The Great Pretender by Susannah Cahalan

Author:Susannah Cahalan
Language: eng
Format: epub
Publisher: Grand Central Publishing
Published: 2019-11-04T16:00:00+00:00

The most concerning part, from my perspective, is that the DSM approach rendered the practice so rigid, so fixed, that the patient, the person, the human, was lost. As I would learn, this doesn’t just affect the relationship between doctor and patient, but can increase misdiagnosis.

I had tested this out myself with Dr. Michael First, the man who introduced Spitzer and mentioned Rosenhan at the memorial lecture.

“I’m nervous,” I said as I turned on the tape recorder in First’s office. “Why am I nervous? Have you been SCIDed yourself?”

“Nope,” Dr. First said.

Dr. First is not exactly warm and fuzzy—he’s hyperclinical and a straight shooter, two things that have made him key in the creation of the last three incarnations of the DSM—but the chunky metal ring I spotted on his finger during our interview betrays what I interpret as his softer, Woodstock-hippie vibe. He is often called upon to consult in high-profile criminal cases, recently that of the murder of six-year-old Etan Patz, which ended in a hung jury (the defendant was found guilty in a second trial). But his main contribution to the DSM world is the SCID—the Structured Clinical Interview for DSM—a prewritten set of interview questions designed to make a psychiatric diagnosis based on DSM criteria. I had asked if he would be open to SCIDing me about my experience with psychosis, pretending that he didn’t know the diagnosis. Dr. First seemed open to a challenge—even if the odds were stacked against him.

In 2008 he appeared on a BBC reality show called How Mad Are You? where ten people—five “normal” and five who had been diagnosed with psychiatric conditions—lived in a house observed by a psychiatrist (Michael First), a psychologist, and a psychiatric nurse, and engaged in a variety of tasks, including performing stand-up comedy and cleaning out cow stalls. The panelists’ goal was to ferret out the mentally ill and correctly label them with only five days of observation. The panelists didn’t do such a hot job. They nailed the guy with obsessive-compulsive disorder after watching him struggle to clean up cow manure, but incorrectly diagnosed one volunteer with bipolar disorder (where no disorder existed) and one with a history of schizophrenia (there was no history). It’s worth recognizing how astonishingly deep Rosenhan’s thesis has cut: Despite all of psychiatry’s efforts to legitimize itself in the time since, the impossibility of distinguishing sanity from insanity had received the most mainstream of honors—its own reality show.

First began. “Okay, I’m going to do it straight through as if we’re doing it for real because we are doing it for real.”

He rattled off the first few questions and I answered them in quick succession: “How old are you?” “With whom do you live?” “How long have you been married?” “Where do you work?”

I explained that I had been dating my husband for seven years, but that we had met when I was seventeen. I told him about our recent marriage. He asked about work so I summarized my history at the New York Post, where I had worked for even longer than I’d known my husband.

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