The moment we were admitted to the hospital, we abandoned our symptom, and we behaved the way we usually behave. The question was, would anyone detect we were sane . The answer was, no. Susan your new book, the great pretender, centers around the story of this man. Who is he . Susannah hes a stanford professor, and he was the architect of this amazing study with the incredible footage you just played, called on being sane in insane places. He and seven other people undercover innt Psychiatric Hospitals around the country. Their mission was to test the nature of diagnosis and see if there sanity would be detected. As he said, they were not. Susan the study was done in the early 1970s. Why are you interested in it today . Susannah it came from a very personal place. I emerged from my previous book, my memoir, brain on fire, my experienceed with an autoimmune disease that targeted my brain that was briefly misdiagnosed as a serious Mental Illness. Originally bipolar disorder and then schizoaffective disorder. After that book came out, i was inundated by emails from the general public, a lot of people answers looking for like my own. Some of whom found answers because of my book. I also received many emails from people who felt lost within the Mental Health system, who felt they were not being seen and not being heard. Really atrocious stories of their care. I started to question a lot of these issues of diagnosis and misdiagnosis, and the question of what is Mental Illness. This led me specifically to one story that i called my mirror image, and that really had an effect on me. Susan we have a trailer from netflix we are going to play a little bit of because your book was made into a movie. I want to show people who didnt read your first book to give a sense of what you went through. [video clip] my head hurts, my stomach hurts, my hands are numb. Tested susannah for every infectious disease. All of the results are negative. Her eeg is completely normal. Her mri is normal. Its all normal. Her condition continues to regress. Manic behavior, paranoia. One is saying bipolar, the next is saying schizophrenic, psychotic. We should look at hospitals better equipped to deal with this. Susan when did this happen to you . Susannah 2009. I was 24 at the time. A lot of that time i dont remember, and it is always very bizarre to see it recreated in movie form. I wrote a book about a time that is very much lost to me, and then it was recreated as a movie, so i have very strange feelings about that whole experience. As it was depicted, i experienced very serious signs of serious Mental Illness, you typically associate with serious Mental Illness psychosis and , hallucinations, delusions. I was violent, paranoid, angry. There are various points, doctors had various diagnoses that ran the gamut from bipolar disorder to schizoaffective disorder to various others in between. Susan how did you get better . Susannah i was very lucky, and that is something i understand now to a greater degree, having done the great pretender, this new book. I chanced upon this amazing, forward thinking, beautiful soul listenedor who really to me and my parents, and really took a very indepth patient history, and was able to dig in and discover the cause, which was at that time a very newly discovered autoimmune disease of the brain called autoimmune encephalitis. Which is a mouthful, but yes. Susan what was the treatment plan . Was it medication, pharmaceuticals that made you better . Susannah it was not. It was the arsenal you would use to treat any other autoimmune disease. In my case, that was steroids, taking plasma out of your blood in exchange for new plasma, and ivig treatment. That is what cured me. Susan is there a chance you will get it again, or are you cured for life . Do you know . Susannah unfortunately, the disease itself was only named in 2007. I was treated in 2009. I was the 217th person. The Natural History of the illness is not well understood, so there are a lot of question marks. One of those is the relapse rates. There are relapse rates. It can come back, but i was treated very swiftly and aggressively, another example of my luck. So hopefully those rates are lower, but i do live with the threat that it could return. Susan you were out on the book tour and you book get hearing from people saying maybe my diagnosis is also wrong. How did you get from there to this project . Susannah actually, out on book tour in boston, around that time i actually encountered the story that would haunt me of this young woman. When i was kind of proselytizing, i was talking about this illness to whomever would listen to me, and i wanted to get the word out that this condition existed. At one point, i found myself in a Psychiatric Hospital presenting to doctors. After my presentation, one of the doctors came up to me and said, we have a woman here, she sounds a lot like you. We are going to test her for your illness. I remember walking through the halls of that hospital thinking, is that the person . I remember being moved by the thought that someone could have had what i had. I found out two weeks later this person did have what i have. What i had. She fit the same profile and had the same diagnosis, but there was a stark difference between us. I was misdiagnosed for one month. She was misdiagnosed for two years. She had been misdiagnosed with schizophrenia. And unfortunately, her doctor told me she would never fully recover and that she would operate the rest of her life as a, quote, permanent child. This really not only angered me, but it galvanized me to continue asking these questions of, what is Mental Illness . At that point, i actually mentioned the story to two neuroscientists who i am friendly with. And one of them turned to me and said, you and this woman are kind of like modernday pseudopatients. I had no idea what she meant by that. That night, she sent me this on being sane in insane places, and it asked very similar questions to the ones percolating around my mind of, what is Mental Illness . What do these labels mean . Is there validity there . I remember reading that and thinking and feeling really seen, and really relating to it on a deep level. Susan you write in the book, the ability to answer this question, what is Mental Illness, shapes everything from how we medicate, treat, and hospitalize, how we police, and who we choose to imprison. That is broad. Can you talk about why this topic covers so many aspects of society . Susannah the broad general idea what is eccentricity . What is personality trait . What is pathological . These questions are about the self. Who we are, how we define ourselves. That touches all of us. In a broader sense, the idea of, what is Mental Illness does effect if someone behaves in a way during a psychotic experience, should we look at it in the same way as someone who is not psychotic . The labels and the context of these diagnoses has an effect on the way we see, for better or worse, people who have these illnesses. I think that it is a broad swath of an influence on our culture and society. Susan by profession, you are a journalist. Susannah yes. Susan so how did you use your journalism skills in answering these questions . Susannah i read that study and immediately related to it. I thought, i want to know more. I wanted to know about David Rosenhan, who is alluring to me in many ways. He is a very charismatic man. I wanted to know about these other volunteers. He had seven other people he had recruited. Who were these people . Why did they put their lives on the line for this assignment . For what reason . So i started to dig. At that point, i got access to his unpublished book, his diary entries, and eight bankers boxes worth of correspondences that chronicled his career at stanford. And i started to dig. And that dig turned into a six year investigation. Susan and how far did it take you geographically . Susannah honestly, all over the country. England as well, but mostly, i hopscotched from the and stanford. Those were kind of my home turfs, but i went everywhere in between on this wild goose chase for these seven other people and more information about David Rosenhan. Susan we know about stanford because thats where he taught. What was the haverford connection . Susannah before he was recruited to stanford based on this study, when he was working on this study, rumors that he was working on Something Big reached stanford. He was recruited there to become a tenured professor. He was previously at swarthmore. It was there that the idea for the study came to him. It was not actually his own idea, which is what i discovered in his unpublished book. But it was actually his students. In an abnormal psychology seminar, who asked him, we want to see the idea of madness up close. He actually said to them, if you want to see it up close, become a mental patient. These were his words. Go undercover in a Psychiatric Hospital. They all said, yes, we want to. But the problem was when he actually posed this idea to their parents, none of them approved it. So David Rosenhan decided to go in himself. That is where the germs of this study started. Susan i want to get back to the study in a bit, but readers of your book will also get a brief history of how this country and western societies have treated Mental Illness over time. So i would like to have you walk us through a little bit of that. Lets say the early part of the 20th century, people who were diagnosed with Mental Illness, what were the options available . Susannah weve had so many different stages in terms of the way we treat and view Mental Illness. I kind of start the book with the story of nelly bly. Thats kind of where i start in terms of the modern history of psychiatry. Because you can go back to you know, we could go back forever, with ancient egyptians boring holes into peoples skulls to try to release the demons of the mind. These questions have plagued humanity forever. But i started with nelly bly, who was this amazing woman. Original what we call sob sister. They wrote these sob stories, kind of amazing investigative reporters when women did not do such things. She in her early 20s, went undercover in a hospital on what is now roosevelt island. It was notorious. It was a hellhole. She went undercover as a psychiatric patient, one of the first to do so in this way. The top tabloidy what she found was appalling. Basically, the idea of insanity was a one size fits all. If you were off or different, you would be basically put into an insane asylum. And there, care did not exist. There was neglect and outright abuse. What she chronicled in the two part expose shocked the country. But it was going on all over the place during the turn of the century. Susan who paid for those institutions, which were all over the country at that time . Susannah i believe we paid for them during that time. Some were private, as they are now. There are state institutions and private institutions. Susan technology started coming along. There is something called electroshock therapy. Is that still in use . Susannah it is, and susan what does that do . Susannah it is electroconvulsive therapy now. Its very different than it was then. It is still very controversial. It is interesting because in the time that David Rosenhan was going undercover, it was still the kind of scary electroconvulsive therapy we think of and associate with movies like one flew over the cuckoos nest. These were therapies that created that a lot of people describe as sledgehammers. Because we do not really know how they work. They send electrical currents to the brain. In the past, they would induce seizures and people would break their backs and bite their tongues. That is no longer the case. It is very different now. But these contributed to the general publics distrust of psychiatric institutions and psychiatry at the time. Susan theres another thing, you can tell us when it became put into use, but a procedure called a lobotomy. What is a lobotomy . Susannah that is one of the darkest chapters of the history of medicine and psychiatry in particular. It was first created there was the first test on chimpanzees. It is basically a shutting off of the connections between the prefrontal lobe and the rest of the brain. It is supposed to reduce higher functioning. It was intended to treat psychosis and a host this idea of onesizefitsall insanity. It was used to treat homosexuality and psychosis and depression. It was just one of these disgusting sledgehammers we should be very ashamed of in our past. Susan in 1991, the bbc did a documentary on Mental Health called madness. They had interviews with two people that really popularized, maybe even invented this procedure. We have a clip to show people. Lets watch that. [video clip] that is a picture of me. That it that is . Yes. [laughter] and oswald freeman. I had no misgivings about him about lobotomy until dr. Freeman began to do the lobotomies in his office. One day, i walked in as he was he is alobotomy, and great man for recording things photographically. He had someone hold the ice pick while he took the photograph. He asked me, will you hold the ice pick while i take the photograph . I did not want to have a picture of me holding an ice pick at a patients head. So i said, no, id rather not. Susan it is hard to watch. Susannah it is. Susan how long was it practiced . Susannah i am not sure of the exact timeline, but many people in this country, i think hundreds of thousands of people in this country underwent it. The most shocking story for me, or poetic in many ways, was the story of rosemary kennedy, who had a lobotomy done by Walter Freeman and james watts. I read a lot other biographers had done books about rosemary. The passages about her pre and postlobotomy were heartbreaking. Her mother, giving birth, had a difficult birth. I think there was oxygen deprived to her brain. She had always been a little bit different than the rest of her siblings, but she was vivacious and very alive, but very after very strong and beautiful. After the lobotomy, one of the writers described her as a painting that had been brutally slashed. She could hardly come up with any words. She walked pigeon toed. She would basically be an invalid the rest of her life. It was a travesty. Susan so often, we see in this town of washington that political figures who have personal stories in their lives use them to galvanize Public Policy efforts. How did the kennedy family, her brother who became president of the United States in particular, incorporate this experience into his view of and work on Mental Health issues . Susannah this was an amazing story, the connection between rosemary and how it affected us in the long term. Jfk was obviously very affected by his sisters story. That, i think, 100 had an effect on his policy, which was the community Mental Health care act. He kind of turned away from many of the institutions in a bid to create a Community Care model, which would take people out of these warehouses where people were mistreated and abused and neglected and have people treated in the community. That was the ideal of it. Unfortunately, he died before any of this was actually actualized. The result was that these Community Care models were not enacted. And the money did not follow the patients even though the hospitals did close. Susan you write that the second step of that was when Lyndon Johnson came into office with the signing of medicare and medicaid in 1965. What happened at that point that affected federal policy on Mental Health treatment . Susannah there is something called the imd exclusion, which reduced eliminated funding for any mental hospitals that had more than 16 beds. That just again facilitated the mass closure of a lot of these big state institutions that were , again, very broken and needed fixing, but they were outright closed without any safety net in place for very sick people to go. Susan so, state versus federal role in treating Mental Health changed as a result of that. What did states where they expecting something from the federal government that never materialized . Susannah i guess they were trying to they knew they werent going to get the funding, so what was the outcome . They would close the institutions. If they were going to be losing money, the result was, if they closed the institution, they would save money. It was really a follow the money story, i think. Some statistics, as you mentioned, the Community Care aspect of this never materialized. I found in our archives that they celebrated the 50th anniversary of this act passing as though it had a big impact. Didnt have a big impact at all on society . Of course it did. I think you walk the streets and see people who are i think it closed a lot of places that were terrible, but i think it left a lot of people who needed our help the most without help. So it had a huge effect on closing very bad places, which is thats a great thing, but i think it was not fully actualized. I think that there is a lot that could have been done with these ideals. And in fact, i relate to a lot of ideals of treating people within the community. That is a wonderful model, but the money was not there. You can see on your walk for me in new york city, i can see it on my walk to work every day, passing Homeless People who are very seriously sick. Susan the stat you have in your book is 90 of the Mental Health beds that were available when jfk signed the bill in 1963 have closed. Susannah yeah. Susan at the same time, our population has doubled in about that time. Where are these people going . Is anah of course, it broad and very complex story. We have many drugs available to treat people. Perhaps some of those people would not need to be hospitalized. That is a valid point, but there are still very sick people who are not getting the help they need. So we are, at l