Tuesday, November 5, 2013

Memoirs of Madness: Five of the Best

The memoir of madness has been with us far longer than Sylvia Plath’s Bell Jar or William Styron’s Darkness Visible. Firsthand accounts of life beyond the limits of sanity have been around from at least the early nineteenth century, as this alluring bibliography attests. 

Below I’ve picked five of my favourites, all dealing with illness that includes elements of psychosis. I’ve chosen these memoirs because they are all vividly written and because they provide vital insights into the treatment and lifestyle needs of people with mental illness. Each and every one of these memoirs makes the loud and clear declaration that it is never more important to view the mentally ill person as a complete human being with human needs and emotions than when they are most acutely ill.

Madness: A Bipolar Life by Marya Hornbacher

Already a classic in the field, Hornbacher’s riveting immediacy, hold-onto-your-hat style and liquid prose make this memoir un-put-down-able, even as the reader squirms. She ignores her bipolar diagnosis, ditches her medication and descends into alcoholism, destructive relationships and psychosis before colliding with the consequences of her illness and making a slow journey back to sanity. Meeting her husband Jeff, finding meaningful work and suffering extended stays in a psychiatric ward are all part of the fabric of this painful and visceral but ultimately uplifting memoir.

Madness: A Memoir by Kate Richards

This memoir is written in the tradition of Hornbacher’s but Richards has a talent and voice that are hers alone. Richards’s seductive prose demonstrates that great pain and suffering can actually amplify the sensory perceptions that make life rich and meaningful. At the start of the memoir the narrator’s psychotic depression has left her an emotional adolescent, addicted to sleeping pills, dependent on alcohol and lacking in life skills. But sustained by music, literature, philosophy and the outdoors, meaningful work as a medical researcher, strong friendships and the support of a wise psychologist, Kate and the reader emerge into the daylight – with all the down sides as well as the joys and possibilities that stem from coming to terms with life and chronic illness.

One of the key strengths of this memoir is the passages written while the narrator is in psychosis, seemingly drawn from Richards’s diaries. They explore the limits of meaning, collapsing the difference between subject and object and demonstrating the dangers and lure of madness. At the same time the memoir encompasses vivid accounts of episodes in psychiatric hospitals and a grounded critique of Australia’s mental health system.

Flying with Paper Wings: Reflections on Living with Madness by Sandy Jeffs

Sandy Jeffs is a popular Melbourne poet and an acclaimed community educator on mental illness (in her own words ‘professional lunatic’). In this honest and moving memoir she reflects on a life lived with the chronic illness of schizophrenia following a semi-rural childhood riven by constant battles between her alcoholic mother and violent, controlling father.

Jeffs’s experiences in Melbourne mental hospitals from the 70s onwards, mostly harrowing but occasionally affirming, the stubborn viciousness of her inner voices, the sustaining support of her alternative family, and the world of literature and philosophy that feed her intellect and spirit all enrich this narrative. Entirely lacking in self-pity, this is a document imbued with the wisdom and clarity of a well-lived and nurturing life despite mental health that is at times precarious, with plenty of useful lessons for carers, professionals, policy makers and the general reader.

Hurry Down Sunshine: A Father’s Story of Love and Madness by Michael Greenberg

Photograph: Marion Ettlinger
This is a poignant and beautifully written memoir about bipolar disorder from the perspective of fatherhood. Greenberg narrates the horror of watching his beloved daughter Sally switch suddenly into bipolar psychosis at the age of 15 and eke out a slow, shaky recovery in a no-frills Manhattan psychiatric hospital during a sweltering summer. It is meticulously and delicately written in a realist style that conveys the heaviness and various losses that result from watching a loved child disintegrate, as well as the financial stresses of living in New York, and of dealing with an inflexible, privatised health care system.

Greenberg describes madness as something that takes his daughter far away from him, and vividly conveys his fears that she will never return. The awkward encounters between his current and his ex-wife, the eccentricities of the other patients, as well as the burden he already bears of supporting a mentally ill brother, ground this memoir in a complex and challenging context.

The Center Cannot Hold: My Journey through Madness by Elyn Saks

Elyn Saks is a tenured professor of law and psychiatry at the University of Southern California with degrees from Oxford, Yale and Vanderbilt, and an expert in mental health law. She has also had the experience of being forcibly restrained for hours on end in psychiatric wards and forcefed medication while suffering acute psychosis. This memoir describes Saks’s struggle to accept and manage a diagnosis of schizophrenia, while forging a stellar academic career.

Saks first experienced full-blown psychosis as a young postgraduate on a philosophy scholarship at Oxford. In The Center Cannot Hold she documents her torturous journey towards accepting the severity of her illness and the need to take medication. During this period she was able to avail herself of skilled psychoanalysts who understood the emotional content of her delusions and enabled her to maintain some degree of equilibrium.

Saks gives important insights into her state of mind during her most acute episodes and how traumatised she was by the dehumanising treatment she experienced after suffering a breakdown at Yale. Key here are the human aspects of the illness – the way it is affected by stress, Saks’s struggles to maintain her academic career, and the shocking attitudes of psychiatric staff who valued compliance over healing. ‘While medication had kept me alive, it had been psychoanalysis that had helped me find a life worth living’, Saks asserts. The support and intellectual engagement that her career and her academic colleagues provide, her ultimate acceptance of the need for ongoing medication and her fulfilling marriage in her mid-forties together enable a life that is ‘rich and satisfying’.

Narratives of madness

These memoirs are riveting yet educational reads for the general public, as well as important guideposts for sufferers. But they are also vital documents for mental health practitioners, akin to qualitative research about the experiences of users of mental health services.

Three of them, Madness: A Bipolar Life, Madness: A Memoir and The Center Cannot Hold, contain a similar trajectory – after experiencing the extremes of the illness, sometimes worsened by addiction, the sufferer eventually comes to accept the need to take medication and to manage addictions and stresses, and learns how to maintain a balanced, fulfilling life. 

This trajectory suggests that if the right level of support and skill were offered early enough, sufferers might be able achieve recovery without the self-destruction and descent into addiction that are so commonly represented as necessary stages on the journey.

All five of them reflect on the human elements that make the long-term management of illness – and just as important a fulfilling life – possible.

In The Center Cannot Hold and Madness: A Memoir, what makes this journey possible is the loving, sustained attention of therapists who provide a safe psychic space in which the patient can explore emotional defences and gradually embrace maturity.

In Hornbacher’s case it is her ever-patient psychiatrist, the hospital she lives in for months on end, where staff are unendingly accepting and supportive, and the unconditional love and fortitude of her husband that together create a safety net in which she is harboured until the illness is tamed.

In Flying with Paper Wings, it is Jeffs’s ‘two Demeters’ – the female friends with whom she has lived in a peaceful setting on the rural fringes of Melbourne for 30 years.

In Hurry Down Sunshine, it is the sustained love and attention of Sally’s family, including the father–narrator, that eases Sally's transition to precarious sanity.

Creativity, purposeful work and strong friendships also play vital roles. Secure housing is vital and the fact that most of the stories feature middle class sufferers is no accident. Kate Richards expresses how lucky she is to be able to afford to choose her own therapist, and to buy a home that offers not just long-term security but a haven.

One of the reasons for the importance of these memoirs is their various critiques of the psychiatric profession and the mental health sector.

The memoir of Richards, a medical researcher, has not one decent psychiatrist throughout its 200-plus pages. Not one. They are helpful in dispensing medication, but the healing she receives comes from a psychologist. The implication is that the problem is systemic, due to faulty training – Richards is ‘sacked’ by one psychiatrist, while others demonstrate various levels of boredom and disengagement.

Sandy Jeffs also questions psychiatry, having left her long-term therapist, Dr Y, after 27 years. She is critical of what she calls ‘Fastpsychiatry’ and ponders the dangers and possibilities of investigating the psychic content of her delusions with a new therapist, Dr K, who is willing to explore with her the darkest underpinnings of her hostile voices: ‘If I could heal that little girl, would the persecutory content of my delusions and voices diminish, and allow me to embrace her?’

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