8

“I MIGHT NOT BE UNMASKED”

Rosenhan pulled from his real-life experience to make a kind of bizarro-David, one with a new last name, address, and occupation. He took on his mother’s maiden name and became David Lurie, an out-of-work economist / advertising executive. This would be easy to fake since he had, in real life, pursued a master’s degree in mathematics. (He dropped this focus when he didn’t rank first in his class. Rosenhan didn’t do anything that he didn’t feel he was the best at, his son, Jack, has explained to me, so he decided to switch to psychology.) Beyond growing a beard (“lest I be recognized!”), he didn’t alter his physical image much, planning simply to wear shabbier items from his own wardrobe.

He went ahead and arranged his visit at Haverford through Kremens, making sure no others on staff would be aware of his ruse. Yet, despite all his bravado, as zero hour approached he began to get cold feet. “Thinking and discussing are not like doing,” he wrote in his unpublished book. “I was frankly panicked. Would I actually get in? On the basis of such a simple symptom? I began to have serious doubts not only about my ability to get in, but even about my desire to be hospitalized.”

His wife, Mollie, did little to alleviate her husband’s worries. And she was not one to keep quiet when things bothered her. They had met on the first day of Rosh Hashanah outside a synagogue in Lakewood, New Jersey, in 1958. The two young lovers got so lost in conversation that they didn’t even make it inside for services. When Mollie left Rosenhan’s side later that summer to return to the University of Chicago, they exchanged desperate letters. One by Rosenhan read: “Remember how I touched your arm and you touched it and wanted to be touched, so I touched your breast and [you] put your arms around me. I’m thinking I loved you without thinking you loved me back… I wanted to receive so greedily and tearfully. It hurts. My, it hurts terribly.” Two weeks after their first meeting, Rosenhan boarded a flight to Chicago and proposed. As independent as she was, Mollie desperately wanted a family, having been an only child raised in a crowded hotel. (Both of her parents were innkeepers who catered to wealthy Jews on summer vacation.) She and Rosenhan married and a few years later adopted two children—first Nina and then Jack.

Mollie was the prickly one, the difficult one, the tough one—she was notoriously persnickety about her food and would haughtily return meals at restaurants, never too shy to make her grievances known. Or at least that’s how she appeared. Close friends described her as warm and caring with a delicious sense of humor. She was a feminist when that was still a dirty word, and she was a scholar, receiving her PhD in Russian history, teaching college classes, publishing on a wide array of feminist issues, and later co-founding the Stanford Center for Research on Women while also raising the couple’s two young children. One of her closest childhood friends shared with me a picture that seems to sum her up: Mollie as a teen on a trip to Israel, sitting in the bed of a truck, holding a semi-automatic rifle.

Mollie appeared to be the force in the couple, but those who knew them well saw something else. Rosenhan knew how to sway her. Though she hated the thought of her husband going into a psychiatric hospital, it didn’t stop her from helping him prep for his role.

On Wednesday, February 5, 1969, Rosenhan set the study in motion by cold-calling Haverford State Hospital to ask for help. The phone logs recorded a man who had difficulty expressing himself “as his speech was retarded, and he was very emotional.” The idea of Rosenhan’s speech being “retarded,” or, in more modern parlance, delayed, is laughable knowing the natural and gifted speaker he was. Perhaps his nerves were getting the better of him; perhaps, out of fear that he would be exposed as a fake, he leaned into his acting role; or perhaps the operator expected to hear the voice of a “crazy person” so that’s what she heard. Either way, he needn’t have worried: The operator was concerned enough about his symptoms to advise that “David Lurie” consult with his wife about coming to the hospital the following afternoon. It was his first test, and he had passed with ease.

Rosenhan had a hard time sleeping that night. By the morning, his dread had shifted into tingly jitters mixed with sudden clearheadedness of purpose. He put on an old raggedy button-down shirt, worn gray flannel slacks, a moth-eaten beige pullover, and tired Clarks that had long served as his weekend gardening shoes.

If Rosenhan glanced at the New York Times that morning during breakfast, he might have noticed this story: Two court-martialed soldiers were held in a sanity inquiry for mutiny after taking part in a sit-in demonstration. A psychiatrist had testified that the soldiers, who allegedly led the mutiny, were sane—but that they both “suffered impairment of their ability to do what was right by society’s rules because both [have] sociopathic tendencies.” But did this make them crazy? The jury was still out.

If sanity and insanity exist, how shall we know them?

It was time for Rosenhan to commit himself to the mental hospital.

Like all of us, Rosenhan didn’t or couldn’t share some things even in his private writing. Through his son, Jack, I learned that Rosenhan’s younger brother struggled with manic depression (now called bipolar disorder). Rosenhan’s family home was a rigidly Orthodox one, and as his younger brother came of age he grew even more conservative—becoming Ultra-Orthodox, the opposite of David, who may have studied the Torah as a hobby but approached Judaism with a scholar’s eye more than as a true believer. His brother’s extremism capsized other aspects of his life. He had difficulties with money, for example, and during manic phases when off his medications would often call Rosenhan to discuss his finances, issues with his growing family, and his various paranoid fixations that this or that person was out to get him.

“My dad was constantly on the phone with his brother dealing with that and trying to help with that,” Jack said. “I would hear my father being upset and just saying when he’s on his lithium he’s fine, but when he’s not he has these manic episodes and these grandiose ideas. Eventually [because of] one of those ideas he moved his entire family to Israel.” Jack believed that these experiences with his brother shaped Rosenhan’s interest in psychology—especially abnormal psychology—and contributed to his zeal for reform, but Rosenhan never discussed this family issue publicly.

On the late-winter morning of February 9, 1969, Rosenhan and Mollie climbed into their VW hatchback, leaving five-year-old Jack and seven-year-old Nina, both of whom were blissfully unaware of their father’s plans, with a babysitter. A new worry had cropped up, overriding even the fear of exposure: “a fear that I might not be unmasked.” Rosenhan handled the stick shift as his thoughts raced: “Do I need shirts, ties, and underwear, or will I be wearing pajamas all day? Or will it be government-issued clothes? Do I need a heavy sweater for the cold days? Will I be going out at all? The children were in school. Will I be permitted to call them? Do they even have phones on the ward? Will they allow me to smoke, and could I bring my lighter?”

The Rosenhans drove through the Philadelphia Main Line. Stately mansions with pristine lawns lined the way. A semicircular gray stone wall provided the only indicator that they were entering Haverford State Hospital’s manicured grounds. They drove to the five-story red-brick admissions building, aka Building Four.

No wonder people called it the Haverford Hilton. Built just seven years before Rosenhan’s visit, in 1962, Haverford Hospital was an outlier in Pennsylvania in that it was new—few states were allocating funds to building psychiatric hospitals. A psychiatrist who worked there described a large recreation building with a gym, billiards room, pool, barbershop, beauty salon, and soda fountain. There was a four-hundred-seat auditorium, bowling alley, library, and fully equipped surgical unit with X-ray equipment, an operating room, and a high-speed sterilizer (cutting-edge at the time).

It was “the Queen Ship,” a shining example of the next generation of psychiatric hospitals. Back when Haverford State was being built, a project designed to address the overcrowding in nearby Norristown State Hospital, the construction was delayed five years as neighbors protested the placement of a mental hospital (no matter how groundbreaking) so close to their expensive properties. In response, Superintendent Jack Kremens went door-to-door, introducing himself to convince the community that the hospital would not be a danger or an eyesore, but a welcome addition to the community. He not only got approval but even managed to sign up a few neighbors as volunteers. After it was built, Kremens proudly called it his own “showpiece of radical design,” the first of its kind in the world, he told reporters.

Kremens was being hyperbolic, however. It was really the second of its kind. Five of Haverford Hospital’s buildings, which catered to long-term hospitalizations, were modeled off the revolutionary work of British psychiatrist Humphry Osmond.

Osmond, a “guru of the 1960s psychedelic movement” who is credited with bringing LSD to the mainstream of scientific research, was among the first to study similarities between the effects of psychedelics and psychosis. During Osmond’s psychiatric residency, he chanced upon a paper written by chemist Albert Hofmann, who had described the effects of the new chemical compound lysergic acid diethylamide (LSD) in 1943 after ingesting trace amounts of it, resulting in a whopper of a bike ride. Osmond recognized Hofmann’s symptoms—depersonalization, hallucinations, and paranoia—in the presentations of schizophrenia he’d seen in his residency. He speculated that maybe LSD affected the brain similarly to the way schizophrenia did—a new theory of the neurobiological cause of mental illness during a time when psychoanalysis still dominated the field. Armed with this brain chemical theory, Osmond conducted a series of experiments dosing psychiatric patients (and—why not?—himself) with LSD and mescaline. He also administered the drugs to alcoholics, other addicts, and treatment-resistant psychopaths with successful results.

Osmond’s acid trips also piqued his interest in the environment’s influence on the experience of madness, leading to the realization that the way buildings are structured can aggravate or temper positive and negative hallucinations. He argued that most hospitals should be torn down. “They’re ugly monuments to medical error and public indifference,” he told Maclean’s magazine in 1957. In his redesign, he made the wards circular to promote greater social interaction, while also adding access to solitary spaces that would allow patients the dignity of privacy.

Osmond gave LSD—which he said allowed one to “enter the illness and see with a madman’s eyes, hear with his ears, and feel with his skin”—to architect Kiyoshi Izumi, with whom he was working on a design for a Canadian psychiatric hospital. To see with a madman’s eyes was a precondition, Osmond felt, to work with or build for him, because, as he wrote in his famous 1957 paper “Function as the Basis of Psychiatric Ward Design”: “It would be heartless to house legless men in a building which would only be entered by ladders or very steep gradients,” in the same way that it would be heartless to erect a depressing or ominous structure for people who had perceptual or emotional issues.

While under the influence of LSD, architect Izumi traveled to traditionally designed hospitals and found serious flaws for anyone dealing with issues of perception. The patterned tiles that covered the walls confused the eyes. The lack of calendars and clocks created a foreboding timelessness. The recessed closets were so dark that they seemed to gape like open mouths. The raised hospital beds were too high for patients to comfortably sit and touch the floor with their feet—something that seemed to be comforting during psychosis. The long corridors were intimidating.

Osmond agreed, calling the old hospitals “illusion-producing machines par excellence, and very expensive ones at that. If your perception is a little unstable, you may see your old father peering at you from the walls.” Osmond and Izumi built their ideal mental hospital in Canada, a design that Kremens’s Haverford copied. Though Haverford didn’t use Osmond’s cheese wedge design (creating a double-Y-shaped structure with private rooms, shared sitting rooms, and shared bathrooms instead), the hospital incorporated many of Osmond’s theories. Pleasant, uplifting colors replaced patterned tile. The beds were lowered closer to the floor. The furniture was supposed to look like it had come from the patients’ own homes. Patients now came first—at least in terms of their immediate surroundings. That is, if you were lucky enough to live in one of Osmond’s buildings.

Rosenhan wasn’t.

When Rosenhan walked into the admitting room, he noticed that the furniture seemed “used here but not loved.” State-issued. Drab. “Not a picture nor an object nor a poster softened its state-owned décor. Clearly purchased at the lowest bid for the minimum specifications… it was owned by an anonymous State,” he wrote. This was a part of the hospital apparently untouched by Osmond’s theories. Rosenhan introduced himself to the receptionist in an almost giddy state, high from the alien sensation of using a name that wasn’t his own. When she asked for his driver’s license he nearly gave himself away but quickly recovered, saying he’d left it at home. The receptionist moved on to the next question on the form without comment.

Case Number: #5213

Patient name: “Lurie, David”

Address: 42 State Road, Media, PA

Next of kin—name, relationship: Mrs. Mollie Lurie (wife)

Age on admission: 39

Birthdate: 11/2/29

Race: W

Sex: M

Religion: Jewish

Marital Status: Married

Occupation: Advertising writer

Employer: Unemployed

Previous hospitalizations: None

And then they waited.

And waited.

This stoked Rosenhan’s irritation. He thought about how Mollie would not get home in time to relieve the babysitter and there was no pay phone in sight to call. What if I had really been a patient? he thought.

Then, at a quarter to four, nearly two hours after his appointment, the admitting psychiatrist, Dr. Bartlett, called Rosenhan into his office.