6

THE ESSENCE OF DAVID

I returned to California six months later to revisit the files, which had been relocated to their intended owner, a clinical psychologist and a close friend of Rosenhan’s named Florence Keller. Florence had saved the files in the frenzied aftermath of Rosenhan’s disabling strokes when Rosenhan was being moved to an assisted living facility a decade before his death in 2012. During the frantic cleanout, Florence managed to salvage a box marked ON BEING SANE. When Florence alerted Rosenhan, he asked that she hold on to it for him.

Florence is trim and attractive, a handsome woman in her early seventies. There is something of Katharine Hepburn in the way she navigates the world—floating with an easy confidence as she swings open the door, welcoming me in with a wide smile. She gave me a tour of her Joseph Eichler–designed Palo Alto midcentury bungalow with its orange and Meyer lemon trees. I noticed two identical New Yorker magazines side by side on the kitchen table.

“Why the two?” I asked.

“It’s the one thing LaDoris and I can’t share,” she said, laughing. LaDoris, her partner for over thirty years, goes by many names—“LD” or “Herself,” as Florence calls her, and “Judge Cordell” to the rest of the world. She’s a Palo Alto celebrity, the first African American female judge to sit on the bench of the Superior Court, who in her retirement now provides legal commentary for the national news and leads protests on all manner of issues, from upholding judicial independence to combating police brutality. If you live in Palo Alto, it’s likely that LaDoris either helped you, married you, or advocated for you.

From the moment I removed my shoes and stepped through her front door, Florence and I became partners in crime. I called her my Rosenhan whisperer. She was one I would rely on at every stage of the investigation, through every increasingly surprising twist. She was the person who had the most insight into Rosenhan’s mind, and his secrets. The two had met at a mutual friend’s party, where she found herself in lively conversation about how almost all curse words aimed at men were really directed at women. The bald man with a glimmer in his eye readily agreed, and the two started listing words that fit her theory.

“Son of a bitch, bastard…”

“Motherfucker…,” he added.

They each rattled off as many epithets as they could, and by the time they’d run out of insults, the two were fast friends.

I asked Florence to help me translate the dozens of pages of Rosenhan’s handwritten notes scrawled out on yellow legal pad paper, written before and during his hospitalization for the study. His handwriting at first had seemed easy and accessible—he had beautiful penmanship—but, strangely, the minute you began to read, you realized that the letters themselves were impossible to decipher. “Echt David,” meaning “the essence of David,” quipped Florence.

Over the coming months, I burrowed into that unpublished manuscript. The study began, I would quickly learn, not with Rosenhan’s plan to challenge psychiatry as he knew it, nor even with a Nellie Bly–inspired curiosity about the conditions inside the asylums, but with a student request in his abnormal psychology honors class at Swarthmore College in 1969.

“It all started out as a dare,” Rosenhan told a local newspaper. “I was teaching psychology at Swarthmore College and my students were saying that the course was too conceptual and abstract. So I said, ‘Okay, if you really want to know what mental patients are like, become mental patients.’”

January 1969

Swarthmore, Pennsylvania

The campus—the whole world, really—seemed to be losing its mind. In the first six months of 1969, there were more than eighty-four incidences of bombings, bomb threats, and arson reported on college campuses. America was mere months away from the national shock of the Manson Family murder spree. Plane hijackings were common. The world had just watched police officers use billy clubs and tear gas on crowds of unarmed protesters at Chicago’s Democratic National Convention as onlookers chanted, “The whole world is watching.” Richard Nixon’s inauguration fell the same week as the start of Swarthmore’s spring semester. Some of Rosenhan’s students had joined the tens of thousands in Washington who cheered and booed, throwing bottles at the presidential motorcade and holding up signs announcing, NIXON’S THE ONE… THE NUMBER ONE WAR CRIMINAL. Nixon, in a moment of inspiration, stuck his head out the top of his limo and made the now infamous V-for-victory sign with his arms. We now know that Nixon’s self-serving political meddling helped prolong the Vietnam War, a personal victory achieved by any means necessary. The nightly news showcased the Vietnam War in real time as casualties hit their peak in 1968. We were in an unwinnable war with an enemy on the other side of the earth killing thousands of young men, for what? In the face of such inexplicable acts on a global scale, madness no longer seemed to be restricted to the asylums. Some young men who had low draft numbers exploited the system by pretending to be out of their minds to get out of the war. Why not, after all? Everything seemed insane.

“It’s easy to forget how intense the ’60s were,” wrote Swarthmore alum Mark Vonnegut (the son of that famous writer) in his memoir The Eden Express, which chronicled his own experience with psychosis during this turbulent time.

In 1969, the concept of mental illness—of madness, of craziness, of deviance—had become a topic of conversation like never before in the history of our country. It became more of a philosophical debate than a medical one. Wasn’t “mental illness,” many argued, just a way of singling out difference? Madness was no longer shameful; it was for the poets, the artists, the thinkers of the world. It was a more enlightened way to live. The young embraced psychoanalyst Fritz Perls’s slogan (popularized by Timothy Leary): “Lose your mind and come to your senses.” Only squares were sane.

And then there were the drugs. Two million Americans had dropped acid by 1970, getting a glimpse of the “other side” and joining the “revolution by consciousness”—convinced, as Joan Didion wrote, “that truth lies on the far side of madness.” They did not want what society (their schools, their parents, President Nixon) needed from them. They believed that they were all a razor wire away from the madhouse—and they may well have been.

Young people moved to utopian communities in the middle of nowhere. One of the country’s most popular bumper stickers was QUESTION AUTHORITY. Growing Up Absurd, written by an openly bisexual anarchist who linked the disillusionment of youth with the rise of corporate America, was a runaway bestseller. The 1966 surrealist film King of Hearts featured a small French town during World War I where the happy denizens of the local asylum take over, prompting the viewer to ask, Who is truly sane in a war-ravaged world gone mad? Ken Kesey’s trippy novel One Flew Over the Cuckoo’s Nest did more than any other book to incite the public against psychiatry. (In a few short years, the 1975 movie starring Jack Nicholson would further outrage viewers.) The power of Kesey’s story has endured. I’m sure that if someone asked you for an example of a “sane” person railroaded by a mental institution, you would immediately cite Cuckoo’s Nest as the classic example. Though the book was intended to critique conformity on a grand scale, the novel will forever be associated with the evils of psychiatry. The book, as one psychiatrist put it, “gave life to a basic distrust of the way in which psychiatry was being used for society’s purposes, rather than the purposes of the people who had mental illness.”

Kesey, a star athlete and the son of a dairy farmer, found his revelatory moment while working nights as an aide at Menlo Park Veterans Hospital. He enrolled in a government-sponsored experiment at the same hospital, where researchers dosed him with a series of drugs—including mescaline, Ditran, IT-290, and his favorite, lysergic acid diethylamide (LSD).

These experiences birthed the ultimate antihero, Randle Patrick McMurphy, who fakes his way onto a ward to get out of serving a prison sentence. “If it gets me outta those damn pea fields I’ll be whatever their little heart desires, be it psychopath or mad dog or werewolf,” McMurphy says.

Once free of his prison sentence, McMurphy causes as much trouble as he can on the ward and in doing so discovers that his fellow patients aren’t so different from him after all: “Hell, I been surprised how sane you guys all are,” McMurphy tells the other patients. “As near as I can tell you’re not any crazier than the average asshole on the street.” The big difference, McMurphy is shocked to find, is that the other men shackled themselves to the institution voluntarily. They chose to be there.

Harding, one of the patients, explains why: “I discovered at an early age that I was—shall we be kind and say different?… I indulged in certain practices that our society regards as shameful. And I got sick. It wasn’t the practices, I don’t think, it was the feeling that the great, deadly, pointing forefinger of society was pointing at me—and the great voice of millions chanting, ‘Shame. Shame. Shame.’” He wasn’t sick in the biological sense, but was made sick by the world around him.

Even more pointedly, the narrator, Chief “Broom” Bromden, pretends he can’t hear or speak, but documents everything and gets away with it because the institution sees him only as a crazy man with a broom, and so he is invisible. In the end, McMurphy’s battle is lost. The authoritative powers of the institution—embodied by the monstrous Nurse Ratched—converge on McMurphy, who is lobotomized for the sake of convenience, never again to be a problem on Ratched’s ward.

Suffice it to say, in the early 1970s, psychiatric hospitals were not getting a good rap.

On top of it all, Cold War paranoia touched everyone, as stories of men and women interned in Soviet psychiatric hospitals for political reasons reached the US. Thousands of dissenters in the USSR were hospitalized against their will, including one outspoken general named Pyotr Grigorenko, who served in the Red Army before he began to question the policies of the Communist Party. He was diagnosed with “paranoid development of the personality with reformist ideas rising in the personality, with psychopathic feature of character, and the presence of symptoms of arteriosclerosis of the brain” (a Russian nesting doll of a sentence if I ever heard one). He spent five years in one of the worst Soviet “psycho-prisons” until he was finally released and allowed to immigrate to the US.

Which was scarier: using psychiatric labels as a tool of oppression, or the possibility that many of these Soviet psychiatrists actually believed that someone who didn’t support Communism must be crazy?

And yet this exploitation of psychiatry was also happening in America—by the White House, in particular. To discredit Daniel Ellsberg, the man who leaked the Pentagon Papers to the New York Times, former CIA agent Howard Hunt sent the “plumbers” (men who did the White House’s dirty work) to his psychoanalyst’s office to find information there to discredit him.

The most famous person singled out for his mental health history was Republican presidential candidate Barry Goldwater, whom psychiatrists (without personally examining him) called unfit to serve, describing him as, among other things, “a dangerous lunatic” in a 1964 Fact magazine article titled “1,189 Psychiatrists Say Goldwater Is Psychologically Unfit to Be President!” The American Psychiatric Association, embarrassed by the resulting fallout (and Goldwater’s successful libel suit against Fact), implemented the Goldwater rule in 1973, an ethical principle banning psychiatrists from making armchair diagnoses of public figures they have not examined, which continues even in the face of opposition today.¹ A cardiologist, they argue, wouldn’t dare diagnose someone they saw only on TV, so neither should psychiatrists. This rule suggests that psychiatry should be held to the same standards as other medical specialties, a defensiveness that is revealing: “Psychiatrists are medical doctors; evaluating mental illness is no less thorough than diagnosing diabetes or heart disease,” the APA wrote.

At the same time, the lay public continued to wonder, Does madness even exist? This might seem like an absurd question to anyone who has lived with mental illness—either personally or through a loved one—but in a time when people were labeled “mentally ill” simply for their attraction to people of the same sex, it was a legitimate debate. The emerging anti-authority movement questioned so many of our assumptions, arguing that all madness was a social construct. They quoted French philosopher-historian Michel Foucault’s Madness and Civilization as proof that psychiatric institutions had, from the very beginning, used confinement as a tool for domination. Sociology professors taught the labeling theory, which presented mental illnesses as self-fulfilling prophecies hoisted upon us by society’s own need to classify and stereotype “deviants.”

If this sounds familiar, it is because these are the same impossible questions (in different contexts) that we’ve been circling as long as we could reason. And Rosenhan would crystallize all of this in his blockbuster study.

Meanwhile, the growing anti-psychiatry movement launched critical attacks from within the academy’s own ranks. R. D. Laing, a Scottish psychiatrist, offered arguments that were most appealing to the counterculture. He theorized that insanity was a sane response to an insane world. Schizophrenia, Laing would write, was a super sanity—a kind of insight only those with truly open minds could achieve—and he believed that one day, “They will see that what we call schizophrenia was one of the forms in which, often through quite ordinary people, the light began to break through the cracks in our all-too-closed minds.”

In 1967, he wrote, “Madness need not be all breakdown. It may be breakthrough.” Students carried dog-eared copies of his books The Divided Self (1960) and The Politics of Experience (1967)—two of his most popular and groundbreaking works—in their back pockets, a badge of honor advertising their cynicism about the societal judgments imposed on the mind, proclaiming their higher consciousness about the self, about sanity, about society. But it was easy to poke fun at him. “Schizophrenics were the true poets,” Erica Jong would joke in Fear of Flying. “Every raving lunatic was Rilke.” Soon enough, reports of rampant drug use at Laing’s asylum-style London house called Kingsley Hall emerged. Alongside his rise as a guru, Laing seemed to grow into a caricature of kookiness as he flirted with “rebirthing” sessions and other bogus ’70s-era treatments, along with copious drugs and alcohol. (I’ll never be able to purge the sight of Laing, red-faced and perspiring as he mimed pushing himself through “his mother’s birth canal” on a patterned couch, captured on video and screened for me by his former cameraman.)

Hungarian-American psychiatrist Thomas Szasz called mental illness a “myth” and said that the concept of mental illness was “scientifically worthless and socially harmful.” The opening of his most famous book, The Myth of Mental Illness, reads, “There is no such thing as mental illness,” and the book relegates psychiatry to the realm of alchemy and astrology. Psychiatrists used medical jargon, he argued, without having any real credibility. “If you talk to God, you are praying; if God talks to you, you have schizophrenia. If the dead talk to you, you are a spiritualist; if you talk to the dead, you are a schizophrenic,” he wrote. Institutional psychiatry in particular was an instrument of oppression to control troublesome or morally deviant characters, whom he called “parasites.” Psychiatry wasn’t just oppressive, it also enabled the worst among us, he argued. At least for a time, Szasz’s arguments were compelling to intellectuals in and outside the field. (According to Rosenhan’s private notes, he was far more inspired by Szasz’s view of mental illness than Laing’s—at least at first. In later retellings, however, as Szasz fell out of favor he would credit Laing with inspiring his famous study.)

The anti-psychiatry movement made not-so-strange bedfellows with the civil rights movement. Both were united against a common enemy: the power of “the institution” that decided what was “normal” or “acceptable” in society.

This spirit fully permeated Rosenhan’s Swarthmore College, an ivory tower liberal enclave with Quaker roots, surrounded by blue-collar, conservative, meat-and-potatoes Delaware County, Pennsylvania. In the spring semester of 1969, the campus had never been so politicized. Though typical university controversies still existed—like whether the admissions office should maintain its ban on students with beards working as tour guides—now they were conducted alongside contentious debates over whether or not to allow naval recruiters on campus.

In the midst of these protests, the Swarthmore Afro-American Student Society (SASS) staged sit-ins and walkouts calling for greater representation of black students on the campus that had opened its doors to them only two decades earlier, and whose minuscule numbers had barely hit double digits. With tactics that included hunger strikes, the SASS successfully delayed the opening of Swarthmore’s spring semester, resulting in a week of canceled classes dubbed “The Crisis of 1969,” which ended only when President Courtney Smith suffered a fatal heart attack in a campus stairwell. One writer suggested that President Smith died “from a broken heart.” The campus mourned the popular president’s death, and the Afro-American Student Society’s terms were back-burnered. Swarthmore became known as “the place where the students killed the president”; Vice President Spiro Agnew is said to have nicknamed it “the Kremlin on the Crum” (the Crum are the woods that surround the college). Needless to say, the atmosphere on campus that spring was electric.

And these trade winds helped steer a delegation from David Rosenhan’s abnormal psych seminar to approach him in his smoky lab in the basement of Swarthmore’s Martin Hall at the start of the spring semester in 1969—a meeting that would set in motion a chain of events that would change the world.