and not in the same way it had for me. In the April issue of Science, following the January publication of “On Being Sane in Insane Places,” furious letters to the editor filled twelve whole pages. “Through the publicity attracted by his methods,” one Yale psychiatrist wrote to Science, “Rosenhan may have provided society with one more excuse for pursuing the current trend of vilifying psychiatric treatment and neglecting its potential beneficiaries.” Another wrote: “It can only be productive of unwarranted fear and mistrust in those who need psychiatric help, and make the work of those who are trying to deliver and teach about quality care that much harder.” They were, understandably, standing their ground—but that same ground was now shifting beneath them.

The debate Rosenhan had touched off continued to rage for decades. In 2004, author and psychologist Lauren Slater claimed that she replicated the study. Her work prompted a round of scorching critiques from many of the same members of the psychiatric community who had ripped Rosenhan’s study more than thirty years earlier. I marveled at how psychiatry could be so defensive, when so many others had acknowledged the problems before Rosenhan arrived to document them with hard data. Why attack the messenger?

Finally, I stumbled upon a link that got me a little closer to that messenger: A BBC radio report that aired before David Rosenhan’s death revealed that Rosenhan’s personal files were with his close friend and colleague Lee Ross, a seminal Stanford social psychologist. I soon found myself in a rental car, hopelessly lost on my way to Stanford University’s Department of Psychology in Jordan Hall.

“I’m so sorry I am late,” I hear myself say to Lee Ross on the audio recording I made of our meeting. I can hear in my voice how painfully aware I am of the stature of the man I’m interviewing. Lee Ross has written well over a hundred research papers, authored three and edited five influential academic books (when I visited him, he was in the midst of co-writing The Wisest One in the Room, a book that pushes readers to apply the best of social psychology research to their own lives), and founded the Stanford Center on International Conflict and Negotiation with, among others, psychologist Amos Tversky (a subject of Michael Lewis’s recent The Undoing Project).

Lee also coined the term fundamental attribution error, which theorizes that people are more likely to credit other people’s faults to internal factors (she’s late because she’s a directionally challenged idiot with no time management skills) but credit external factors when we think of ourselves (I’m late because Stanford’s campus is needlessly confusing, and it’s impossible to find a parking spot). His research interests range from shortcomings in intuitive judgment and decision making, to sources of interpersonal and intergroup misunderstandings, to “naive realism”—a way of viewing the world that refuses to acknowledge that everyone experiences realities differently. He documented the shortcomings of the “intuitive psychologist” in one of his early papers, which showed how researchers’ biases color the interpretations of their data. He studied belief perseverance, or the tendency of people to dig in when presented evidence contrary to their convictions. He also coined the term false consensus effect to describe how people often overestimate how common their beliefs are—particularly dangerous in those who hold extremist views.

In other words, if I had to narrow Lee’s interest down to a few words, it would be the fallibility of belief. And he was close friends with David Rosenhan, the man whose past I had come to mine.

Lee Ross is a kind man but, according to a colleague, “doesn’t suffer fools.” He speaks slowly. His wildly engaging eyes, his gentle voice, and his congenial way of angling his head in your direction as you try to make a point, seeming to peer right inside you, made me nervous.

When, in my rambling way, I told Lee about how my own story led to David Rosenhan’s, he interrupted me.

“I had Guillain-Barré,” he said. “I had hallucinations, too. But I had hallucinations because I was severely sleep-deprived, because I couldn’t close my eyes. They like to say everybody’s about six degrees Fahrenheit from hallucinating.”

(Auditory hallucinations, the symptom most associated with serious mental illness, are actually quite common in the general population—as widespread as left-handedness, some studies say. A host of medical conditions can induce them: high fevers, of course, but also hearing loss, epilepsy, alcohol withdrawal, bereavement, and intense stress. If you do hear voices, you’re joining an esteemed group that includes Socrates, Sigmund Freud, Joan of Arc, Martin Luther King Jr., and Winston Churchill.)

Guillain-Barré syndrome is an autoimmune disease that occurs when the body’s immune system targets nerves, which can sometimes result in paralysis. Lee’s case struck him five years before our meeting, and at one point, he could not swallow or talk. It is hard to imagine a worse fate for a man so interested in conversing with the world. After several months of treatment, hooked up to a respirator and a feeding tube, Lee recovered and the lingering effects are minor, if there are any.

Coincidentally, David Rosenhan had suffered from Guillain-Barré, too. Lee mentioned this as he pointed out the office down the hall where Rosenhan had worked for more than thirty years. That two people who shared the same floor of a small office building had had the same rare autoimmune disease shocked one doctor with whom I shared this information—it’s a one-in-a-billion chance, the doctor said. But it was true: I would later confirm this coincidence with Rosenhan’s family and friends. It was the first of many small, improbable details I would encounter in my investigation.

Before my visit, Lee had set aside a stack of books that had once belonged to Rosenhan and that Lee believed were key to his thinking: The Myth of Mental Illness by Thomas Szasz, Self and Others by R. D. Laing, and Asylums by Erving Goffman—all works associated with the anti-psychiatry movement.

As I thumbed through Rosenhan’s books, Lee told me the origin story of their friendship. They had met in the early 1970s when Rosenhan joined Stanford’s psychology faculty after leaving Swarthmore College. Stanford in those days was home to an all-star roster of psychologists, including Philip Zimbardo, who led the much-publicized Stanford Prison Experiment in 1971. The observational study, which recently spawned a movie, purportedly simulated prison life in the basement of the university’s Jordan Hall with volunteers playing the parts of fake guards and fake prisoners. After a few days, the guards, drunk on their own power, abused the prisoners, who withdrew and grew resigned to their fate. Zimbardo’s study was published in 1973, not long after Rosenhan’s. The Stanford Prison Experiment made Zimbardo a legend the same way “On Being Sane in Insane Places” did for Rosenhan.

Lee and I had been chatting for a few minutes when he casually reached up and removed a box stuffed with papers from the top of his filing cabinet. He fingered through files, stopping at a fat folder bursting with pages.

I blinked. Realizing what it contained, I couldn’t believe my luck—if I was right, this treasure trove would be almost as good as being able to interview Rosenhan himself. Pages peeked out from a folder titled ON BEING SANE and another marked PSEUDOPATIENTS. Papers stuck out in various directions. The files were organized, or rather disorganized, according to how Rosenhan left them—once I started pawing through it I quickly realized that the mess revealed more about his mind than anything sanitized by an archivist. There was something voyeuristic, even indecent, about the digging, but, for better or worse, my years working in a tabloid newsroom weaned me off any shame about going through people’s dirty laundry.

Sometimes the contents corresponded to the description on the folders; often they did not. You’d open up a folder on, say, Rosenhan’s work about altruism in children and you’d find a bill of sale for his Mercedes. There were drafts of “On Being Sane in Insane Places,” which Rosenhan had cut out into sections and pasted back together like an elaborate puzzle, and dozens of pages of handwritten diary entries from his time inside the hospital. A folder marked CRITICISM held brutal comments from his peers: “pseudoscience presented as science,” “unfounded,” “entirely unwarranted.” If this folder was any indication, Rosenhan clearly had pissed off psychiatrists. And he seemed proud enough of it to keep the evidence.

I came to a stack of paper held together by a thick but weathered rubber band. The first page read:

Chapter 1

We never really know why ideas are born. Only how and when. And while origins hardly matter when an idea is fully formed and articulated, they may make something of a difference when it is still being shaped. What stands in tonight’s shadows sometimes mars tomorrow’s path.

I find myself unable to say why this research began in any sense that reveals to me something more about the ideas. Perhaps you, better than I, can infer something more from the circumstances. Let me describe them.

His unpublished book. There were at least two hundred pages here. My heart raced. This was the manuscript that his publisher, Doubleday, had sued him for. These were the pages they fought for but never received—pages the world had never before seen. I tried to look casual as I set it aside and continued my frantic search for information. I wouldn’t be able to rest until I understood the study inside and out, including what led to its creation and the context of its consequences. I wanted to be inside the heads of everyone involved. And here was my chance. I tried to contain my enthusiasm when I opened up the folder marked PSEUDOPATIENTS.

My Rosetta stone. The names of all the pseudopatients.

David Lurie, pseudopatient #1, was a thirty-nine-year-old psychologist who pretended to be an economist and got himself admitted for ten days to Billington State Hospital. He was released with the diagnosis of schizophrenia, schizoaffective type, in remission.

John and Sara Beasley, pseudopatients #2 and #3, husband and wife, psychiatrist and psychologist, went undercover. John went in twice, first at Carter State for three weeks and then at Mountain View for two. John described his time inside as “Kafkaesque.” Sara admitted herself to Westerly County and spent eighteen days inside. Both were released with a diagnosis of schizophrenia in remission.

John’s sister, Martha Coates, pseudopatient #4, was a widow who posed as a housewife. She joined the study after her brother and sister-in-law and spent two weeks at Kenyon State Hospital, where she became the fourth pseudopatient in a row to receive a schizophrenia diagnosis.

Laura and Bob Martin, pseudopatients #5 and #6, followed. Laura, a famous abstract painter, was admitted to the only private psychiatric hospital in the study. She spent a shocking fifty-two days there until she was released with a different diagnosis than the rest: manic depression. Her husband, a pediatrician, admitted himself to a less-than-stellar psychiatric hospital, claiming to be a medical technician. He, too, was diagnosed with schizophrenia.

Carl Wendt, pseudopatient #7, went undercover four times, totaling seventy-six days locked away. His obsession with the study worried Rosenhan, who became concerned that Carl had grown “addicted” to it.

Finally, there was Bill Dixon, #8, Rosenhan’s graduate student, who infiltrated a failing public hospital for seven days and also received a diagnosis of schizophrenia, making the total seven out of eight patients to receive that diagnosis. All twelve hospitalizations had resulted in misdiagnosis.

It didn’t take long to figure out that pseudopatient #1, David Lurie, was really David Rosenhan, which led me to the swift realization that all the names had been changed. There would be no simple, ten-minute internet search for Bill Dixon or Martha Coates. The hospitals, too, had been renamed.

Lee’s voice yanked me back to the present moment in his Stanford office.

“David was in some ways a little hard to know,” he said.

“What do you mean?” I asked.

“Well…” Lee paused here, choosing his words carefully. “He had secrets, in other words, as most people do. It was the dramatist in him. He was, as that saying goes, a riddle wrapped in a mystery inside an enigma.”

In retrospect, I wish I had asked him exactly what he meant. But in the moment, I was too distracted by the promise of the pages in front of me.

Lee pivoted back to the files. “You may find the answers to your questions in this,” he said, gesturing to the papers. But then he added: “Where’s that one thing?” He searched through the pile, stopped at one folder, removed it, and walked it back to his filing cabinet. “This is personal,” he said. He placed the folder in his cabinet, closed the drawer, and smiled at me. Was this smile an invitation? Or was I reading too much into all of this?

It was only when I walked back to my car that Lee’s words began to circle in my brain: riddle, mystery, enigma.