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A Masterclass On Madness: My Thoughts On The Great Pretender

I was deeply moved when I read Susannah’s memoir Brain on Fire, but I was moved even more after I read her second book, The Great Pretender. It unlocks a new level of understanding when it comes to mental health and psychology, and I admire Susannah’s brilliant work of investigative journalism. The first reason is because of its in-depth understanding of the three stigmas of mental illness.

The three stigmas of mental illness according to this source are public stigma, which are discriminatory attitudes that people have of mental illness. Self-stigma, which is a negative attitude that someone has towards themselves about mental illness. Institutional stigma is systemic discrimination that involves limiting opportunities for people with mental illness whether intentional or unintentional.

Susannah Cahalan’s book demonstrates multiple examples of these stigmas, that raise awareness of our broken mental health system and how it negatively affects people. One example of public stigma would be in chapter two where mental illness was publicly stigmatized against anyone by choice. This meant that anyone could be falsely diagnosed as mentally unstable and be sent away, “The malleability of the era’s definitions of insanity meant that any man of a certain means and pedigree could just pay off a doctor or two and dispatch whomever he wanted gone, a disobedient wife, for example, or an inconvenient relative.” Susannah stated in her book, “This understandably bred a widespread anxiety over false diagnoses. Newspapers stoked this fear by publishing a litany of articles about people sidelined into mental hospitals who weren’t truly sick.”

One example of self-stigma would also be in chapter two, where one of the undercover patients Nellie Bly self-stigmatizes herself as she begins to convince herself of her adopted madness saying, “For once I did look insane,” she explained. “Unable to control myself at the absurd picture I presented, I burst into roars of laughter.” One example of institutional stigma would be in chapter four, where mental illness was stigmatized against those with mental illness by closing psychiatric hospitals.

This meant that those who needed mental health treatment were being abandoned by society. “Meanwhile, psychiatric hospitals closed at a rapid clip across the country. By the time California Governor Ronald Reagan took office in 1967, state hospitals had released half of their patients. Under Reagan’s leadership, California passed several acts that hastened the demise of the institutions across the state—and the rest of the country followed.” Susannah explained in her book, “Yet even as the hospitals were being closed, psychiatry’s reach was spreading wide outside the asylum, like ground ivy, into Hollywood, government, education, child-rearing, politics, and big business, enjoying a sudden social cachet while turning its back on the people who needed help the most—the seriously mentally ill.”

These three examples of stigmatizing mental illness, not only reflect society’s misunderstanding of mental illness, but it even reflects society’s negative attitude of treating mental health as a money-making joke. Susannah’s revelation of these details highlights her intelligent skills as a journalist, but they also highlight my second reason for admiring her second book—her empathy. Susannah displays a tremendous level of empathy for those in psychiatric institutions because she almost became one of them.

The experience allowed Susannah to see herself in these patients, especially in one patient. In chapter one of her book, Susannah recounts interacting with a psychiatrist who diagnosed a woman with schizophrenia but didn’t feel right about it. She explained how the psychiatrist saw her in this patient saying, “In fact, she reminded him of me. The woman was of a similar age, had a similar diagnosis, and exhibited similar symptoms. But she also appeared similar to the sea of others with serious mental illness who were being treated alongside her.”

When Susannah went to a hospital unit and was walking past a group therapy meeting, she thought of that young woman and was interested in seeing her. When the two finally met, Susannah was able to see that the woman tested positive for the same disease she had autoimmune encephalitis. Unlike Susannah, this woman was misdiagnosed for two years, and the aftereffects have caused her to no longer care for herself. Susannah then realized that she and the young woman are the same saying, “What happened to this young woman almost happened to me. It was like seeing my reflection through the looking glass. She was my could-have-been, my mirror image.”

Having investigated Nellie Bly’s case, she understood how Nellie felt about feeling guilty for abandoning those women at Blackwell Island because that’s how she felt about the woman she met at the hospital unit who was her ‘mirror image.’ Finally, during a dinner conversation with a McLean Hospital psychologist named Dr. Deborah, Susannah expressed how unfair it is that her ‘mirror image’ is suffering and due to their similarities her ‘mirror image’ should have received the same treatment she did by saying, “There shouldn’t have been any difference between us; she should have received the same treatment, she should have had the same quick and urgent interventions, and she should have had the opportunity to recover as I had. But she had been derailed because of one crucial difference: Her mental diagnosis had stuck. Mine hadn’t.”

Susannah’s detailed understanding of stigmatized mental illness and her empathy towards others who represented what could have been her future, allowed this book to become a masterclass session on what true madness is. It’s madness to know that people have little to no understanding of the difference between sane and insane. It’s also madness to know how many ways a person can be treated as less than human, simply because of their mental illness. We must become better than this, we are better than this, we’re human beings for goodness’s sake. There should be enough humanity in us all to listen to each other, better understand each other, and take care of each other.

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