Book Review: 'Voluntary Madness' by Norah Vincent

VOLUNTARY MADNESS

My Year Lost and Found in the Loony Bin

By Norah Vincent

Viking. 287 pp. $25.95

Norah Vincent, a self-styled "immersion journalist" who achieved success with "Self-Made Man," an account of the 18 months she spent in disguise as a man, has now followed that accomplishment with "Voluntary Madness: My Year Lost and Found in the Loony Bin." The subtitle here is important, I think. During a four-day stay in a lockdown facility because of the mental stress she suffered researching her first book, Vincent was over-medicated and exposed to the appalling conditions that the mentally ill sometimes endure during treatment. She resolved to make this the subject of her next book -- not just to report on those conditions but to immerse herself in them, i.e., to commit herself, as a so-called crazy person, to three institutions to see how they actually work. She spent 10 days in a grimy, urban public hospital, another 10 days in a small private mental institution somewhere in the Midwest and two weeks at a seaside alternative-treatment center. Call me crazy, but even including the first four days that gave her the idea, I don't see how that adds up to a year.

There's also the issue -- for me at least -- of whether Vincent was/is mentally ill, or was pretending to be, or perhaps a combination of both. (As in: when a woman is encouraged to play dumb, and she does, until one day you realize, "Jeez, that woman isn't playing; she's dumb as a plank!") Ten or 15 years ago, the author felt enough mental distress that she went to a therapist. She was given Prozac and then other prescription drugs that today she very much regrets taking. It seems she was suffering from depression. But was it depression in the actual, clinical sense? After all, during the breakdown following "Self-Made Man," when she entered the "loony bin," as she persists in calling these places, she was able to "play sane" enough to talk herself out of the facility in just four days.

For the purposes of this book, Vincent only pretended to take the heavy medication that the Big City Warehouse pressed upon her, and then, for the second part of the experiment, in the rural treatment center, she deliberately went off a low dose of 20 milligrams of Prozac she'd been taking all along. Not surprisingly, she started acting nutty. (The craziest thing you can do is go off your medication, because guess what? You can become mentally ill again.) But even during the ensuing depression that sometimes left her lying in a fetal position in her empty bathtub, the author was able to perk up enough to have interesting conversations with the psychiatrist in charge, go for afternoon runs in town, stop in a bar for an occasional beer -- in other words, get on with her life.

And in the alternative-treatment center, of course, she has a wonderful time doing deep breathing, getting rebirthed, composing sand mandalas. She makes some genuine personal breakthroughs and emerges a happier person.

This book is very nicely written. It addresses timely topics that need to be addressed: the general perfidy of the pharmaceutical corporations; the laziness of doctors who prescribe rather than listen; the overly cozy relationship between doctors, drug companies and the American government. But I have some serious concerns about "Voluntary Madness." Vincent -- and at least she is honest about this -- has an enormous bias against drugs as a treatment for mental illness, and, more disturbing, she appears not to believe in mental illness at all. She thinks we can cure it by ourselves or, better yet, avoid it altogether. "I'm not saying," she writes, "that eating right and exercising, nurturing your heart and challenging your brain, will save you. It won't. There is no saving, of course. You never 'arrive.' You move. You get on with it. That's the prescription. In the end, and after a long, long trip, there's only one thing I can tell you about happiness, about well-being, as I understand it. You want to be happy? You want to be well? Then put your boots on."

These are the rousing last words of this account, and I think that advice would work perfectly well for a neurotic, self-absorbed individual who sees self-inflicted unhappiness and even an occasional suicide "attempt" as a way of getting attention and establishing a reliable identity. I have two pretty close friends who have lived that way all their lives up into their 70s. But what about severe schizophrenia and the torment of voices you can never stop? What about severe clinical depression, the real kind, which is to Vincent's ailments as cancer is to the common cold? What if a severely mentally ill person gets hold of this book and decides to go off his or her medication and commits suicide? As a person whose grandmother and aunt killed themselves before there were drugs for this sort of thing, I can't help but be concerned. I think anyone who's suffered with a loved one afflicted by these tortures will share my concerns as well.

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