Book Cover of 'Voluntary Madness'
Am I mentally ill? Or have I been diagnosed as such because it means that the insurance companies will pony up for my meds and my stays in the hospital only if I am placed in a category in the Diagnostic and Statistical Manual of Mental Disorders (DSM), whether I truly belong there or not?
And what is 'mentally ill,' anyway? What can it mean to say that someone is mentally ill when the DSM, the psycho-bible, is, in my and many other far more qualified people's estimation, not a scientific document, but rather an entirely subjective and seemingly infinitely amendable and expandable laundry list of catchall terms for collections of symptoms.
There is, at least in the quantifiable sense, no such thing as schizophrenia, bipolar disorder, major depressive disorder, social anxiety disorder, and a whole host of other accepted diseases listed in the DSM. There is no real test for any of them (only questionnaires and symptomatic observation). They are unduly subject to political and professional fashion, and even lobbying by special- interest groups. Hence the successive redefining of homosexuality in 1973 and 1980, and, finally, its excision from the DSM in 1987.
We are nowhere near understanding the causes and mechanisms of mental illness well enough to develop reliable diagnostic criteria for any of them. We infer backward from the symptoms to the disease, which is why, when it came to doing the research for this book, it was so easy for me to gain admission to various hospitals on the pretext of undergoing a major depressive episode, even though in at least one case I was feeling quite well.
People have often asked me how I was able to do this so easily, and I always shock them when I say, 'Anyone could do it.' Getting yourself committed is very easy. Easier than it should be.
This has been true for a long time. In 1972, psychologist David Rosenhan and a group of his colleagues and graduate students conducted an experiment in which eight participants, or 'pseudopatients,' none of whom had histories of mental illness or institutionalization, set out to see how difficult it would be to get themselves committed.
They presented themselves at various hospitals across the United States, saying that they were hearing voices. They said that the voices were repeating the words 'empty,' 'hollow,' and 'thud.' They claimed to be suffering from no other symptoms and otherwise behaved normally. All eight were admitted, seven with diagnoses of schizophrenia, and one with a diagnosis of bipolar disorder. None of the staff was able to identify the pseudopatients as impostors during their stays, though a number of patients were reported to have done so.
The pseudopatients were all discharged after an average stay of nineteen days, at which time their schizophrenia was diagnosed as being 'in remission.'
The results of the experiment were published in the journal Science, and the authors concluded ominously, 'It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals.'
I am sure that another Rosenhan experiment, if conducted today, would yield equally worrying results.
But this book is not another Rosenhan experiment. Though it does cast an unabashedly critical eye on the system, the practice of psychiatry, and the prevailing view of mental illness, it does so solely through the lens of my experience.
If you are looking for evidence, you will not find it here, except in the notoriously unreliable form of eyewitness testimony. My own.
The formal case against the leviathan has been made already, and is still being made in the courts and the newspapers. A number of people, several of them professionals in the field, have written extremely well-documented exposes of psychiatry, psychiatric medications, the pharmaceutical companies, and the DSM. These books are far too seldom read, in my opinion.
I admire and support what these writers, dissenting doctors, and journalists have accomplished. Initially, I sought to follow their lead. I saw probing the phenomenon of mental illness today as an effective and provocative way to take the measure of my culture. But as I plunged myself deeper in the project, I, and it, took a sharp turn inward, becoming somewhat less about what I saw around me and more about my private struggle to find a way out of chronic mental distress, a distress that the system not only seemed unable to heal but, more often than not, had only made worse.
As you read, you will see that what begins as the mostly detached report of the proverbial journalist at large, first in a big-city public hospital, then in a private rural hospital, and finally, in an alternative treatment program, soon dovetails and then merges indistinguishably with the very personal account of a bona fide patient's search for rescue and, if possible, a touch of lasting self-awareness along the way. The journalist and the patient are both me: one doing a job, or trying to; the other slouching, in her own time, toward bedlam; and each, by turns, pushing the other up and along or dragging her down.
What follows is the record of that dual journey, shot through with observational inexactitude. This is what I saw and what I thought. It is what happened to me, inside and out. That's all. It is not, nor was it intended to be, an argument, a polemic, or an investigative report, though it is, at times argumentative, conjectural, and raw. It draws no hard-and-fast conclusions. It asks. It surmises. It prods. It also wanders, meanders, spirals, and circles back. But in the end, it does no more and no less than take you with me. And that, after all, is really what you're here for, isn't it? To come along for the ride.
That much I know I can promise you. A bumpy, loopy, sideways, up-and- down ride.
A journalist I once knew had a saying about our profession: The most you can hope to do is inform and entertain.
As an invitation to these pages, that sounds about right.