EPILOGUE

Whenever the ratio of what is known to what needs to be known approaches zero,” Rosenhan wrote, “we tend to invent ‘knowledge’ and assume that we understand more than we actually do. We seem unable to acknowledge that we simply don’t know.”

Unlike Rosenhan, I don’t want to “invent knowledge” where it’s lacking. The truth is that I simply don’t know so much. I know that David Rosenhan exaggerated and fabricated parts of his own story, the results of which were introduced on one of the most exalted pedestals in academia. I know Rosenhan’s flawed work had an effect on Robert Spitzer and the creation of the DSM. I know that the study had a wide influence, contributing to the shuttering of psychiatric hospitals. I know that at least one pseudopatient’s experience supported Rosenhan’s thesis—and I know that one did not. I don’t know why he never finished his book, why he never published on the topic again, or how he would feel about this book. I can guess, but I cannot know.

I don’t know what happened to the other six pseudopatients. Did they exist at all? I will admit that I still keep imagining all the different ways a pseudopatient could unmask herself (maybe I’ll walk down the street one day, and I’ll feel a light tap on my shoulder, turn around, and there you are). Because in the end I believe that he exposed something real. Rosenhan’s paper, as exaggerated, and even dishonest, as it was, touched on truth as it danced around it—the role of context in medicine; the dismissal of psychiatric conditions as less legitimate than physical ones; the depersonalization felt by the mentally ill “other”; the limitations of our diagnostic language. The messages were worthy; unfortunately, the messenger was not.

When I had unearthed everything I could possibly find, I met with Lee Ross, the Stanford psychologist who introduced me to Rosenhan, and with Florence, my Rosenhan whisperer—the two living people intellectually closest with Rosenhan and most responsible for my obsession with him—to share my findings. Lee wrestled with his reaction to the news that Rosenhan may have fabricated his work. We sat in his living room and picked apart the arguments. Florence shared her perspective: “I was surprised initially when Susannah suggested that, but I don’t find it reprehensible,” she said. “I know I should, and it’s science, but knowing David, David had a certain prankster quality to him.”

Florence has seen as much of Rosenhan’s files as I have and has no doubt that Rosenhan made up a good bulk of the paper, but she is more forgiving about the liberties he took. She likened him to a novelist creating a scene. She did not see him as a villain—she loved the man—but more as a rascal who had successfully punked the world; or, as she put it, as a latter-day Till Eulenspiegel, a prankster evoked in many German fairy tales, who “plays practical jokes on his contemporaries, exposing vices at every turn, greed and folly, hypocrisy and foolishness.

“What I’ve come to think about with David and this whole thing is his twinkle,” Florence said. “You could imagine him saying, Well, if I had completed this study, it would have been exactly as I described it.”

Florence’s acceptance of the possibility that Rosenhan’s work may not have been completely legitimate opened something inside Lee. “There is a certain shadowy quality when you probe into David’s work and life,” Lee Ross said. “It’s just that feeling of you can’t quite pin things down. Things don’t quite add up sometimes. And I think he… I don’t want this to have more connotations than it does. There is a way in which he kind of led multiple lives. And by that I just mean I think he was a somewhat different person in somewhat different contexts.” I couldn’t help but smile a little—that was, after all, one takeaway from Rosenhan’s paper: that we’re never all one way, that insane people are never always crazy, nor are sane people always rational. Lee continued: “I would be surprised, not unbelieving, but very surprised and very unhappy to learn [that he lied]. It would make me even more feel that David was struggling for a place in the sun.”

Though I had to wonder: Was he struggling not for but with his place in the sun?

Rosenhan, with his twinkle and shadowy quality, managed to expose truths—even if those truths contained problematic fictions—and created something that we still debate, pillory, celebrate, and investigate nearly half a century later. The study may have “proved” something that people believed was true, and, for better or worse, that was enough to change everything. Maybe it’s as Chief Bromden says in One Flew Over the Cuckoo’s Nest: “It’s the truth even if it didn’t happen.”

There were no lines around the block to attend Rosenhan’s funeral. No national newspaper covered his passing. The sparse attendance was partially due to how inured Rosenhan’s community had grown to their grief. A series of tragedies hit the aging professor with such senseless brutality that people could not help but make comparisons to Job. It started with his daughter Nina’s death in 1996 in a car accident, followed by Mollie’s lethal lung cancer diagnosis, followed by Rosenhan’s first stroke—a small TIA that would likely have gone unnoticed if Rosenhan had not insisted that he be checked out. Florence noticed a slight difference in her friend after that first scare. With a mind so nimble, he was good at hiding it, but there was a new hesitation, a few seconds of delay that had never existed before. Mollie died in her bed at home in 2000, around the time that Rosenhan suffered a massive stroke from which he would never recover. The stroke and the other illnesses that had befallen him had damaged his vocal cords so that the familiar baritone voice faded into silence. The man who took daily multi-mile walks around Stanford’s Dish, the professor who made you feel truly seen, the warm, approachable raconteur, turned into a shell of himself. He lost his ability to walk and moved into a nursing home. The stalwarts—among them his friend and caretaker Linda Kurtz; his son, Jack; and Florence—came frequently to check on him. Otherwise, people forgot about him. When I contacted his former friends and colleagues, many of whom had attended parties at his house for years, they inquired about how he was because they had not heard about his death.

At his funeral, Rosenhan’s close friend Lee Shulman, who spent many hours studying the Talmud with Rosenhan in a study group, gave a speech that perfectly captured Rosenhan:

David’s fame was based on many accomplishments, but one stands out as a powerful beacon. His essay in Science, “On Being Sane in Insane Places,” begins with an opening sentence that should be intoned in the register of the yeshiva student whom he would always remain: “If… sanity and insanity exist… how shall we know them?”…

If you have never actually read that article, or it’s been a long while, you just may have forgotten its rhetorical power… It is a proclamation, a moral outcry, a scream of pain and a demand that the world bear witness.

David Rosenhan is no clearer a figure to me now, even after my years of relentless digging into his personal and professional past, than he was the day I first heard Dr. Deborah Levy talk about his study. He was, as Lee Ross said, “a somewhat different person in somewhat different contexts”; depending on what kind of light you cast on him, you could view him as a hero or a villain, a scoundrel or a rascal, a charlatan or a Cassandra, a selfless leader or a selfish opportunist.

But there’s one story that sums him up for me, as a thinker, as a father, and as a human.

Jack was thirteen when his father invited him to join him on a trip to New York City to meet with an editor and discuss the pseudopatient book that he would never publish. The two were walking through the crowded streets of downtown Manhattan when they noticed an open grate on the sidewalk. Through the hole you could see below to a whole hidden world. They nearly gasped when a huge dump truck drove by underfoot.

“Don’t say a word, just follow me,” Rosenhan said, leading his son to one of the hardhats manning an elevator that led belowground.

He introduced himself as David Rosenhan, professor of engineering at Stanford University. In a flash, Rosenhan and Jack were fitted for hard hats and boots. Zoom! They were in an elevator headed underground to see the building of the infrastructure of the New York City subway system firsthand. Their guide seemed impressed by Rosenhan and his credentials and gave them the full tour. Jack kept worrying that they’d be busted. Just one complicated engineering question and we’re toast, he thought. But Rosenhan seemed as cool and confident as always, carrying himself as if he belonged there, as if he were the king of the underground, a world invisible to the people who walked in droves above them. This simple fact blew Jack’s young mind: His father could so easily become someone else.

He was the great pretender.