We Need a New Way of Thinking About Mental Illness
Four new books suggest a model that leans away from pathology, and towards a more holistic understanding of mental health
I n recent years, suicide rates across America have considerably risen and continue to rise in almost every state. For this reason, there is a need for a guide on reporting suicides. The CDC, in this guide, warns that there are many reasons a person might kill themselves, “Researchers found that more than half of people who died by suicide did not have a known diagnosed mental health condition at the time of death. Relationship problems or loss, substance misuse; physical health problems; and job, money, legal or housing stress often contributed to risk for suicide.” The implication here is that a “known mental health condition” is materially different from a known traumatic life event, addiction, or physical health problem.
It’s a popular Western notion that mental illness is a disease of the brain — one that arises from chemical imbalances, not from life events, and that will go away if treated with medication. But as suicide rates continue to rise, perhaps we need to widen the scope of what mental illness is, how it is caused, and what we can do to help those who are suffering. I believe that losing a job, not having enough money to live, substance abuse, and something like physical health are mental health issues, and our mental health is inextricable from our physical health, our economy, and our culture. This is a belief based on my own experiences with mental health and diagnosis — but I’m not alone. Four new books on mental illness offer a similar perspective, portraying the complexity of mental health and how it is inextricably tied to every aspect of our lives and the cultural framework in which we live.
When I was thirteen, I attempted suicide, and was subsequently diagnosed with bipolar disorder, at the time called manic depression. Doctors told me I’d be taking Lithium for the rest of my life, and the illness would never go away. My parents thought I’d never graduate college, get married, or have children. When I was 28, the palms of my hands exploded with a thousand liquid-filled blisters, a form of eczema. A doctor told me to get used to it, because it would never go away either. I thought I’d never be able to write again.
In both cases, the doctors were right: eczema and mental illness are diseases of the body that never go away. But I learned that diseases inside the body are very often triggered by our environments. There wasn’t anything inherently wrong with me. More often than not, there was something very, very wrong with my surroundings, my culture, and the outside world. I learned to understand my body and mind, and the way I respond to the world around me. My skin issues and mental issues became manageable, and sometimes seem to disappear, though I know they never will. What I mean to say is, it’s all much more complicated than taking a pill.
Mental illness has always been a source of inspiration for books, television, and movies. Recently, because of a larger awareness of the dangers of stigmatization, popular shows and movies have made it a priority to portray mental illness in more complex, nuanced, closer to real life ways. Maniac on Netflix worked hard to get mental illness right. Sharp Objects portrayed the full range of mental illness and pathology of a mother and her daughters. But there’s a limit to how much nuance can be portrayed onscreen, and mental illness still gets flattened into a trope; Netflix’s 13 Reasons Why, for instance, though hugely popular, was criticized for glamorizing suicide and not offering hope. Books, though, are in the unique position to offer the space necessary to really dive into the causes and effects of mental illness, and recent releases have been using that space to portray how a mental illness develops in tandem within the dynamics of a family, a culture, or a country. In their own way, these books offer a more complete and complex view of mental illness than the one we might be used to.
In Katya Apekina’s The Deeper the Water the Uglier the Fish, Edith and Mae are raised in Louisiana by their mother, Marianne. Marianne never gets a formal diagnosis, but she is sometimes manic, sometimes depressed, sometimes disappears for days or weeks, eventually attempts suicide, and is hospitalized. Her daughters, one of whom she shares an almost psychic bond with, are sent to New York to live with their father, Dennis, an acclaimed and successful novelist, who is either an eccentric artist, a narcissist, a psychopath, a pedophile, or some combination of which. Dennis and Marianne met when she was a child and he was an adult. He married her when she was a teenager and he was in his 30s. In an old letter from Dennis to Marianne he writes, “I don’t know how to be with you without wanting to kill you and devour you and then bring you back to life, and then write about you and do it all again. Isn’t that love?”
The book is told in short bursts from multiple perspectives, not only Dennis and Marianne but their friends and acquaintances. It contains letters, therapist’s notes, New York Times book reviews, and transcripts of phone conversations, and moves back and forth in time as the mystery of this family and its psychology unfolds. It’s a structure that encourages the reader to wonder: when did Marianne’s mental decline begin? Did her mental illness begin with Dennis? Was she born this way? Was her deterioration willful and selfish, a product of her disease, or upbringing, or a combination of all three? Can the actions or inactions of someone close to us trigger a psychotic episode? The book made me think of mental illness as lying on an ever-shifting spectrum, not just lodged inside the body, but dependent on the culture and environment in which an individual was raised. Because of course we are inextricable from the world and the people who surround us, but this very idea of a lack of a definitive boundary between our bodies and the rest of the world is a sign of mental illness. As Marianne says, “it’s terrible to always have to keep track of the edges of things.”
In Anne-Marie Kinney’s Coldwater Canyon, Shep is a Gulf War Veteran, with Gulf War Syndrome and PTSD, on permanent disability. He follows a young woman who he believes to be his daughter from Nebraska to Los Angeles. He watches as she works in a café and goes on auditions. He hangs out at the local strip mall convenience store, where he is a trusted friend of the family that owns the store, and where he bears witness to the dramas of the neighboring Armenian mafia. Coldwater Canyon is a story of man who is, for a myriad of reasons, is unable to face his traumas and instead avoids them, hoping for the fantasy life he has lived alongside of for years, to come true.
Shep’s behavior can be seen as criminal, creepy, abusive, sad, or any combination thereof. The reader is never asked to pass judgment on Shep, or to provide excuses for him; he is portrayed in an open and honest light, and his delusion about his daughter is not presented as a mitigating factor. But it’s still a delusion, one around which he has shaped his entire adult life. He even believes he had a hand in helping her single mother to raise her, by spying on the mother and daughter throughout her childhood. He believes the mother, a woman with whom he had a brief affair before the war, was bolstered by his presence, by his energy. It’s impossible to extract Shep’s behavior from this delusion, and it’s impossible to extract his delusion from his experiences: his father was never around, his mother died when he was young, and he was raised by a cold and unloving grandmother. He grew up knowing he was a burden. His neurosis was shaped by poverty, loneliness, grief, and then war, and then PTSD, and then the mysterious symptoms of Gulf War Syndrome. I found myself wondering: Is his stalking a crime, or mental illness? Can behavior be both, and can a criminal behavior be met with empathy and understanding?
As I read Coldwater Canyon, I thought about how our culture’s tendency to vilify men, without also vilifying it all; the culture, the country, the weight of the actions of generations, the lack of social structure that should be in place to protect us from all the things that break us, sometimes beyond repair: poverty, racism, sexism, power structures, dysfunctional families, violence, capitalism, that a few rich white men need to ceaselessly become richer at the expense of all of us, while we tear each other apart, unwilling to take the mental health of our citizens into account for their actions.
Esme Wang’s The Collected Schizophrenias and Rheea Mukherjee’s The Body Myth are about illnesses that are seemingly on opposite ends of the mental health spectrum. While both conditions are extremely complex and not readily understood, schizophrenia is viewed as an illness over which a person has little control, while the fictitious health conditions that the Munchausen’s patient comes up with are perceived as an attempt to willfully exert control over other people. But of course it’s not so simple. In both books, there is a woman at its center who finds it almost impossible to live inside of the world as it is.
The Body Myth takes place in India and there is much pondering of the American way of labeling illness in order to medicate and fuel the pharmaceutical industry. The narrator, Mira, becomes enamored with a woman afflicted by mysterious ailments — headaches, pain, seizures. She knows the woman is faking but finds her so alluring that she doesn’t care. We are pulled alongside the narrator because we want the answers to these questions: If she is faking her illness — Why? Does her husband know? Does her doctor? If so, do they care? If they are encouraging a false narrative she has for herself, what is wrong with them? Do they have an illness as well? Are those around her complicit in perpetuating her mental illness?
Mira turns to Western philosophy to help her understand this woman she yearns for. She studies Simone de Beauvoir, who says the body is not a thing; it is a situation; it is our grasp on the world. Mira paraphrases Foucault: “there was a time society regarded the insane as wise souls on a higher level of consciousness…that respond to the world asymmetrically.” Whereas in modern days, psychiatry “suppresses their tendencies and coos them back to the reality we’ve semi-agreed to all agree upon.”
Mira presents the possibility that mental illness may be an enhanced, unadulterated peek at the true world, one that takes us away from the shared world that we know as our reality. In this view, a mental illness is not inside of the body at all, and the biochemistry of the physical body is perhaps just a byproduct. In other words, we won’t know anything about mental illness if we only look at the physical body and not the divine. It’s fascinating to think about the faking of a mental illness as a mental illness in itself, and to view mental illness as a window to the divine. It’s a valuable addition to the myriad ways to think about mental illness.
Esme Wang, in The Collected Schizophrenias, also discusses this association of mental illness with the divine. The Collected Schizophrenias is a collection of essays that tell the non-linear and ever-shifting story of the author’s various diagnoses. Wang writes about the term that often accompanies a schizophrenic diagnosis — “loosening of associations.” These are associations that are socially agreed upon — our culture’s understanding of reality. Mira from The Body Myth would say a loosening of associations is likely closer to any kind of universal truth, but that’s not a place where we can live. As Wang writes, “No one ever came out of a conversation with the gods for the better.”
Part of the pleasure of reading these essays is in discovering how much I related to the narrator. I think about when my daughter was a baby, peacefully sleeping in her bed, and I lay awake, terrified and frozen, sure I was hearing people quietly moving through the house, moving towards my baby’s room to steal her. I heard a shoe stepping on a toy, I heard a sharp intake of breath. I heard the door open. I knew none of these things were actually happening but I had to get up and check on my daughter, and check every inch of the apartment, behind the shower curtain, inside every closet. Most nights I never made it back to sleep.
Wang’s essay “The Slender Man, the Nothing, and Me” is about the powerful imagination of young girls. In it, Wang posits that we might be part of a larger story without fully knowing how. When she was twelve, she and her friends believed they were in a book, a book that was being written about them. I had an eerily similar experience of shared stories with a friend when I was twelve. Are we mentally ill when we are twelve, or are we just twelve-year-olds? The essay explores a 2014 attempted murder perpetrated by two young girls (since diagnosed with two different types of schizophrenia) who believed they were killing to win the favor of the Slender Man, a creation of online horror fans. Wang ends the essay by saying that she believes very much that your surroundings and who, or what you may come into contact with shape who you are, and shape the development, the severity, and the existence of your mental illness.
Wang craves a correct a diagnosis, because it makes it easier to live with herself. Especially interesting is Wang’s resistance to the recent politically correct way we are to refer to mental illness these days — by positioning mental illness as something that happens to you, not something you are. For example, we are not to say “he is depressed” and certainly not “he is a depressive.” Instead, we are to say “he suffers from depression.” Wang prefers to refer to herself as schizophrenic, because, “Isn’t it cruel to insist on a self without illness?” This was a refreshing and wondering reminder that mental illness is personal, and an individual gets to define themselves, and that the way we understand ourselves inside of our world can, will, and should never-endingly shift.
When I think about myself when I was thirteen, I don’t think I was bipolar. I don’t really know what I was, except that I was a sensitive child living in an unpredictable and volatile home, and my life at school was not all that different. I felt big feelings, and was extremely sensitive to hormonal changes. I was also a writer with a flair for the dramatic and a tendency to prefer fantasy to reality. Aside from the violence that surrounded me when I was young, I am still the same girl, but I’ve spent a long time learning how to understand myself, and one of the best and most fun ways of doing that is by reading thought-provoking, risk-taking, dangerous and heartbreaking books.
I think what I needed to hear from doctors when I was thirteen and suicidal, and when I was 28 and exploding in rashes, was this: Here is a possible diagnosis, but really, we don’t know. Let’s see what we can do to help alleviate your suffering. There are many options, let’s try until we find something that works. You might have this now, but you won’t suffer forever. We will figure out how to manage it, and nothing is static. Nothing in this Universe stays the same, and that includes you. The world around you will shift, and the people, and your perceptions. In order for all of this to exist, there has to be both creation and destruction, and with that, beauty and violence, good and bad, justice and inequality. Our world and ourselves exist on the full spectrum of emotion and possibility. We just need to learn to be able to handle the contradictions, and harness the positive to use to fight the negative. We just need to learn how to get by, and we will. There was nobody to tell me this when I was thirteen, but now, we have books that open up new, healthier ways of thinking about mental illness.