Some years ago I attended a lecture by the psychologist Kay Redfield Jamison at the National Museum of Health and Medicine. The topic was manic-depressive illness and the artistic temperament, which was also the subtitle of her acclaimed book “Touched With Fire.” I was there to hear about the lives of Lord Byron and Robert Schumann and Virginia Woolf and other troubled geniuses, but what I remember most vividly are Jamison’s introductory remarks. She was unsmiling — stern, really — as she admonished the audience never to romanticize the lives of the mentally ill, even those who channel their illness into great works of art. She wanted to be sure that we left the auditorium understanding that mental illness is not only unromantic, it is a crushing psychic burden that is at best endured, day by painful day.
This stark truth echoes through the pages of these two new books on severe mental illness. Neither of these volumes, one by a practicing psychiatrist and the other a patient’s memoir, elevates or sentimentalizes the disordered mind in any way. And each in its own way draws a troubling but illuminating picture of what it’s like to be locked into unrelenting emotional and mental chaos.
Christine Montross is a psychiatrist at Butler Hospital in Rhode Island, and in “Falling Into the Fire” she introduces us to many of the patients she has met and treated in the locked wards there. We meet 25-year-old Lauren, who has been hospitalized 23 times in the past four years, each time for ingesting something dangerous: light bulbs, batteries, barbecue skewers, scissors, pins — the inventory goes on. We meet 34-year-old Eddie, who has spent some $50,000 on multiple treatments to “repair” his skin — skin that nobody else finds unattractive. We encounter the gentle and blissful Colin, a disciple of Amma the Hugging Saint and her doctrine of love, who is so focused on his spiritual quest that he forgets to eat. And there’s Anna, terrified and ashamed of her persistent thoughts of stabbing or drowning her 15-month-old son.
These stories are fascinating in the macabre way that psychiatric case studies can be, but “Falling Into the Fire” is not a mere catalogue of human oddities. Montross does want to illustrate the “messy, unsatisfying, nonconforming human mind,” but this is also her story — and the story of all those whose mission it is to comprehend and treat these perplexing illnesses. The circumstances for probing and healing these troubled psyches are far from ideal these days, she notes. In this era of managed care and brief hospitalizations, psychiatry has been reduced to little more than crisis management, and we feel Montross’s frustrations as she stabilizes and releases patients who are still unwell — only to see them readmitted again and again.
Yet this is not a political book, nor is it a whine about the hegemony of insurance companies or the perils of psychiatric drugs. Montross prescribes antipsychotic drugs when called for, to stabilize patients in crisis, but she also draws on a range of therapeutic approaches, including psychoanalysis and attachment theory, focusing on her patients as human beings with human afflictions. Her patients’ neurons are certainly misfiring, but these individuals have just as certainly led beleaguered lives with fractured relationships. Montross describes the challenging task of sorting all that out and designing the most effective interventions case by case.