Mental Illness then and now: Part I

Mental illness is rife with the drama and conflict and complications that often make a good story.  They are sad and can be scary and unpredictable, which makes them fertile ground for unreliable narrators, twist and turns, or just bringing the reader into a setting she has never been into before: a hospital for the mentally ill.

I ended up reading five books on what it is like to be mentally ill for different reasons in the Reading Challenges, although reading a book on the mentally ill was one of the categories.  Don Quixote was one but I said my peace about that one. In this two post series I am splitting them up between the treatment of mental illness a few decades ago, and then mental illness now, to talk about how it was considered differently over time.

For today’s post, I am starting with the books set in mid century America.  What struck me about both of these is that they are about genuine illness, however, what sets them apart from the modern day books I want to talk about is that they are much more focused on conformity than present books.  And the mysterious old school treatments. Society plays a role in how illness is manifested and treated: I learned in grad school that catatonia, where a person with schizophrenia freezes into a position and stays like that (with a ‘waxy flexibility’), is much less common now than it was a few decades ago.  With the severely and persistently ill population I have worked with over two different hospitals, I can only remember one patient with any kind of catatonia in the record.  Treatments that I have done with this population and my experiences training and working in hospitals are very different today than the two protagonists who let me into their worlds in these two books.

And just briefly, in case you don’t know, there are only two ways you end up in a hospital for mental illness in the present day: 1. Clear danger to self or others 2. Too symptomatic to function. You can’t just be sent up the river interminably anymore because you flirt too much with the mailman and your husband is tired of you or your new stepmother wants to have her own family with your father.  Especially as a kid, commitments are short and focused on how to make things go better when they are back out in the world, not locking away a nuisance.

one flew over the cuckoos nest

One Flew Over the Cuckoo’s Nest, Ken Kesey

I don’t know how I did not read this in my teens either. I was more intimidated by it then, I thought it was longer, and I didn’t have the quick reference of the internet to tell me it was a manageable 300 pages. It was on my summer reading challenge list for high school which was full of giant tomes, and it went by book rather than amount of pages read, so I had to economize my eight weeks.  I actually think it is a good read for older teens, as depressing as it is, because it is about conformity and change and living fully in your world.

Randle P McMurphy is the perfect character to try to buck the system.  Through the entire story there is question over if he even belongs there in the first place, maybe some addiction/impulse control issues, but nothing serious.  In the book they wonder if he is trying to get out of a harder sentence (and did not explain to him that a hospital is a sentence without a clear termination, unlike jail or forensic commitments.  Don’t think you can do that today). But he is intact enough and not cowed and a misfit so much as to believe that he really can’t conform enough to cut it on the outside so he needs to follow the rules of the ward and the Big Nurse’s conception of what is ‘therapeutic’ or merely how she wants it.  These patients are bullied by the nurse and the orderlies into believing they deserve to be there interminably because they just can’t ever fit in and have to be taken care of.  And are lucky to have a life of absolute routine and boredom with little choice. IYes, they have their illnesses and hangups, but nothing that justifies months of commitment to a hospital. If there is anything I have learned, it is that most people can carve a spot for themselves in the world or at least be given the chance to try.  Thankfully today there are halfway houses instead of just hospital sentences, and services designed to help a person fit in where their edges just might not conform.

McMurphy wakes these guys up to remember the world out there, and even though it can be scary and confusing sometimes, it is worth being in it, just to live. Yes, both he and Nurse Ratched take it to a horrific level, and McMurphy does scam the patients some, but like the narrator observes at the end, some of the bravado with the repeated shock treatments is to fight a battle for these guys. And even after it all goes down many of these guys decide that maybe the hospital is not for them and go elsewhere.  Maybe out of trauma from what happens but one of them decides to have his wife pick him up and give it a go.  Also, another difference from today:  if you are in a separate hospital (not on a medical floor) you can wear your regular clothes.

It is clear why this novel is considered a 20th century classic.  Poignant and real, dripping with context, powerful conclusions.  I was going to read Brideshead Revisited for this one, but maybe not.

the bell jar

The Bell Jar, Sylvia Plath

I did get to this one in high school, at the recommendation of my father because I was so interested in mental illness. But I also re-read it on a train trip into the city a few weeks ago and I was pulled in this time in a way I do not remember being at 15 when I initially picked it up.  The main character Esther was harder for my fifteen year old self to relate to. The first half she is on a trip that she won in NYC to write for fashion magazines and although interesting the book is very much the world of a girl in 1950’s America. As an adult I find that world fascinating and so different from my early twenties college girl in the early 2000s experiences. Conformity is also huge in this one, and although fascinating the differences, I far from wish I was a young woman at that time. The emphasis on marriage and the way that others in her life devalued her studying and overachievement because it could stand in the way of her marriage prospects was nothing like the enjoy-your-youth and find-who-you-are-before-you-get-too-involved-in-any-serious-relationship college world that I experienced.

The book was valuable in that she loses all her drive and her focus and her making sense. The illness hits her so hard that she cannot be objective or motivated toward anything other than wanting to die, and she changes and friends think that she is weird and don’t understand her anymore and she stops doing what she loves. Her edgy, have to be the best at everything before she is ill is harder to relate to.  She does end up being okay, for a time, and even gets married despite not being a virgin, but we also know that she lost the battle in the end.

Sylvia also brings to life what it is like to fall ill in a world that is much less treatment savvy than today.  A world much more focused on everyone fitting into a smaller mold, especially for women, a mold that cannot always accommodate a smart woman who wants more than just a house and kids.  Being one of those women I feel so lucky to be in the time that I am in.

Yes, these books are the two classic mental illness books of the last century.  The ones for the next post are less iconic but deserve a look too.

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