Mad Muse: The Mental Illness Memoir in a Writer's Life and Work [1 ed.] 9781789738100, 9781789738070, 9781789738094

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Mad Muse The Mental Illness Memoir in a Writer’s Life and Work

PRAISE FOR MAD MUSE: “Jeffrey Berman’s Mad Muse: The Mental Illness Memoir in a Writer’s Life and Work is a tour-de-force. Examining autobiographies of writers who examine their own states of ‘madness’ from William Styron and Andrew Solomon to Kate Millett and Linda Gray Sexton, Berman teases out how best-selling accounts of mental illness both reveal and mask a writer’s struggle with their sense of displacement and dis-ease. Brilliantly written, the book should be on the desk of any reader who believes that such autobiographies are ‘self-help’ manuals in dealing with their own discomforts and displacements. A truly original work of both literary criticism and psychoanalytic insight.” Sander L. Gilman, Distinguished Professor of the Liberal Arts and Sciences and Professor of Psychiatry, Emory University, USA Jeffrey Berman’s Mad Muse is a very insightful, and beautifully written, account of memoirs of madness. Focusing on seven writers of memoirs of mental illness, he draws out the many dimensions of such writing, including helping to heal oneself and helping others to understand the experience of madness. His discussion of my own story is extremely well done. He manages to capture my experience and convey my effort to give a window into the mind of someone suffering with schizophrenia. He also highlights the experiences that helped me evade my “grave prognosis.” Finally, he does a wonderful job, as with the other memoirists, of connecting my academic work, in my case on mental health law, with my own story. Berman’s book is both insightful and—importantly— bound to have a positive effect on stigma. A really powerful work that should be widely read by consumers themselves, family members, mental health clinicians, mental health lawyers and advocates, and the general public. Professor Elyn Saks, USC Gould School of Law and best-selling author of The Center Cannot Hold “How does a writer write about his or her own mental illness? What is the role of a mental illness memoir in a writer’s life story? What part does the mental illness memoir play in our institutional narratives of mental illness? Jeffrey Berman has long been known for his lucid expositions on the relationships between psychoanalysis, literature, mental illness, and the creative imagination. Here Berman takes readers on a deeper journey. His tour of mental illness memoirs addresses some of the most important voices in American literature. To the question ‘is this new territory?’ Absolutely. And has he done it again? Yes, but better.” Professor Dawn Skorczewski, Brandeis University, USA

Mad Muse The Mental Illness Memoir in a Writer’s Life and Work BY

JEFFREY BERMAN

United Kingdom – North America – Japan – India Malaysia – China

Emerald Publishing Limited Howard House, Wagon Lane, Bingley BD16 1WA, UK First edition 2019 Copyright © Jeffrey Berman, published under exclusive licence by Emerald Publishing. Part of Chapter 1 is reprinted from Surviving Literary Suicide. Copyright © 1999 by Jeffrey Berman. Published by the University of Massachusetts Press. Reprints and permissions service Contact: [email protected] No part of this book may be reproduced, stored in a retrieval system, transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without either the prior written permission of the publisher or a licence permitting restricted copying issued in the UK by The Copyright Licensing Agency and in the USA by The Copyright Clearance Center. No responsibility is accepted for the accuracy of information contained in the text, illustrations or advertisements. The opinions expressed in these chapters are not necessarily those of the Author or the publisher. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library ISBN: 978-1-78973-810-0 (Paperback) ISBN: 978-1-78973-807-0 (Online) ISBN: 978-1-78973-809-4 (Epub)

FOR JULIE, AGAIN, WITH LOVE

ALSO BY JEFFREY BERMAN Joseph Conrad: Writing as Rescue The Talking Cure: Literary Representations of Psychoanalysis Narcissism and the Novel Diaries to an English Professor: Pain and Growth in the Classroom Surviving Literary Suicide Risky Writing: Self-disclosure and Self-transformation in the Classroom Empathic Teaching: Education for Life Dying to Teach: A Memoir of Love, Loss, and Learning Cutting and the Pedagogy of Self-disclosure (with Patricia Hatch Wallace) Death in the Classroom: Writing about Love and Loss Companionship in Grief: Love and Loss in the Memoirs of C. S. Lewis, John Bayley, Donald Hall, Joan Didion, and Calvin Trillin Death Education in the Writing Classroom Dying in Character: Memoirs on the End of Life Confidentiality and Its Discontents: Dilemmas of Privacy in Psychotherapy (with Paul W. Mosher) Writing Widowhood: The Landscapes of Bereavement Writing the Talking Cure: Irvin D. Yalom and the Literature of Psychotherapy Off the Tracks: Cautionary Tales about the Derailing of Mental Health Care (with Paul W. Mosher) Vol. 1: Sexual and Nonsexual Boundary Violations; Vol. 2: Scientology, Psychoanalyst Meets Aliens, False Memories, The Scopes Trial of Psychoanalysis, Bizarre Surgery, Lobotomy, and the Siren Call of Psychopharmacology

CONTENTS Acknowledgmentsix

Introduction: Out of the Closet to Bear Witness 1. “The Landscape of Depression”: William Styron and Darkness Visible

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2. “My Proclaimed Sanity and My Conjectured Madness”: Kate Millett and The Loony-Bin Trip81 3. “A Strange and Driving Force, a Destroyer, a Fire in the Blood”: Kay Redfield Jamison and An Unquiet Mind119 4. “For Better or Worse You Inherit Me”: Linda Gray Sexton and Searching for Mercy Street and Half in Love 159 5.  “Truth Is Bendable”: Lauren Slater and Lying205 6. “I Cannot Separate Her Homophobia from My Own”: Andrew Solomon and The Noonday Demon253 7. “Someone Acts Through My Brain”: Elyn R. Saks and The Center Cannot Hold283 Conclusion: The Challenges of Reading Mad Memoirs

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Bibliography339 Index361

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ACKNOWLEDGMENTS In his 1969 book Totality and Infinity, the French philosopher and ethicist Emmanuel Levinas (1906–1995) argues for the importance of the faceto-face encounter with the suffering other as the basis of all witnessing. A personal encounter, he suggests, encourages empathy, openness, and engagement. I have taken Levinas’s words as literally as possible, sending chapters of the present book to the memoirists under discussion. I am deeply grateful to Kay Redfield Jamison, Linda Sexton, Andrew Solomon, and Elyn R. Saks for taking the time from their busy schedules to read and comment on my manuscript. They corrected factual errors, revealed additional information pertinent to my study, updated me on their lives and work, and allowed me to use their comments in this book. Their mental illness memoirs have proven inspirational to countless readers, including to scholars like myself, who recognize how illness is often a catalyst for creativity and a source of hope for others. I would not have been able to conduct the research for this book without the invaluable help of the Interlibrary Loan staff at the University at Albany. Special thanks to Timothy Jackson, Angela Persico, and Glen Benedict for fulfilling scores of interlibrary requests. I am grateful to the two anonymous readers for their many thoughtful suggestions for revision. One of the readers’ reports, nine single-spaced pages long, was the most detailed and helpful evaluation of a book-length manuscript I have received in a half century of scholarship. On one occasion, in the Styron chapter, I cite the reader’s own words, upon which I cannot improve. Thank you, both, whoever you are! I am alone responsible for whatever lingering weaknesses remain. Special thanks to Ben Doyle, Anna Scaife, and the entire staff of Emerald publishing, especially S. Rajachitra, Senior Project Manager, who was in charge of the production of the book. Parts of my discussion of William Styron appeared in “Darkness Visible and Invisible: The Landscape of Depression in Lie Down in Darkness,” in The Critical Response to William Styron, ed. Daniel W. Ross (Westport,

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Acknowledgments

CT: Greenport, 1995, pp. 61–80), and in “William Styron and the Landscape of Depression,” in my book Surviving Literary Suicide (Amherst: University of Massachusetts Press, 1999). Part of my discussion of Kay Redfield Jamison’s Robert Lowell: Setting the River on Fire appeared in a review published in American Imago, vol. 75 (2018), 105–113.

INTRODUCTION: OUT OF THE CLOSET TO BEAR WITNESS

If I lose my demons, the Bohemian-Austrian poet and novelist Rainer Maria Rilke (1875–1926) bemoaned, I will lose my angels as well.1 In Rilke’s view, demons and angels are metaphors of madness and creativity, respectively, and he feared that any effort to exorcise the former, the inspiration behind his work, would result in the destruction of the latter. Rilke’s statement, which explains his decision not to enter psychoanalysis, has been quoted by several writers, including Alice W. Flaherty in her 2005 book The Midnight Disease: The Drive to Write, Writer’s Block, and the Creative Brain.

“COMPULSIVE MEMOIRISM OF THE MENTALLY ILL” Many people have long been intrigued by the mysterious relationship between mood disorders and creativity. For the past half century, literary writers, therapists, and scientists have explored this question in memoirs devoted to their own psychological disorders. In effect, these authors have it both ways: writing about madness ingeniously fuses their demons and angels together into a single work. Flaherty, for example, an associate professor of neurology and psychiatry at Harvard Medical School and the head of the Neurology Brain Stimulator Unit at Massachusetts Hospital, is Rilke’s literal words, in the standard translation by Jane Bannard Greene and M. D. Herter Norton, betray a slight equivocation: 1

Perhaps certain of my recently expressed scruples are much exaggerated; as far as I know myself, it seems to me certain that if one were to drive out my devils, my angels too would get a little (let us say), a very little fright and – you do feel it – that is exactly what I may not risk at any cost. (vol. 2, p. 51)

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Mad Muse: The Mental Illness Memoir in a Writer’s Life and Work

the author of several scientific papers. She acknowledges in The Midnight Disease for the first time in public her own experiences with mental illness; her postpartum mood disorder, which had several manic as well as depressed features, occurred after she had given birth prematurely to twin boys who died. She was hospitalized at McLean, a fabled institution in Belmont, Massachusetts, which has a long literary tradition – the poets Robert Lowell, Sylvia Plath, and Anne Sexton had also been treated there, as have many contemporary writers, such as Susanna Kaysen. Flaherty did not look forward, as she wryly puts it, to becoming the patient of former colleagues. Who could blame her for being ambivalent about disclosing her psychiatric experiences? Why, then, did Flaherty go public about her mental illness? The reasons are varied, as she suggests in The Midnight Disease (2005). The memoirs of the mentally ill and of drug addicts are often, and sometimes rightly, ridiculed by reviewers for just this obsession with the author’s own suffering. But at least they let other sufferers know they aren’t alone. (p. 36) The motives that compelled her to become a modern-day ancient mariner, condemned to tell her tale again and again, were not entirely altruistic. “Perhaps the compulsive memoirism of the mentally ill can help to explain an age so memoir-mad that most young novelists present their thinly veiled autobiographies as fiction” – though she presents her experiences as neuroscience (p. 36). There were other reasons Flaherty decided to write about her illness. Trained to regard psychoanalytic therapy as unscientific, she changed her mind as a result of her illness. “During my postpartum break I watched in amusement and horror as my beliefs shifted” (p. 90). Discussions of fantasies and unconscious motives fascinated her. She also became aware from her own illness and treatment how double-edged powerful treatments can be. Sharing her own experiences with patients – and readers – heightened her authority. Moreover, writing about her own experiences gave her a strong personal interest stake in the subject. A paradoxicalist, Flaherty delights in presenting counterintuitive truths. Believing, irrationally, that she was somehow responsible for the deaths of her twins, she began to speak publicly about her guilt, to the horror of her listeners, as she confesses. “No one could absolve me of such a crime except God, and I was an atheist. So I wrote to keep from

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speaking” (p. 216). We write instead of speak, she adds, “when we are ashamed to look our audience in the eye” (p. 216). Flaherty recognizes that writing is a solution to the problem of suffering but knows that the inability to write is the cause of much suffering. Suffering may be good for the writer, but too much suffering prevents writing: “almost without exception, no one is severely ill and still creative” (p. 66). As a neurologist, Flaherty is interested in the changes in the brain that produce hypergraphia, the medical term for an “overwhelming desire to write,” and hypergraphia’s “more common and tormenting opposite,” writer’s block (p. 2). As a student of literature, Flaherty became a scientist because of the “seductiveness of literary theory”: she needed to create meaning to her stories. But not too much meaning. Sometimes the goal of psychotherapy is not to help people make sense of their lives, but to help them make less sense of them – to break a few links in the narrative chain so that behavior can be more unpredictable and creative. (p. 219) Flaherty raises a question in The Midnight Disease that many authors of illness narratives raise: if she had a choice, would she wish never to have been ill? She could not have predicted her answer before her illness. “I loved my sorrow. It was as if I had been preparing all my life for that event, and that I had entered into my birthright” (pp. 204–205). Other memoirists, as we shall see, answer the question differently. Flaherty writes not to forget what happened, and certainly not to seek closure, but to remember. “There are worse things in life than painful desire; one of them is to have no desire” (p. 205). Flaherty’s story of mental illness is unusual in the sense that it was triggered by a specific life event. Most memoirs of madness, however, cannot be traced to a single incident. Some memoirists suggest that mental illness mysteriously descends upon them and then inexplicably leaves, sometimes later returning, other times, not. Around one-third of all patients suffering from depression improve with no or minimal treatment. Many memoirs do not focus on causes at all but on the consequences of mental illness and on the psychiatric treatments that did or didn’t work. Only a small number of patients write about their experiences with mental illness, but there is a growing interest in this subgenre. Mental illness memoirs, however, are among the most difficult to write, mainly because of the stigma and shame that continue to surround mood

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disorders such as depression and manic depression, and thought disorders such as schizophrenia. Sometimes an author will pen a single mental illness memoir and then either write books on unrelated subjects or embrace silence, content to have written a single book. Clifford Beers (1876–1943) is an example of the latter. His memoir A Mind that Found Itself, first published in 1908, remains a classic, describing the abusive psychiatric treatment to which he was subjected when hospitalized for depression and paranoia. Beers never wrote another book; instead, he devoted the rest of his life to founding the American mental hygiene movement. But many of the most celebrated memoirs of mental illness are not an author’s first or second book. For some authors, a “mad memoir” occurs late in life and remains the crowning literary achievement of their careers. A NEW SUB-GENRE LARGELY IGNORED OR MISTRUSTED Many of the well-respected scholarly studies of autobiographical writing have little or nothing to say about mental illness memoirs. In her pioneering Reconstructing Illness: Studies in Pathography, first published in 1993, Anne Hunsaker Hawkins observes that book-length narratives of illness, what she calls “pathography,” a word Freud used in his 1910 study of Leonardo da Vinci (SE, vol. 11, p. 130), are almost exclusively a modern genre. She offers a large taxonomy of pathographies: AIDS/HIV, cancer, cardiovascular and heart disease, cerebrovascular disease, lupus, neurological disease, and “other illnesses.” Curiously, Hawkins says nothing about mental illness stories, an omission that becomes more glaring in the second edition published in 1998, where she neglects to mention Styron’s 1990 memoir Darkness Visible. Ann Jurecic’s Illness as Narrative, published in 2012, does not contain a single word about psychological illnesses, almost as if mood and thought disorders do not exist. Nor does Neil Vickers discuss mental illness memoirs in his chapter on “Illness Narratives” in the 2016 volume A History of English Autobiography, edited by Adam Smyth. Vickers makes only passing reference to Styron’s Darkness Visible. “It has to be said,” Vickers notes, in an understated sentence, “that literary scholars were slow to consider illness per se as an interesting human predicament supplying a compelling occasion for writing” (p. 392). Literary scholars have been even slower to consider mental illness.

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Sometimes theorists’ characterizations of mental illness memoirs are astonishing, such as the following statement in the second edition of Reading Autobiography: A Guide for Interpreting Life Narratives (2010): Although mind and body interact across a permeable border, it is important to distinguish narratives of mental breakdown or psychological vulnerability from those of physical impairment and illness because of different challenges in narrating the story as well as in the discourse around and treatment of such illnesses. The life narrator describing a breakdown from an asserted position of recovery is always suspect. How can memoirists authorize themselves as postbreakdown writers? (p. 145) The coauthors, Sidonie Smith and Julia Watson, do not make this claim about any other type of memoir, including older ones on HIV/AIDS, impairment, disability, trauma, or addiction, or emergent forms of memoir, such as narratives of rights, testimony, incarceration, or reconciliation. It’s not clear why Smith and Watson single out memoirs on psychological breakdown and recovery as the only stories that are always suspect, nor why they believe that only this type of memoir should be approached from the hermeneutics of suspicion. Apart from their use of the odd word “authorize,” which almost implies that those who suffer from mood or thought disorders lack the authority, permission, or strength to write about their lives, Smith and Watson assume, incorrectly, that those who suffer from mental breakdowns cannot accurately remember or convey their experiences. But as Kay Redfield Jamison and others have suggested, people who suffer from mood disorders are not depressed or manic all the time: there are periods of lucidity that make writing possible. Had Smith and Watson qualified their generalization, suggesting that memoirs of mental breakdown and recovery are sometimes suspect – as we shall see in Kate Millett’s The Loony-Bin Trip (1990) – the statement would have been more accurate. Elsewhere in Reading Autobiography (2010), Smith and Watson are more empathic, and one cannot quarrel with many of their other statements, as when they remark about Susanna Kaysen’s Girl, Interrupted (1993) that “securing the authority of some experiences is a tricky rhetorical process of speaking credibly and ethically about a dehumanizing and self-alienating past” (p. 35).

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Einat Avrahami declares in The Invading Body: Reading Illness Autobiographies (2007) that the reader’s encounter with illness memoirs “creates ethical and emotional engagement in a way that affords something beyond a sense of the indeterminacy of meaning” (p. 4). The engagement requires as much empathy as possible. As I suggest in Narcissism and the Novel (1990), although empathy has often been dismissed as a touchy–feely concept that is antithetical to rigorous critical thinking, empathy allows us to begin to understand the other, particularly, the suffering other. Eric J. Cassell remarks in The Nature of Suffering and the Goals of Medicine (1991) that empathy is crucial for the physician: the clinician cannot know the patient, the illness, or the circumstances without the true awareness of the patient’s experience. This is one of the meanings of the word ‘empathy’ – the infusion of the patient’s physical, transcendent, affective, and cognitive state into the doctor’s knowledge of the patient’s experience of illness. (p. 202) Empathy is no less essential for the literary critic. “As a genre,” Hawkins notes, “pathography is remarkable in that it seems to have emerged ex nihilo; book-length personal accounts of illness are uncommon before 1950 and rarely found before 1900” (p. 3). This is largely true of mental illness memoirs, though Gail Hornstein’s extensive Bibliography of First-Person Narratives of Madness in English (5th ed., 2011), now in its fifth edition and available online, documents more than 60 stories written before the twentieth century. Hawkins raises a compelling question: why do most personal accounts of illness appear in the second half of the twentieth century? She offers two possible explanations: perhaps because such illness is set apart from normal life by hospitalization or perhaps because we now tend to consider health as the norm and illness as a condition to be corrected, never simply accepted. (p. 11) Ann Jurecic offers another reason for the explosive growth of illness narratives in the second half of the twentieth century: the profound need people have to tell these stories in an era when religious and folk explanations no longer give a satisfying and complete meaning to their experiences, and when biomedicine largely excludes the personal story. (2012, p. 9)

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UNDERSTANDING MEMOIRS BACKWARD AND FORWARD “It is quite true what philosophy says: that life must be understood backwards. But then one forgets the other principle: that it must be lived forwards.” Kierkegaard’s observation (p. 161) enables us to see how authors write about mood or thought disorders in novels, literary criticism, psychiatric textbooks, or law monographs years before they publicly disclose their own illnesses in memoirs. Reading both backward and forward, we can see how the themes of these memoirs are central to their life and work. One might not have predicted at the beginning of their careers that they were struggling with depression, manic depression, or schizophrenia, but one can see retrospectively, after the publication of their memoirs, how illness catalyzed their work, and how they used their writing in the service of recovery and health. “Why another book on depression?” Hilary Clark raises this question in the Introduction to her 2008 edited volume Depression and Narrative: Telling the Dark. Her answer is my answer. I would say that there can never be enough visibility for this illness or condition whose stigma causes the sufferer to dissemble and “pass,” forgoing needed treatment, or to withdraw from others in shame – a condition misrepresented by myths and stereotypes that inevitably color, and cover, our understanding. (p. 1) To my knowledge, no one has studied how a mental illness memoir relates to a memoirist’s other published writings. Psychological illness may be incipient in a hidden or benign way early in an author’s career, and then, for reasons unknown and impossible to predict, may suddenly emerge, changing irrevocably the writer’s life. Illness is sometimes the driving force behind creativity. To understand the story of an author’s mental illness and recovery, then, we must examine all of his or her writings. Mental illness is often intergenerational, the story of mental illness, intertextual.

CREATIVE MALADY My thesis recalls the one propounded by the English physician Sir George Pickering in his 1974 book Creative Malady. Pickering argues that illness played a major role in the creativity of such otherwise diverse figures as

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Charles Darwin, Florence Nightingale, Mary Baker Eddy, Sigmund Freud, Marcel Proust, and Elizabeth Barrett Browning. Pickering defines three types of illness: organic illness, disease of one of the organs of the body; psychosis; and “psychoneuroses,” by which he means a “lesser degree of mental disorder” (p. 284). Creative Malady was published before the groundbreaking research on mood disorders and creativity by Nancy Andreasen, Kay Redfield Jamison, and others. Flaherty doesn’t cite Pickering in The Midnight Disease, but she would be sympathetic to his belief that an “illness that is not debilitating or disabling, or threatening to life, may provide the ideal circumstances for creative work” (p. 17). The memoirists in my study would, almost certainly, endorse Pickering’s thesis, though they might point out, ruefully, that the notion of creative malady depends upon a “mad muse” that is always temperamental, unpredictable, and sometimes treacherous. Developing Pickering’s thesis, I argue that creative malady in the form of a serious mood or thought disorder has played an essential role in the lives and writings of several acclaimed memoirists. Pickering’s idea of creative malady recalls Edmund Wilson’s thesis in his 1941 literary study The Wound and the Bow. Known as the “Dean of American Letters,” Wilson (1895–1972) discusses how Sophocles’s Philoctetes, rendered into an outcast as a result of an incurable wound caused by a snakebite, acquires godlike power in the form of an invincible bow. Wilson regards the play as a parable of human character, an example of creativity deriving from a wound or psychic injury. The victim of a malodorous disease which renders him abhorrent to society and periodically degrades him and makes him helpless is also the master of a superhuman art which everybody has to respect and which the normal man finds he needs. (Wilson, p. 240) Philoctetes suffers from a physical illness, including periodic seizures and a suppurating wound that is sickening to others, but Wilson points out that Sophocles has “special insight into morbid psychology” (p. 237), a “clinical” knowledge that explains Freud’s lifelong interest in the ancient Greek dramatist. In Andre Gide’s adaptation of the play, Wilson writes, Philoctetes becomes emblematic of a literary person, transmuting his suffering into art, mysteriously released from pain through the power of artistic expression: “I even sometimes forgot my sadness by uttering it” (p. 236). Sophocles’s play thus represents for Wilson the “idea that genius

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and disease, like strength and mutilation, may be inextricably bound up together” (p. 237). David Coleman offers a similar thesis in The Bipolar Express: Manic Depression and the Movies (2014). After listing 40 major film directors and actors who suffered from severe mood disorders, Coleman, a former screenwriter who acknowledges his own 30-year struggle with manic depression, argues that there is an “undeniable synchronicity between creativity and madness, and likewise, a sustained therapeutic benefit in creativity for the mentally ill” (p. 36). He likens this form of “occupational therapy” to a “hermit crab’s need to find an outer shell in which to make its comfortable home.” Developing the metaphor, Coleman observes that the actor “feels confident and protected inside the identity shell provided by the role, but he falls into introversion and emotional confusion when required to be himself out of it.” Coleman cites the Italian director Federico Fellini, who surmised in an interview that the artist for him was “someone who is called by demons and must reply to the summons” (p. 188). Coleman quotes an observation by the British psychoanalyst Anthony Storr (1920–2001) in his 1988 book Churchill’s Black Dog, Kafka’s Mice, and Other Phenomena of the Human Mind that mood disorders are frequently a catalyst for artistic creativity: “Creative work must be inspired by drives which have nothing to do with worldly success” (Coleman, p. 102; Storr, p. vii). I don’t wish to imply that mental illness memoirs are the “key to all mythologies,” the title of the pedantic scholar Edward Casaubon’s illfated and never completed book in George Eliot’s novel Middlemarch (1871–1872). The present book will not unlock the mystery of either mental illness or artistic creativity. Nor do I wish to reduce biography to illness or disease, emphasizing the dysfunctional or abnormal aspects of a person’s life. Nevertheless, I believe that memoirs of mental illness offer an insight into how authors regard their struggle with mood or thought disorders, how they use illness in the service of creativity, how they attempt to express the inexpressible, and how their stories cast light on the darkest of subjects. THE AMBIGUITIES OF MAD MUSES AND MAD MEMOIRS “Mad” can refer to either mental illness, anger, or both. Not all people who are mentally ill are angry, nor are all angry people mentally ill,

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but sometimes authors are both mentally ill and angry, especially when they suffer the curse of writer’s block. As a synonym for mental illness, “mad” often has pejorative connotations, as does the word “loony” (and “crazy”). Tellingly, two of the memoirists in my study use these negative words in their titles or subtitles: Kay Redfield Jamison’s An Unquiet Mind: A Memoir of Moods and Madness (2011) and Kate Millett’s The Loony-Bin Trip (1990). The memoirists use these derogatory words as deliberate strategies to call attention to and overcome the shame and stigma of mood disorders. “Manic depressive” also contains disparaging connotations, but as we shall see, Jamison prefers this term to what she perceives to be the less accurate word “bipolar.” The first word in “writing madness” can be either a noun or verb; in more than one memoir, writing madness implies either the despair that occurs when one cannot write or the black rage that occurs when a writer unleashes a torrent of words against a hated enemy. Alexandra Styron raises a chicken-or-egg question about her father, William Styron, that can be asked about other blocked writers: does the inability to write lead to depression, or does depression lead to an inability to write? Mental illness raises another chicken-or-egg question, one that is both psychological and philosophical: are “mind” and “self” identical or separate? Does a brain disease result in a diseased self? Yeats’s rhetorical question in “Among School Children” – “how can we know the dancer from the dance?” – alerts us to the difficulty of separating mind from self. Does powerful antipsychotic medication change both the brain and the self? Neuroscience research shows how both psychotherapy and medication change the brain; does that mean the self is also changed? Is there indeed a core self or a collection of selves that constitute identity? The muses have a long and evocative history. In Greek and Roman mythology, there were nine muses, or goddesses, the daughters of Zeus and Mnemosyne. The muses presided over the arts and sciences; metaphorically, a muse is a person or force that is a source of inspiration or creativity. To borrow from Longfellow, when the muses were good, they were very good, but when they were bad, they were horrid. Nabokov calls Mnemosyne, the personification of memory, a black muse in his 1951 memoir Speak, Memory. The force behind mental illness memoirs is indeed a dark muse, the conjoined demons and angels Rilke did not wish to disappear. The demons were necessary for Rilke, who famously said in a letter to Rodin in 1902, “to work is to live without dying” (vol. 1, 88), a statement

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that reveals his belief that work is both a form of self-therapy and the means by which one achieves immortality. The memoir has different ambiguities. Much ink has been spilt over the differences between autobiography, a chronological narration of one’s life, and memoir, an account of only one aspect or part of one’s life. The relationship between autobiography and memoir has always been complex and shifting. As G. Thomas Couser observes in Memoir (2011), in the past the autobiography has been considered superior to the memoir, but now the opposite is true. We have not lately experienced an autobiography boom, he adds, but we have experienced a memoir boom, which shows no signs of abating. Madelon Sprengnether points out that nonfiction writing (often of the memoir variety) has surpassed literary fiction in sales and popularity. Autobiographical modes of writing have also penetrated the halls of academia in the form of personalized literary criticism. (p. 160) Whatever term we use to describe personal accounts of illness or disability – autobiography, memoir, life-writing, pathography, or Couser’s neologism, autopathography, which he later abandoned because of its pejorative connotations – the genre has long been controversial, in part because of the notorious unreliability of memory, from which the word memoir derives. One of the most striking conventions of the subgenre of illness narratives is the demand for a happy ending. We all like to think we are better – or better off – than we once were, Couser writes in Memoir. We dislike telling stories that turn out badly for us. It may be ‘human’ to do so. (p. 45)

FAKE MEMOIRS Every memoirist confronts the problem of memory, but some memoirs contain experiences that prove to be deliberate fabrications. Such was the case with James Frey’s memoir A Million Little Pieces, purportedly about his drug-and-alcohol abuse experiences. A critical and popular success when it appeared in 2003, the memoir was chosen as an Oprah’s Book Club selection. Confronted with evidence that he had lied, Frey confessed during his second appearance on the Oprah Winfrey Show that the “same ‘Demons’ that had made him turn to alcohol and drugs had also driven

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him to fabricate crucial portions of his ‘memoir’” (Hamel). Unlike Rilke’s demons, Frey’s apparently could not be trusted. In a legal settlement, Frey’s publisher, Random House, offered a refund to readers who believed they were deceived by the memoir, which is now regarded as a semi-fictional novel. Sidonie Smith and Julia Watson spend more time discussing Frey’s “hoax memoir” than the real ones by Styron or Jamison, which perhaps explains their extreme suspicion of the sub-genre in Reading Autobiography. Ben Yagoda makes only passing reference to mental illness narratives in his 2009 critical study Memoir: A History, but he suggests that these memoirists, unlike those written by celebrities, politicians, and business leaders, “faced the camera straight on and told the truth – the more unsettling, shocking, or horrifying the truth, it sometimes seemed, the better” (p. 228). Yagoda reserves most of his criticism for memoirs that fabricate the truth, such as A Million Little Pieces and Augusten Burroughs’s 2002 memoir Running with Scissors, but he is ambivalent about the long-term trends that contribute to the memoir boom: “more narcissism overall, less concern for privacy, a strong interest in victimhood, and a therapeutic culture” – the latter of which he mistrusts. Yagoda never acknowledges his mistrust of empathy – surely he would concede that empathy is desirable at least some of the time, particularly when we encounter genuine human suffering. Despite this mistrust, Yagoda’s empathy for Clifford Beers is apparent, as when he discerns that the single most important factor in Beers’s recovery was his very determination to write an account of his ordeal, and thus seek to improve conditions in such institutions and the care and treatment of the mentally ill generally. (pp. 148–149) Not all writers share Yagoda’s skepticism over the memoir boom. “I could not agree with critics who lambasted the memoir genre for being too narcissistically self-indulgent,” the essayist Philip Lopate avers. It seems to me that if anything, what is wrong with many memoirs and autobiographical poems is that they are not confessional enough. They do not go far enough. I am endlessly interested in the wormy little thoughts and regrets and excuses that people have for their behavior. (p. 85) Few readers would accuse the memoirists in this book of not going far enough in their self-disclosures, though they do not reveal the full story of their illness and recovery. The story can never be fully known much less written.

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All of the memoirists made the fateful decision to “come out” about their mental illness, a risky decision in light of the continuing shame and stigma surrounding mental illness. It’s impossible to exaggerate the difficulty of their decision. Before their self-disclosures, they all felt deeply ambivalent about coming out of the closet to bear witness to their own mental illness. I want to mention briefly two writers who illustrate this ambivalence over self-disclosure: the first writer incurred the sharp disapproval of his friends and editors when he decided to write about his depression; the second writer felt like an impostor for not admitting his depression.

F. SCOTT FITZGERALD: “THE AUTHORITY OF FAILURE” F. Scott Fitzgerald is not known as a memoirist, but his three essays that appeared in three successive issues of Esquire in February, March, and April 1936 represent one of the earliest and most poignant first-person accounts of a writer’s loss of self-confidence and the corrosive effects of depression. Totaling only 15 pages, the three essays – “The Crack-Up,” “Pasting It Together,” and “Handle with Care” – were published posthumously with other autobiographical writings in 1945 under the title The Crack-Up. The writings were dismissed at the time as the product of a failed author, but now they are recognized as a minor literary masterpiece. Fitzgerald’s early readers were not ready for a subgenre that would become highly praised a half century later. The Crack-Up draws a parallel between the country’s Great Depression, beginning in October 1929, and Fitzgerald’s own depression, which he describes vividly as an “over-extension of the flank, a burning of the candle at both ends; a call upon physical resources that I did not command, like a man over-drawing at his bank” (p. 77). The banking metaphor, which evokes a major cause of the historical Depression, captures Fitzgerald’s belief that he was “only a mediocre caretaker of most of the things left in my hands, even of my own talent” (p. 71). He notes that a man can crack in many ways – and he develops the metaphor deftly throughout the essay – but he doesn’t give us the specifics of his own crack-up. He reveals nothing about his tempestuous marriage to Zelda; his heartache and guilt over her own breakdown and institutionalization; or his years of denial that he had a serious alcohol problem. Some of Fitzgerald’s personal statements are suspect, as when he claims that, like most Middle Westerners, he

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“never had any but the vaguest race prejudices” (p. 73). On the contrary: The Great Gatsby (1925) contains one of the most virulent anti-Semitic characters in American literature, Meyer Wolfshiem, whose cufflinks made from human molars symbolize the predatory Jew. Despite these evasions and blind spots, the “Crack-Up” essays abound in psychological insights, including the following: “The test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time, and still retain the ability to function” (p. 69). Patricia Hampl points out in an essay that appeared in The American Scholar in 2012 that the quote is a restatement of the concept of “Negative Capability” formulated by Fitzgerald’s lifelong literary hero, Keats: “That is when a man is capable of being in uncertainties, Mysteries, doubts without any irritable reaching after fact & reason” (p. 261). Fitzgerald alters the statement enough, however, to make it his own, thus revealing his own genius. Only two years before the publication of the “Crack-Up” essays, Fitzgerald had shown in his darkly autobiographical novel Tender Is the Night (1934) how his psychiatrist-hero, Dr Dick Diver, was unable to hold two opposed ideas in his mind at the same time and still retain the ability to function. Dick tries to heal a mentally ill patient, Nicole Warren, a disguised portrait of Zelda, through the love cure, but in the end he cannot love her or himself enough, and he fails as both her psychiatrist and husband. Dick turns out to be a wounded hero, reflecting Fitzgerald’s belief that he was himself a wounded novelist. In one of the few examples of Fitzgerald’s narrative distance from his doomed protagonist, Dick’s Swiss colleague, sensing that the American psychiatrist has lost the ability to maintain professional boundaries, urges him to take a “leave of abstinence,” an echo of Freud’s statement in his 1915 essay “Observations on TransferenceLove” that psychoanalysis must be carried out in a state of “abstinence” (SE, vol. 12, p. 165). Dick mechanically corrects his colleague’s broken English – “The word is absence” (p. 194), but the Freudian slip betokens the failure of the love cure as a treatment for severe mental illness. Noting that public confession is “contemptible to many people,” the biographer Matthew J. Bruccoli documents how the “Crack-Up” essays damaged Fitzgerald’s as a successful writer. “His friends were appalled by the articles, finding in them a mixture of self-pity, egotism, and exhibitionism” (p. 405). In Bruccoli’s words, Fitzgerald’s editor Maxwell Perkins found the essays “embarrassing” and wished he had never written them. Even the man Fitzgerald regarded as his intellectual conscience, Edmund

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Wilson, the editor of The Crack-Up, disliked the essays when he first read them, though he later changed his mind. Hemingway regarded the “Crack-Up” essays as “cowardly and shameful” and cruelly caricatured the de profundis confession in his memoir A Moveable Feast, published posthumously in 1964. Nearly everyone missed the irony that although Fitzgerald believed he embodied, as he self-deprecatingly declared, the “authority of failure,” the “Crack-Up” essays demonstrated a new kind of American autobiographical writing, as Hampl remarks. The publication of the “Crack-Up” essays looks now like a sharp pivot, marking a fundamental change in American consciousness and therefore in narrative voice, an evident moment when the center of authorial gravity shifted from the “omniscience” afforded fiction’s third person to the presumption (accurate or not) of greater authenticity provided by the first-person voice with all its limitations. According to Scott Donaldson, the author of several literary biographies, Fitzgerald wrote the “Crack-Up” essays when he was at his lowest point, deeply depressed and alcoholic. “Probably they had a therapeutic effect” (p. 126). Fitzgerald managed to stop drinking and emerge from depression, but he lived only for four more years, dying in 1940 at age 44.

SHERWIN NULAND: “I WAS AN IMPOSTOR” Not revealing one’s depression may lead to a different problem. Born Shepsel Ber Nudelman in the Bronx, New York City, Sherwin Nuland (1930–2014) was a distinguished American surgeon who taught at the Yale School of Medicine. His 1994 book How We Die: Reflections on Life’s Final Chapter won the National Book Award for Nonfiction and was a finalist for the Pulitzer Prize. Nuland authored a dozen books on a variety of subjects, including dying and death, the human body, the history of medicine, Leonardo da Vinci, and Maimonides. In none of these books did he reveal his extensive psychiatric history, which was known only to a few people. Nuland spoke for the first time about his illness and recovery in his 2001 TED talk, which was released in 2007. Titled “How Electroshock Changed Me,” the talk begins conventionally, with Nuland giving a brief history of the use of electricity in the treatment of depression. His tone is

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lighthearted, almost bantering, and it’s clear that he is enjoying himself as he describes the first patient receiving the novel treatment. Electroshock therapy fell in and out of favor, he reports, and only in the last 10 years has it experienced a renaissance. Seven minutes into the twenty-two-minute talk, Nuland pauses and abruptly asks his audience, “Why am I telling you this story?” His voice begins to quiver as he prepares himself for a statement he has never made in public. Since he was invited to give his talk, he admits, he has been planning this moment, debating with himself the wisdom of self-disclosure. Then it comes. “I am a man who, almost thirty years ago, had my life changed by two long courses of electroshock therapy.” He relates how for years he struggled with depression, partly as a result of a difficult childhood and adolescence – his immigrant orthodox Jewish parents could not read or write English, and the family was close to poverty. Nuland admitted during a National Public Radio (NPR) interview with Guy Raz following the TED talk that his father, who had syphilis, was given to rages and didn’t speak with anyone in the family. Nuland struggled with depression during the early years of his career, remaining in bed until 10 or 11 in the morning, scheduling surgery in the afternoon, but over time, the mood disorder worsened, partly as a result of a failed marriage and a dreadful divorce. Unable to practice surgery, he admitted himself to the acute psychiatric unit of his university hospital where he was released after several weeks, unimproved. He was 43 at the time, and it appeared to everyone that his life and career were over, as he discloses in his TED talk. “I shuffled when I walked. I was bowed over.” He didn’t bathe or shave, and he was overcome by feelings of worthlessness and inadequacy. Lost in obsessional thoughts, Nuland entered the Institute of Living in Hartford, Connecticut in the spring of 1973, where he continued to deteriorate despite psychotherapy and medication. The seven or eight senior staff psychiatrists viewed his case as hopeless. “There was nothing that could be done for this surgeon who had essentially separated himself from the world.” Considered a lost cause, he spent nearly a year in the hospital. Finally, the psychiatrists recommended the treatment of last resort, prefrontal lobotomy, a brain-mutilating treatment pioneered at the Connecticut hospital in the 1940s but largely abandoned after the introduction of antipsychotic drugs in the 1950s. The psychiatrists knew that if successful, Nuland would be left with no affect, unable to return to surgery. The spectrum of results produced by lobotomy, Nuland sarcastically states in

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the TED talk, ranged from “pretty bad to terrible, terrible, terrible.” He compares his life at the time to Edvard Munch’s unnerving “The Scream.” Nuland credits his recovery to a 27-year-old resident who, visiting him several times a week over a period of months, suspected he was severely depressed, not terminally psychotic. The resident urged the senior psychiatrists to try electroshock therapy; humoring him, they agreed. Nothing happened at first, but after the eighth or ninth treatment, he began to notice a difference, a diminishing of pain and the return of sanity. After a few more treatments he began to respond to talk therapy. By the time he had received 20 treatments, he was well enough to be discharged, resuming his surgical career and beginning his career as a writer. Nuland’s mordant humor is evident when he shares with his audience the mantra he recites when he finds himself becoming depressed again or engaging in obsessive thoughts: “Ah, fuck it!” Nuland’s story is relevant to the memoirists in the present book not mainly because he was helped by electroconvulsive therapy (ECT), which, despite its gruesome portrayal in One Flew Over the Cuckoo’s Nest, has proven effective for many severely depressed patients who don’t respond to other treatments. Rather, Nuland’s story is relevant because he always felt dishonest concealing his psychiatric past from his readers. One would think from his books that he emerged unscathed and strengthened from a troubled childhood, but the opposite was true. He had long felt guilty about not disclosing his history of mental illness. “I’ve always felt that somehow I was an impostor because my readers don’t know what I’ve told you.” Nuland keeps his eyes down in his TED talk when he reveals this, not looking at his audience; one wonders whether, like Flaherty, he wrote to keep from speaking. Nuland offers many reasons during the TED talk for his decision to reveal his psychiatric past, beginning with what he calls the frankly selfish motive to unburden himself, but there are other, better reasons, including the belief that by speaking personally, he will be able to help some of his listeners. If I, with the bleakness of spirit, with no spirit, that I had in the 1970s, and no possibility of recovery, as far as that group of very experienced psychiatrists thought, if I can find my way back from this, believe me, anybody can find their way back from any adversity that exists in their lives.

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Tearing up, the agnostic Nuland closes his talk with three short sentences. “There is recovery. There is redemption. And there is resurrection.” There’s nothing naïve or sentimental about Nuland’s vision of hope, though in How We Die he offers a more paradoxical vision of hope that can exist even when rescue from terminal illness is impossible. The “most abiding of hope of all,” he suggests, “resides in the meaning of what our lives have been” (p. 242). Nuland never wrote a memoir about his treatment, but his TED talk, which has been heard by hundreds of thousands of people, is regarded, according to Emily McManus, as “one of the most powerful moments in the conference’s history.” In revealing his past history of mental illness, Nuland was no longer interested in concealing an important aspect of his identity, no longer interested in what Erving Goffman calls, in his seminal 1963 book Stigma, “passing,” which he defines as the “management of undisclosed discrediting information about self” (p. 42). In Greek and Latin, Goffman reminds us, “stigma” referred to a mark or brand made on skin by burning with a hot iron; the word evolved into a “wound,” something concealed from others, such as Philoctetes’s wound. For Goffman, one disguises from public view a “spoiled identity.” Passing strategies include fabrication, concealment, and discretion. Most of Goffman’s examples of stigma were “abominations of the body or physical deformities,” “blemishes of individual character,” or “tribal stigma,” but one can readily see how mental illness is also stigmatized. Goffman notes that stigmatized people attempt to avoid embarrassing not only themselves but others, those who witness stigma. “Coming out” is a reverse form of passing. It takes courage for a stigmatized person to reveal a spoiled identity; it also takes trust that others will accept a spoiled identity that has hitherto been concealed.

THE WOUNDED STORYTELLER Anyone who writes a mental illness memoir is a wounded storyteller. The expression comes from Arthur W. Frank’s 1995 book of the same title, subtitled Body, Illness, and Ethics. Frank is interested mainly in physical illness, but nearly all of his insights apply to mental illness as well, including the motivation behind writing.

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The ill person who turns illness into a story transforms fate into experience; the disease that sets the body apart from others becomes, in the story, the common bond of suffering in their shared vulnerability. (p. xi) As wounded, Frank continues, people may be cared for; but as storytellers, “they care for others” (p. xii). Frank calls The Wounded Storyteller a “survival kit, put together out of my need to make sense of my own survival, as I watch others seeking to make sense of theirs” (p. xiii). He acknowledges that his theory of the wounded storyteller arises from his own history of illness, which he chronicles in his 1991 book At the Will of the Body: Reflections on Illness, where he discloses his experience first with a serious heart attack, arising from a viral infection, and then with testicular cancer. Among Frank’s acute insights in The Wounded Storyteller is that storytelling is for another just as much it is for oneself. In the reciprocity that is storytelling, the teller offers herself as a guide to the other’s self-formulation …. Thus all stories have an element of testimony. (pp. 17–18) Frank coins the expression “remission society” to describe those who, like himself, have been effectively cured but who still worry about the return of their disease – an expression also true of those who are psychologically stable but who worry about the return of their mood or thought disorder. Frank’s observation that “Disease interrupts a life, and illness then means living with perpetual interruption” (p. 56) is also true of mental illness memoirists. Using Ronald Dworkin’s expression, Frank describes every illness story as a “narrative wreck.” Storytelling is “repair work on the wreck” (p. 54). The first signs of this shipwreck, as we shall see, may appear in the writings that long predate a memoir of mental illness. Hints of madness may be immanent throughout the body of a memoirist’s work. Many mental illness memoirs reveal insights into trauma theory, the ways in which knowing and not knowing about traumatic events, as the literary theorist Cathy Caruth argues, are embedded in language. Frank doesn’t mention in The Wounded Storyteller Pickering’s idea of creative malady, but a sentence indicates how it can apply to a postmodern view of identity. “The

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postmodern memoirist writes to discover what other selves were operating, unseen, in a story that is a writer’s own, but that writer is several selves” (p. 70). Some of Frank’s comments take on additional significance of which he was not aware at the time, such as when he refers to Nuland’s description of the “baggage we shall all take to the grave” (p. 94). Frank describes in The Wounded Storyteller three types of illness stories: the restitution narrative, which has a basic storyline: “Yesterday I was healthy, today I’m sick, but tomorrow I’ll be healthy again” (p. 77); the chaos narrative, which “cannot literally be told but can only be lived” (p. 98); and the quest narrative, in which illness is the “occasion of a journey that becomes a quest” (p. 115). The memoir, Frank asserts, is the “gentlest” type of quest story: “Trials are not minimized, but they are told stoically without flourish” (p. 120). The quest story, Frank adds, accepts illness as a “calling, a vocation” (p. 166) – a statement that characterizes every memoirist in this book.

THE DIFFERENCE BETWEEN SURVIVAL STORIES AND TRIUMPH NARRATIVES The mental illness memoirs that I discuss are all survival narratives, but they are not the “triumph narratives” about which Kathlyn Conway complains in Beyond Words: Illness and the Limits of Expression (2007). Conway defines triumph narratives as nonfictional stories of illness and recovery that shrink from the complexity of their experience and focus on one slice of it – the final resolution – which they portray as a triumph that results from determination and a positive attitude. Conway prefers, as I do, stories that take us into the “darker and less familiar corners of the territory of illness” (p. 2). All of the memoirs in my study acknowledge the reality of physical and mental suffering and the ambiguities and compromises of living with serious mental illness. Without exception, the memoirists cannot return to their lives before they experienced psychological breakdowns; their lives have been irrevocably changed.

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WRITING/RIGHTING WRONG Penning a mental illness memoir is an example of “writing/righting wrong.” The literary critic Sandra M. Gilbert uses the expression in her 1995 memoir Wrongful Death, which documents her successful malpractice suit against the University of California at Davis Medical Center, where her husband Elliot died of complications following routine prostate surgery in 1991. She then wrote Death’s Door: Modern Dying and the Ways We Grieve. In writing Wrongful Death, I understood that I was writing (recording) as well as seeking to right (rectify) wrong, and now, as I retell the tale, I realize that ‘I am still at the same subject,’ still engaged in the same fearful and fierce activity – and seeking to right a mortal wrong. (pp. 86–87) Indeed, there is perhaps no better expression than writing/righting wrong to describe a mad memoirist’s activity. Mental illness implies that something has gone wrong with one’s mental health, and the memoirists turn to writing as a method to record and rectify wrong. Regardless of whether memoirists believe they are victims of psychiatric abuse, they all write to regain and affirm their health. I believe that all of the memoirists in this book would agree that their writing has been therapeutic, leading, in Gilbert’s words, to “moments of transformation when rage and grief yielded to visionary consolation” (Death’s Door, p. 91). They would agree with Gilbert’s need to confront her demons no matter the cost. That which I feared the most, as I bleakly put it to myself, was what I had to confront, and I had to confront it precisely because in order to stand the pain of my loss, I had to stand up to the pain and loss, strive to withstand them by looking at them. (p. 93) And they would understand Gilbert’s fear that by writing about the most painful experience of her life, she had turned herself into a “loser,” a “whiner,” a “complainer” (p. 94). Nevertheless, like her, they were prepared to tell their stories no matter the consequences. Writing became for the memoirists in this book, as it did for Gilbert, a countershame technique, a method to expose and detoxify shame.

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Writing/righting wrong has characterized my own work as well. The driving force behind much of my teaching and writing has been the effort to come to terms with the suicide of an admired college teacher, Leonard Port, on Labor Day, 1968, when he telephoned me from Brooklyn, New York, a five-hour drive from Ithaca, where I was a graduate student, with the news that he was in the process of killing himself. For years I could not speak about Len’s death without crying. I have never been suicidal, but I found myself in the position of other suicide survivors. The expression has a special meaning. Unlike rape survivors, incest survivors, and Holocaust survivors, a suicide survivor is a relative or friend of a person who has attempted or completed suicide. Suicide survivors not only bear witness to a loved one’s efforts to end his or her life but also endure the devastating aftermath of these catastrophic events, which often permanently darken one’s vision. Like most suicide survivors, I was overwhelmed by grief, confusion, and anger. Suicide survivors often feel intense survivor guilt. The closer one is to the person who commits suicide, the more guilt one feels. If I were more loving, more attentive, more available, the suicide survivor thinks, my relative or friend would still be alive. As I wrote in my 1994 book Diaries to an English Professor: Pain and Growth in the Classroom, Although I cannot bring Len back to life or journey into the heart of his darkness, I play the role of significant other to my students, especially to those whose lives have been touched by suicide or by other traumas and who are still burdened by their own private albatross. (p. 131) My first book, Joseph Conrad: Writing as Rescue, which grew out of my doctoral dissertation, was a study of the role of suicide in the novelist’s life and art. After the death of my first wife, Barbara, on April 5, 2004 – she died of pancreatic cancer at age 57 – I wrote a book about our life together: Dying to Teach: A Memoir of Love, Loss, and Learning. I have continued to write books about love and loss, spousal loss memoirs, end-of-life memoirs, and death education. I turn to writing, and teaching, to understand the tragedies of life. I don’t seek “closure,” a word I dislike; rather, I seek ways to live with the dead and to keep alive my memory of them. The memoirists in this study may have been inspired by a mad muse, but they crafted their stories through discipline and hard work. Good writing always involves rewriting: revising, recasting, reshaping. Many believe,

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as I do, that rewriting is the most important part of writing. As the adage suggests, genius involves more perspiration than inspiration. To illustrate this, Jamison cites a sentence from Seamus Heaney’s memorial address of Robert Lowell; the same sentence appears in John Banville’s glowing review of Jamison’s biography in the Irish Times: “The molten stuff of the psyche ran hot and unstanched, but its final form was as much beaten as poured, the cooling ingot was assiduously hammered” (Robert Lowell, p. 282). THE PLAN OF THIS BOOK Proceeding largely chronologically, Chapter 1 focuses on William Styron, the author of the iconic Darkness Visible, which appeared in 1990, when he was 65, years after the publication of the novels that established his reputation as one of the country’s greatest writers. No memoir has played a greater role in educating the public on the dangers of untreated depression. The landscape of depression in Darkness Visible appears in all of Styron’s novels, and his fictional projections are beset by the same symptoms of mental illness that he writes about in his memoir. Three of Styron’s major characters kill themselves, tortured by the same fears that afflicted their creator. It was as if by projecting his deepest fears onto his characters, Styron was trying to heal himself – a technique that worked for decades, until he reached his sixties, when the words were no longer able to flow. After his breakdown and recovery, Styron attempted to fictionalize his psychiatric experiences, failing each time; only when he decided to write a memoir in the first person was he able to tell his story. Darkness Visible remains the most influential mental illness memoir, an inspiration to countless readers, including those writers who found themselves in his situation. Long mistrustful of psychotherapists, whom he mercilessly caricatured in his fictional and nonfictional writings, Styron nevertheless played a key role in suicide prevention, helping readers of Darkness Visible when they wrote to him in distress. Anyone who values bibliotherapy, or what the literary critic Suzette Henke calls in her 1998 book Shattered Subjects: Trauma and Testimony in Women’s Life-Writing “scriptotherapy” – “writing out and writing through traumatic experience in the mode of therapeutic reenactment” (p. xii) – would want Darkness Visible to be on a list of required books to read about mood disorders. Few people realize, however, that depression returned to Styron years later, forcing him to consider

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suicide once again. Anticipating he would die by his own hand, he even wrote a letter to future readers of Darkness Visible, apologizing for what he considered to be a betrayal of trust. Alexandra Styron’s 2011 memoir Reading My Father casts much light on the novelist’s final years, helping us to understand the ghosts that haunted his life and the limits of medical treatment of severe depression. Chapter 2 explores Kate Millett, a leading feminist literary critic credited with provoking a sea change in our understanding of patriarchy, gender roles, and sexual politics. Millett’s memoir The Loony-Bin Trip appeared in 1990, when she was in her mid-50s. The memoir, her sixth book, reveals her outrage over being treated as a “mental patient.” Involuntarily hospitalized on at least three occasions, Millett maintained that she was “busted” for being different, not crazy. She was furious with her relatives and friends who, she felt, conspired with her psychiatrists to institutionalize her. Millett remains one of the most powerful critics of psychiatric abuses – and perhaps the major American literary figure in the antipsychiatry movement. Readers of her books may find themselves in a quandary, torn between, on the one hand, her stated intentions to present herself as a victim of a patriarchal society, and, on the other hand, considerable evidence of an unacknowledged mood disorder. Millett didn’t deny that she was severely depressed at times, but she asserted that she was never manic depressive, a disease that seemed more shameful to her. Why she insisted on a firm distinction between depression and manic depression remains unclear: scientific evidence suggests the two mood disorders are interrelated. Millett’s reading of her own life clashes with those of her relatives and friends who were fearful that she would commit suicide, as she attempted to do six times, twice “seriously,” by her own admission. How does one respond to an author who insists that her loved ones are involved in a conspiracy to force her into a psychiatric hospital? At what point does an author’s vision of an institution, in this case, psychiatry, strike the reader as paranoia? How does a reader determine whether a narrator is reliable or unreliable? There are no easy answers to these questions. Millett struggled throughout her life to resolve the conflict between her “proclaimed sanity” and her “conjectured madness.” Of all the authors in this study, Millett best embodies the “mad muse”: a depressed writer motivated by fierce anger toward patriarchy and the need to reject psychiatric diagnosis and treatment.

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Chapter 3 discusses Kay Redfield Jamison, one of the country’s most prominent researchers of moods and creativity. Her memoir An Unquiet Mind appeared in 1995, when she was 49, shortly after the publication of her first two groundbreaking books: Manic-Depressive Illness (1990), coauthored with Frederick J. Goodwin, and Touched with Fire: Manic-Depressive Illness and the Artistic Temperament (1993). Jamison and Millett inhabit parallel universes, or at least parallel belief systems. Jamison became floridly psychotic while she was an assistant professor of psychiatry at University of California, Los Angeles in the 1970s, fearful that if she told anyone about her illness, she would lose her academic position, her license to practice psychotherapy, and her credibility as a scientific researcher. There were few examples of therapist-turned-patient memoirs in the 1990s, and Jamison made a decision that transformed her life – and the lives of many of her readers who were inspired by her story. Unlike Darkness Visible and The Loony-Bin Trip, An Unquiet Mind portrays mood disorders as a brain disease, treatable, in most cases, with a combination of psychotherapy and psychopharmacology. An Unquiet Mind allows us to see how Jamison wrote about herself, in disguised form, in her coauthored psychiatric textbook. She crafts a language in her memoir that reproduces the soaring highs and abysmal lows of manic-depressive disorder. Jamison is candid in An Unquiet Mind about the side effects of powerful psychiatric medication and the compromises she is willing to make to remain healthy. Some of the details of her struggle with manic depression appear in her moving 2011 spousal loss memoir Nothing Was the Same, where she reveals how the illness affected her marriage. Jamison’s 2017 book Robert Lowell: Setting the River on Fire is a probing study of genius, mania, and character. No one has written about Lowell’s life with greater insight or empathy than Jamison; and while she never speaks in the book about her own struggle with manic depression, one senses that without an understanding of her own illness, she never would have understood Lowell’s. Chapter 4 highlights Linda Gray Sexton. The daughter of the Pulitzer-Prize winning poet Anne Sexton, Linda Sexton coedited her mother’s voluminous correspondence and then authored five other books, four of which were novels, which established her own literary reputation. Her first memoir, Searching for Mercy Street: My Journey Back to My Mother, Anne Sexton, was published in 1994, disclosing her ambivalence toward a mother who was physically and sexually abusive, sometimes dissociating

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into fugue or trancelike states. Linda Sexton had access to her mother’s extensive psychotherapy tapes, acquiring dark knowledge that she often wished she did not have. But she used these insights in her fictional and nonfictional writings, helping us to understand what it’s like growing up with a severely ill mother. Linda Sexton began writing about young women like herself, struggling to find positive role models, particularly a healthy mother–daughter relationship, in her first book, Between Two Worlds, published in 1979, when she was only 26. She continued to write about the mother–daughter relationship in her novels. Reading these novels in light of her first memoir, one sees how Linda Sexton used her fiction to work through the severe conflicts in the mother–daughter relationship. Yet despite these novels, Linda Sexton felt that it was only through a memoir that she could tell the story of her problematic relationship with her mother. She struggled for years to escape from Anne’s looming shadow, but it seemed for a time that the sins of the mother would be repeated in the daughter’s life, when she became a mother herself. One is reminded of Santayana’s observation that those who do not understand the past are condemned to repeat it. Linda Sexton’s second memoir Half in Love: Surviving the Legacy of Suicide, published in 2011, is a harrowing account of her own struggle with mental illness, a story that reveals the intergenerational nature of mental illness. With the help of psychotherapy, medication, and a strong support system, Linda Sexton found a way to honor her mother’s memory while creating her own life. Her two illness memoirs demonstrate the ongoing nature of psychological recovery. Chapter 5 examines Lauren Slater, where we see a different form of an embattled mother–daughter relationship. Throughout her writings, Slater implies that the source of her difficulties is her mother, who appears more deeply disturbed than her daughter. After being a psychiatric patient for many years, Slater became a psychotherapist and wrote Welcome to My Country, published in 1996. One of the most affecting moments in the memoir occurs when she returns to the psychiatric ward of the hospital where she was treated, on several different occasions, but now she is there to treat her own patient. Startled by the eerie familiarity of the place, she is not yet ready to share her psychiatric history with the hospital’s staff. Two years later followed Prozac Diary, about her love–hate relationship to the antidepressant; both illness memoirs enjoyed critical and popular success. Then Slater wrote Lying: A Metaphorical Memoir, published in 2000, when she was 37. Lying has generated, predictably, a firestorm of criticism,

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with reviewers assailing the use of an unreliable narrator and densely metaphorical language that make it difficult, if not impossible, to distinguish between narrative truth and historical truth. The distinction recalls Donald B. Spence’s 1984 book, Narrative Truth and Historical Truth: Meaning and Interpretation in Psychoanalysis. “Narrative Truth is confused with historical truth, and the very coherence of an account may lead us to believe that we are making contact with an actual happening” (p. 27). Why would a writer who acknowledges in her other books that she suffered from severe depression as well as borderline personality disorder suddenly claim in Lying that she was diagnosed with epilepsy for which she received psychosurgery? Why create a fictional case study in a memoir that purports to be true – despite its title? Why hide behind metaphor? What are the ethical responsibilities of a memoirist to tell the truth about her mental illness? These and other questions bedevil Slater’s readers. Complicating the difficulty of understanding Lying is Tracy Slater’s 2015 memoir The Good Shufu that calls into question her older sister’s portrait of their mother. A close reading of Lauren Slater’s earlier and later books offers clues as to why she chose to present Lying in a highly metaphorical way, in the process, crafting a new type of mental illness memoir. Chapter 6 considers Andrew Solomon. His renowned The Noonday Demon: An Atlas of Depression appeared in 2001, when he was 37. Solomon’s third book, it remains perhaps the best single personal, cultural, and scientific study of the baffling illness. The Noonday Demon narrates two stories, the history of depression, from the beginning of the story, 2,000 years ago, to the present, and the history of Solomon’s own depression. Few readers know that seven years before the publication of The Noonday Demon, Solomon began writing the story of his depression, which had not yet developed into a serious clinical illness, in his first and only novel, A Stone Boat (1994). Highly autobiographical, the story describes Solomon’s relationship with the most important person in his life, his beloved mother. The novel chronicles their intimacy and, in the most heartbreaking scene in the story, shows how his mother, terminally ill with cancer, takes her own life, with the hesitant assistance of her family. The rational suicide had unintended consequences, as Solomon documents in The Noonday Demon, planting a seed within himself where none had previously existed, almost resulting in his own suicide years later. A Stone Boat and The Noonday Demon are complementary texts, both showing how a mother’s homophobia led to her son’s severe

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depression and identity crisis. Solomon’s decision to write about his own depression and suicidality in The Noonday Demon demonstrates the need to bear witness; he incurred risks in publishing the book, which contains confessions not seen in other memoirs or autobiographies. There is nothing lurid or sensational in The Noonday Demon, but it is not for the faint-hearted. Solomon’s 2013 book Far from the Tree: Parents, Children, and the Search for Identity provides us with additional details of the story of his illness and recovery. Solomon has become one of the country’s most visible mental health advocates, and his writings probe with uncommon insight and steely courage the ambiguities of illness and disability. Chapter 7 turns to Elyn R. Saks, who holds an endowed professorship at the University of Southern California Gould School of Law. Her 2007 memoir The Center Cannot Hold, published when she was 51, is one of the few first-person accounts of schizophrenia, a disease that is not conducive to “creative malady.” Indeed, there are few first-person accounts of schizophrenia, and those in existence, such as Joanne Greenberg’s I Never Promised You a Rose Garden, are now thought to describe a less debilitating psychological disorder. Saks was not ready to discuss her mental illness in her first three books, which explore with great subtlety the intersections of law and psychiatry, but she came to believe that the best way to demonstrate that those who have schizophrenia can lead a productive life was through her own story. More than perhaps any other memoir about schizophrenia, The Center Cannot Hold initiates us into the frightening world of psychotic voices, hallucinations, and delusions. Saks shows us what life is like when there is no internal “regulator” that filters information, resulting in bewildering messages received simultaneously that produce chaos and torment. Unlike the other memoirs in this study, which provide few insights into the authors’ psychotherapy, The Center Cannot Hold allows us to see aspects of the writer’s psychoanalysis. Freud believed that psychotic patients could not establish effective transference relationships with their analysts, but Saks shows how this is possible – and also how, in the case of one of her therapists, a negative countertransference relationship undermined a long analysis. Saks does not name the four psychoanalysts she describes in The Center Cannot Hold, but she leaves clues that help us identify three of them, one of whom is still alive. With this knowledge, we gain additional information about the story of her illness and ongoing recovery – ongoing

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in the sense that she believes both psychoanalysis and antipsychotic medication will be necessary for the rest of her life, a price she is willing to pay for continued health and productivity. In the Conclusion I discuss the challenges of reading mad memoirs. The stories inspire hope and courage in readers, particularly those who may be beset by the same illnesses. Such reading may have unintended consequences, however, especially when a reader identifies more with the memoirist’s illness than recovery. Moreover, some readers, such as a memoirist’s relatives, for example, may not wish to learn about the writer’s illness, particularly when the story implicates them in the memoirist’s conflicts. It is often painful to read mental illness memoirs, even when they end hopefully. Nevertheless, mental illness memoirs are survival stories. The memoirs represented a lifeline for the authors, providing them with clarity and comfort when they were in desperate straits, and allowing them to convey, however imperfectly, an experience that almost drove them out of their mind. QUESTIONS The memoirists in this book raise many questions about the origins, treatment, and meaning of mental illness. Are depression, manic depression, and schizophrenia mainly psychological diseases, influenced by life events, such as early childhood loss, parental conflict, or child abuse? Are they also social diseases, influenced by poverty, neglect, and stigma? What is the role of genetics in depression, manic depression, and schizophrenia? Styron’s Darkness Visible emphasizes early maternal loss and a later biographical event, the toll of a lifetime of heavy drinking. Millett’s The Loony-Bin Trip, Jamison’s An Unquiet Mind, and Saks’s The Center Cannot Hold reveal relatively little about the memoirists’ childhoods. By contrast, Linda’s Sexton’s two memoirs, Searching for Mercy Street and Half in Love: (Surviving the Legacy of Suicide), and Slater’s Lying: A Metaphorical Memoir, emphasize traumatic mother–daughter relationships as the key issue in the development of severe depression, suicidality, and borderline personality disorder. The conflicted mother-son relationship gives rise to virulent homophobia that appears to be the major factor in Andrew Solomon’s depression as described in The Noonday Demon. Jamison and Saks view their mental illness largely as a brain disease, though they don’t rule out psychological factors. Time and the safety of a hospital setting are the

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healing factors in Darkness Visible; but involuntary hospitalization is the central trauma in The Loony-Bin Trip. In her introduction to the 2017 volume Experiments in Life-Writing, Julia Novak raises intriguing questions about the ways in which writers have engaged with and enlarged the range of modern and postmodern autobiography. She points out that the proliferation of experiments in the vast field of life-writing has created particular challenges for developing any reliable criteria for an absolute distinction between factual and fictional narrative – a distinction that is, however, felt to have profound implications for the readers and subjects of auto/ biographical texts. (p. 9) Similarly, there are no absolute distinctions between psychological health and illness, as Freud noted in his 1909 case study Analysis of a Phobia in a Five-Year-Old Boy, the story of Little Hans: That no sharp line can be drawn between “neurotic” and “normal” people – whether children or adults – that our conception of “disease” is a purely practical one and a question of summation, that predisposition and the eventualities of life must combine before the threshold of this summation is overstepped, and that consequently a number of individuals are constantly passing from the class of healthy people into that of neurotic patients, while a far smaller number also make the journey in the opposite direction, – all of these are things which have been said so often and have met with so much agreement that I am certainly not alone in maintaining their truth. (SE, vol. 10, pp. 145–146) Questions abound for literary theorists of mental illness narratives. To what extent does the phenomenon of the mad muse demonstrate the interdependence of autobiography and fiction, constituting a form of modern self-representation that Max Saunders calls “autobiografiction”? Are referential genres like the memoir more authentic in capturing the essence of illness than fictional genres? When is an apparent breach of narrative trust in a mental illness memoir justified? What are the benefits and risks of taking an intertextual approach to a writer’s representation of mental illness? How do reading strategies alter the interpretation of a mental illness

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memoir? Does a reading strategy based on the hermeneutics of suspicion, for example, lead to a different meaning than a strategy based on empathy or reparation? Following Julia Novak’s lead, I do not claim to resolve these questions, but I indicate what is at stake in exploring them. “You must change your life.” All of the memoirists in this book would endorse Rilke’s injunction, which appears at the end of his 1908 poem “Archaic Torso of Apollo.” They all worked, and wrote, to change their lives. They would also agree with William Faulkner’s gnomic observation in his 1951 novel Requiem for a Nun: “The past is never dead,” the attorney Gavin Stevens asserts. “It’s not even past” (p. 92). And they would agree with the nineteenth-century German poet Heinrich Heine whose words, describing the psychogenesis of the Creation, were cited first by Kurt Eissler in his biography of Goethe (vol. 2, p. 1182) and then by Jamison in her study of Lowell (185) to evoke the unique relationship between psychosis and artistic creativity: · Sickness, methinks, has been the final cause. · Of the whole urge to create. · By creating was I able to recover. · By creating I became well.

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1 “THE LANDSCAPE OF DEPRESSION”: WILLIAM STYRON AND DARKNESS VISIBLE

Darkness Visible (1990), William Styron’s riveting account of his descent into mental illness, chronicles the development of his depression from its origins in October 1985 to its near-fatal conclusion two months later, when the novelist narrowly rejected suicide, hospitalized himself, and initiated the healing process. The “unlikely bard of depression,” Styron explores the personal, psychological, and literary implications of depression, a mysterious disease that has “yielded its secrets to science far more reluctantly than many of the other major ills besetting us” (p. 11). Darkness Visible is Styron’s most accessible book, and it has elicited an outpouring of enthusiastic responses from his readers. To appreciate the book’s affirmative ending, one must recognize that Styron, an ironist in the tradition of James Joyce and William Faulkner, was always wary of “inspirational” literature throughout a writing career that spanned more than half a century. He was notoriously skeptical of professional healers, and his fictional psychiatrists and ministers provide little hope for those searching for psychological relief or spiritual redemption. Yet it is precisely Styron’s irony and skepticism, his refusal to accept anything on faith alone, that make the ending of Darkness Visible so convincing. Darkness Visible does not reveal, however, all of the salient details of Styron’s illness, nor does it foretell the events that occurred after the book’s publication. He was 65 when his memoir was published, and he lived for another 16 years,

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dying in 2006 at age 81. He became even more severely depressed in 2000, once again brooded over suicide, and wrote farewell letters to friends and his readers, fearing he would not be able to prevent himself from the act he most dreaded. The last six years of Styron’s life qualify the feeling of hopefulness on which Darkness Visible ends. Styron never wrote about his second depression, but we have information about it from three sources: his biography, correspondence, and daughter’s memoir. Among the most private of novelists, Styron believed that writers’ biographies should be published only after their deaths. He was pleased, nevertheless, with James L. W. West’s 1998 authorized biography, a sympathetic study that deftly integrates the novelist’s life and work. We learn additional details about Styron’s mental illness from the 2012 publication of his Selected Letters, a 672-page tome that includes letters from 1967 to 2002, edited by his wife, Rose, a poet and human rights activist who was married to the novelist for “fifty-four not uncomplicated years” (p. vii). Alexandra Styron’s engaging 2011 memoir Reading My Father is a startlingly personal book that divulges aspects of Styron’s alternatingly compassionate and frightening personality. Her memoir casts new light on both her father’s life, in general, and Darkness Visible, in particular. Indeed, the two memoirs are complementary texts and, occasionally, countertexts. After reading the daughter’s story, we can see what her father omitted from his own story. “BEYOND EXPRESSION” The difficulty of writing about depression, Styron notes at the beginning of Darkness Visible, is that it remains “nearly incomprehensible to those who have not experienced it in its extreme mode” (p. 7). He returns to this theme at the end of the book, observing that the “horror of depression is so overwhelming as to be quite beyond expression, hence the frustrated sense of inadequacy found in the work of even the greatest artists” (p. 83). Styron describes the indescribable feelings of madness to which he almost succumbed in late 1985: the gloom slowly closing in on him, the growing dread and alienation, the indefinable anxiety that seized hold of him. He singles out, among the most debilitating symptoms of depression, “confusion, failure of mental focus and lapse of memory” (p. 14). His mind was dominated at a later stage of the illness by “anarchic disconnections.” There was also a bifurcation of mood: “lucidity of sorts in the early hours

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of the day, gathering murk in the afternoon and evening” (pp. 14–15). He likens the pain to drowning and suffocation, metaphors also used by Sylvia Plath in her largely autobiographical 1963 novel The Bell Jar to describe her own suicidal depression. Styron identifies a “sense of self-hatred – or, put less categorically, a failure of self-esteem” as one of the worst manifestations of the illness (p. 5). The self-loathing became so virulent that he lost the ability to write. He concluded that he was not worthy of receiving the prestigious French award Prix Mondial Cino del Duca, given annually to an outstanding humanistic scientist or artist, which had been bestowed on him when the paralyzing illness struck. Styron recounts his bizarre behavior in Paris upon receiving the award, and only when he hears himself blurt out the words – “I’m sick … un problème psychiatrique” – does he overcome the “smug belief in the impregnability of my psychic health” (p. 15). Styron records the other symptoms of depression eroding his will to live: a growing hypochondria, including “twitches and pains, sometimes intermittent, often seemingly constant, that seemed to presage all sorts of dire infirmities” (pp. 43–44); exhaustion combined with sleeplessness, producing a “rare torture” (p. 48); the loss of libido and an indifference to food; and a growing obsession with suicide that compelled him to revise his will and pen a farewell note – a task the novelist was unable to execute. It turned out that putting together a suicide note, which I felt obsessed with a necessity to compose, was the most difficult task of writing that I had ever tackled. (p. 65) He finally abandoned the effort because he was unable to reconcile the intention to maintain the “sheer dirgelike solemnity” of the suicide letter with the melodramatic words he heard himself contrive. He also describes a phenomenon experienced by others suffering from severe depression, the sense of being accompanied by a second self – a wraithlike observer who, not sharing the dementia of his double, is able to watch with dispassionate curiosity as his companion struggles against the oncoming disaster, or decides to embrace it. (p. 64) Styron’s mood disorder was not manic depression, associated with euphoric highs, but what he calls “unipolar depression,” leading straight down into an abyss. The two physical factors that contributed most to the

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onset of the illness were fits of anxiety resulting from his body’s sudden intolerance to alcohol, a substance he had been abusing for 40 years, and a dangerous dependency upon Halcion, a tranquilizer prescribed to him for insomnia by a physician who was unaware that it could precipitate a major depression, especially in the heavy doses he recommended. A third factor was the loss of the ability to write, a lifeline that had usually served Styron well despite periodic bouts of writer’s block. He spent years attempting to write a novel about his experience during World War II, and though he was able to publish short sections of the story, The Way of the Warrior, he ultimately gave up on the project, unable to figure out a theme or direction. He was always anxious about his writing and thin-skinned about negative reviews of his books: “He once said,” reports his daughter, “he could remember every single word of some of his bad reviews, though almost nothing from the raves” (Reading My Father, p. 104). A harsh review could derail his work for days or weeks. Styron’s loss of self-confidence as a novelist was symptomatic of a larger loss of self-confidence as a person. Writing was “torture” for Styron during these blocks, and he identified strongly with Joseph Conrad who similarly suffered when he found himself shipwrecked amidst the creation of a story. “I can understand Conrad saying that there was hardly a day that he approached his writing desk without wanting to burst into tears,” Styron lamented in 1984 (Selected Letters, p. 572). The difficulty of writing is a frequent theme in Styron’s correspondence – and in Conrad’s as well. Styron is in the tradition of what I call, in my 1977 book on Joseph Conrad, writing as rescue. Though Conrad could never take for granted the return trip home, writing involved for him a two-way journey: “it plunged him downward into the abyss but supplied him with a rope long enough for rescue” (Berman, p. 28). The same was true for Styron until depression struck late in his life. Styron has few good words for the psychiatrists who treated him before and during his nearly seven-week stay in the psychiatric unit of Yale-New Haven Hospital, where Sherwin Nuland was later hospitalized. The physician Styron calls “Dr Gold” spoke with the dry platitudes of the Diagnostic and Statistical Manual of Mental Disorders, the psychiatric reference work that Styron himself read, during the early stages of the illness, in an unsuccessful effort to cure himself. Dr Gold prescribed antidepressants that did nothing to lessen Styron’s pain. When Styron’s illness progressed to the point that he feared committing suicide, the psychiatrist remained

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reluctant to hospitalize him because of the “stigma” involved – an attitude Styron understandably finds deplorable. He encountered in the hospital an “odiously smug young shrink, with a spade-shaped dark beard (der junge Freud?),” who used group therapy to belittle and bully his patients (Darkness Visible, p. 73). None of this speaks well for psychiatrists who, in Styron’s view, rarely empathize with a mentally ill person. Styron concedes that although psychopharmacology and psychotherapy help many patients, neither was able to arrest his descent into hell. The real healers for him were the hospital environment – with its enforced safety, solitude, and stability – and time. After his release from the hospital, the love and support he received from his family, particularly from his wife, were invaluable.

“THE LANDSCAPE OF DEPRESSION” An “autodidact in medicine” for much of his life, Styron was surprised to learn upon falling ill that he was “close to a total ignoramus about depression” despite the later realization that he was probably always an incipient depressive. Until the onslaught of my own illness and its denouement, I never gave much thought to my work in terms of its connection with the subconscious – an investigation belonging to literary detectives. (Darkness Visible, p. 78) Styron was astonished to discover after recovering from his illness that his novels had long foreshadowed his suicidal obsession: Suicide has been a persistent theme in my books – three of my major characters killed themselves. In rereading, for the first time in years, sequences from my novels – passages where my heroines have lurched down pathways toward doom – I was stunned to perceive how accurately I had created the landscape of depression in the minds of these young women, describing with what could only be instinct, out of a subconscious already roiled by disturbances of mood, the psychic imbalance that led them to destruction. (pp. 78–79) The landscape of depression dominates Styron’s earliest novel, Lie Down in Darkness (1951), and it constitutes the psychic setting of his later novels, including Set This House on Fire (1960), The Confessions of Nat Turner

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(1967), and his last completed novel, Sophie’s Choice (1979). Styron mentions that three of his major characters commit suicide; others, including Cass Kinsolving, the tormented hero of Set This House on Fire, remain obsessed with self-destruction. Like Hemingway, with whom he has much in common, and also like Conrad, Styron was preoccupied with suicide from the beginning to the end of his career. Gavin Cologne-Brookes reports in his 2014 critical memoir Rereading William Styron that while the novelist was still in the throes of a suicidal crisis, prior to writing Darkness Visible, a time when he was struggling to fictionalize his experience of depression, he gave considerable thought to Hemingway, as an unpublished holograph fragment, located in the Styron archives at Duke University, reveals. I loved a great deal of his work but I don’t think I would have liked him much as a person, for he was inescapably a braggart and a poseur, and no other illustrious writer has left behind him a spoor of accounts testifying to so much atrocious meanness. But that night I was not pondering his character or his talent; I was thinking again of his terrible ending, which made me reach out to him in tenderness and brotherhood. (Cologne-Brookes, p. 236, n. 1) Again like Hemingway and Conrad, Styron’s artistic interest in suicide arose from his own inner conflicts. As with Hemingway and Conrad, writing about suicide kept Styron’s demons at bay, but he turned reluctantly to professional help when he could no longer write.

LIE DOWN IN DARKNESS Reading Lie Down in Darkness in the light of Darkness Visible, one is struck by the extent to which Styron’s fictional characters anticipate the symptoms of clinical depression that he himself writes about nearly four decades later in his memoir of madness: gloom, dread, alienation, confusion, panic, memory loss, drug and alcohol addiction, and hypochondria. Characters are driven in despair to physicians and psychotherapists who offer maddening platitudes and glib diagnoses rather than insight and compassion. Before the novel’s heroine, Peyton Loftis, jumps to her death from the twelfth story of a Harlem building, she is oppressed by the same

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feelings of self-loathing, dependency, and abandonment that Styron writes about in Darkness Visible. Moreover, she dwells morbidly upon all the losses in her life; describes the torment of mental illness in ways that are most closely connected to drowning and suffocation; and, perhaps most striking of all, experiences in the final hours of her life the same wraithlike observer that her creator experienced 35 years later. Lie Down in Darkness chronicles an American family’s inexorable drift toward madness and self-destruction. Milton Loftis is a Virginia attorney in his 50s who is devastated by the suicide of his beloved daughter Peyton. His wife, Helen, is a nervous, straitlaced woman whose frail health collapses as a result of the earlier death of her older daughter Maudie, born with severe physical and mental disabilities. Maudie’s death deepens Helen’s bitterness toward life, producing a black depression from which she never recovers. Nor does Loftis psychically recover from Peyton’s death. While neither Loftis, Helen, nor Peyton bears an exact resemblance to the portrait of clinical depression Styron presents in Darkness Visible, they experience collectively nearly all the symptoms of their creator’s descent into mental illness. Lie Down in Darkness begins in August 1945, immediately after the atomic bombing of Japan, but for Milton Loftis a more catastrophic event has occurred. The novel opens with a train carrying Peyton’s coffin home to Port Warwick, Virginia, where her parents await its arrival. Juxtaposing past and present, Styron uses flashbacks, interior monologues, and, in Peyton’s final 50-page section, first-person stream of consciousness prose to illuminate the family tragedy. Loftis cannot defend himself against the “bewildering sorrow” of Peyton’s loss. Styron emphasizes the numbing, paralyzing, mystifying nature of sorrow: it is not a passive but an active adversary, a force that seizes control of body and spirit and overpowers the will to live. Helen Loftis’s struggle against depression begins long before the deaths of her two children – her adored Maudie, whom she has always favored and fiercely protected, and Peyton, with whom she has fought bitterly her entire life. Even when the family is intact, Helen is a “hurt” and “neurotic” woman. Her psychological conflicts take the form of physical complaints, and she becomes as dependent upon sleeping pills as her husband is on alcohol. In her bitterness toward those whom she views as betraying her, she becomes, in the words of one character, a “nest of little hatreds” (p. 105).

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Not that Helen lacks reasons to be disappointed with life. Her husband’s womanizing and alcoholism distress her, as does his capacity for selfindulgence and rationalization. Maudie’s disabilities fill Helen with sorrow and guilt, and Peyton’s intimacy with her father fuels Helen’s jealousy and anger. Helen Loftis unburdens herself to Carey Carr, an Episcopal minister who recognizes that she is consumed by hatred and guilt. He tells her, significantly, that she suffers from low self-esteem and that she must love herself before she can love other people. He welcomes the opportunity to counsel her, flattered by her willingness to be her minister and analyst. Like a therapist, he encourages Helen to share her feelings with him, repeats her statements back to her, and reassures her that everyone has shameful thoughts. As Helen’s visits increase, however, he becomes annoyed by her growing dependency on him. His tangled erotic feelings toward her prevent him from maintaining the healthy professional distance necessary for a minister or therapist. As a youth, he was overly sensitive and unsure of his masculinity, and he exhausted himself by writing hundreds of sonnets that he knew were miserably bad. His mother hurried him to a sanitarium following his nervous breakdown; later, he entered a seminary from which he emerges a “changed” man – changed more in appearance than in essence. His passion to save Helen from religious despair derives as much from his own incomplete relationship to God and wounded narcissism as from the need to offer a helping hand. Carr is the first of Styron’s many ineffectual ministers, physicians, and therapists, most of whom are naïve, insincere, glib, and pietistic, driven to cure others in an effort to cure themselves. Like her mother, Peyton proves to be beyond cure or redemption. She writes a two-page suicide letter to her father, on her 22nd birthday, in which she compares her illness to a physical disease, yet her language, both here and in the convoluted stream of consciousness interior monologue at the end of the novel, evokes a symptomatology startlingly similar to Styron’s description of clinical depression in Darkness Visible: sleeplessness, loss of mental clarity, panic, and most striking of all, a sense of drowning. I feel adrift, as if I were drowning out in dark space somewhere without anything to pull me back to earth again. You’d think that feeling would be nice – drowning like that – but it isn’t. It’s terrible! (Lie Down in Darkness, p. 35)

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She refers in the same letter to the “absolute panic” upon seeing her estranged husband and the feeling that “something terrible is happening to me” (p. 36). The letter reveals Peyton’s other preoccupations that become more evident later in the novel: an enigmatic reference to an alarm clock she has bought recently, a symbol, perhaps, of her desperate need for order, unity, and perfection; the belief she has been unkind to the people in her life, whom she now fears have abandoned her; and her growing obsession with death. Fear compels Peyton to visit the Newark psychiatrist Irving Strassman. She has earlier expressed interest in psychoanalysis, confiding to her husband that “[m]aybe I need to be analyzed” (p. 315), yet she is immediately hostile to Strassman. “I don’t think I like you,” she sputters, “I think I’m more intelligent than you.” Strassman is no less insulting: “Perhaps so, but certainly less stable” (p. 330). The therapy never progresses beyond this impasse: Peyton is a recalcitrant patient, Strassman, an antagonistic analyst. Like Dr Gold in Darkness Visible, Dr Strassman betrays Styron’s belief that psychiatrists are ineffectual and pompous. “Be calm. Be calm” he intones (Lie Down in Darkness, p. 329), labeling her “dangerously abstracted” (p. 330), a term she mockingly repeats to herself. When Peyton offers a promising clue to her illness – “all hope lies beyond memory, back in the slick dark womb” – Strassman responds dismissively. “That’s what I mean, your abstraction” (p. 355). Peyton concludes that he cannot help her and breaks off therapy. Styron’s correspondence reveals that his lifelong disdain of psychotherapy rarely wavered. The main difference between Europe and the United States, he wrote from Rome to his friend and future editor Robert Loomis in 1951, was that in the former there is an almost complete lack of chatter about psychoanalysis and the ills of the brain. It struck me like a brick just the other day: I haven’t seen hide nor hair of a head-feeler since I’ve been over here and when someone mentions Freud it’s as if he had spoken of some obscure entomologist, so little is one’s consciousness in the psyche. (Selected Letters, pp. 165–166) Styron placed psychotherapists in the same category as literary critics and academic scholars: “To my mind they are the scum of the earth”

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(p. 246). He was especially incensed with the psychiatrist Fredric Wertham, who, shortly after the assassination of Robert Kennedy in June 1968, had condemned The Confessions of Nat Turner for inciting racial violence. Styron generally did not answer his critics, but he could not remain silent about the psychiatrist’s charges. Inasmuch as no responsible literary critic (and this includes presumably the distinguished body that awarded the book the Pulitzer Prize) discovered any such incitement to violence in the novel, I find your charge reckless and without foundation. (pp. 437–438) The only positive reference to psychotherapy in his correspondence is an enigmatic sentence written from Italy in November 1953 to the novelist John Marquand in which Styron states he is unable to figure out a reason to return home, “unless it is to get psychoanalyzed” (pp. 193), an observation that tonally does not seem tongue-in-cheek. Suicide is nearly always overdetermined, arising from different causes. Peyton’s suicide seems motivated primarily by the wish for self-punishment. She comes to accept Helen’s accusations that she has tried to harm Maudie – Peyton’s sororal guilt is excruciating. Helen brings up this incident several times in the story, always with the intention to hurt her daughter. Peyton repeats her mother’s accusation to Strassman, who inexplicably refuses to pursue it. Peyton’s suicide is symbolic murder of the (m)other and accomplishes several goals: it confirms Helen’s judgment that her daughter is unfit to live, symbolically destroys the mother who has rejected her, and represents the ultimate self-punishment for harboring matricidal feelings. Had Dr Strassman been familiar with Freud’s “Mourning and Melancholia,” which Styron read after his 1985 depression, he would have recognized the relationship between Peyton’s depression and object loss. “The distinguishing mental features of melancholia,” Freud writes, are a profoundly painful dejection, cessation of interest in the outside world, loss of the capacity to love, inhibition of all activity, and a lowering of the self-regarding feelings to a degree that finds utterance in self-reproaches and self-revilings, and culminates in a delusional expectation of punishment. (SE, vol. 14, p. 244)

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These symptoms unerringly characterize Peyton’s illness – and Styron’s own. Her need for self-punishment is so intense that near the end of her monologue she imagines her head on an executioner’s block. Many of Peyton’s symptoms resemble post-traumatic stress disorder (a diagnosis not yet in existence at the time Styron wrote Lie Down in Darkness), which is defined as a psychologically distressing event, outside the range of ordinary experience, that produces recurrent and intrusive recollections of a traumatic incident, along with intense fear, terror, and helplessness. Peyton’s flashbacks, horrified recollections of the past, sexual numbness, feelings of estrangement from others, and a conviction of a foreshortened future are all symptomatic of this disorder.

A WRAITHLIKE OBSERVER Climbing the staircase of the Harlem building from which she leaps to her death, Peyton experiences an inner observer watching her every action. “I stood erect: Did I have a companion? I felt that someone was watching me, myself perhaps; at least I knew I was not alone” (Lie Down in Darkness, p. 367). This wraithlike observer seems to arise from psychic splitting. The psychoanalysts John Maltsberger and Dan Buie theorize in their essay “The Devices of Suicide” that many self-inflicted deaths arise from a “hostile introject” or killer self that orders a person to die. This destructive introject is internalized within one part of the self and succeeds in persecuting the other part of the self. The hostile observer is experienced in less pathological states not as a murderous self but as a chronically nagging conscience that makes relentlessly perfectionistic or omnipotent demands upon the self – a state of mind that Styron’s major characters know all too well. The description of Peyton’s wraithlike observer unerringly foreshadows Styron’s account of his own inner observer almost four decades later in Darkness Visible. Not that the author and his fictional character experience the identical depression: there is a manic quality to Peyton’s interior monologue in Lie Down in Darkness that is absent from the gray landscape of depression in Darkness Visible. Peyton’s monologue contains some of the most poetic descriptions of a suicidal consciousness found anywhere in literature. Her suicide arises from the desire to end her selfpunishing guilt and to discover a more positive father surrogate of whom

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she has long been in pursuit. She tells Harry that she has sinned “only in order to lie down in darkness and find, somewhere in the net of dreams, a new father, a new home” (Lie Down in Darkness, p. 362). Peyton is also in quest of a mother figure, a pre-Oedipal theme that has remained largely ignored by literary scholars. She has never had a loving, attentive mother; psychologically, she was abandoned by Helen at birth. Maternal loss figures prominently in Peyton’s depression along with Oedipal fixation on her father. Loftis is always kissing, fondling, or gazing at her as if she were his lover. Ironically, Peyton is her mother’s daughter: both women are incapable of loving others or themselves, are in precarious mental health, accuse their husbands of neglecting them, regard sex as a torture, and are oppressed by sinister moods they can neither understand nor control. “You’re a Helen with her obsessions directed in a different way” (p. 337), Harry tells her. Like her mother, Peyton has been searching for a protector. “You left me just like you always do,” she reproaches her husband. “When I needed you. Why didn’t you come and rescue me?” (p. 304). We know from the beginning of Lie Down in Darkness that Peyton has committed suicide, and thus we are thrust into the position of helpless observers. The novel’s suspense lies in discovering the reasons for her death and its impact on her family and friends. We see throughout the story the devastating personal and interpersonal consequences of suicide: Peyton’s father remains deranged with grief, her mother embittered and withdrawn, her husband sick with sorrow. Walking along the mass graves at Potter’s field, the bereft Harry confesses to a grave-digger, “I could have stopped her”; moments later, his stomach churning, he thinks: “I just don’t know whose fault it is” (p. 318). The history of the published criticism on Lie Down in Darkness reveals a tendency to heroicize Peyton’s suicide. Richard Pearce suggests in his 1971 monograph that “Peyton’s suicide ends with a note of resurrection” (p. 17), though he concedes that this is not in character for the unreligious young woman. Samuel Coale argues in his 1991 book William Styron Revisited that while all the figures in the novel are insulated from reality, “Peyton’s suicide seems a triumph, in that she ejects herself from his cocoon” (p. 43). David Hadaller’s 1996 book Gynicide offers the most affirmative reading of Peyton’s suicide. Citing an observation by the feminist critic Dale Marie Bauer that “self-violence is a subversive strategy against a culture which has internalized violence,” Hadaller claims that Peyton commits suicide

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“as a way of finalizing her desire to remain unenclosed by the language of the patriarchy” (p. 76). The problem with these readings is that they ignore not only the jumbled thought processes contributing to Peyton’s thinking, which has resulted in tunnel vision, but also her anguished cries for help. If we take Peyton’s character seriously, we must acknowledge her terrifying psychotic depression. To romanticize and rationalize an act that is the culmination of psychotic depression is as misguided as to judge and condemn it. As Lie Down in Darkness closes, we are left with the image of a dead and dying family. Maudie and Peyton are in the earth, and Loftis and Helen are beyond recovery. Loftis becomes so enraged by Helen’s refusal to take him back that he tries to choke her after Peyton’s funeral. Years later, Carey Carr cannot forget the sudden eruption of violence. The last few pages of the novel describe a black evangelical speaker named “Daddy Faith,” a smiling, avuncular man who holds out the promise of everlasting peace to the mesmerized masses gathered for baptism. “Who loves you, my people?” he asks, to which they respond, “You, Daddy! Daddy Faith! You loves us! You, Daddy!” (p. 378). As Marc Ratner has noted, Daddy Faith is a “showman, not a healer of souls” (p. 52), and it is difficult to find convincing affirmation in the final pages of the novel. Styron observed in a 1951 letter to his former Duke English professor and mentor William Blackburn that he wrote the last 15,000 words of Lie Down in Darkness in about two weeks, the most exhausting fortnight I’ve ever spent, or imagine I will ever spend. I lost fifteen pounds and I’m still in a state of semi-convalescence. I had to become Peyton and kill myself in the first person, and as it worked out I came pretty literally close to it. (Selected Letters, p. 90) Without using the word sublimation, Styron implies that killing off his fictional projection was a substitute for killing himself. One recalls Hemingway’s canny observation to A. E. Hotchner: I spend a hell of a lot of time killing animals and fish so I won’t kill myself. When a man is in rebellion against death, as I am in rebellion against death, he gets pleasure out of taking to himself one of the godlike attributes, that of giving it. (p. 152)

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Styron could not know that, decades later, he would come perilously close to succumbing to Peyton’s fate. His powerful identification with a fictional character in Lie Down in Darkness enabled him to tap into his deepest fears and obsessions.

A MIRROR OF STYRON’S CHILDHOOD LIFE Styron admitted in a 1982 interview in The New York Times Book Review that Lie Down in Darkness is a “mirror” of his early family life. Helen Loftis was modeled on his stepmother, “as close to the wicked stepmother image as one can possibly imagine,” while Milton Loftis was modeled on his father: The basic torment between Peyton and her family was really a projection of my own sense of alienation from my tiny family – that is, my father, whom I really loved and this strange woman who had just come on the scene and who – I think I’m speaking as objectively as I can – was really trying to make my life a hell. (“Interview with William Styron,” p. 26) Styron’s other father figures, while more sympathetically portrayed than Milton Loftis, are cut from the same cloth as Styron’s father. Yet it is important to recognize, as John Kenny Crane does, that in each of Styron’s major novels we see an admired father figure who, unlike Milton, “does not drink, does not do battle with a shrewish wife, does not flounder in self-pity and inertia” (p. 117). The shadowy figure in Styron’s life is his mother, and he implies in Darkness Visible that her death in 1939, at age 52, was one of the crucial determinants of his later depression. Pauline Styron developed breast cancer two years after her son’s birth in 1925 and had a double mastectomy. She did well for a time, but the cancer returned, spread throughout her body, and she remained bedridden for the rest of his life, in unbearable pain. She died one month after her son’s 14th birthday. Styron’s lightly fictional portrait of his mother appears in “A Tidewater Morning,” first published in Esquire in August 1987 and then republished along with two other semiautobiographical stories as a book of the same title in 1993. The story, which might be called more aptly “A Tidewater Mourning,” is told by a 13-year-old narrator, Paul Whitehurst, who manages to restrain his

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horror when he hears his mother’s prolonged scream of pain – “a scream, long and hopeless, containing a note of anguish like nothing I had ever heard before” (p. 89). His father, unable to endure his wife’s suffering, cries out in despair, insisting that her physician give her more morphine, which is no longer effective. “‘It’s past endurance, that pain!’ His voice rose, at the edge of breaking. ‘She’s going mad!’” (p. 91). Paul tries to escape from his mother’s agony, but despite the fact that it has been nearly half a century since her death, he cannot forget her ordeal. Nor can he express grief. Styron told his biographer that although he could not recall his reactions to his mother’s death, he was certain that he had not been able to weep. “Almost surely he never let his sorrow show or experienced the catharsis of tears,” West observes. As a result, the biographer plausibly conjectures, Styron “was never able fully to rid himself of an immense subconscious burden of sorrow over his mother’s death or of an illogical feeling of guilt” (p. 53). West characterizes Styron’s reaction to his mother’s death as “incomplete mourning” (p. 445), but it may also be what bereavement experts call pathological or “complicated grief,” the intensification of grief to the level where the person is overwhelmed, resorts to maladaptive behavior, or remains interminably in the state of grief without progression of the mourning process toward completion. (Horowitz et al., p. 1157) We will see the same phenomenon in Linda Sexton’s and Andrew Solomon’s writings. It seems probable that Pauline’s illness produced in the boy a desire to rescue his mother from death. Feelings of guilt and helplessness emerged when the rescue fantasy ultimately failed. This may be one of the sources of the pervasive rescue fantasies of Styron’s characters, who similarly fail to save loved ones from illness and death.

SET THIS HOUSE ON FIRE The landscape of depression haunts Styron’s next novel, Set This House on Fire. The main character in the story, set mostly in Italy, is Cass Kinsolving, a struggling alcoholic painter who falls under the evil spell of the wealthy American playwright Mason Flagg. Narrated by an American lawyer named Peter Leverett, the story centers on Flagg’s rape of the 13-year-old Italian peasant girl Francesca and her brutal murder. Cass remains under

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the spell of the sadistic Flagg for most of the novel. Believing that Flagg has slain the virginal Francesca, the outraged Cass bashes his skull and hurls his hated enemy off a steep precipice. It is not Flagg, however, but another man, a “village idiot,” who has committed the murder. Upon discovering that he has executed the wrong person, Cass is prepared either to kill himself or to spend the rest of his life in prison, but he is befriended by an Italian policeman, Luigi Migliore, who convinces the authorities that Flagg’s death is a suicide. The novel ends with Cass’s repudiation of his death wish and his renewed commitment to life. Set This House on Fire is a sprawling and sometimes melodramatic novel, but the story takes on unexpected biographical meaning in light of Styron’s comments in Darkness Visible about his lifelong tendency toward depression. Cass tells Leverett that a turning point in his life occurred when he was discharged from a California psychiatric hospital after World War II: There was this chief noodle specialist there – one hell of a guy. He was a Navy captain, name of Slotkin. I’d told him about my schoolboy interest in painting, and he got me in one of these therapy painting classes, and I reckon I was a painter from then on out. That’s how I ended up after the war in New York instead of back in Carolina, I guess. Anyway, we couldn’t come to any agreement whatsoever about my melancholia or whatever it was, with its manic-depressive overtones, but I had a lot of long talks with him, and there was some patient gentle quality the guy had that almost swung me out of my blues, and just before I left the place – uncured – he gave me a two-volume edition of Greek drama. (p. 129) Cass’s reference to “manic-depressive overtones” is significant, for although Styron writes about his unipolar depression in Darkness Visible, many psychiatrists believe, as Flaherty suggests in The Midnight Disease, that unipolar and bipolar depressive disorders are not completely separate phenomena. The two conditions are opposite ends of a spectrum, with substantial overlap in symptoms, treatment, and even inheritability. On such a view, writers with unipolar depression are simply those whose manic periods are quite mild. (Flaherty, p. 33)

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Coleman makes an even stronger observation in The Bipolar Express: A simpler continuity exists between upper manic and lower depressive states in some European countries, where the disorder is considered as one, rather than diagnosable as two separate but closely aligned affective illnesses, as is the case in the United States. (p. 1) Styron’s burst of creativity when completing Lie Down in Darkness, resulting in a near-breakdown, may have been a state of hypomania, a period of extreme energy that is close to full-blown mania. “Many people with hypomania,” Flaherty writes, “find it an extraordinarily productive and pleasant state, even as others may find the hypomanic person irritable or irresponsible” (p. 33). Tellingly, Styron’s characters, including Peyton Loftis and Cass Kinsolving, show symptoms of both depression and manic depression. Styron’s characters also exhibit “mixed states,” including what’s called “agitated depression,” in which features of mania and depression do not cancel each other out to produce a normal state; instead, they add up to tormented states of frozen or unsatisfiable desire. Mixed states produce the most painful form of writer’s block. Manic, depressed, and mixed states are related to states that all humans feel to some extent; they are merely exaggerated in creative writers, and perhaps especially in writers with mood disorders. (Flaherty, p. 222) If anyone knew the torture of writer’s block better than Franz Kafka – who observed to his friend and future biographer Max Brod that “a non-writing writer is, in fact, a monster courting insanity” (qtd. in Pawel, p. 97) – it was Styron. Cass’s experience with “art therapy” prefigures Styron’s experience a quarter of a century later at Yale-New Haven Hospital with art therapy, which he dryly characterizes as organized infantilism. Our class was run by a delirious young woman with a fixed, indefatigable smile, who was plainly trained at a school offering courses in Teaching Art to the Mentally Ill; not even a teacher of very young retarded children could have been

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compelled to bestow, without deliberate instruction, such orchestrated chuckles and coos. (Darkness Visible, p. 74) A believer in bibliotherapy, Slotkin has the good sense not to offer Cass self-help books, which he would have rejected as simple-minded, but classic Greek drama, presumably Greek tragedy, which allows readers to gain deep insight, experience intense pleasure, and undergo cathartic release. It is never entirely clear why Cass is so filled with self-loathing, a poisonous feeling Styron conjures up but does not trace back to its origins. Cass records in his journal: At least I understand the quality & the quantity of what I do possess which is a mysterious self-hatred so prideless & engulfing it would turn a Hitler or a Himmler purple with envy and which I at least understand enough to keep it (roughly speaking) within the bounds of reason. (Set This House on Fire, p. 283) Cass is tortured by dreams and fantasies of murdering his sleeping wife and family and then killing himself. He attributes his child’s near death from scarlet fever to God’s punishment for harboring infanticidal thoughts. Apart from the plot’s contrived double murder, Cass Kinsolving is an artist figure who bears kinship to the novelist in several ways. Like Styron, Cass is born in 1925 and serves in the United States Marines during World War II. He is blessed with prodigious creative talent and cursed with periodic artist’s block. Both Cass and his creator share a spiritual devotion to classical music; an abiding love for serious literature, philosophy, and psychology; a fascination with but mistrust of Freud; and the same ironic sensibility. Cass reports that while in Europe about half his nightmares involved Negroes waiting to be executed – a foreshadowing of Styron’s next novel, The Confessions of Nat Turner. Cass’s anxiety and panic attacks prefigure those that Styron writes about in Darkness Visible. Styron’s reading of the Diagnostic and Statistical Manual of Mental Disorders in an attempt to diagnose and heal himself parallels Cass’s reading of the Merck Manual of Diagnosis and Therapy in an attempt to cure Francesca’s dying father. Most intriguing of all, Styron’s wraithlike observer appears in Set This House on Fire, as Cass admits in his journal:

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What saves me in the last analysis I have no way of telling. Sometimes the sensation I have that I am 2 persons & by that I mean the man of my dreams & the man who walks in daylight is so strong and frightening that at times I am actually scared to look into a mirror for fear of seeing some face there that I have never seen before. (p. 361) The movement toward self-destruction in Set This House on Fire is opposed by a stronger countermovement toward self-preservation. Luigi Migliore, who is responsible for both Cass’s freedom from prison at the end of the novel and for his redemption, observes authorially: I’m not a religious man … and this you well know. However, I studied among the humanist philosophers – the Frenchman Montaigne, Croce, the Greek Plato, not to speak of course, of Gabriele D’Annunzio – and if there’s one thing of the highest value I’ve discovered, it is simply this: that the primary moral sin is self-destruction – the wish for death which you so painfully and obviously manifest. I exclude madness, of course. The single good is respect for the force of life. (p. 195) Styron does not regard suicide as a moral sin, as Luigi does, but he endorses the policeman’s words, particularly the belief that suicide committed as a result of insanity is not a moral transgression. (Luigi’s fascist political views do not undercut his role as Cass’s consultant in humanist philosophy.) Cass discovers, through Slotkin’s wise counsel and Luigi Migliore’s timely intervention, that acute self-loathing need not be terminal. Cass’s slaying of Flagg, who in a Dostoevskian sense symbolizes his darker self, releases him from the virulent self-hatred poisoning his life. Some readers have been troubled by Cass’s escape from punishment for his crime, but he has been ennobled through suffering and is prepared at the end to start life anew, purged of his toxic self-destructiveness. His Kierkegaardian choice of being over nothingness underscores the novel’s existential ending. Speaking from hard-won experience, Cass voices Styron’s rejection of self-inflicted death. “Suicide?” Cass put in. He removed the cigar from his teeth and squinted at me, making a thin smile. “It does not take anything whatsoever, my friend. Maybe desperation. Guts is

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the last thing it takes.” He gazed at me, not without humor, shrewd, tugging gently at his line. “It doesn’t take courage, guts, or anything else. You’re talking to a man that knows.” (p. 49)

THE CONFESSIONS OF NAT TURNER Suicide does not appear explicitly in Styron’s next novel, The Confessions of Nat Turner. “I had never known of a Negro who had killed himself,” Nat acknowledges in response to a slave-owner’s statement, and in trying to explain this fact I tended to believe (especially the more I examined the Bible and the teachings of the great Prophets) that in the face of such adversity it must be a Negro’s Christian faith, his understanding of a kind of righteousness at the heart of suffering, and the will toward patience and forbearance in the knowledge of life everlasting, which swerved him away from the idea of self-destruction. (p. 27) Yet Nat Turner may be viewed as a chronic suicide: one who engages in repetitive, risky behavior that ultimately results in death. “While Nat Turner did not commit suicide,” the neurosurgeon and Dylan Thomas biographer James Nashold notes, he was so deluded by his beliefs that he completely misread the social climate of slavery and was shocked when other slaves did not rise up with him to kill the white owners. Thus, despite overwhelming evidence against the chances of success with a slave revolt, Nat acted in such a way that not only caused his own death but the deaths of over two hundred other slaves killed in revenge after the failed revolt. (personal communication, December 9, 1997)

SOPHIE’S CHOICE Suicide figures prominently in Styron’s masterpiece, Sophie’s Choice. The novel remained on the New York Times bestseller list for more than

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40 weeks and received the first American Book Award fiction in 1980. Meryl Streep received an Academy Award for her performance in the film; many people, myself included, regard her performance as the greatest by an American actress. Sophie’s Choice is Styron’s darkest and most autobiographical novel. The narrator, Stingo, is a portrait of the artist as a young man. Both author and narrator are born in Tidewater, Virginia, in 1925 and lose their mothers at the same age; enlist in the United States Marines during World War II, after which they complete their education at Duke; work briefly for the publisher McGraw-Hill; write similar first novels based on their infatuation with a woman who commits suicide; craft a later novel about Nat Turner that provokes sharp controversy; and meet a Polish survivor of Auschwitz whose story they later immortalize. We see two Stingos, a callow youth in the 1940s, when the story takes place, and a wiser self who narrates the story in the 1970s. The older Stingo regards his younger self with a mixture of affection and scorn. Styron constantly plays off the older narrator against his younger counterpart, as novelists often do in a bildungsroman. Styron forces his readers to revise their understanding of Stingo’s complex story. The inspiration behind Stingo’s first novel Inheritance of Night (the early draft of Lie Down in Darkness) is a letter he received from his father in 1947 informing him of the recent death of a captivating 22-year-old woman, Maria Hunt, with whom Stingo is hopelessly in love during his early adolescence. Styron describes this woman in his nonfictional This Quiet Dust (1982) as the “source of my earliest and most aching infatuation” (p. 290). Maria Hunt kills herself, Stingo discovers, by leaping from the window of a Manhattan building. She came from a tragic household: her father was a “near-alcoholic and always at loose ends,” and her mother was “pretty unremitting and cruel in her moral demands upon people,” particularly upon her daughter (Sophie’s Choice, p. 44). James West sheds more light on the elusive woman who served as the model for Maria Hunt. West notes that when Styron was 15 years old, he became entranced with a teenager whose parents fought bitterly and finally divorced. “Anna,” as West refers to her in his biography, was psychologically unstable, as was her mother, who was institutionalized frequently for mental problems. Anna married a young naval officer, gave birth to a child, and then began suffering from postpartum depression.

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Her mental health soon deteriorated, and after attempting to drown her baby in a bathtub, she was committed to a Williamsburg state sanitarium, where her mother had been confined earlier. Of the several women who served as models for Peyton Loftis in Lie Down in Darkness, Anna was the “tragic source.” Styron completed the novel before she was released, but then, in an eerie example of life imitating art, she committed suicide in late 1951 by driving her automobile off a dock in Newport News. Styron’s father, unaware that she had served as the source for Peyton, sent his son a newspaper clipping of the bizarre suicide, which proved upsetting to the novelist. “She had been alive during the time he was writing Lie Down in Darkness,” West avers, which concluded with the suicide of the fictional character based on her. Now she had killed herself. Had he predicted, in writing the novel, that Anna would take her own life? Or worse, had he somehow caused her to kill herself? (pp. 201–202) Though Styron knew he was not responsible for Anna’s fate, her suicide became a troubling postscript to the publication of Lie Down in Darkness. Maria Hunt’s death gave birth not only to Peyton Loftis but to her other avatar, Sophie Zawistowska, who commits suicide with her psychotic lover, Nathan Landau, at the close of Sophie’s Choice. Although Sophie was based on a Polish survivor of Auschwitz whom Styron knew briefly while living in New York City immediately after World War II, she also seemed to be an incarnation of Maria Hunt. “And what is still ineffaceable about my first glimpse” of Sophie, Stingo remarks, is not simply the lovely simulacrum she seemed to me of the dead girl but the despair on her face worn as Maria surely must have worn it, along with the premonitory, grieving shadows of someone hurtling toward death. (p. 46)

“MALIGNANT DEPRESSION” Sophie’s life is a case study in what Stingo calls “malignant depression” (p. 94). The word guilt dominates her vocabulary, guilt so pervasive that it recalls Little Father Time in Thomas Hardy’s Jude the Obscure, the morbid boy who hangs himself and his younger half-brother and half-sister

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because of the conviction that the world would be better without them. “Done because we are too menny” (p. 405), he scrawls in his suicide note. But whereas Father Time remains a two-dimensional character, illustrative of Hardy’s Schopenhauerian belief in an impending universal death wish, the three-dimensional Sophie experiences a depression that arises from the most horrendous event in history. Sophie is the daughter of a prominent anti-Semitic Polish professor, yet despite her family’s position, she and her two children are shipped to Auschwitz in 1943. Fiercely protective of her children, she encounters a fiendish doctor who forces her to make a horrifying choice: she must decide which child will live and which will die in the gas chambers. It is an impossible decision, and Sophie’s Choice is one of the few novels (another is Joseph Heller’s Catch-22) whose title has entered the English language to become a complex metaphor, in this case, an insoluble moral dilemma. If Sophie fails to make a choice, she will lose both children. She chooses to save her son though he, too, later perishes. Her guilt is so overwhelming that she cannot live with herself after surviving Auschwitz. She is sent to a Swedish displacement camp in 1945 where she tries to kill herself by cutting her wrist with a shard of glass. She selects a church for the suicide in order to rage against God, who she believes has abandoned her. A more serious suicide attempt occurs when she tries to drown herself at Jones Beach shortly after Nathan forsakes her. Stingo rescues her, and after he drags her onto the beach she cries out, regurgitating half a gallon of seawater onto the sand. Oh God … why didn’t you let me die? Why didn’t you let me drown? I’ve been so bad – I’ve been so awful bad! Why didn’t you let me drown? (p. 364) Sophie’s feelings of drowning establish her kinship with Peyton, retrospectively (and with Styron himself, prospectively). Their need for selfpunishment arises from the fear that they have killed or injured a loved one. Each sees herself as abandoned by a lover or husband. Stingo has little sympathy for psychoanalysis, yet his interpretation of Sophie’s unhealthy relationship with Nathan evokes contemporary attachment theory. Her love for Nathan was so totally consuming, yet at the same time was defined by such childlike dependency in a hundred ways, that the terror that surrounded her in his unexplained

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absence was utterly demoralizing, like being caught in that strangling fear – the fear that she might be abandoned by her parents – which she had often felt as a little girl. (p. 318) Sophie’s farewell letter to Stingo conveys poignantly in broken English the depth of her self-loathing, her rage against God, and her wish to remain united with Nathan in life or in death: My dearest Stingo, your such a beautiful Lover I hate to leave and forgive me for not saying Good-Bye but I must go back to Nathan. Believe me you will find some wunderful Mademoiselle to make you happy on the Farm. I am so fond of you – you must not think bei this I am being cruel. But when I woke I was feeling so terrible and in Despair about Nathan, bei that I mean so filled with Gilt and thoughts of death it was like Eis Ice flowing in my Blut. So I must be with Nathan again for whatever that mean. I may not see you again but do believe me how much knowing you have meaned to me. Your a great Lover Stingo. I feel so bad, I must go now. Forgive my poor englische. I love Nathan but now feel this Hate of Life and God. FUCK God and all his Hande Werk. And Life too. And even what remain of Love. (pp. 499–500) Sophie’s suicide letter is striking in its efforts to comfort Stingo, whom she does not want to hurt. She knows he will be shattered by her suicide, and she does everything she can to free him from guilt over her actions. She writes the letter in despair, and despite her imperfect English, the letter is poignant, not inarticulate or melodramatic. She is in irremediable pain, and her words are rending. She seeks Stingo’s – and the reader’s – understanding and forgiveness, not judgment, not unlike Styron’s later suicide letter to future readers of Darkness Visible. Earlier Nathan tells Stingo that the novel he admires above all others is Madame Bovary, not only because of its formal perfection but also because of its resolution of the suicide theme: “Emma’s death by self-poisoning seeming to be so beautifully inevitable as to become one of the supreme emblems, in Western literature, of the human condition” (p. 185). The same can be said about Styron’s portrayal of suicide in Sophie’s Choice. Without romanticizing the double suicide, Styron depicts the chain of events that leads inexorably to an appalling conclusion. Sophie has symbolically died

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in Auschwitz’s gas chambers years earlier, and the sodium cyanide she and Nathan swallow in their Brooklyn rooming house is the culmination of her obsession with death. Stingo has hinted repeatedly that Sophie’s story will end tragically, and we are saddened but not shocked at her fate. Does Sophie freely choose suicide, or does a deranged lover thrust it upon her? Suicide is rarely a “free” choice in that, according to Jamison and other experts, the majority of people who attempt or commit suicide suffer from a mood disorder that clouds their judgment – and Sophie is severely depressed. The reader infers from her farewell letter to Stingo that she is prepared to accept whatever course of action Nathan decides. Her rage toward God is evident in her letter, as is her belief that life no longer holds any meaning or value to her. Sophie presumably chooses suicide, but depression makes the choice for her. She knows that by returning to Nathan, her savior and destroyer, she will be required to carry out the suicide pact to which she has agreed in the past. Sophie makes two terrible choices, the first in Auschwitz, the second in Brooklyn, and in both cases she is swayed by the thinking of a man who is not in his right mind. Unlike Sophie, whose violence is directed against only herself, Nathan’s fury threatens to destroy anyone in its path. Stingo remains oblivious to this violence in the beginning of the novel but soon recognizes Nathan’s madness. Several times Nathan inexplicably turns against Stingo and verbally abuses him. Nathan’s paranoid schizophrenia may have a biochemical component, but he also embodies a characterological darkness that has both moral and psychological dimensions. His monstrous hatred of non-Jews connects him with the Nazis he despises. Although Sophie agrees to the suicide pact, Nathan would have felt no hesitation in murdering her before killing himself. His violence is apparent when he beats her and urinates on her face during their weekend in Connecticut the previous autumn. Nathan’s suicide pact with Sophie, enacted by swallowing the same form of cyanide poison used by officers like Hermann Göring to escape the Nuremberg Trials, identifies him with the final solution the Nazis intended to impose upon the world.

STINGO’S RESCUE FANTASIES Stingo cannot prevent Sophie’s suicide, just as earlier he was unable to prevent Maria Hunt’s suicide. He can rescue them, however, in another

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way, through the immortality of art. He resolves to write about Sophie’s life, just as earlier he decided to write about Maria Hunt’s, and while it takes him 30 years to complete the eponymous heroine’s story, the result is Styron’s magnificent Sophie’s Choice. Stingo is well suited for writing about Sophie, acknowledging that in his career as a writer he has “always been attracted to morbid themes – suicide, rape, murder, military life, marriage, slavery” (p. 110). Apart from the wry inclusion of marriage in this list of violent subjects, Stingo is drawn to characters whose crimes are beyond expiation. Sophie’s Choice is finally about Stingo’s choice – his decision to devote more than a decade of his life to writing a single novel. He reveals a good deal about himself and his creator, including the extent to which early maternal loss shapes the content of their art. The childhood incident that has the greatest formative impact on Stingo involves what he believes is an unforgivable crime he committed against his mother when he was 12, a year before her death. Stingo’s mother suffers from terminal bone cancer and is confined to a bed or a chair, from which she passes the day reading. She is the same dying figure Styron later writes about in “A Tidewater Morning.” Stingo’s responsibility during the chilly winter months is to hurry home after school to stoke the fireplace. He “abandons” her one frigid afternoon by accepting a schoolmate’s invitation to ride in his new Packard-Clipper. Stingo arrives home hours later, long after the fire died out, to find his father messaging his wife’s numbed hands, both parents silently reproaching him. The father later marches his wayward son to the toolshed, where he receives his just deserts by shivering for the rest of the evening. Stingo recalls how he would have willingly frozen to death to expiate his heinous crime, one that was “ultimately beyond expiation, for in my mind it would inescapably and always be entangled in the sordid animal fact of my mother’s death” (p. 297). Dan Ross argues in a perceptive psychoanalytic interpretation of Stingo’s dreams that Styron’s narrator is oppressed by guilt over the failure to rescue the three most important women in his life: his mother, Maria Hunt, and Sophie. The guilt is heightened by the fact that Stingo waits so long before he finally writes the story that Sophie entrusted to him years earlier. “It is certainly a curious fact,” Ross observes, that a storyteller as gifted as he would withhold so dramatic a tale for a quarter of a century, especially when, as I have

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suggested, Sophie seems to have bequeathed the story to him as a special gift, the surviving offspring of their relationship. Stingo’s narration evokes the “compulsive obsessiveness of the Ancient Mariner, insisting repeatedly on the necessity of speaking the unspeakable” (Ross, pp. 144–145).

“A STUDY IN THE CONQUEST OF GRIEF” Stingo’s attitude toward suicide changes in the course of the novel. In the beginning, he recalls his brief career as a junior editor at McGraw-Hill and his dismay over the sentimental or juvenile manuscripts that he had to evaluate for publication. He cites a letter from a desperate author whose manuscript has been rejected by several publishers. To the author’s veiled threat of suicide should her manuscript be rejected again, Stingo writes in his reader’s report: I should hate to be responsible for anyone’s death but it is absolutely imperative that this book never be published. Decline! (Why do I have to keep reading such shit?). (p. 7) Stingo’s supercilious response slowly gives way to empathy when he reflects upon Maria Hunt’s life. He asks himself: “Would I be able to summon the passion, the insight to portray this young suicide? Could I make it all seem real?” (p. 449). Stingo never seriously doubts his ability to capture Maria Hunt’s and Sophie’s stories. His task as a novelist is complicated by the fact that he is both an observer of and participant in Sophie’s history. Sophie’s Choice is a more compassionate novel than Lie Down in Darkness. Styron’s narrator is older, wiser, more vulnerable. Suffering has expanded his vision. Not since the death of his mother has he allowed himself to cry, but on the last pages of Sophie’s Choice Stingo breaks down and weeps, an act that allows him to purge his rage and sorrow. The final entries, which he describes as “A Study in the Conquest of Grief” (p. 508) – a title Styron could have used for Darkness Visible – represent both his cathartic outpouring of emotion and his decision to re-create the story of all the doomed characters in his life. Stingo mourns not only Sophie’s and Nathan’s deaths but also Maria Hunt’s and Nat Turner’s. These characters will live forever in the novelist’s imagination – and in his reader’s as well.

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“MY WRITING HAD KEPT SERIOUS EMOTIONAL DISTRESS SAFELY AT BAY” Writing serves multiple purposes for Stingo, enabling him to memorialize lost friends and to cast light on two subjects about which it is nearly impossible to write: the Holocaust, with its unspeakable crimes against humanity, and depression, which Styron calls in Darkness Visible a “simulacrum of all the evil of our world” (p. 83). Writing also allows Stingo to ward off his own demons. [M]y writing had kept serious emotional distress safely at bay, in the sense that the novel I was working on served as a cathartic instrument through which I was able to discharge on paper many of my more vexing tensions and miseries. (Sophie’s Choice, p. 438) For a writer who has long mistrusted psychoanalysis, and who satirized the spirit of Freudianism in Lie Down in Darkness and Sophie’s Choice, Styron surprisingly believes in the writing cure. “When I’m writing,” he declares in his 1958 Paris Review interview, I find it’s the only time that I feel completely self-possessed, even when the writing itself is not going too well. It’s fine therapy for people who are perpetually scared of nameless threats as I am most of the time – for jittery people. Besides, I’ve discovered that when I’m not writing I’m prone to developing certain nervous tics, and hypochondria. Writing alleviates those quite a bit. (Cowley, Writers at Work, p. 272) Styron adds in the same interview that while much of the morbidity and depression of modern life arises from the explosive increase of scientific knowledge of the self-associated with Freudianism, the good writing of any age has always been the product of someone’s neurosis, and we’d have a mighty dull literature if all the writers that came along were a bunch of happy chuckleheads. (p. 282) Styron’s words recall D. H. Lawrence’s observation: “One sheds one[‘]s sicknesses in books, repeats and presents again one[‘]s emotions, to be master of them” (Letters, vol. 2, p. 90).

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Reading is also therapeutic for Stingo. He remarks early in Sophie’s Choice that when he was in his early twenties, “reading was still a passion and thus, save for a happy marriage, the best state possible in which to keep absolute loneliness at bay” (pp. 11–12). Nothing in the later pages of the novel undercuts or qualifies this affirmation. Stingo’s observation about André Gide’s diaries affirms the power of literature to change the writer’s and reader’s lives: the more catastrophic the humiliation or the disappointment, I noted, the more cleansing and luminous became Gide’s account in his Journals – a catharsis in which the reader, too, could participate. (p. 173) The memoirists in the present book would agree that writing helps them keep serious emotional stress at bay, but not everyone believes that writing is therapeutic. The literary critic A. Alvarez expresses a contrary point of view, or, at least, a serious qualification in his influential 1970 study The Savage God: A Study of Suicide. Writing about Sylvia Plath’s suicide in 1963, Alvarez observes, for the artist himself art is not necessarily therapeutic; he is not automatically relieved of his fantasies by expressing them. Instead, by some perverse logic of creation, the act of formal expression may simply make the dredged-up material more readily available to him. The result of handling it in his work may well be that he finds himself living it out. (pp. 36–37) Alvarez qualifies himself here: no one believes that art is necessarily therapeutic or that writing automatically relieves the writer of dark emotions. In most cases, however, writing is therapeutic, though sometimes writing does not provide psychic relief and, rarely, it may be countertherapeutic. Nancy Mairs speaks for most writers when she observes in her 1994 memoir Voice Lessons: On Becoming a (Woman) Writer: “Whatever I wrote, I wrote out of that pain, and whatever I wrote assuaged the pain a little but never enough” (p. 19).

STYRON’S HEART OF DARKNESS Nowhere is the cathartic power of literature more evident than in Darkness Visible, where Styron does more than perhaps any other literary writer to

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educate readers about the reality of suicidal depression. Darkness Visible is essential reading for anyone seeking bibliotherapy or scriptotherapy. It is not a how-to book: there is none of the unrestrained theorizing or psychobabble or its successor, pharmababble, that characterizes the vast popular literature on survival. Nor does the story offer false hope to the millions of people who suffer from mental illness. Styron’s openness, insight, and mordant humor in Darkness Visible enable readers to participate in his frightening descent into black depression – and to emerge slowly into the world of radiant light. In the process, we see the landscape of depression dissolving into a scene of renewal and rebirth.

WHY MEMOIR? Given the fact that Styron’s fictional stories focus on depression and suicide, why, then, did he write about his psychiatric experiences in a booklength memoir, something he had never done before? As James West points out, Styron originally intended to fictionalize his illness and recovery, but he had second thoughts after writing nearly a 100 pages during a threemonth period. “Passages early in the fragment,” West observes, “show that he was uncomfortable with self-revelation.” Styron’s fictional narrator, Paul Whitehurst, who had also appeared in “A Tidewater Morning,” speaks authorially when he confesses that “It is easy to become beset by hesitations when thinking of setting down a personal chronicle of one’s own mental illness” (West, p. 450). Unhappy with his fictional efforts, Styron was ready to abandon the project. Styron changed his mind, however, when he read an article in the New York Times about Primo Levi, the Italian Jewish chemist, Holocaust survivor, and memoirist who had taken his own life on April 11, 1987, at the age of 67. The suicide provoked much discussion and harsh judgment at an academic conference at New York University. The indignant Styron was moved to write a short article that appeared in the op-ed section of the New York Times on November 27, 1988. To his surprise, the article, “Why Primo Levi Need Not Have Died,” inspired several readers to write letters of support, some of which were published in the Times. Styron was invited to give a lecture at a 1989 symposium on affective disorders sponsored by the Department of Psychiatry at the Johns Hopkins University School of Medicine. Upon the urging of Tina Brown, the editor of Vanity Fair who had attended the conference, Styron expanded the talk into a 15,000-word

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essay published in the magazine in December 1989, and it then appeared the following year, with an additional 4,000 words, in book form. Like Styron’s article published in the New York Times, Darkness Visible is an example of writing/righting wrong. Styron situates his depression and nearsuicide attempt in the larger context of the many nineteenth- and twentiethcentury artists who have taken their own lives. But the question still remains. Given Styron’s discomfort with selfdisclosure, why did he choose to write a memoir? West never addresses the question, but the answer, I suspect, lies in Styron’s wish to bear witness to his experience, to speak as candidly and personally as possible, without the masks, guises, and subterfuges of fiction. Writers usually experience the greatest freedom to express disturbing truths in fiction rather than in autobiography – art is a lie that makes us realize truth, as Picasso famously said – but it was the memoir that allowed Styron the greatest freedom to limn suicidal depression. Switching from third to first-person narration proved to be the key to writing the story. In Goffman’s terms, writing fiction allowed Styron to disguise from public view his spoiled identity; writing a memoir, by contrast, enabled him to reveal that which he had formerly tried to hide. In Arthur Frank’s terms, Styron takes on the identity of a wounded storyteller in Darkness Visible, and in doing so, he creates an empathic bond with his readers. It took courage to write the memoir: depression and suicide remain stigmatized subjects today, and even more so in 1990, a time when there were few first-person accounts of mood disorders. Thomas Eagleton (1929–2007), the United States Senator from Missouri, was forced to remove himself as the Democratic vice-presidential candidate in 1972 after revelations of his history of depression and electroshock therapy. Few public figures came forward during this time to declare they had suffered from mental illness. It’s true that before Darkness Visible, there were lightly fictionalized accounts of writers’ mental illness, most notably, Sylvia Plath’s The Bell Jar and Joanne Greenberg’s I Never Promised You a Rose Garden, but significantly, both novelists used pen names at the time of publication: “Victoria Lucas” and “Hannah Green,” respectively. Plath committed suicide shortly after the publication of her novel, and Greenberg did not disclose her real name to readers for several years. By contrast, Styron used his own name and wrote in his own voice. Once he made the decision to switch from third person to first person, he wrote the story in a few months. Styron’s decision proved to be life transforming.

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The authenticity of Darkness Visible derives from Styron’s ability to evoke through vivid details the commonalities of suicidal depression. He writes with the clinical detachment of a psychologist about his unbearable psychic pain, self-loathing, mental constriction, dichotomous thinking, isolation, helplessness, and longing for death. The memoir abounds in Styron’s self-lacerating humor, which allows us to see the tragicomic elements of the story. He describes his “better-than-average amateur’s knowledge about medical matters” but then adds, parenthetically, that it is a knowledge “to which many of my friends, surely unwisely, have often deferred” (p. 9). He admits that although Madame del Duca graciously accepted his psychiatric explanation of his bizarre behavior after the presentation ceremony, she probably regarded him as a “weird number” (p. 16). He uses the word “zombielike” to characterize his state of mind during the celebration dinner, when he lost the 25,000-dollar del Duca check. The psychiatrist’s warning that the antidepressant he was about to prescribe might result in impotence provokes this sardonic sentence: Putting myself in Dr. Gold’s shoes, I wondered if he seriously thought that this juiceless and ravaged semi-invalid with the shuffle and the ancient wheeze woke up each morning from his Halcion sleep eager for carnal fun. (p. 60) Darkness Visible is about depression, but it never becomes depressing. Styron reminds his readers that just as he was able to survive a potentially fatal illness, so might others. To use Kathlyn Conway’s distinction, Darkness Visible is a survival narrative, not a triumph narrative. There is nothing breezily optimistic about the memoir; the hope Styron offers is hard earned. He is careful not to overgeneralize from his experience. He acknowledges that his suicidal depression was atypical; neither medication nor psychotherapy helped him, but he does not rule out their efficacy to others. He does not conceal his resentment toward “Dr Gold,” but he refuses to condemn psychiatry in general. Nor does he deny the existence of mental illness or the value of hospitalization, as those in the antipsychiatry movement do. At no time does Styron intimate, as other writers who have attempted or completed suicide do, such as Virginia Woolf, that suicide is an act of heroic defiance or transcendence. Nor does he stigmatize suicide, as Hemingway did. Styron would sympathize with the yearning for death in Sylvia Plath’s and Anne Sexton’s poetry, but he would also suggest that such desire should be resisted fiercely.

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Styron is aware of the high suicide rate among artists, and he cites several poets, novelists, and painters who took their own lives, including Hart Crane, Randall Jarrell, Vincent van Gogh, Virginia Woolf, Arshile Gorky, Cesare Pavese, Romain Gary, Vachel Lindsay, Sylvia Plath, Henry de Montherlant, Mark Rothko, John Berryman, Jack London, Ernest Hemingway, William Inge, Diane Arbus, Tadeusz Borowski, Paul Celan, Anne Sexton, Sergei Esenin, and Vladimir Mayakovsky. Styron views these people as fallen comrades who deserve sympathy for the private horrors they were unable to endure. “THE FUNDAMENTAL QUESTION” The artist about whom Styron writes at greatest length in Darkness Visible is not on the list – Albert Camus. Styron’s indebtedness to the French existentialist is well known. Styron stated in a 1963 letter to Pierre Brodin that [o]f the moderns of any nationality, including the United States, Camus has had the largest effect upon my thinking, and I have valued the quality of his moral intensity more than anything I have found in any other contemporary. (qtd. in Ratner, p. 136) Camus was a “great cleanser of my intellect,” he opines in Darkness Visible (p. 21). In Styron’s judgment, Camus’s The Myth of Sisyphus contains the century’s most famous pronouncement on suicide: “There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth considering amounts to answering the fundamental question of philosophy” (p. 23). Camus’s death in a car accident in 1960 at age 46 horrified Styron. “I have almost never felt so intensely the loss of someone I didn’t know” (p. 22). Styron ruminated over the death and began to suspect that although Camus had not been driving the death car, he must have known the driver was a “speed demon.” Styron sensed there was an element of “recklessness in the accident that bore overtones of the near-suicidal, at least of a death flirtation” (p. 22). The death reinforced Styron’s earlier suspicion that Camus’s rejection of suicide in The Myth of Sisyphus does not ring true. Romain Gary, who had tried to arrange a meeting between the two writers in 1960, later told Styron that Camus had hinted he was suicidal. Gary visited Styron in 1978, and the two men continued to discuss

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Camus’s death. Gary was himself becoming depressed around this time. “He said that he was able to perceive a flicker of the desperate state of mind which had been described to him by Camus” (p. 25). Gary’s ex-wife, the actress Jean Seberg, was also severely depressed. Styron reports that not long afterward she took a fatal dose of pills and that in 1980 Gary shot himself in the head. Styron’s deteriorating mental health in 1985 may have been further undermined by his close identification with two admired writers whom he associated with suicide. Styron does not imply that Camus’s premature death invalidates or qualifies his rejection of suicide in The Myth of Sisyphus – Oliver Todd’s 1997 biography of Camus reveals no hint that he was depressed or suicidal near the end of his life – but Styron does intimate, as he describes his feelings leaving Paris in 1985, that his own fate seemed inextricably linked to Camus’s. Paraphrasing his deceased mentor, Styron began to fear that “I would be forced to judge that life was not worth living and thereby answer, for myself at least, the fundamental question of philosophy” (p. 28). Styron’s literary instincts prompted him to draft a suicide note, yet his failure to craft the right words may have saved his life. The suicide note was the most arduous writing task of his life; there was something “almost comically offensive in the pomposity” of the sentence he intended to use as his final farewell: “For some time now I have sensed in my work a growing psychosis that is doubtless a reflection of the psychotic strain tainting my life” (p. 65). The suicide letter lacks the metaphorical power of Peyton Loftis’s and Sophie’s suicide letters, but there is nothing psychotic, deranged, or pompous about the note. Nevertheless, the perfectionistic Styron tore up the suicide note and vowed to leave in silence. Fortunately, art came to his rescue when he most needed it. As he prepared for his death, he happened to watch the tape of a film in which could be heard a soaring passage from Brahms’s Alto Rhapsody. A lover of classic music his entire life, Styron had been numb to its pleasures for months, but he realized when he heard the joyful sounds that he could not forsake life and art. The next day he hospitalized himself and began the healing process. Styron’s reference to Brahms’s Alto Rhapsody is intriguing because although he identifies the music with “all the joys” of his family and home life (p. 66), a few pages later in Darkness Visible he returns to the passage and makes a different association, the incomplete mourning associated

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with his mother’s death. He speculates that his narrow escape from death may have been “belated homage” to his mother. I do know that in those last hours before I rescued myself, when I listened to this passage from the Alto Rhapsody – which I had heard her sing – she had been very much on my mind. (p. 81) One of the anonymous reviewers of Mad Muse offered a shrewd suggestion that I had not seen. “It’s surely not accidental that the Goethe poem that the music is set to concerns a depressive third person character, with strong echoes of Styron’s own state.” Given, then, Styron’s identification with the joyful and sorrowful aspects of the Alto Rhapsody, it appears that his use of allusion and intertextuality has both conscious and unconscious determinants. Styron’s other allusions in Darkness Visible, particularly his reference to the story of Job (part of which he uses for the memoir’s epigraph), Dante’s Divine Comedy, and the metaphysical poets who evoke the “dark night of the soul,” are significant. “These texts,” Kathlyn Conway remarks, because they so aptly represent the experience of emotional suffering that threaten to annihilate the self, become a kind of shorthand, a metaphorical vocabulary whose meaning is assumed to be all but universally understood. At the same time, Conway adds, the language of these passages is surprisingly devoid of evocative images; instead it connotes absence, nothingness, darkness, and confusion. It is a language that suggests the kind of anguish that is dark and turned in on itself. (p. 91) Styron pays tribute in Darkness Visible to a close friend, a “celebrated newspaper columnist,” who was hospitalized for severe manic depression in the summer of 1985 and whose recovery, largely due to lithium and psychotherapy, inspired his own. It was he who kept admonishing me that suicide was “unacceptable” (he had been intensely suicidal), and it was also he who made the prospect of going to the hospital less fearsomely intimidating.

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Each writer became part of the other’s support system. “The help he gave me, he later said, had been a continuing therapy for him, thus demonstrating that, if nothing else, the disease engenders lasting fellowship” (pp. 76–77). Styron doesn’t identify the name of the acclaimed columnist, but he was the humorist Art Buchwald, who (along with his friend Mike Wallace) disclosed on Larry King Live in 1997 that he had experienced two serious bouts of suicidal depression. Styron told him, Buchwald dryly observes in his end-of-life memoir Too Soon to Say Goodbye, that if Buchwald had one more depression, he would be “inducted into the Bipolar Hall of Fame” (p. 38). For a deeply private writer, Styron is remarkably self-disclosing in Darkness Visible, yet he does not tell the entire story of his 1985 illness and recovery. As Gavin Cologne-Brookes observes, “the memoir blends forthrightness with necessary evasion” (p. 56). Styron does not reveal, for example, that one day before his hospitalization, he wrote a suicide letter to his closest friend, Peter Matthiessen. I’ve gone through a rough time. I hope you’ll remember me with love and tenderness. I wish I’d taken your way to peace and goodness. Please remember me with a little of that zen goodness, too. I’ve always loved you and Maria [his wife]. (Selected Letters, p. 577) Some of Styron’s statements to Philip Caputo in an interview begun shortly before the breakdown and resumed a few months afterward indicate he was still seriously contemplating suicide in the hospital; he had actually telephoned a friend to bring him a lethal dose of barbiturates (Caputo, p. 157). Styron’s friend advised him to wait a few days, at which point the suicidal depression had begun to lift.

READING MY FATHER Brenda Dyer characterizes the structure of Darkness Visible as a tragicomic romance. We see a full revolution from good to bad to qualified good, the movement of tragicomic romance down to hell and then out again into a redeemed world, the happiness of which is qualified by the unforgettable experience of hell. (p. 46)

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Styron’s story darkens, however, when we read Alexandra Styron’s Reading My Father. Seven years younger than her next sibling, she conveys not only love and tenderness for her father but also anger and dread. At times querulous and taciturn, cutting and remote, melancholy when he was sober and rageful when in his cups, he inspired fear and loathing in us a good deal more often than it feels comfortable to admit. (p. 5) Throughout his daughter’s memoir the novelist emerges as human, all too human. Alexandra Styron’s point of view toward her father is sharply different from her mother’s and James West’s. The biographer always writes with a combination of respect, sympathy, and scholarly detachment about the differences between William and Rose Styron and their often fraught marriage. She liked to invent parts of her day as she went along. He wanted his day predictably structured; he disliked surprises; he detested the telephone. These tensions were at the heart of their marriage, dividing them (sometimes dangerously) but also binding them together in a strong, complex symbiosis. (p. 361) Rose Styron hints at marital tensions in her editorial comments in Selected Letters, but she rarely elaborates or dwells on them. She refers to her husband as a “kind, physically gentle man who flew into legendary short-lived rages at all of us” (p. x), but she takes these moments in stride. Immersing herself in her husband’s letters after his death, she realized how much she did not know about him. Reading these letters made her “miss him more, respect and admire him more,” but it also “sparked old doubts, and certain resentments, and regrets about my own responses in later years” (p. xi).

A SCANDAL By contrast, Alexandra Styron shows us her father’s thunderous side, in the process deepening our understanding of Darkness Visible. Of all the demons that plagued my father in the cauldron of his depression, guilt had the longest fangs. He wept

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and wailed over his shortcomings, his laziness and lack of fortitude. (p. 221) This observation is consistent with Styron’s emphasis in Darkness Visible on the intensity of his self-loathing. But what we don’t see in William Styron’s memoir is his fear that a “scandal” would soon emerge about his life and that, when it did, his family would “hate” him. Alexandra then elaborates. This last fear remained vague and never exactly bore fruit. But, in his darkest hours, Daddy did try to tell my mother the names of all the women he had slept with over the course of their marriage. (I knew this secondhand, through a friend of my mother’s – it’s not something she would ever share with me – but she did talk freely about my father’s rather unbearable “confessions” all that fall). Though Mum’s conduct through Daddy’s ordeal was unimpeachable, and her devotion to him almost freakish, I believe she drew the line at that particular indulgence. (p. 222) It must have been unsettling for Rose Styron to read her daughter’s memoir, particularly when Alexandra, while taking an extracurricular theater study class in Manhattan’s West Village during college, saw her father’s mistress working there. The gray-haired woman was a relative, by marriage, of a close family friend, and had often been to the Styron home, “my mother’s guest,” Alexandra indignantly reports. Rose Styron, the daughter adds, had known about her husband’s infidelities for years. Styron was not yet married in 1952, when Lie Down in Darkness was published, but he could imagine how Milton Loftis’s secret lover, Dolly Bonner, feels about her relationship to his family. “To be known as ‘his mistress’ by the children of the man you love is likely to cause worry and fretfulness and maybe broodings at night” (Lie Down in Darkness, p. 68). Helen is obsessed with her husband’s mistress even after her death, and she cannot stop dreaming about her. “Many times Dolly had died in her dreams, often by the knife that Helen wielded, grinning, but more often by disease.” Of all the corpses inhabiting the landscape of Helen’s dreams, Dolly Bonner’s stands alone, “faceless like the rest, head down in the shadows, with its legs – suppurating, clotted by a swarm of sucking, avid flies – unmistakably Dolly’s” (pp. 283–284). Rose Styron is no Helen Loftis, but

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one can understand her chagrin when reading her husband’s letter in 1981 describing his sexual adventures in Paris while attending François Mitterrand’s inauguration as President of France (Selected Letters, p. 548), or another letter written in 1984 about a near-catastrophe while driving drunk near his home and engaged in a sex act with a 19-year-old woman (p. 570). No wonder Styron did not want anyone to publish his correspondence while he was still alive, as he wrote to William Blackburn in 1966. Styron omits in Darkness Visible any references to his fear of scandal, sexual or otherwise, and he also omits remarking on his abject dependence on his wife while in the throes of depression. Wretched and panic-stricken, Daddy began suddenly clinging to my mother as if she were the last raft on the Titanic. He’d spent more than twenty years pushing her away. Now he wouldn’t let her out of his sight. (Reading My Father, p. 221) Styron penned Darkness Visible after he had returned to health, careful to look upon his illness with a stoical, ironic eye, but Alexandra, quoting from a diary entry written by her sister Polly the night before his hospitalization, captures his panic-stricken language and behavior. When I went upstairs to his room he was lying there, with his long gray hair all tangled and wild. I took his hand, which was trembling. “I’m a goner, darling,” he said first thing. His eyes had a startled look, and he seemed to be not quite there. His cool, trembling hands kept fumbling over mine. “The agony’s too great now, darling. I’m sorry. I’m a goner.” (Reading My Father, p. 223) If Styron’s words strike some readers as self-pitying, we must remember that he was trapped in a panic attack, when one feels driven to madness. Self-pity is a part of the story of depression, and the knowledge that Styron felt he was a goner bespeaks what it feels like to be in the throes of mental illness.

WRITING MADNESS Reading My Father is fascinating partly because, in the words of one of the anonymous readers of Mad Muse, it shows “what may have been omitted

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or occluded in the primary autobiographical writings.” Reading My Father also demonstrates, one of the anonymous reviewers adds, how life-writing, often treated as a highly individualistic form, is entangled with social, familial, and relational networks and conflicting accounts, especially when it is about an experience of mental illness whose nature may itself be relational and intergenerational and whose representation is often intertextual. We will see similar entanglements in the Millett, Sexton, and Slater chapters. Part memoir, part elegy, and part eulogy, Reading My Father captures William Styron’s many confounding sides, including his “egalitarian spirit and his raging narcissism” (p. 196). A graduate of Columbia University’s MFA program, Alexandra demonstrates a family’s difficulty living with a writer whose life revolved around his work, for better or worse. Under the spell of a fickle muse, he experienced the ecstatic highs of astonishing bursts of creativity and the abysmal lows of paralyzing blocks. Alexandra conveys more poignantly than James West the vagaries of her father’s creative process. Unable to complete a novel after the publication of Sophie’s Choice in 1979, Styron spent his remaining decades ruminating over the novels he could not bring to life. He succeeded in crafting elegant short fiction and an iconic memoir, but he always felt he was primarily a novelist – and thus, in light of the desertion of his muse, a failed writer. His sanity depended upon novel writing, and his failure to complete another novel affected every aspect of his life. Those of us who were close to him saw the signs for years, in his reticence to talk about his work, in the set of his shoulders as he approached his study, in the profound privacy and solitude of his experience. His writing must have been, literally, driving him mad. And that, more than any of his other peccadilloes, may have been his greatest secret. (Reading My Father, p. 156) The sports writer Red Smith is credited with the statement, “Writing is easy. You just open a vein and bleed.” Styron would have gladly opened all his veins if the solution to writer’s block were that easy. Alexandra Styron raises a chicken-or-egg question about her father’s depression and writer’s block. Did his depression prevent him from

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writing, or did writer’s block lead to depression? She favors the latter explanation, but her father’s lifelong editor, Robert Loomis, disagreed strongly. “His illness made it impossible for him to finish anything. Not the other way around” (p. 163). The two possibilities are not mutually exclusive. Writing was always vexing for Styron. He wrote enough during the beginning and middle of his career to keep from becoming seriously depressed, but depression returned and never entirely left him when he couldn’t slay the gorgon surrounding The Way of the Warrior. Alexandra describes the uncompleted novel as her father’s “magnetic and elusive white whale” (p. 243), one the monomaniacal novelist could not defeat. Gavin CologneBrookes raises another chicken-or-egg question. “The unanswerable question Darkness Visible poses is whether the memoir echoes the novels or the novels echo the experiences he illustrates in the memoir” (p. 57). Again, both explanations seem true. Styron sought his entire life to write about the darkness of depression and suicide, as his novels demonstrate, but when he could no longer imagine that he was writing about fictional characters, he turned to the memoir, which allowed him to bear witness to his own suffering. Like many people, Styron was good at disguising his depression, at least during the initial stages. “I did not see the handwriting on the wall: incipient depression,” Rose Styron admits (Selected Letters, p. x). Robert Loomis also missed it, as he told Alexandra Styron. “I didn’t know that the depression was setting in.” Loomis mistook Styron’s depression for irritability over negative reviews of his books. Both depression and harsh criticism permanently eroded Styron’s self-confidence. “I don’t think he ever got his self-esteem back,” Loomis continued. “The wounds were open, and they just wouldn’t close” (Reading My Father, p. 166). After the breakup of a four-year relationship, Alexandra Styron went into psychoanalysis in 1987, at age 21, to make sense of her life. Her confusion, she readily admits, was caused by growing up with a “nutcase” father who was angry or depressed much of the time. If there was a golden rule in the house, she caustically says, it was, “Don’t ask Daddy about his work” (p. 5). Family life followed a strange irony: “the more fun my father had, the less he wrote. And the longer he strayed from his desk, the more difficult it was to feel good” (p. 103). She quotes a statement her mother made about the novelist that became part of his medical records: “often angry, down on world and/or me, pattern over yrs, when not in middle of a book” (p. 165).

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ALL THE FINEST GIRLS Of Styron’s four children, Alexandra Styron is the only one who has followed in her father’s footsteps by becoming an author. Writing Reading My Father was an act of filial love and devotion, one that her father might have appreciated if he were in good health; she is as intent on capturing troubling subjective truths as he was. Her decision to become a writer required a number of counteridentifications, as can be seen in her 2001 novel All the Finest Girls, which reveals her life growing up in a privileged Connecticut family darkened by her parents’ unhappy marriage and her father’s volatile moods. The narrator of All the Finest Girls, Adelaide Abraham, has a problematic relationship with her father, Henry, a polarizing philosophy professor whose writings betray a doom-and-gloom approach to the country’s incendiary racial conflicts. “He made quite a splash; his scholarship and keen intelligence were difficult to ignore. But, in a post-Holocaust world, Hank’s philosophy was ultimately totally unpopular” (p. 101). Estranged from her father, in part because of his divorce from his wife, Adelaide (which is also the name of Paul Whitehurst’s dying mother in “A Tidewater Morning”) remains furious at him, believing he has betrayed not only those closest to him but also his ideals. She writes him a vitriolic letter, after his remarriage to his young teaching assistant, in which she tells him that she is now enrolled in a “snappy little course on contemporary American philosophy. You are not on the syllabus.” For her part, she adds, “I took comfort in a philosophy constructed in direct opposition to his beliefs: I embraced my own very human right to ignore his existence” (p. 103). In real life, though, Alexandra Styron could not ignore her father’s looming presence, even if he ignored her career as a novelist. One of her deepest disappointments was his refusal or inability to read her novel: “Has Daddy read my book?” I asked my mother. I was trembling with anxiety and riven with hurt. “I don’t know,” she said, her voice reedy, strained. “He’s not feeling well. He’s been going downhill a bit.” I said I was sorry to hear it but didn’t ask to speak with him. I was too confused by my welter of emotions. What, exactly, was I to feel?

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When Ed [her future husband] and I went home for Easter, my father avoided or ignored me all weekend. On the stands that month was an interview I’d done with Talk magazine, in which I’d neither confirmed nor denied the autobiographical elements of my novel. But I had said something like, “Nobody’s parents are perfect.” Stricken by Daddy’s coldness, I went up to his room, where he lay on the bed reading, and groveled before him. “I’m really sorry about that piece,” I said. “It was all taken out of context. I didn’t mean anything by it.” “Okay,” he said, gruffly, putting his face back in the book he was reading. “Fine.” (Reading My Father, p. 274) It was not fine, however, and Alexandra Styron tempered her disappointment with the knowledge that her father’s generosity of spirit was compromised during his final years, when he was racked with physical and psychological illness. His life was never the same after 2000, when depression returned again with a vengeance, along with two separate bouts of oral cancer in 2004 and 2006. James West ends his biography with an affirmative coda evocative of autumnal ripeness: “Styron takes his daily walks and still sets a good pace. At seventy-two he remains innovative and productive” (p. 456). That was true in 1998 but not two years later. “Styron’s final years are unproductive, as the results of depression affect his narrative ability.” Rose Styron’s muted sentence in Selected Letters (p. xxv) tersely characterizes the events following August 20, 2000, the turning point in his permanent decline, when he was once again hospitalized for acute depression. Alexandra Styron offers more details. What happened next is, depending on how you look at it, just another chapter in my father’s picaresque journey to the grave or a monumental turn of events, after which nothing would ever again be properly aligned. (Reading My Father, p. 263) Around this time Styron asked his friend Edward Bunker to provide him with a “suicide cocktail,” later apologizing for the request in a letter written on June 4, 2000: “That was a half insane idea of mine and of course one that would put you in jeopardy. Forgive me for the loony thought” (Selected Letters, p. 635).

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Overwhelmed by hallucinations, paranoid delusions, and mania, Styron continued to reject talk therapy and psychopharmacological medication, insisting instead on electroconvulsive therapy (ECT), which is often effective for depressions that cannot be treated in any other way. He must have been desperate; Rose Styron reports in her essay “Strands,” appearing in the 2001 edited volume Unholy Ghost: Writers on Depression, that her husband “begged” her not to approve ECT for him, fearful that his brain would be permanently altered (p. 134). He had a number of ECT treatments but then developed serious side effects, forcing an end to the procedure. Alexandra Styron’s patience for her father was exhausted by this time. There was a willful self-indulgence about my father’s behavior, a childishness. It was as though he were throwing himself on the pyre of depression, rather than trying to resist the flame. (Reading My Father, p. 247) And yet Gavin Cologne-Brookes’s recollections of visiting Styron for the last time, in March 2002, were not entirely gloomy. He noticed that Styron’s gait showed signs of Parkinson’s disease, but he was the “same cheerfully glum Bill,” a particularly apt oxymoron. Styron was candid about the therapy he had received. “You know I had shock treatment, don’t you? Well, it was my decision, and it worked. But I feel spacey much of the time. It’s hard to describe” (p. 36). A SUICIDE LETTER TO HIS READERS About a third of the people who attempt or complete suicide leave a note, but Styron may have been the only novelist who penned a suicide letter to his readers apologizing for an act that never occurred. Styron’s second major depression was so severe that he wrote a letter to his readers on June 5, 2000 confessing that he might not be able to prevent himself from taking his own life. The unprecedented letter, filled with foreboding, was mailed to James West: To Readers I hope that readers of Darkness Visible – past, present and future – will not be discouraged by the manner of my dying. The battle I waged against this vile disease in 1985 was a successful one that brought me 15 years of contented life, but the illness finally won the war.

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Everyone must keep up the struggle, for it is always likely that you will win the battle and nearly a certainty you will win the war. To all of you, sufferers and non-suffers alike, I send my abiding love. William Styron To be made public at my death and published in all subsequent editions of Darkness Visible. (Selected Letters, p. 640) Styron’s communication to his readers, on which Selected Letters ends, implies that suicide is like terminal cancer, beyond a person’s control. The paradox of the letter is that although many people regard suicide as the ultimate act of free will, the decision to terminate existence, it is sometimes an involuntary act, beyond volition. If, as clinicians and researchers like Kay Redfield Jamison tell us, the vast majority of people who attempt or commit suicide suffer from a mood disorder and, therefore, are not thinking clearly, then the degree of free will is radically limited. This is what Styron greatly feared. Reading Styron’s note to his readers, one is grateful that he resisted ending his life, but if he did, in fact, succumb to suicide, I don’t think that many of his readers would find the note “pornographic.” This is indeed Marc Etkind’s cynical thesis in … Or Not to Be, a 1997 collection of suicide notes. Etkind opens the book with a startling statement. “In reading these, the most intimate documents, you are a sadistic voyeur, transforming someone else’s pain into your own pleasure. Suicide notes simply should not be read by strangers” (p. vii). We may no doubt experience a wide range of emotions when reading a suicide note, including dark emotions, but most readers will experience compassion, particularly if the suicide attempt has been unsuccessful or, as in Styron’s case, remains unenacted. One can only imagine the unspeakable terror that drove Styron, riven with panic, to write the letter – and perhaps the inexpressible satisfaction he might have experienced, during his final hours six years later, when he knew he was dying of something else, pneumonia. Succumbing to pneumonia is, in many ways, like drowning and suffocation, gasping breathlessly with lungs filled with mucus until death arrives mercifully. Drowning and suffocation, we recall, are major symptoms Styron associated with suicidal depression. But Styron’s final drowning and suffocation did not come from

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self-inflicted death. The only way we can know we will not die of suicide, someone once said waggishly, is to die of another cause, and perhaps Styron had that consolation in his final hours. A LIFELINE Even after Styron realized that he would never bring The Way of the Warrior to life, he had two remaining lifelines: his family and friends, and his readers. He received a torrent of letters from readers of Darkness Visible testifying that the book helped to save their lives, and he faithfully answered nearly every letter, grateful he could help. One cannot escape the impression from reading Alexandra Styron’s book that her father was, like everyone else, a flawed human being – perhaps more flawed than many people – but his best self was his literary self, the author of an imperishable memoir that touched innumerable lives. After writing Darkness Visible, Styron took on a new purpose in life, patiently answering nearly every letter from readers who were desperately seeking comfort. No one would have predicted, from Styron’s early or even middle career, that he would become an outspoken activist for suicide prevention – he was selected as the Honorary Director of the American Foundation for Suicide Prevention, a position that placed the normally reclusive writer in a public spotlight. He took the role seriously, and in doing so, found a new purpose in life. Many writers, some of them depressed and suicidal, have paid tribute to Darkness Visible. To cite only one, the distinguished British developmental biologist and BBC broadcaster Lewis Wolpert praises Styron repeatedly in his 1999 memoir Malignant Sadness: The Anatomy of Depression, citing his “marvelous descriptions of depression” (p. x) and his acute understanding of hopelessness that is a key factor in the disease. Wolpert opens his book with an arresting sentence: “Severe depression is a weird state – if you can describe your depression you almost certainly have not truly experienced it” (p. 1). That’s one of the reasons Wolpert admires Darkness Visible: Styron never pretends he has captured the disease. Like Styron, Wolpert also needed the security of a locked psychiatric ward when he was in a state of suicidal crisis. One sees a camaraderie between Styron and his readers, particularly his depressed, suicidal readers, that is rare in literature. It is no exaggeration to say that writer and reader each needed the other for support. Styron

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referred to these missives, without boasting, as “You-saved-my-life” letters, which he received almost every day after the publication of Darkness Visible. In one particular letter, the writer thanked Styron for the “book that was every bit as responsible for saving my life as the surgeon and internist who put my body back together after my suicide attempt” (Selected Letters, p. 630). “More than once,” Alexandra Styron remarks, he got a late-night call from the police. Someone somewhere was intent on committing suicide, but they kept mentioning Bill Styron. Was it possible he might try talking the poor fellow down? (p. 10) Styron obliged. These letters and telephone calls are dramatic examples of a positive contagion effect, a writer’s ability to inspire hope and courage in others. He knew, as he wrote to his friend Willie Morris shortly before the publication of Darkness Visible, that a vast number of people suffer from the malady of depression: “my message is fairly simple: tough it out, brothers and sisters, for one day you will get well” (Selected Letters, p. 608). Writing while her husband was still alive, Rose Styron commented on her husband’s power to comfort his readers and, in the process, receive comfort from them. Bill’s spoken and written words of encouragement to countless such individuals and the speeches he’s given surely contribute to his own sense of well-being, and perhaps have even stimulated his continued creativity. Thus, the vision of a writer whose premier demand had been respect for his privacy, need for solitude and control of his environment slowly alters while the anxieties of those around him subside. (“Strands,” p. 136) Expressed differently, gratitude strengthens both donor and recipient. Styron’s message, expressed by a mental health professional in one of his novels, might have been satirized as a bromide; but coming from Styron himself, a survivor of a harrowing diabolical disease, the words have brought hope to a vast readership. A reader can admire Darkness Visible without having endured black depression, but the memoir has special meaning for those who have been in Styron’s situation. Admitting that he has “fought intermittently with the same illness since college,” Peter Fulham observed in The Atlantic in 2014, upon the 25th anniversary of

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the magazine publication of Darkness Visible, that Styron’s book was, “in almost every way, a first, and for that reason, his memory is solidified not just as a great American writer but as a pioneering advocate for mental health.” Writing in the New York Times on August 3, 2018, the thirtieth anniversary of the publication of “Why Primo Levi Need Not Have Died,” Pagan Kennedy cites Alice Flaherty’s statement to her that Styron was the “great god of depression” because of the profound influence of Darkness Visible. (According to Kennedy, Flaherty was Styron’s friend and doctor, a fact that does not appear in The Midnight Disease.) Kennedy also points out that Darkness Visible became a “guidebook” for many writers suffering from severe mood disorders. Kennedy quotes Andrew Solomon’s statement to her about the importance of the memoir. I got depressed and everyone said to me: “You have to read the Bill Styron book. You have to read the Bill Styron book. Have you read the Bill Styron book? Let me give you a copy of the Bill Styron book.” Solomon adds: “On the one hand an absolutely harrowing read, and on the other hand one very much rooted in hope.” Styron would have appreciated the influence of Darkness Visible, but he would have pointed out, with genuine humility, that the memoir speaks to the power of fiction and nonfiction. “There is a continuity in literature,” Styron wrote to a Florida-born poet and writer in 2001 who had said that reading Sophie’s Choice as an undergraduate in 1992 had changed his life. “How gratifying it is to me,” Styron continued, to think that my work may have inspired you in some way to create your own. It’s important – essential I should say – that books, which are lifelines to the future, continue to be written and read. I hope you will persist in your own quest to explore, as you put it, the darkest side of humanity and that you will find the right way of expressing what you have to say. I’m touched to think that my work may have helped in that valuable process. (Selected Letters, p. 638) In the end, Darkness Visible, Styron’s final study in the conquest of grief, became an enacted rescue fantasy, demonstrating a writer’s power to save lives.

2 “MY PROCLAIMED SANITY AND MY CONJECTURED MADNESS”: KATE MILLETT AND THE LOONY-BIN TRIP

Kate Millett dedicates her 1990 memoir The Loony-Bin Trip to “those who’ve been there,” fellow travelers who were diagnosed as medically psychotic, “crazy,” when they were in fact sane the entire time. She insists throughout the story that those who receive a psychiatric diagnosis are worse off than criminals: the latter retain their civil rights while the former are judged mad and stigmatized for the rest of their lives. The Loony-Bin Trip is one of the most extreme examples of the antipsychiatry movement, second only to Ken Kesey’s iconic 1962 novel One Flew Over the Cuckoo’s Nest. Millett’s memoir raises fascinating questions for readers, including those who, like her dedicatees, have been there and those who have not. Do we believe Millett’s version of reality, that she was involuntarily hospitalized, “busted,” as she derisively calls it, merely for acting differently? Or do we believe her family and friends’ accounts, that she was dangerously psychotic, out of control, and had to be protected from harming herself? Were her years of taking lithium a “collusion” with the psychiatric establishment, as she angrily maintains, or a treatment that saved her from almost inevitable suicide, as her family and friends argue? Is psychiatry a sinister form of totalitarian control or a medical specialty that aims to ameliorate suffering? After reading The Loony-Bin Trip, one recalls a statement in Henry James’s classic novella The Turn of the Screw: “the story won’t tell, not in any literal, vulgar way.” Millett’s memoir is

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fraught with ambiguity and mystery, not about the possible existence of ghosts, as in James’s psychological thriller, but about the spectral workings of the human mind. Juxtaposing past and present, The Loony-Bin Trip focuses on several key psychiatric events in Millett’s life. The memoir opens in 1980 when she is at her Poughkeepsie, New York farm, an artist’s colony for women that became the Millett Center for the Arts in 2012. Forty-five years old, she decides to go off lithium, which she has been taking begrudgingly since 1973, her first psychological crisis. She has long detested the drug because of its debilitating side effects: diarrhea, tremors, and mental sluggishness. Abstaining from the drug without “freaking out,” she believes, will reestablish her sanity and demonstrate that she was never psychotic. The story then flashes back to 1973 when, stressed by a disintegrating marriage, a problematic relationship with a lesbian lover, the loss of her studio apartment in the Bowery in lower Manhattan, and an unsuccessful effort to prevent a civil rights activist in Trinidad accused of murder, Michael X, from being executed, Millett appeared to break down while giving a public lecture at the University of California, Berkeley, where she was a visiting professor. Alarmed by her behavior, and using a pretense, her older sister, Sally, an attorney, drove her to Highlands Hospital in Oakland where she was diagnosed as manic depressive and committed against her will. A few days later she was taken to Herrick Hospital in Berkeley and then to Napa State Hospital, a hospital “for the indigent,” where she was treated with the antipsychotic drug Thorazine and lithium, a mood stabilizer used for manic depression. She was released after 10 days only when she signed a document, which she later claimed was written under duress, stating that she was voluntarily hospitalized, and agreed to the need for further treatment. Later that summer, when she returned to her home in Minnesota to visit her mother, she was again involuntarily committed, this time to the Mayo Wing of the University of Minnesota Hospital. Ten days later she was released by her lawyer, a “civil rights” victory that appalled her family. Millett narrowly avoided another institutionalization in New York City in July 1980 when her younger sister, Mallory, two friends, and a young psychiatrist tried to convince her to hospitalize herself for her own safety. When she refused, they sought to commit her involuntarily. Racing out of her apartment and screaming for help, she saw three squad cars and two ambulances with six ambulance crew members ready to carry her away.

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She was “rescued” only when she persuaded a sympathetic policeman that the crisis was due to a “family misunderstanding” rather than a psychological breakdown. The officer reminded the family that patients cannot be hospitalized against their will in New York. Millett was jubilant, but her psychiatric ordeal was not yet over. The most terrifying scene in the story, which gave rise to the title of the memoir, occurred a few months later when she flew to Ireland and found herself inexplicably detained at the Shannon airport and then committed to a psychiatric hospital where she spent three weeks incommunicado. The story becomes Kafkaesque at this point, and the reader shares Millett’s confusion over the bewildering events that have conspired against her. Why was she arrested? For simply being a “lithium truant,” as she bitterly speculates? Why did her family, friends, and a lawyer-friend who specialized in civil rights cases refuse to secure her release from the hospital? How can she now prove she was sane the entire time? The Loony-Bin Trip becomes a gothic horror story, recalling not so much the events in The Turn of the Screw but the sensation fiction of Wilkie Collins, whose 1859 novel The Woman in White focuses on the wrongful patriarchal arrest and confinement of a virtuous heroine later proved to be sane. Millett was finally released, but her life would never be the same.

SEXUAL POLITICS To understand Millett’s antipsychiatric vision in The Loony-Bin Trip, her conviction that manic depression is a patriarchal construction, a psychological “disorder” that has been used to force women to submit to a repressive society, we may look at her earlier books, all of which document her rejection of authoritarian control. Millett achieved instant fame with the publication of Sexual Politics in 1970, which began as her Columbia University doctoral dissertation. Nearly 550 pages long and abounding in hundreds of scholarly footnotes that reveal her prodigious reading and keen assimilation of primary sources, Sexual Politics is, as Barbara Hardy enthused in her New York Times review, a rare achievement: Its measure of detachment is earned by learning, reason and love, its measure of involvement is frankly set out. It is a piece of passionate thinking on a life-and-death aspect of our public and private lives.

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Sexual Politics remains, nearly a half century later, a groundbreaking book, articulating an entirely new way of reading male authors. There’s little that is personal in the highly polemical Sexual Politics – Millett’s startling self-disclosures appear in her later books. Nevertheless, she never shrinks from conveying her anger and indignation over the historical mistreatment of women. She argues convincingly that sexual politics pervades every aspect of life. Like race and class, sexual politics is “primarily an ideology, a way of life, with influence over every other psychological and emotional facet of existence” (p. 237). Already we can see her interest in the psychological implications of her thesis. In her view, Freud was the “strongest individual counterrevolutionary force in the ideology of sexual politics during the period” (p. 251). She doesn’t entirely reject psychoanalysis. The “real tragedy of Freudian psychology,” she opines, “is that its fallacious interpretations of feminine character were based upon clinical observations of great validity” (pp. 252–253). She objects not only to the discredited theory of penis envy but also to what Freud believed were the three corollaries of feminine psychology: passivity, masochism, and narcissism. It’s noteworthy that Millett regards therapists as politically conservative, all of whom deplore, in her opinion, “individual maladjustment to social and sexual role” (p. 314). Sexual Politics is an impressive work of scholarship and criticism – the “Bible of Women’s Liberation,” as the New York Times referred to it – and it has justifiably earned the status as a feminist classic. Its achievement is not marred by occasional factual errors, as when Millet declares in a footnote that Freud’s famous patient “Little Hans” was his grandson (p. 258, n. 65). Little Hans was, in fact, the pseudonym for Herbert Graf, the son of the Viennese music critic Max Graf. (Millett was probably thinking of Freud’s discussion in Beyond the Pleasure Principle of his 18-month-old grandson, Ernst Halberstadt, whose game of throwing and retrieving a reel of thread was the inspiration behind his grandfather’s theory of the repetition-compulsion principle.) Millett is guilty of more serious interpretive errors, however, when she reduces the complexity of a character’s motivation, as can be seen in her discussion of D. H. Lawrence’s autobiographical novel Sons and Lovers. In the most wrenching scene of the story, Paul Morel gives his dying mother, consumed by ravenous cancer, milk diluted with water. “By a nice irony,” Millett asserts, the son is murdering her who gave him life, so that he may have a bit more for himself: he who once was fed upon her milk now

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waters what he gives her to be rid of her. Motherhood, of the all-absorbing variety, is a dangerous vocation. When his first plan doesn’t work, he tries morphine poisoning. (p. 350) Millett’s reading ignores the many moments in the novel when Paul is griefstricken over his mother’s terrible suffering. As Paul dilutes her milk with water, Lawrence tells us that the son “loved her more than his own life” (p. 42). After Paul laced her milk with crushed morphine, “he put the feeding-cup between her lips that he would have died to save from any hurt” (p. 464). Millett’s failure to grasp the complexity of Paul’s tortured emotions, the depth of his love as well as his hate, is symptomatic, as we shall see, of her reductive interpretation of character motivation in The Loony-Bin Trip. Millett’s comments in Sexual Politics about Norman Mailer have relevance to some of her own thematic preoccupations. Mailer is paradoxical, full of ambivalence, divided conscience, and conflicting loyalties. There is probably no other writer who can describe the present and its “practical working-day American schizophrenia” so well. (p. 440) Millett uses words like “schizophrenia” and “schizophrenic,” not to mention “mad” and “crazy,” in a metaphorical rather than clinical sense. She is attuned to the ways in which novelists like Mailer repeat themselves in the effort to work through their deepest fears. “When a novelist is obsessed with certain traits of behavior, his characters tend to repeat themselves from one book to the next” (p. 441). This statement is true of her own writings. There are many reasons why novelists and memoirists may feel haunted, but what’s significant is the way in which they return repeatedly to their demons in an effort to exorcise them. Millett is also sensitive to the ways in which oppression creates a dark psychology among the oppressed. She singles out Marxism for neglecting, “perhaps out of nervous dismay, to notice how thoroughly the oppressed are corrupted by their situation, how deeply they envy and admire their masters” (p. 90). Millett refers to Jean Genet here, but one can add that sometimes those struggling with mental illness may bitterly resent their caregivers and physicians. THE PROSTITUTION PAPERS: A CANDID DIALOGUE Millet’s next book, The Prostitution Papers, published in 1971, played a significant role in freeing her, as she admits in the introduction, “from

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the academic manner – distant, ironic, mandarin – with which I had begun as a writer” (p. 9). Following the publication of Sexual Politics, which launched what promised to be a trailblazing academic career, Millett became a full-time activist and organizer for the women’s movement. Forging a different literary style resulted in a more personal, direct, and self-disclosing relationship with her readers. She acknowledges that her Oxford University education – she was one of the first American women to be awarded first-class honors while studying at St. Hilda’s College, Oxford – was paid for by a wealthy aunt who demanded, as a condition for financial support, that Millett break off her relationship with a female lover. As Millett ruefully confesses in The Prostitution Papers, the “upshot was that I had to renounce my friend or give up Oxford. Didn’t do either: I lied to them and went to Oxford with her” (p. 91). Her aunt, a leading figure in St. Paul, Minnesota and a friend of F. Scott Fitzgerald, found out about the broken promise and never forgave her niece. Millett later wrote about her, “Aunt Dorothy,” with whom she was never reconciled, in the 1995 memoir A. D. Millett relives in A. D. some of the nightmarish events she writes about in The Loony-Bin Trip, but one new detail is that she has learned from her aunt to “detest and despise” psychiatrists. For this reason, Millet was aghast when her aunt disclosed that, following the death of her husband, she had been seeing a psychiatrist. “Only a terrible crisis” Millett informs us, “would bring her to confide in such a person.” Her aunt’s revelation is so disturbing to Millett that she cannot help adding, A. D. in the hands of a shrink: the goddess of wisdom trafficking with a quack. You do not leave the church and abjure confession to tell your troubles to a paid listener – submit your very soul to a charlatan without even spiritual pretensions. (A. D., p. 75) The Prostitution Papers is the first of Millett’s confessional books. She shatters “political correctness,” an expression not yet popularized, by acknowledging personal weaknesses she had criticized in Sexual Politics. An observation in Sexual Politics about Norman Mailer’s The Naked and the Dead – “the novel is so ambiguous, so uncertain of itself, that it tends to endorse what it appears at first to parody” (p. 450) – is no less true of her own books. The most striking example of a subject at first parodied and then endorsed is female masochism. “There is much cant about female

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masochism,” she points out in The Prostitution Papers. “One hears from males in general and Freudians in particular that it is congenital.” Yet even as she recognizes that female masochism is a hoax, she surprisingly reveals that she has acted masochistically in her own life. It’s true that she places quotation marks around the questionable word, but that doesn’t detract from the power of her self-disclosure. Yet I know that I behave “masochistically” myself; I know that I continually make myself suffer in ways that men wouldn’t think of. And I do it because masochism is part of the female role. It’s feminine and I have been trained into it, even unconsciously. (The Prostitution Papers, p. 97) Millett doesn’t give specific examples of her self-destructive behavior – she’s not ready to do that – but a few pages later she reveals that “This has been the most difficult bit of writing I’ve ever done, the most costly in time and psychic energy” (p. 100). Millett discloses near the end of The Prostitution Papers, almost as an aside, that she worked in St. Peter’s Asylum, a “lock-up” mental health hospital, during the summer when she was 18. She describes the inmates more as political prisoners than patients. Millett devotes only a few sentences to this experience, but the summer job made an indelible impression on her. Soon she will be one of the inmates struggling to escape. FLYING “What are you writing now, dear?” Millett’s mother asks her near the end of the sprawling 1974 semi-stream-of-consciousness autobiography Flying. “Another book, Mother, a little crazy, it’s about me. No, well, not quite an autobiography” (p. 433). Helen Millett is not misled by her daughter’s evasive answer. “You’re not going to put that awful stuff about Lesbianism in it?” To which her daughter confides to the reader, “Hit finally. At last. There it goes, blown” (p. 433). Flying was a daring autobiography when it appeared in the mid-1970s, and its revelations about Millett’s bisexuality and lesbianism scandalized her staid Irish Catholic family, particularly her mother, to whom the book was dedicated. Described by The Times (London) as an “experiment in total truthtelling,” Flying is remarkably frank about the instant fame Millett achieved early in her career, when she was celebrated for Sexual Politics.

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She achieved perhaps the ultimate symbol of American stardom, appearing on the August 31, 1970, cover of Time magazine, which hailed (or demonized) her as the “Mao Tse-tung of Women’s Liberation.” The 1970s was a heady time for Millett, when everyone seemed to be talking about Sex Pol, as she affectionately calls it. (Sex-Pol was the title of a book of essays by the Marxist psychoanalyst Wilhelm Reich, whom Millett references in Sexual Politics; Sex-Pol was also the nickname, as Christopher Turner observes, of a German organization in the early 1930s which, in its commitment to sexual and political reform, sought to unify Freudianism and Marxism [p. 130].) Embarrassed and yet proud of her fame, she worried about betraying the feminist movement by remaining with her husband, Fumio Yoshimura, a Japanese sculptor to whom she was married from 1965 to 1985. It’s no surprise that their marriage was faltering. The 1970s was the era of free love, and Millett describes the shock of falling in love with a woman as well as the need for public self-disclosures, about which she remains ambivalent. It had never before occurred to me to regard myself as subject matter. Though I like to imagine this is my first book, I seemed, at thirty-six, to be past the age of the obligatory autobiographical novel. Sensible friends recommended research topics: pollution, erudition, etc. The confessional should wait upon one’s ripe old age. (Flying, p. 83) And yet in the next breath she concedes that she cannot imagine living to a ripe old age. Flying chronicles the sudden end of Millett’s once-meteoric academic career, when she was dismissed from her teaching position at Columbia’s Barnard College in 1968. Scattered throughout Flying are hints that she is crashing. She recalls climbing to a rooftop with her friend Jill where they discuss their “nervous breakdowns.” Neither can understand the other’s breakdown – nor can the reader because of a lack of detail. “Mostly I am terrified it will come again,” Millett nervously confesses (p. 191). She confides to her friend Paul in London that “Last time I was here I was more than a little crazy. Had something like a nervous breakdown” (p. 261). Finishing the documentary film on which she was working “saved my life” (p. 261). She similarly confides to her friend Celia that “I went crazy” and then adds, crying, “Celia it was awful it hurt so, thinking I could never work and wanted to die the future was too boring to wait for” (p. 448).

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The breakdown of Millet’s grammar evokes more poignantly than her words the frightening loss of psychological control. Millett offers additional information in Flying about the summer after her freshman year of college when she worked in a psychiatric hospital, a snake pit. The only psychiatrist in the whole place was an administrator for eight thousand people. Two part-time psychologists interviewed a few promising patients a week. Get to see a doctor if you break a leg, discredited physicians from the city. One invites me over for Schubert and starts to come on. Rumors they abuse the female patients, fucking hopelessly crazy bodies. Mind all gone do they feel the indignity of use? (p. 138) Idealistic, Millett resolves, after reading Karl Menninger, that retraining psychiatric aides, the only personnel close to patients, is the key to psychiatric reform, but when she discloses the scheme to “big nurse” and volunteers to stay on as a “free-lance therapist,” the idea is ridiculed. Never again will she consider the possibility of evolutionary psychiatric reform. Her prescription for psychiatric reform is to dispense entirely with the profession. One of the most intriguing moments in Flying occurs when Millett records a conversation with the British writer Doris Lessing (1919–2013), the author of The Golden Notebook. Lessing, who was awarded the Nobel Prize for Literature in 2007, listens empathically to Millett’s agony over writer’s block and encourages her to write self-disclosingly. She confides to Millett that the most difficult passages to write in The Golden Notebook were those that were highly personal – the passages of which she is now most proud. Lessing received many letters from grateful women who were able to identify with her nerve-racking experiences. “And she tells me people write her from loony bins,” Millett confides to her own readers. “And she writes back” (p. 358). Lessing appears to have been the inspiration behind The Loony-Bin Trip. “I cannot cure this woman’s mind but I do read her manuscript,” Lessing explains to Millett in Flying. And it is fascinating. The whole thing pours out of her. So I suggested she write a book. Now I can’t wait to read it. In fact this is the only sort of thing that interests me now. What people write about their lives. I want to see what you do too. (p. 358)

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SITA Millett’s next book, the 1976 memoir Sita, is mainly about her tumultuous relationship with a woman whose life was alternatingly a drama and melodrama. The book jacket’s description is revealing. Immersed in the mania of this love, the narrator dwells on what it was at its best, honestly, unsparingly recounting all the hopes and tricks and evasions – the minutiae of the erotic dance as well as the mundane patterns of living together. The word mania is striking, for the memoir contains many of the details of Millett’s psychiatric crisis that appear in The Loony-Bin Trip. Indeed, Sita appears to be a rehearsal for The Loony-Bin Trip, an effort to alert readers to painful and shameful details that will be interrogated more fully 14 years later. Sita is among the first to be alarmed over Millett’s deteriorating mental health. Once when she came to visit me at my farm during my breakdown and I was busy being crazy and had neglected to wash my hair, she hit upon that as the most visible proof of my madness. Wrote a nasty letter to all my friends and family bringing my deplorable condition to their notice on this account. I was already a damaged product. (p. 25) Millett doesn’t elaborate on why she believes Sita’s letter was “nasty” rather than “concerned,” “worried,” or even “desperate,” adjectives others might use to describe a friend’s efforts to help a loved one in a crisis. Millett refers repeatedly to her “breakdown,” and it’s evident that her crisis is ongoing throughout the story. Sita is implicated in the events that led to Millett’s involuntary hospitalization at Highlands Hospital, Herrick Hospital, and then at Napa State Hospital. Millett’s family used Sita “as bait when they moved me from place to place, so that the seventy-two-hour imprisonment the state permits in each of its ratholes would go on” (p. 97). Millett notes Sita’s “complicity” in the forced hospitalization in Minnesota. Once again, Sita is on the losing side, in Millett’s judgment. There was a trial with the best local civil-rights lawyers on my side, and I won. A sanity trial, the modern counterpart of

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an inquisition against a witch. Sanity is probably impossible to prove, but they couldn’t prove insanity either. We won: I would not be committed for life. (p. 98) Millett assumes, here and elsewhere, that had she lost the “insanity” trial, she would have been institutionalized “for life,” rather than temporarily, until she recovered, as occurs with most voluntary and involuntary psychiatric hospitalizations. The two women repaired their quarrel; Millett can forgive Sita’s complicity but never forget it. Elsewhere, however, Millett remarks that she cannot forgive Sita’s treachery. The anger of the bin was in me, my fury at what they had done in order to lock me up, to dope me and hold me and make me despair of freedom. I tried but I could not forgive her. And she would permit me no anger, imagined I was still mad. And I suppose I was, a little. And she drove me madder. (p. 133) Millett then acknowledges the “long spiral downward into suicide. Six tries, two of them in earnest” (p. 133). She agreed to return to lithium as a resentful concession to avoid becoming suicidal again. Millett ponders the question of transmuting the story of Sita into a novel, a process that would give her the “cover of fiction” and perhaps make the experience “more worthwhile, less disreputable, even more ‘real’ to readers” (p. 251). Turning the story into a novel would allow her to escape from the “suspect waters of the personal, the autobiographical, the experiential – and into the safe harbor of fiction.” Writing fiction would also allow her to conceal her spoiled identity. Despite the temptation to create “high art,” she rejects fiction in favor of autobiographical experience. Yet even as she makes the fateful decision to write the story of Sita as a memoir, she realizes that, to an extent, all stories are fictional, if only because of the writer’s decision, conscious or not, to omit information. “What do you leave out, what do you falsify?” (p. 273), a question that preoccupies readers of The Loony-Bin Trip.

THE BASEMENT AND GOING TO IRAN Millett’s next two books focus on torture, not the psychological torment caused by her involuntary hospitalization in American and Irish psychiatric institutions, but the sadistic abuse of a shocking crime in Indiana in the

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mid-sixties and the wide-spread persecution of prisoners during the Iranian revolution. Published in 1979, The Basement: Meditations on a Human Sacrifice documents the case of Sylvia Marie Likens, a young woman tortured by Gertrude Baniszewski and her children over a four-month period in the basement of their home. The brutal crime enables Millett to speculate on why the victim appeared to collude in her own torture. Millett is both participant and observer in the 1982 exposé Going to Iran, where she describes her trip during the nascent states of the Iranian revolution. Arrested and then worried that she might be executed for being a lesbian – homosexuality was a crime punishable by death – she cannot help thinking about her earlier psychiatric imprisonment. Something breaks in me as it did when I was imprisoned before. The loony-bin trip. Hope fumbles, optimism, the expectation that one will be treated fairly: something breaks in fear, the nightmare known about but never expected, what happens to other people, the unlucky ones. (p. 251) Near the end of the story, shortly before her release, she learns from a friend that Sita has committed suicide, a loss that she doesn’t have the time to understand or mourn. Curiously, Millett refers to her lover’s death several times in Sita without informing us that she took her own life.

THE LOONY-BIN TRIP The Loony-Bin Trip thrusts readers into Millett’s dark world, a journey fraught with confusion, doubt, and insecurity. Part One focuses on the idyllic farm Millett purchased in upstate New York. Life is good, and Chapter 1 ends with Millett giving thanks for her special relationship with Sophie Keir, with whom she had been living for several years. “This is the happiest summer of my life” (p. 17). Chapter 2 opens on the opposite note. “Another morning and I wake up uneasy beside her. Something is going wrong with us. This new bickering, this vexation. A monstrous quarrel is growing between us” (p. 18). The Loony-Bin Trip abounds in sharp contrasts like this, where euphoria is followed inevitably by gloom. Millett expresses love and admiration for a relative or friend one moment, followed by anger, fear, and suspicion the next moment. She captures the startling affective changes of those who suffer from mood disorders, including the exuberance, grandiosity, and paranoia associated with manic states, and the abject

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self-loathing, dejection, and hopelessness associated with depression. Everything is unstable in the memoir, and readers find themselves as destabilized as the narrator. Reading the memoir is precarious and unnerving, like a car careening out of control. Readers may find themselves infected by the memoir’s dark emotions. Unlike other first-person accounts of mental illness, where there is a firm distinction between the author narrating the story and the benumbed, often confused protagonist who lives it, there is little narrative distance in The Loony-Bin Trip between Millett the author and Millett the autobiographical narrator who is having a breakdown. She seems to escape from the claustrophobic vision at the end of the story, when she announces that she has been able to stop taking lithium, thus proving to her own satisfaction that she has never been manic, but a surprise awaits the reader that calls into question her conclusion. Millett is on solid ground in attacking psychiatric abuses, but she remains troubled and perplexed about the reality of mental illness, preferring to deny its existence rather than understand its complex causes and consequences. MILLETT’S READING OF OTHER ACCOUNTS OF MOOD DISORDERS Before looking at how Millett interprets her relatives’ and friends’ behavior, we may observe how she reads other memoirs of mood disorders. She points out in the preface to the University of Illinois edition of The Loony-Bin Trip (2000) that after the initial publication of her memoir a decade earlier, [t]wo more books have since emerged that describe depression brilliantly, William Styron’s Darkness Visible and Kay Redfield Jamison’s Unquiet Mind, though the latter derives from a conventional psychiatric point of view, and the former offers no explanation at all, merely the experience itself. (p. 9) Millett praises the two books but mischaracterizes them. It’s true that Styron was helped by neither psychopharmacology nor talk therapy, both of which he criticizes, but he is emphatic that what saved him from suicide was the decision to hospitalize himself, a crucial detail that Millett ignores. She also ignores his observation about medication. Psychiatry must be given due credit for its continuing struggle to treat depression pharmacologically. The use of lithium

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to stabilize moods in manic depression is a great medical achievement; the same drug is also being employed effectively as a preventive in many instances of unipolar depression. (Darkness Visible, p. 54) Millett could have mentioned, in a statement that would have accurately characterized Styron’s experience, that although other psychiatric patients have been helped by hospitalization, she has not been one of them. Instead, she overlooks many of Styron’s most noteworthy observations. It is “something of a paradox,” he writes in Darkness Visible, that in this austere place with its locked and wired doors and desolate green hallways – ambulances screeching night and day ten floors below – I found the repose, the assuagement of the tempest in my brain, that I was unable to find in my quiet farmhouse. (pp. 68–69) Styron could not be clearer about what saved his life. “For me the real healers were seclusion and time” (p. 69). One would hardly call Kay Redfield Jamison’s An Unquiet Mind: A Memoir of Moods and Madness “conventional,” even if one meant by the word, as Millett probably did, a story that affirms the value of both medication and psychotherapy. Jamison took a risk writing about her history of violent mood swings, her delusional and grandiose thoughts, her close call with suicide, her ruined first marriage, and her extravagant spending that left her broke. Jamison risked not only disapproval by members of her profession but also losing her license to practice therapy. Part of the achievement of An Unquiet Mind is that it demonstrates the seductive nature of manic-depressive illness, a “fascinating, albeit deadly, enemy and companion.” Jamison shows both its alluring beauty and its deadly consequences, a characterization to which Millett objects. Millett’s dismissive readings of Styron and Jamison may be explained, in part, by Harold Bloom’s “anxiety of influence,” the theory he advanced in his 1973 book of the same title that writers misread their precursors in an effort to establish their own originality. A CONSPIRACY Although gender does not make someone patriarchal – women can and do oppress other women in a patriarchal society – Millett’s rejection of

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psychiatry as a patriarchal institution that oppresses women is called into question in The Loony-Bin Trip by the fact that all of her female relatives and friends, not to mention a female psychiatrist, urge her to seek medical help. Moreover, one suspects that if any of her relatives or friends doubted the necessity for hospitalization, she would have shared that information with the reader, since it would lend support to her conviction that she was never mentally ill. Instead, she uses the pronoun they to convey her belief that everyone conspires against her. She presents two points of view in the story, her own and everyone else’s. Though she concedes that there may be a “middle ground of being a little crazy (flipped out, upset, frazzled) or see crazy as a mixed state, an ambivalent affair” (p. 86), she never believes that she has been mentally ill, never psychotic. Throughout The Loony-Bin Trip, Millett’s loved ones seem to be plotting against her. Sophie is “running” her life, acting like a “bullying sergeant,” like a “prison guard in those prisons I thought I had left forever” (p. 28). Millett’s sister Sally, lover Sita, and husband Fumio “conspire with the state – the three of them, three of the people I love most in the world” (p. 39). Rejecting what is for her the fraudulent diagnosis of manic depression, Millett accuses her older sister of being motivated by “righteous spite” (p. 96). Millett is even angrier at her younger sister, whom she accuses of trying to imprison her. My little sister Mallory sits in uncomfortable glory in what is her bid to jail me – will this create family balance? I wonder. Mallory, who is so skittish herself, the flighty actress sister now sitting in judgment as part of the tribunal. (p. 152) Millett does not directly attack her mother in The Loony-Bin Trip for signing the commitment papers to institutionalize her at the University of Minnesota Hospital, but in her biography Mother Millett, she conveys her mother’s treachery. “Mother testified against me, her eyes dead as stone, empty as the void” (p. 31).

INTERPRETING TAPE-RECORDED CONVERSATIONS To avoid solipsism, or at least to present as objectively as possible a dissenting point of view before rejecting it, Millett includes two different tape-recorded conversations in The Loony-Bin Trip. The first involves a tape given to her by one of the apprentices volunteering at the upstate

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New York farm. Kim’s recording, based on her journal entries, documents the self-destructive consequences of Millett’s decision to discontinue lithium. The recording, which occupies seven pages of the memoir, describes Kim’s fear of Millett’s anger, Millett’s incessant screaming and ranting, her condemnation of the other apprentices, and her infliction of harm on others and herself. Throughout the tape Kim characterizes Millett as unreachable. “The only thing that’s crazy,” Kim concludes, “it is that you don’t see that.” Millett’s response? “A youngster’s truth – how deftly it accuses me.” Millett continues to feel, notwithstanding the apprentices’ statements to the contrary, that “If only no one had told them I was mad. Then I wouldn’t be” (p. 143). The second and more notable tape-recorded conversation occurs in Millett’s loft, when Mallory, Sophie, Janie Washburn, and a stranger who turns out to be a young psychiatrist, Dr Pulp, conduct an “inquisition” regarding her mental health. The tape-recorded dialogue allows us to hear not only the arguments used by the four women to persuade Millet to hospitalize herself voluntarily but also her hostile reactions to their statements. The chapter is among the most eye-opening in the memoir, betraying the feelings of helplessness experienced by a mentally distressed person and her anxious family and friends. As we read the chapter, we wonder how we might react to a person in a psychological crisis. Dr Pulp, whose medical license, Millett informs us, is “tantamount to police powers,” begins by acknowledging Millett’s long friendship with Janey Washburn: The doctor: “You two have known each other a long time.” “Yup – twenty-seven years or something. Janey likes to brag that we’re each other’s oldest friends, but she’s not a very good friend at this moment.” Janey’s face is hurt, uncertain. She had imagined in coming here she was doing a yeoman’s duty as a friend: one concerned, worried, anxious to help, consulted in crisis and unafraid, staunch. The moment my words are out I regret them. The doctor tries again. “Kate, some of the things people have been telling me that have been happening to you recently.…” “Well, they’re rumor and speculation.” I look around the room: only Sophie has been with me continuously; Mallory visited the farm for a day two months ago, Janey for a day one month ago; the doctor and I are total strangers – what has she

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to go on? I settle in and ask Sophie to pass me an ashtray. The doctor goes on: “I feel if I were to run down a list of them.…” “It would be hilarious,” I suggest. The doctor: “Well, what I would be doing is – might seem a process of accusing.” “You are, I agree.” “And I don’t want” – “Well you are. And they are accusations that one is non compos mentis. And believe me, lady, I have a fine mind” (p. 148). Dr Pulp does everything possible to empathize with Millett’s situation, beginning with the statement that Millett is one of the most articulate people she has encountered. Millett repeatedly changes the subject, offering learned but irrelevant disquisitions on language and culture. Each time Dr Pulp tries to bring her back to the present. When the psychiatrist remarks, in exasperation, “I don’t know why we can’t talk about this,” meaning Millett’s present distress, the latter tells us that the psychiatrist’s words were expressed “in a whining New York accent” (p. 150). Asked her professional degrees, the psychiatrist responds truthfully that she has an M.D., to which Millett concludes that “she is no mere therapist with a Ph.D. or an M.A. in psychology – this one has the hunting license.” Millett’s next words reveal the grave sense of danger in which she finds herself. “So you could call an ambulance and get me slammed?” “Right,” she says. She preens, for the first time now not a little girl, not a junior scholar, not a feminist foot soldier, but a general who could take me in tow as her captive and patient. The wonder, the frisson, the excitement in her approach to me now. Intimidation gives way to power. (p. 150) Millett functions as a defense attorney throughout the scene, attempting to find weaknesses in the defendant’s case. “Who’s paying you?” she challenges the psychiatrist in a “[w]onderful moment of confrontation.” The four women had not anticipated the question. “Only the doctor keeps her cool: ‘I had assumed that Mallory would,’ the doctor replies blandly.” When Millett demands to know the psychiatrist’s fee, Mallory responds, “that isn’t important right now.” Mallory’s answer is appropriate, but Millett tries to discredit it by citing her sister’s belief in astrology, whereas Millett is an “age-of-reason type” (p. 154). Suddenly the situation seems on the verge of exploding into violence when Millett accuses the psychiatrist of “threatening me with assault,” forced hospitalization. “It’s true that I

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do have that capability,” Dr Pulp grants, “but I really don’t want to do it.” Declaring that the psychiatrist should be ashamed of herself for her “collusion with the state,” Millett then counters with her own threat of assault: “cause if you do I’d want to slug you,” to which the psychiatrist responds, “Kate – don’t slug me” (pp. 156–157). Millett intends her readers to share her anger and indignation over the situation, her belief that the prosecutors are persecutors, but the psychiatrist has been trying to answer Millett’s provocative questions as honestly and sensitively as possible. The psychiatrist uses none of the “deceptive simplistic jargon of the profession” (p. 150) of which Millett finds her guilty. It’s hard to believe the psychiatrist speaks in a “whining” voice, “preens,” and relishes her power to commit a patient involuntarily. Later in the conversation, as Millett becomes more belligerent, Dr Pulp “oozes succulent self-satisfaction” when she expresses her distaste over involuntarily hospitalizing a patient. The tape-recorder offers objective evidence of the dialogue during this scene, but Millett ascribes the most nefarious motivation to the four women who are trying to help her. Escaping hospitalization, Millet interprets the psychiatrist’s final words to her as a monstrous joke: “you didn’t decompose … you kept your cool” (p. 167). Millett uses the two taped recordings to dramatize the surreal events of her life, when she was forced to undergo an Inquisition in an effort to prove her sanity. Readers, however, may reach the opposite conclusion, not that she was guilty of a crime, but that she was experiencing an acute psychological crisis.

SLEEPLESSNESS One of the core symptoms of manic depressive disorder is sleep disturbance. During a manic episode, one may not sleep for days. Sleep disturbance, in fact, is the most common symptom of mania. What’s striking about the many passages in The Loony-Bin Trip is that Millett attributes her sleeplessness to the malevolent actions of others, relatives or friends who are conspiring against her. “I am in too much danger and far too afraid to sleep,” she admits early in the story. “Without the conspiracy I might have been asleep hours ago” (p. 67). A few pages later she makes a stronger accusation. If I can sleep I can draw tomorrow. If I can sleep I will not go crazy, lose my grip, for it is slipping now; I can feel the

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sleeplessness undo me. The mind cannot bear that much wakefulness, and it is two nights now that I haven’t slept. Arguments, dissension, quarreling. Why does she go on goading me if she knows I must sleep? As if she is unaware of what she’s doing, ordering me to sleep and then harassing me so that I cannot. (pp. 82–83) Millett feels so sleep deprived, so “miles away” from sleep, so fearful that another night will pass without restful sleep, that immediately before she falls asleep, she experiences an eruption, a “storm in the mind, jerking me awake. Like a little explosion in the brain cells, a short circuit” (p. 84). Horrified that something will happen to her mind, she realizes that: You can hurt it by not sleeping; you have been playing some championship game with your opponents, day after day without rest, all to show you are made of iron and saner than God. And now you have blown your own fuses. (pp. 84–85)

THE LOONY-BIN TRIP IN IRELAND Sleeplessness is the precipitating cause of Millett’s psychological crisis at the Shannon Airport. Events seemingly beyond Millett’s control in October 1980 conspire against her, resulting in a psychiatric hospitalization described in the most chilling terms. Seventy-eight pages long, “Ireland,” part two of the memoir, can best be compared to the nightmarish world of One Flew Over the Cuckoo’s Nest. It’s never entirely clear why Millett provokes the suspicions of the airport’s menacing chief security officer, Patrick, who seems intent on arresting her for a crime she has not committed. “I suppose it started with washing my hair, this notion of using the airport as a free hotel” (p. 171). She then narrates the events that forced her to spend the night there. Two unfortunate incidents left her airport-bound. Returning her automobile from Ryan Car Rental, she forgot to retrieve her Nikon camera she had stored under the tire in the trunk. While waiting for the car to be located and the camera returned to her, she was ejected from her hotel because of a controversial book found in her room supporting Irish political prisoners’ hunger strikes. “You are not to have propaganda here, nor to distribute it” (p. 179), the hotel manager sternly admonishes her. Without a car or a hotel room, she has no choice but to spend the night at the airport, where she washes her hair in the ladies’ room and then falls asleep.

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Averring that Patrick would love any excuse to arrest her, Millett resolves to “outwit” him. Is she trying to outwit the reader too? Perhaps not consciously, but her narration is so disjointed, her memory so selective, the language so one-sided, that we cannot know for certain what is being revealed and concealed. Despite or perhaps because of her efforts to outsmart Patrick, she finds herself in trouble, and she gives him the telephone number of an Irish friend and law professor, Desmond Roach, who then telephones Mallory in the United States and learns about Kate’s near-hospitalization in New York City a few months earlier. Suddenly a physician at the Shannon airport begins interrogating her about her mental health. Three policemen eventually take her away to a psychiatric institution, Our Lady of Clare, a “mad house” from which she fears she will never escape. A psychiatrist tells her she is “high,” manic, a diagnosis that her mother’s doctor had also used to describe her years earlier. “Why did you stop taking lithium?” the psychiatrist asks her. “We have a report that you went off lithium in July” (p. 195). Millett had actually stopped taking lithium in May, but her response to the physician’s questions evokes her fear of totalitarian control: “Amazing international system of mental policing” (p. 195). All that one can infer from the story is that she was charged with “vagrancy and sleeping in the lavatory” (p. 231), a crime that hardly seems to warrant the drastic actions that follow. ANOTHER VERSION OF THE STORY Most readers of The Loony-Bin Trip are likely to agree with Millett’s version of the story, mainly because she controls the narration. She tells the story of an innocent woman who is humiliated by psychiatry’s oppressive power to enforce repressive conformity. Abandoned by her relatives and friends, she takes on, nearly singlehandedly, the entire psychiatric establishment and prevails. How can the reader not cheer her victory? The meaning of the story changes, however, when we read Mallory Millett’s counterstory, “No Gun Ever Killed,” in the online journal Truth Revolt on June 2, 2014, in which she documents her sister’s psychiatric woes. “We, as a family, had struggled for years with Kate’s issues, many times attempting to hospitalize her so she could obtain the serious help she so obviously needed.” Mallory refers to the time she visited her sister in 1973, when Kate broke down while giving a public lecture at Berkeley on a film Mallory had produced, Three Lives, about three women, one of whom was the filmmaker.

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She was babbling and shouting incoherently whilst I nodded and pretended every word made perfect sense. I could not betray her in public. I sat there feeling my heart melting through my chest and draining into my belly with an indescribable sick empathy. Her humiliation was unbearable as the gale whipped up to a force ten and with one last enormous surge we were left in an empty room. The second screening was cancelled. Mallory Millett recounts in “No Gun Ever Killed” her trepidation over being attacked in her sister’s apartment following the failed lecture. I was afraid to sleep for fear of awakening in a deadly pool of blood with a knife in my back. She stayed awake for five days babbling, ranting and wouldn’t allow me to sleep. She was seeing “little green men” and her eyes were literally rolling around in their sockets. Never have I been more alone and terrified. Referring to her sister’s “genius for chaos,” Mallory Millett implies that Sita committed suicide as a result of reading Kate Millett’s book. Finally, Mallory Millett offers her own explanation of why her sister was committed to a psychiatric hospital in Ireland. Upon arrival at the Shannon airport, she locked herself in the Ladies Room preventing anyone from relieving herself for twenty-four hours until the Shannon police broke down the door and committed her to an Irish psychiatric institution. Whose version of reality do we believe? Mallory Millett’s commentary appears in a publication of the David Horowitz Freedom Center, a radical right-wing think tank. Since its founding in 1988, the Center “has been warning,” to quote from its mission statement, that the political left has declared war on America and its constitutional system and is willing to collaborate with America’s enemies abroad and criminals at home to bring America down. The mission statement alone is sufficient to call into question the accuracy of Mallory Millett’s comments. Some of her statements are so extreme as

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to raise skepticism, such as the assertion that Kate was a “brutal sadist, a violent bully at whose hands everyone about her suffered.” Moreover, Mallory Millett’s accusation that Sita’s suicide was “in response to Kate’s ‘homage’” is likely an oversimplification. Mallory Millett is far from being an objective narrator; nevertheless, one senses that there is some truth to her story. She calls into question her sister’s belief that her relatives tried to lock her up because they hated her politics: “many in our family agree for the most part with her politics and so this accusation is absolutely absurd on it’s [sic.] face.” The explanation over Kate Millett’s incarceration at the Shannon Airport also makes sense. Nowhere in The Loony-Bin Trip does Millett suggest that she had barricaded herself for 24 hours in the airport lady’s room, forcing the police to break the door down to apprehend her. These details, Kate Millett certainly knew, would subvert her intended meaning of her story. The only clue Millett gives us regarding her incarceration occurs when she mentions a friend who raved that I had tried to live in the ladies’ room, for God’s sake, and I ranted back about the Nikon and Ryan and finally gave up. Useless to describe the bin. (p. 253)

MANIA OR HYPOMANIA? Throughout The Loony-Bin Trip Millett makes an implicit and sometimes explicit distinction between mania and manic depression. Unlike Jamison, she presents only the intoxicating side of mania and implies that its destructive side, manic depression, can be averted if other people simply ignore manic episodes without trying to intervene. “Depression is the victim’s dread, not mania,” she writes in The Loony-Bin Trip. For we could enjoy mania if we were permitted to by the others around us so distressed by it, if the thing were so arranged that manics were safe to be manic awhile without reproach or contradiction. (p. 72) She readily admits that she was manic but not that she was manic depressive, despite her relatives’, friends’, and psychiatrists’ statements to the contrary. Millett’s protestations raise a question confronting every biographically oriented scholar. “When a biographical subject tells you who

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he or she is,” Alan C. Elms remarks in Uncovering Lives: The Uneasy Alliance of Biography and Psychology, “you obviously should pay attention. But when the subject tells you who she or he isn’t, you should pay at least as much attention, and sometimes even more” (p. 246). Complicating the situation is the ambiguity between two psychiatric diagnoses on the same mood disorder spectrum, bipolar I and bipolar II. Bipolar I is characterized by the occurrence of at least one manic or “mixed” episode (one in which both mood poles, mania and depression, are experienced simultaneously or in rapid succession) and at least one or more depressive episodes. Bipolar II, which is more difficult to diagnose and is generally more chronic and recurrent, is characterized by the occurrence of at least one hypomanic episode and at least one or more depressive episodes. Hypomania does not always lead to mania, but mania is usually preceded by hypomania. Patients are generally not aware of hypomanic symptoms, partly because hypomania is often associated with heightened productivity. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), released in May 2013, hypomania differs from mania in two ways. Hypomania can affect functioning and quality of life for an individual with bipolar II disorder, but it is not as severe as a manic episode, which may require hospitalization. Additionally, hypomania does not involve psychosis. Those with bipolar II may experience less intense highs, but they often experience more severe and frequent depressive episodes. Bipolar II disorder, requiring the lifetime experience of at least one episode of major depression and at least one hypomanic episode, is no longer thought to be a “milder” condition than bipolar I disorder, largely because of the amount of time individuals with this condition spend in depression and because the instability of mood experienced by individuals with bipolar II is typically accompanied by serious impairment in work and social functioning. The DSM-5 classifies a hypomania episode as (A) “A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least four consecutive days and present most of the day, nearly every day,” and (B) “During the period of mood disturbance and increased energy and

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activity, three (or more) of the following symptoms have persisted (four if the mood is only irritable), represent a noticeable change from usual behavior, and have been present to a significant degree”: inflated self-esteem or grandiosity; decreased need for sleep; more talkative than usual or pressure to keep talking; flight of ideas or subjective experience that thoughts are racing; distractibility; increase in goal-directed activity … or psychomotor agitation; excessive involvement in activities that have a high potential for painful consequences. Few authors who are floridly manic have the control to write a coherent account of their psychosis, but authors who have been manic can write lucidly about their experiences when they are not manic. Authors who have not been manic, we should add, can also write about the experience, though perhaps not with the same authority. One cannot conclude from The Loony-Bin Trip alone that Millett was or was not psychotic when she was hospitalized in Ireland, largely because she wrote about the experience after the event. We can observe, however, that all of the symptoms of hypomania are present in The Loony-Bin Trip. She acknowledges her martyrdom fantasies and delusions of grandeur when she identifies repeatedly with Jeanne d’Arc. She makes a number of astute observations about the power of projection, as when she suggests that “My paranoia has provoked theirs” (p. 44). She also admits that the “more I fear my own insanity the more I must punish yours” (p. 68). These statements carry the ring of truth. There is one passage in which she reveals her experience with a state of mind she has grown to dread: But be honest. You’ve had some moments. The loony-bin trip, the Thorazine, even just the terror. Everything becomes symbol and significance, echo and gesture, doubles and representatives. Did you tell yourself that last time it didn’t happen or you didn’t see it, disbelieved it, remembered it only blurringly in fleeting recollections as irrationality, embarrassing grandiose illusions? Like your cavalier comparisons with Joan on the way to the insanity trial – that must have been it, that was craziness, I’d say to myself. Or confusing the cleaning woman in the hospital laboratory with Sita; their age, their darkness and humility – that was crazy. And I would wince that here, surely, was a confusion as to persons and places. The way the black man in solitary at Napa was Michael X, as all blacks in

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imprisonment were counters, doubles. Knowing I could justify these displacements in my own mind as poetic logic, but still finding them corny or overdone or just plain delusionary. That was crazy. And I have no interest in any more of this, loathe and dread it. (p. 85) One can appreciate how wrenching it must have been to write this passage, to replay the worst nightmare of her life. Revelations like these are destabilizing, conjuring up terrors that threaten to overwhelm reason and self-control. Millett invests both literary and psychological significance to the experience. One doesn’t doubt her honesty here, even if she may not be forthcoming about the details that her sister Mallory reveals. One can also appreciate the intensity of Kate Millett’s shame and terror over the “loonybin” experience, both as historical events that occurred in 1973 and then again in 1980, and also as a recurrent state of mind with which she was all too familiar. Millett suggests, here and elsewhere, that there may be “something on the other side of crazy,” a special preternatural knowledge hinting at a reality that cannot be scientifically validated. The “bin” experience evokes R. D. Laing’s belief in his influential 1960 book The Divided Self that psychological breakdown represents a charting of new psychic territory, an initiation into a higher consciousness. Like Laing, Millett rejects the medical model of mental illness. She would agree with Laing’s rejection of “sanity,” as expressed in his diaries: Sanity is determinism and totalitarianism. It is death to the soul and the end of freedom. Against this self-justified tautology, this invincible and inevitable self-rectitude, the romantic revolt takes its origin. (qtd. in Adrian Laing, p. 51)

IVOR BROWNE Millett’s experience with psychiatry taught her to be guarded, wary, evasive. She regards psychiatrists as adversaries, for they have the power to hospitalize, which for her means the power to imprison. Psychiatric hospitalization, she maintains, whether voluntary or involuntary, is tantamount to a life sentence, where one is branded, stigmatized forever. Dr Pulp’s name conveys Millett’s belief that psychiatry is nothing but pulp fiction. “Dr McSomething” asks her whether as a “women’s libber” she is prejudiced against men, a “cute, tangential” question. When she tells him she

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was promised a female psychiatrist, he replies, “Your only mistake then was trusting the people who brought you here,” a remark that echoes “for the rest of my life” (p. 41). The psychiatrist at Our Lady of Clare informs her ominously that she is under the government’s “jurisdiction” and that she has no civil rights because she is not an Irish citizen. Warned that the “great Dr McShane” regards her as a lithium truant, she escapes from the hospital and is “captured.” If she resists again, she is admonished, she will be placed in a straitjacket. Humiliated and broken in spirit, she swallows her medication. Aided by a friend, she is transferred to St. James Infirmary, where Dr Browne, the “highest shrink in Ireland, the head doctor,” pronounces her competent and releases her. He regards her anger as “reasonable” and then, psychodynamically oriented, recommends that she go into therapy, “to go over the ground about my mother and father and so forth” (p. 249), a recommendation she disregards. Millett was fortunate in meeting Ivor Browne, who in many ways resembled R. D. Laing in his opposition to traditional psychiatry and skepticism over psychotropic drugs. The Chief Psychiatrist of St Brendan’s Hospital and a professor of psychiatry at University College Dublin, Browne impressed his patients with his compassion and devotion. Ciara Dwyer described Browne in a 2008 interview as a “maverick who has never been afraid to go against the tide.” His 2008 autobiography Music and Madness charts his efforts to remove mental patients from large institutions and integrate them into the community. In the introduction to the book, the Irish novelist Colm Tóibín, who was briefly treated by Browne, describes him as a “towering and powerful influential figure in Irish psychiatry over the past half century,” a man whose “extraordinary powers of perception and sympathy made him a great doctor” (pp. 7–8). Music and Madness was published decades after Millett’s encounter with Browne, but she would have appreciated the book’s epigraph, which comes from a poem by Emily Dickinson, that: “Much madness is divinest sense/to a discerning eye.” Regardless of whether the involuntary hospitalization in Ireland was medically or legally justified, it remains the central trauma of Millett’s life, one to which she returns in nearly all of her later writings. It is impossible to exaggerate the significance of the trauma in her life. Nor can she forget it. The Loony-Bin Trip is, first and foremost, a trauma narrative, and if she is not mad in a psychiatric sense, she is certainly mad in an emotional sense, filled with rage.

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THE LANGUAGE OF MANIC DEPRESSION Millett succeeds in The Loony-Bin Trip in crafting language that reproduces the moods of manic depression. Speech samples taken from manic and depressed patients, Jamison observes in Robert Lowell, reveal that manic speech is “more pressured, distractible, and colorful” than non-manic speech. “Manic patients use more adjectives and action verb and more words that reflect power and achievement; they also express themselves more vibrantly, with more color, and greater urgency” (p. 278). The Loony-Bin Trip confirms Jamison’s observation. Millett’s language becomes more intense when relatives and friends express alarm over her threatening or outlandish behavior, as when Sophie informs her that the apprentices are leaving the farm. “I blow up, full Irish steam, a stream of words, abuse matching theirs” (p. 67). Ending lithium, she experiences terrifying dreams of lightning striking the barns – and her brain. Then I had feared the electrical short circuitry, the terrible reflex that tore me awake and made me fear sleep and dread the future, fear my mind would snap like crossed eyes in the old wives’ tale, snap, and I would be forever on the other side of madness, trapped as behind a mirror so that I could not come back. (p. 95) Millett’s prose captures mania’s euphoric, exuberant quality; she lengthens her sentences during these moments, forging an affective stream-ofconsciousness prose. Recalling her hospitalization in Ireland, Millett uses what she calls the “tricks of poetry” to capture her state of mind: “the rhyming, the finding of similitudes and parallels, duplications and dualities” (p. 236). By contrast, Millett’s descriptions of depression are more subdued and qualified, consistent with Jamison’s insight that depressed patients use more qualifying adverbs; their speech is more impoverished and predictable than that of manic patients or normal individuals. Manic patients tend to talk more about things, depressed patients about themselves and other people. (p. 278) Millett equates depression with surrender and submission, resulting in unbearable silence. Debra Beilke has observed that Millett “seems to fear the diagnosis of mental illness – the label, the words – as much as she fears incarceration,”

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a fear that arises, Beilke shrewdly suggests, from Millett’s belief that her mind and her self are identical. “Therefore, psychiatric professionals who label her as ‘sick’ are dismissing her core self, her basic identity, as inherently ‘wrong’ or ‘invalid,’ and are thus not to be taken seriously” (p. 32). By contrast, the other memoirists in our study are able to separate mind from self, allowing them to receive psychotherapy and drug therapy that returns them to their core self that has been affected but not destroyed by a brain disease.

TALK THERAPY In Part Three of The Loony-Bin Trip, “New York City,” Millett continues her assault on psychiatry. Dr Foreman’s office has a “Detestable smell of money,” and his “avaricious assistants are consummately rude to me – a crumpled, has-been writer, condemned by this diagnosis to a lifetime of insanity” (p. 261). Foreman humiliates her by giving an “alcoholic’s lecture” to stop drinking, despite her insistence that she has never had a drinking problem. The only sympathetically portrayed psychiatrist (apart from Ivor Browne) is Dr Benfield, who, “kindness personified,” sees her two or three times a week for clinical depression. She refuses his request to show him the manuscript she is writing – “I regard what I’m working on as sacred or magical enough never to be discussed” (p. 281) – but he is genuinely concerned about her. A Freudian, he maintains that depression is anger turned inward, a theory she rejects, but they get along with each other, and he stops asking her a formulaic question she always resents: “And how does that make you feel?” (p. 281). We learn little else about Millett’s relationship with Benfield apart from his encouragement for her to read, which elicits her scornful response. “Why not read?” Benfield says, imagining that writers read to some purpose. “You don’t know what I read – I read crap.” “Don’t be so puritanical, you’re recovering, resting.” But I’m not; I’m abdicating, sloughing off, giving up. (p. 283) Readers of The Loony-Bin Trip would have welcomed Millett’s clinical sessions with her psychiatrist, yet she must have felt that these discussions were either irrelevant or too private. The reader regrets the absence of these therapy conversations, which might have increased our understanding of Millett’s depression – regardless of whether the mood disorder is internalized

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aggression. It is instructive here to contrast Millett to Doris Lessing who, no less committed to an antipsychiatry vision, nevertheless describes in abundant detail Anna Wulf’s therapy sessions with the nonmedical analyst Mrs. Marks, “Mother Sugar,” in The Golden Notebook. As Lessing remarks in the nonfictional A Small Personal Voice, My own psychotherapist was somewhat like Mrs. Marks. She was everything I disliked. I was then aggressively rational, antireligious, and a radical. She was Roman Catholic, Jungian, and conservative. It was very upsetting to me at the time, but I found out it didn’t matter a damn. I couldn’t stand her terminology, but she was a marvelous person. She was one of those rare individuals who know how to help others. If she had used another set of words, if she had talked Freud talk, or aggressive atheism, it wouldn’t have made a difference. (p. 68) The analyst was helpful, as I pointed out in my 1985 book The Talking Cure, not through the art of psychotherapy, the validation of which Lessing rejects, but through the act of friendship – the ability to empathize and offer insights that are not necessarily psychoanalytic. In a letter to a critic, Lessing has described her therapy as paying for a friend, which I needed desperately, to counterbalance certain very destructive things in my life. I think usually what people are doing when they are in analysis or therapy or whatever, is paying for a friend. (pp. 179–180) Millett finds Benfield empathic and perhaps insightful, but she devotes only a few sentences to their interactions.

THOMAS SZASZ Equating psychiatrists with jailors, Millett cites approvingly in The LoonyBin Trip Thomas Szasz (1920–2012), the century’s most outspoken foe of his own profession. Szasz was one of the first critics of the therapeutic state, and he insisted that government had no right to regulate or influence psychiatry. No one criticized the sincerity of his beliefs, though his

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self-righteousness could be off-putting, as can be seen in an obituary published in the Syracuse Post-Standard on September 12, 2012, which quotes him as saying, I am probably the only psychiatrist in the world whose hands are clean. I have never committed anyone. I have never given electric shock. I have never, ever, ever given drugs to a mental patient. A Libertarian, Szasz was credited by both critics and supporters for defending patients’ civil liberties, and he played a positive role in calling attention to the excessive use of involuntary hospitalization, straitjackets, four-point restraints, medication, and electroshock. For these reasons, one can understand Millett’s admiration for him. Yet one of the main criticisms of Szasz was that in advocating for patients’ civil liberties, he neglected patients’ needs. Millett agrees with nearly all of Szasz’s extreme claims about the “myth of mental illness,” the title of his influential 1961 book. Though Szasz maintained throughout his career that he was not anti-psychiatry but was rather anti-coercive psychiatry, the distinction does not appear in his 2007 book Coercion as Cure: A Critical History of Psychiatry, where he bluntly defines psychiatry as the “theory and practice of coercion, rationalized as the diagnosis of mental illness and justified as medical treatment aimed at protecting the patient from himself and society from the patient” (p. xi). Mental disease is “fictitious disease,” and psychiatric diagnosis is “disguised disdain” (p. xii). Jamison points out in Night Falls Fast that in 1994 Szasz’s insurance company agreed to pay $650,000 to the widow of one of his patients, a physician, who committed suicide while suffering from manic depression. Szasz was found negligent when he advised his patient to stop taking lithium (p. 254).

“A CRISIS TO DIE” Serendipity saved Millett from suicide. The moment she opened the gas pipe in her Bowery loft, she unexpectedly received a telephone call from Sita in California. “Uncanny she could call that exact moment and catch you in the act, wrench you back to life” (p. 76). She informs us three pages later that “Afterward I closed it, shamefaced.” Was she shamefaced because she attempted suicide or failed to complete it? She captures the terrible intensity of suicidal thinking, which is almost irresistible to those in a crisis:

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“How death is an obsession of the mind with the body, wishing the body out of existence” (p. 79). Millett’s next suicide attempt was nearly successful. And then the amazing sound of the gas. A two-inch pipe, a major source, but the sound was still alarming, amazing, falling asleep hearing it, no longer listening, sure I would not change my mind and turn it off; just as sure I wasn’t going to light a cigarette and demolish the neighborhood. A few hours later she woke up and decided not to turn off the roaring jet. As proud of that as I was ashamed to wake up in the morning. The loft was too big, too drafty. The stench was terrible, but a headache was the only effect of the gas in this space. I could have slept right by the pipe, I should have blocked all the drafts in the windows – idiot. Opening them now, airing the whole house now, both floors – the odor must be gone before they come with the truck. I have failed. For this time anyway. There would be others. This is the only suicide attempt she dramatizes; the others she summarizes. And there were. Enough and insistent enough, more and more of a crisis to die. So that at the last I could turn away; having failed, unable to die or live in death any longer, and give living a try. (p. 81)

SHAME No one has written more powerfully about the shame associated with clinical depression than Millett. The word appears dozens of times throughout The Loony-Bin Trip, along with variations of the word: ashamed and shamefaced. Synonyms also appear: humiliation, disgrace, and embarrassment. Nearly every character in the story asks her the question that fills her with the most intense shame: “Are you taking your lithium?” Leon Wurmser, perhaps the leading psychoanalytic theorist of shame, offers a powerful definition that captures its complexity of meaning:

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[T]he word shame really covers three concepts: Shame is first the fear of disgrace, it is the anxiety about the danger that we might be looked at with contempt for having dishonored ourselves. Second, it is the feeling when one is looked at with such scorn. It is, in other words, the affect of contempt directed against the self – by others or by one’s own conscience. Contempt says: “You should disappear as such a being as you have shown yourself to be – failing, weak, flawed, and dirty. Get out of my sight: Disappear!” One feels ashamed for being exposed.… Third, shame is also almost the antithesis of the second one, as in: “Don’t you know any shame?” It is an overall character trait preventing any such disgraceful exposure, an attitude of respect toward others and toward oneself, a stance of reverence – the highest form of such reverence being called by Goethe (1829) “die Ehrfurcht vor sich selbst,” reverence for oneself. This third form of shame is discretion, is tact, is sexual modesty. (pp. 67–68) All three meanings of shame appear in The Loony-Bin Trip: shame as the fear of disgrace, Millet’s anxiety over being diagnosed as mentally ill; shame as the affect of contempt, the scorn directed against the self by others and herself; and shame as a character trait of discretion and selfrespect. “Learn a little discretion” (p. 34), she tells herself, but to narrate her unsettling story she must overcome her discretion. Additionally, Millett reveals the intense self-stigma associated with mental illness, particularly psychosis. “It is quite common,” Marjorie L. Baldwin observes in Beyond Schizophrenia: Living and Working with a Serious Mental Illness (2016), “for members of a stigmatized group to adopt the negative stereotypes associated with that group into their own self-image” (p. 28). Few memoirs of mental illness betray more self-stigma than The Loony-Bin Trip, as the title alone suggests. Millett also captures the feeling of hopelessness, which is the best predictor of suicide, along with a history of failed attempts. Her sentences grow shorter when she describes depression, demonstrating the difficulty of sustained intellectual thought. She repeats certain words, such as “nothing,” to show how the world seems to be empty of feeling and meaning. Without language, she suggests, one loses a protection as necessary to one’s health as skin. To become mute is to be rendered helpless, bereft.

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“A SMALL PROPHYLACTIC DOSE” Millett never concedes that her severe clinical depression inevitably follows mania, though she comes close to implying this in A. D., observing that “Depression, if not the partner of mania, was certainly the partner of incarceration, the shame of it, the loneliness” (pp. 139–140). She insists at the end of The Loony-Bin Trip that her ability to ween herself successfully from lithium is proof that she was never manic. In 1988 on my birthday, September 14th, I took 600 mg of lithium instead of the usual 900, going below the therapeutic level for the first time. On January 1st, I reduced it to 300 mg, and on March 15, daring the Ides of March, I went to sleep for the first time in seven years having taken no lithium at all. Nothing happened. Nothing ever happened. (p. 310) The story thus ends triumphantly, an example of both a restitution narrative and a quest narrative, with Millett’s rejection of the diagnosis that she is “constitutionally psychotic, a manic-depressive bound to suffer recurrent attacks of ‘affective illness’ unless I am maintained on prophylactic medication, specifically lithium” (p. 310). In light of Millett’s conclusion, then, how do we respond to her acknowledgment in the preface to the 2000 University of Illinois paperback edition of The Loony-Bin Trip that she has returned to her medication? She admits “to the moments when the darkness returns and a small prophylactic dose of lithium seems a sensible precaution” (p. 9). The statement, written a decade after the initial publication of the book, contradicts all her assertions to the contrary in the conclusion, where she belittles the idea of remaining on a prophylactic dose of lithium. One admires the honesty of Millett’s selfdisclosure, a revelation that other writers might have omitted. Yet Millett seems to be unaware that this self-disclosure confirms what her relatives, friends, and psychiatrists have been saying all along, namely, that remaining on her medication would keep her stable. Millett might respond to this contradiction by noting that she is on a lower dose of lithium, with fewer side effects, but this is precisely the point Jamison makes at the end of An Unquiet Mind. Many years of living with the cyclic upheavals of manicdepressive illness has made me more philosophical, better

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armed, and more able to handle the inevitable swings of mood and energy that I have opted for by taking a lower level of lithium. (p. 213) Millett is certainly not alone in remaining ambivalent about the need for medication. Most mental illness memoirists share this feeling. David A. Karp captures these conflicting feelings in his 2006 study Is It Me or My Meds: Living with Antidepressants. The author of a previous memoir of depression, Speaking of Sadness (1995), Karp opens Is It Me or My Meds with the decision, in the summer of 2001, at the age of 57, to taper off the drugs that he had been taking for a quarter of a century. A sociologist, like Arthur Frank, Karp speculates on the ways in which medication alters identity. Interviewing 50 people for his book, he observes that, almost without exception, his research subjects believed that drugs made them feel different – transformations that raise moral, psychological, and philosophical questions. His research subjects reached the same conclusion that he did. It is one of ambivalence toward medications, of reluctance to rely on them, of movement from one drug or dose to another, and of uncertainty about the treatment’s efficacy. It also hints at the process through which a clear majority of patients move – from initial resistance to a grudging acceptance of their need for medication. (p. 21) Millett admits in the conclusion of The Loony-Bin Trip that rereading the last section, which was written first, something rings false. “Wait a moment – why call this depression? – why not call it grief? You’ve permitted your grief, even your outrage, to be converted into a disease” (p. 309). It’s true that depression and grief have much in common. Prolonged grief can turn into depression, but there are noteworthy differences between the two. Feelings of worthlessness, intense guilt, suicidal despair, helplessness, and hopelessness are more often present in depression than in grief. Neither a disease nor a disorder, grief may last longer than some past clinicians have asserted, but it usually does not require treatment. Major depression, by contrast, may not lift by itself. The distinction between grief and depression is further complicated in manic depression, where the high of mania results in a plunge to depression. Millett’s treatment of choice is writing, and as the pain of depression lifts, she begins chronicling her experience. Writing is for her, as it is for other memoirists of mood disorders, a countershame act, a way to

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acknowledge vulnerability and heal herself. Though at times she suffered from paralyzing writer’s block and complained bitterly about the loss of creativity as a result of lithium, she authored several books during the years she was on medication. Madness is a fickle muse, but it became a driving force in Millett’s creativity. Writing allowed her to make sense of the maddening experiences in her life, and regardless of whether we accept her views on mental illness, she conveys the voices of madness along with the horror of involuntary psychiatric confinement.

REVIEWS OF THE LOONY-BIN TRIP They are “going to squash you like a bug,” Millett thinks despairingly in The Loony-Bin Trip about the reviews of Flying; the reviews for that will be “first-rate invective” (p. 81). This is often the fate of intellectual provocateurs like Millett; she received her share of vituperative reviews. Norman Mailer wasted little time in pillorying her in The Prisoner of Sex, published one year after Sexual Politics. Whereas Millett limited her attack to Mailer’s writings, he chose an ad hominem approach. “Well, it could be said for Kate that she was nothing if not a pug-nosed wit, and that was good, since in literary matters she had not much else” (p. 95). Literary lawyers, Mailer adds, “cannot do criticism, they can only write briefs, and Kate holds court in the land of Millett” (p. 109). Camille Paglia is no less vituperative in her 1992 volume of essays, Sex, Art, and American Culture. “American feminism’s nose dive began when Kate Millett, that imploding beanbag of poisonous self-pity, declared Freud a sexist” (p. 243). Most of the reviews of The Loony-Bin Trip, however, were generally sympathetic. Some antipsychiatry reviewers lauded the book. “Her book shows,” Thomas Steinbuch argued in a long review essay in Hypatia, that the attribution of mental illness was an attempt to break her autonomous spirit and get her to submit to familial and social authority by turning her over to psychiatric battering. Her triumph over domination is a triumph for women in general. (p. 201) Some mental health professionals praised the book and concluded, as Joyce R. Borkin did in Community Mental Health Journal (1991), that it should be read “by anyone who works with persons who have diagnoses of serious

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mental illnesses. It provides a variety of invaluable insights.” Borkin adds an important qualification. Whether or not we agree with her conclusions, that mental illness should not be treated as an illness at all, it is important to acknowledge the constraints that systems impose on professionals and clients alike. (p. 381) Christian Perring identified the central difficulty in interpreting Millett’s story. The problem for such a book is that Millett tells just one side of the story. She tells it very well, and it’s easy to sympathize with Millett’s plight. But it’s just as easy to be suspicious of her version of events, and it’s possible that her hospitalization was completely justified. In a review in The Washington Post, Marilyn Yalom similarly praises the story’s literary power but reminds us of the unnerving reality following psychiatric deinstitutionalization. Millett’s prose is rich, her passion compelling. If it were not for the sight of thousands of severely disturbed people released from now defunct mental institutions and gracing the pavements of San Francisco, Los Angeles, New York and Washington, one might almost be persuaded by her writing that it is indeed drug-dispensing psychiatrists who cause, rather than alleviate, mental illness. Millett stated in an interview with Edward Iwata in the Los Angeles Times that two reviewers who labeled her as mentally ill were missing the point of The Loony-Bin Trip. “Her book is a plea for understanding,” Iwata concludes, summarizing her authorial intentions, “a radical call for a new tolerance toward mental states that are ‘at the margin’ – from flights of artistic inspiration to states of altered consciousness.” The book’s fiercely antipsychiatry theme, however, was not lost on Millett’s sisters, who wanted her to be hospitalized for her own safety. “Kate was ill,” stated Sally Millett Rau, “and we did what we felt was necessary. I do not feel we ever betrayed Kate in attempting to help her.” Mallory Millett Danaher agreed with her sister’s criticisms of The Loony-Bin Trip. “There’s no question the entire book is a denial,” she told Iwata.

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Kate very clearly was a danger to herself and others. She just isn’t willing to admit it. She perceived us as her punishers, her accusers, when it wasn’t that way at all. Critics of psychiatry who dismiss the two sisters’ comments as motivated by sibling rivalry will have a harder time disregarding Phyllis Chesler’s response. In her 1972 book Women and Madness, Chesler cites Millett’s contributions to feminism. Chesler’s praise for the Loony-Bin Trip appears on the cover of the 2000 paperback edition: Kate Millett is magnificent: a historical figure in her own lifetime, a truly exciting writer, a chronicler of our times.… [Her] critique of institutional psychiatry and our well-meaning collusion with it is devastating and true. Yet in the Los Angeles Times article, Chesler, a feminist psychologist, disagrees with Millett’s categorical rejection of psychiatry. “While deeply flawed, psychiatry helps many people, Chesler said. Drugs, when properly monitored, can cure mental patients. And Chesler said, ‘there is such a thing as mental illness’” (qtd. in Iwata, 1990). Millett mentions Chesler in The Loony-Bin Trip, and one wonders whether she was the model for “Phyllis Gibson,” the clinical psychologist who set up the disastrous meeting between Millett and Dr Pulp, who is “not just a psychologist like Phyllis herself but a psychiatrist. That sort of doctor” (p. 146).

LIFE AFTER THE LOONY-BIN TRIP Millett never resolves the conflict in The Loony-Bin Trip between “my proclaimed sanity and my conjectured madness.” Remaining fiercely antipsychiatry, she was one of the contributors to Alternatives Beyond Psychiatry, a volume edited by Peter Stastny and Peter Lehmann that appeared in 2007. In “The Illusion of Mental Illness,” a shortened and updated version of the Cunningham Lecture in Law and Medicine that she gave in 1992 at Queen’s University in Kingston, Ontario, Millett reiterated her longstanding hostility to psychiatry, which she defines as “ultimately an arm of the state, with state powers, police powers, real locks and bars, drugs and torments” (p. 35). The only “mental” diseases, in her opinion, are those of the brain and nervous system, such as tumors, Alzheimer’s disease, and Huntington’s chorea. Millett continues to attack “commitment hearings,”

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where patients have fewer rights than those accused of crimes. She singles out for criticism neuroleptic drugs, though tellingly, she makes no mention of lithium. The only shift in her position is that now, for the first and only time in any of her writings, she makes a distinction between psychiatry, based on the medical model of mental illness, which she maintains is coercive, “one of the meanest systems of oppression ever developed,” and a “humanistic psychological model” associated with clinical psychology and psychoanalysis. She now laments that, as a result of the medical model of mental illness, psychoanalysis is ruled out as unscientific. Millett’s readers will be surprised by this statement, for in none of her writings does she affirm talk therapy. Millett died in 2017 at age 82, having received a number of honors, including the Best Books Award from Library Journal in 2001, the 2012 Courage Award for the Arts by Yoko Ono, and in the same year the Lambda Pioneer Award for Literature. In 2013, she was inducted into the United States National Women’s Hall of Fame. Parul Sehgal and Neil Genzlinger end their New York Times obituary of Millett by quoting Andrea Dworkin: “The world was asleep, but Kate Millett woke it up.” What shall we finally say about Kate Millett? The Loony-Bin Trip provides, as Anne Hudson Jones observed in The Lancet in 1997, a “fascinating window on the world of madness for those fortunate enough never to have sojourned there themselves” (p. 359). Jones does not offer a critique of The Loony-Bin Trip or the other memoirs she discusses, but we can certainly agree with her conclusion that for all readers, “these patients’ stories give testimony to the remarkable range of human psychological experience and the extraordinary capacity of human beings to endure and prevail even through hellish torments” (p. 361). Jones’s sentence, an echo of William Faulkner’s 1949 Noble-Prize speech – “I believe that man will not merely endure: he will prevail” – speaks to the power of writing/righting wrong. Not all readers of The Loony-Bin Trip will agree with Millett’s antipsychiatry conclusions, but they will be moved by her harrowing story of breakdown and recovery.

3 “A STRANGE AND DRIVING FORCE, A DESTROYER, A FIRE IN THE BLOOD”: KAY REDFIELD JAMISON AND AN UNQUIET MIND

It’s challenging for novelists and literary critics to write memoirs about their own mental illness, as we have seen with William Styron and Kate Millett, respectively, but immeasurably more daunting for psychotherapists. Their professional reputations are at stake when writing about their own mental illness. They could lose not only their present patients, as well as future referrals, but also their license to practice psychotherapy. There’s no stigma for oncologists or cardiologists to write a memoir about their struggles with cancer or heart disease; there is stigma for a therapist to write about personal experience with depression or manic depression. Therapists who write memoirs about being mentally ill may question their sanity in doing so – a fear reinforced by family, friends, and colleagues who may reasonably conclude that writing such a story is crazy. These fears and others confronted Kay Redfield Jamison before she made the momentous decision to write An Unquiet Mind: A Memoir of Moods and Madness, published in 1995. Jamison is an academic superstar today, one of the world’s leading teachers, authors, and researchers on manic-depressive illness, but she must have wondered whether writing about the most turbulent decade in her life, the 1970s, when she was floridly manic and suicidal while serving as an assistant professor of psychiatry at the University of California at Los Angeles (UCLA) Medical 119

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School, would be the end of her career. There were few precedents of psychotherapists writing about being dangerously out of control, and she had good reason to worry that the mental health profession would not look kindly on a confessional memoir about being a wounded healer. Jamison is the Dalio Professor in Mood Disorders and professor of psychiatry at the Johns Hopkins University School of Medicine, where she has taught since the mid-1980s. She is the coauthor, with the psychiatrist Frederick K. Goodwin, of Manic-Depressive Illness, first published in 1990 and now in its second edition (2007), with the addition of a subtitle: Bipolar Disorders and Recurrent Depression. Over 1,200 pages long, the tome is still regarded as the standard medical text on the subject. Jamison’s second book, Touched with Fire: Manic-Depressive Illness and the Artistic Temperament, published in 1993, remains the single best study of the relationship between mood disorders and creativity. Not until her third book, however, the searing memoir An Unquiet Mind, did Jamison write about her own history of manic depression and close encounter with death. Her next book, Night Falls Fast: Understanding Suicide (1999), illuminates with deep empathic understanding the darkest of subjects. Next came Exuberance (2004), a work aptly described by its subtitle: The Passion for Life. The book that followed, Jamison’s moving spousal loss memoir Nothing Was the Same (2009), is a heartfelt tribute to the memory of her husband, Dr Richard Wyatt, a noted schizophrenia researcher, chief of neuropsychiatry at the National Institute of Mental Health, who died of cancer in 2002 at age 63. Jamison’s most recent book, Robert Lowell: Setting the River on Fire (2017), is an examination of genius, mania, and character, a book implicitly about her own life as well as Lowell’s. A recipient in 2001 of a MacArthur “Genius” Fellowship, Jamison has earned several major awards, including being chosen by Time magazine as a “Hero of Medicine.” Other awards include the National Mental Health Association’s William Styron Award as well as the American Foundation for Suicide Prevention Award. Jamison received in 2010 an Honorary Degree of Doctor of Letters from the University of St Andrews, Scotland’s oldest university, where she had studied for a year as an undergraduate. She is also a member of the National Advisory Council for Human Genome Research and the clinical director of the Dana Consortium on the Genetic Basis of Manic-Depressive Illness. In 2017, she was elected a Corresponding Fellow of the Royal College of Edinburgh.

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There were times, however, during Jamison’s adolescence, twenties, and early thirties when these achievements seemed impossible. Psychiatric illness came on slowly, imperceptibly, and she didn’t know what to make of the aberrant moods that befell her. She found herself wearing the same clothes day after day in high school, and she became preoccupied with death and dying. Nevertheless, she “managed to pass as normal in school,” perhaps because the other students were caught up in their own lives. In college, she took a course on abnormal psychology, and, worried that her depression wasn’t “normal,” she decided to see a psychiatrist at the student health service. I got as far as the stairwell just outside the clinic but was only able to sit there, paralyzed with fear and shame, unable to go in and unable to leave. I must have sat there, head in my hands, sobbing, for more than an hour. Then I left and never went back. (An Unquiet Mind, p. 45) The situation reached a crisis in 1974, when, at the age of 28, Jamison became an assistant professor of psychiatry at the University of California, Los Angeles, and was, within three months, “manic beyond recognition” (p. 4). She knew that she had long been beholden to rapidly shifting moods, but she didn’t know that the mood disorder from which she suffered would nearly kill her. During the early years of her illness she refused treatment, remaining stubbornly in denial, even though she knew both from her training and research expertise that manic-depressive illness is beguiling and often fatal. For years Jamison concealed her illness from nearly everyone, but, like Sherwin Nuland, she feared that remaining silent about her secret was “dishonest,” particularly given her research, teaching, clinical practice, and advocacy work on mood disorders. “I am tired of hiding, tired of misspent and knotted energies, tired of the hypocrisy, and tired of acting as though I have something to hide” (p. 7). Even near the end of An Unquiet Mind she worries about whether she made the right decision to come out of the closet – though not, perhaps, for the reason that her readers might suspect. “Somehow, I don’t mind the thought of being seen as intermittently psychotic nearly as much as I mind being pigeonholed as weak and neurotic” (p. 202). Steeped in literature, history, and mythology, not to mention clinical psychology, genetics, neuroscience, and psychopharmacology, Jamison

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observes in Robert Lowell that descriptions of manic-depressive illness have remained remarkably constant over the millennia. Ancient writers like Aretaeus of Cappadocia, who lived around the first century ce, realized, in Jamison’s words, that mania and depression are “lashed together,” an illness of “mutability, of changing form; they are plaited together in action and fate” (p. 158). Jamison has contributed perhaps more than anyone to an understanding of the interaction of mood disorders and the artistic temperament.

TOUCHED WITH FIRE To appreciate Jamison’s accomplishment in An Unquiet Mind, we may look at her preceding book, Touched with Fire (1994), which is groundbreaking in a different way. Seldom do novelists, literary critics, psychoanalysts, and Nobel Prize scientists lavishly praise a study of madness and creativity, a topic that most academics regard warily. Too often a psychoanalytic or psychobiographical study of a creative artist smacks of psychopathology and clinical reductiveness, especially when it is written in psychobabble. Equally often, literary studies romanticize mental illness, ignoring the terrible suffering of those affected with mood or thought disorders. Touched with Fire avoids all of these pitfalls. The book earned glowing praise from the novelist William Styron, the literature professors Leslie A. Marchand and Robert Bernard Martin, the British psychoanalyst Anthony Storr, and the geneticist James D. Watson. They recognized Jamison’s encyclopedic knowledge of literature, her keen understanding of current scientific research on mood disorders, and her nuanced judgments. Touched with Fire received glowing praise from the New England Journal of Medicine. Anyone even remotely interested in this topic will find Touched with Fire a clear and enjoyable book. Students of biography will want it next to their psychohistorical books, and the rest of us will find it a stimulating respite from the usual dry medical textbooks. (Goldman, 1993) No book before Touched with Fire had studied in greater depth the genetic nature of manic-depressive illness; the controversies and evidence surrounding mood disorders; and the scores of writers, artists, and composers, spanning two thousand years, with probable cyclothymia

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(“pronounced but not totally debilitating changes in mood, behavior, thinking, sleep, and energy levels”), major depression, or manic-depressive illness. Jamison accomplishes something almost impossible, a study that bridges the gulf between what C. P. Snow famously called the two cultures, the sciences and the humanities. Valuing both artistic intuition and scientific evidence, she combines subjectivity and objectivity, and she is unafraid to state that her understanding of mood disorders arises from her clinical training, her scientific research, her literary self-education, and her harrowing personal experience with the subject. Touched with Fire inspired a 2015 film of the same title written and directed by Paul Dalio. Touched with Fire remains a controversial book, sparking a debate in Creativity Research Journal between Jamison and Louis A. Sass, a professor of clinical psychology at Rutgers University and the author of Madness and Modernism: Insanity in the Light of Modern Art, Literature, and Thought (1992). Sass points out in “Romanticism, Creativity, and the Ambiguities of Diagnosis: Rejoinder to Kay Redfield Jamison” (2001) that the literaryartistic periods from which she draws her samples of creative individuals come mainly from romanticism rather than from classicism, modernism, or postmodernism. Sass takes a more positive view of schizophrenia than does Jamison, objecting to her characterization of it as a dementing illness similar to Alzheimer’s disease. Additionally, Sass suggests that “successfully creative” people on the schizophrenia spectrum may be found in the modernist and postmodernist periods. Despite these criticisms, Sass begins and ends his rejoinder by praising Touched with Fire, calling it an “eloquent book [that] does an admirable job of showing the potential advantages that are perhaps inextricably associated with the painful and debilitating ravages of manic-depressive illness” (p. 84). WHAT’S IN A NAME? Committed equally to the two cultures, the sciences and the humanities, Jamison was confronted early in her career with a linguistic dilemma: what to call the illness that would shape her entire life as a patient, therapist, teacher, and researcher. Should she use the diagnostic expression that was common during Robert Lowell’s lifetime, “manic-depressive” illness, or the contemporary scientific term that is commonly used in research and clinical practice, bipolar disorder? She raises this question in several of her books, but her fullest discussion appears in Robert Lowell. The advantage

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of “bipolar disorder,” she concedes, is that for many people it appears more acceptable and less stigmatizing than “manic-depressive disorder.” But not for her. “‘Bipolar disorder’ seems misleading, rather trivializing, and far removed from the clinical reality of depression and mania by those who experience them.” There are other reasons, she notes, not to abandon the older term: “bipolar disorder” perpetuates the misconception that mood disorders cycle neatly between opposite mental and physical states. Nothing could be further from the truth. Mania and depression combine to form unstable clinical states that are a mixture of manic and depressive mood, behavior, and thinking. (p. 416) Language has consequences, Jamison reminds us. “Replacing ancient, graphic language with euphemistic diagnostic labels risks minimizing the suffering and complexity of an often deadly illness” (p. 417). Always sensitive to language, Jamison draws her title, Touched by Fire, from a poem by Stephen Spender, one of the few creative writers in her study who did not suffer from a mood disorder. Her comprehensive list of British and Irish poets born between 1705 and 1805 who suffered from recurrent depression includes Samuel Johnson, Thomas Gray, George Crabbe, and Leigh Hunt. Those who suffered from manic-depressive disease include Christopher Smart, William Cowper, Robert Fergusson, Thomas Chatterton, William Blake, Samuel Taylor Coleridge, Lord Byron, Percy Bysshe Shelley, John Clare, George Darley, Hartley Coleridge, Thomas Lovell Beddoes, and James Clarence Mangan. Two poets took their own lives: Thomas Chatterton and Thomas Lovell Beddoes. Other writers born between these dates who possibly suffered from recurrent depression were William Wordsworth, described by some biographers as suffering from severe depression “to the verge of a mental breakdown,” and Sir Walter Scott, who described himself as being afflicted by a “black dog of melancholy.” An inveterate list maker, Jamison also includes the names of poets born between 1705 and 1805 who were confined to an asylum: William Collins, Christopher Smart, William Cowper, Robert Fergusson, John Bampfylde, and John Clare. Jamison devotes a full chapter to Byron, observing that one can be “clinically normal” most of the time and “mad” at other times. “Lucidity and normal functioning are, however, perfectly consistent with – indeed,

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characteristic of – the phasic nature of manic-depressive illness” (p. 154). Byron’s fiery and melancholic temperament “at times crossed over the fine line that separates illness from health,” a situation that applies to other medical conditions, Jamison adds, such as diabetes, thyroid disease, and hypertension, in which an underlying predisposition flares up, occasionally, into acute disease (p. 165). To illustrate the genetic basis for manic-depressive illness, Jamison shows how a family history of mental disorders may be seen in several writers, composers, and artists who were affected by a “taint of blood.” The list includes Alfred, Lord Tennyson, Robert Schumann, the James family (the siblings William, Henry, and Alice, along with their father, Henry James, senior), Coleridge, Virginia Woolf, Mary Wollstonecraft and her daughter, Mary Shelley (author of Frankenstein), Samuel Johnson and his biographer, James Boswell, and Vincent van Gogh. Jamison mentions Ernest Hemingway’s troubled family history. Clarence Hemingway committed suicide, as did three of his children: Ernest, Ursula, and Leicester. The novelist’s granddaughter Margaux Hemingway died by drug overdose in 1996 (after the publication of Touched with Fire) at the age of 41. Jamison comments only briefly on Robert Lowell, suggesting that she may not have anticipated while working on Touched with Fire that she would write nearly a quarter of a century later a 500-page book on the poet. Reading Touched with Fire, one would not suspect that the author suffered from a mood disorder. Jamison rarely uses the first-person pronoun and never discusses the reasons for her interest in the subject. She displays absolute scholarly control: her hundreds of scholarly footnotes abound in literary, historical, and scientific information, and she conveys the sense that she has read everything published on affective illness. Quoting a statement made by Joyce Carol Oates – “[Emily Dickinson] was not an alcoholic, she was not abusive, she was not neurotic, she did not commit suicide. Neurotic people or alcoholics who go through life make better copy, and people talk about them, tell anecdotes about them. The quiet people just do their work” (p. 49) – Jamison appears to be one of the quiet people. At the end of the acknowledgments to Touched with Fire, she refers cryptically to her father, Dr. Marshall Jamison – a meteorologist and former pilot in the United States Air Force – gave me a love for that which is vast, beautiful, and turbulent. My sisters share this inheritance. (p. 358)

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Her father’s turbulence, we learn in An Unquiet Mind, is manic depression. The question Jamison raises near the beginning of Touched with Fire and answers near the end of An Unquiet Mind – “Would one want to get rid of this illness if one could?” – may surprise some readers.

AN UNQUIET MIND Jamison’s language throughout Touched with Fire is cautious, scientific, and factual, as when she observes that “The cyclic and contrasting nature of manic-depressive illness is perhaps its most defining clinical feature” (p. 129). She artfully cites passages from creative writers to illustrate the truth of her observation, but she writes from an outsider’s perspective. There is safety in writing in third person, telling the story of those touched by fire, and though she presents a controversial thesis, she does not appear to be writing about herself. By contrast, Jamison writes about her own experience An Unquiet Mind, using her own words, with testimonial fervor, as can be seen in one of the most remarkable paragraphs in the memoir: There is a particular kind of pain, elation, loneliness, and terror involved in this kind of madness. When you’re high it’s tremendous. The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there, the power to captivate others a felt certainty. There are interests found in uninteresting people. Sensuality is pervasive and the desire to seduce and be seduced irresistible. Feelings of ease, intensity, power, wellbeing, financial omnipotence, and euphoria pervade one’s marrow. But, somewhere, this changes. The fast ideas are far too fast, and there are far too many; overwhelming confusion replaces clarity. Memory goes. Humor and absorption on friends’ faces are replaced by fear and concern. Everything previously moving with the grain is now against – you are irritable, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind. You never knew those caves were there. It will never end, for madness carves its own reality. (p. 67)

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Madness carves its own reality and unreality, and Jamison’s language recreates these psychic universes for her readers, capturing the cyclical rhythms and roller-coaster intensities of manic depression. Her use of forceful verbs, vivid adjectives, rhyming, and sound associations results in impassioned, poetic prose. She uses in the above passage both alliteration, the deliberate repetition of a consonant in nearby words (the “f” sound in “feelings are fast and frequent” and the “s” sound in nearly every word in the sentence about sensuality), and assonance, the deliberate repetition of a vowel sound in nearby words (the “a” sound in “pain and elation”). She contrasts long sentences with short ones, sometimes only two words long (“Memory goes”), to show the abrupt mood changes of manic depression. She also contrasts the flights of mania associated with creativity with the inevitable plunges into abject melancholia. One cannot trust one’s perception or judgment when suffering from this disease. Everything is destabilizing. The landscape of manic depression in Jamison’s writings includes both shooting stars and stygian caves: a world of extremes. Mania, Jamison implies, is a pact with the devil, leading at first to unimaginable pleasures, but then the nature of the diabolical contract changes, resulting in the loss not of one’s soul but mind. The devil, however, in this imperfect analogy lies entirely within the self, making exorcism more problematic. Touched with Fire describes the overlap between two temperaments, the artistic and the manic-depressive, but Jamison is careful not to glorify madness. “Although manic-depressive illness is much more common in writers and artists than in the general population, it would be irresponsible to romanticize an extremely painful, destructive, and lethal disease” (p. 257). She doesn’t romanticize mania in An Unquiet Mind, but she does show its seductive power, particularly in hypomania, a milder form of mania that is often associated with creativity. The image of the shooting star conveys the fleeting brilliance of mania and hypomania, though she always reminds us that sunless caves extinguish the light. DRAWING UPON HER OWN EXPERIENCE: THE TWO EDITIONS OF MANIC-DEPRESSIVE ILLNESS One of the most lucid writers, adept at both literary and scientific language, Jamison observes in An Unquiet Mind that she drew upon her own experience when coauthoring Manic-Depressive Illness (1990; 2007), a decision with which Frederick Goodwin, who knew about her history of

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mood disorders, agreed. The memoir doesn’t identify the specific passages that come from the psychiatric textbook, but reading the two books side-by-side, we can see when she was writing about herself. There are at least eight passages, first-person accounts written by a “manic-depressive patient,” in the first edition of Manic-Depressive Illness that are identical to those appearing in An Unquiet Mind. These first-person accounts also appear in the second edition of the psychiatric textbook, with a footnote explaining that the description of “a patient with manic-depressive illness” was written “by one of the authors, Kay R. Jamison” (p. 868, n.1). The longest passage in the first edition of the psychiatric textbook is a description of a 17-year-old girl who experiences for the first time severe mood swings “before becoming floridly manic in her 20s.” The description, taken from the “Author’s files,” is three paragraphs long, the first of which is this: I was 17 and it was autumn – a wonderfully intense season full of life, friends, sports, desires, and controlled uncertainty about the future. And, then one day, although the days were shorter they seemed interminably longer. I awoke deeply tired, a feeling as foreign to my natural self as being bored or indifferent to life. Those were next. Then a gray, bleak preoccupation with death, dying, decaying, that everything was born but to die, best to die now and save the pain while waiting. I dragged exhausted mind and body around a local cemetery, obsessed with how long each of its inhabitants had lived before the final moment. I sat on the graves writing long, dreary, morbid poems, convinced that my brain and body were rotting, that everyone knew and no one would say. Laced into the exhaustion were periods of frenetic and horrible restlessness; no amount of running brought relief. I started drinking vodka in my orange juice before setting off for school in the mornings and I thought often of killing myself. It was a tribute to my ability to present an image so at variance with what I felt that few noticed I was in any way different. Certainly no one in my family did. Two friends were concerned but I swore them to secrecy when they asked to talk with my parents. One teacher noticed and the parent of a friend called me aside to ask if something was wrong. I lied readily: Fine, but thank you for asking. (p. 196)

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Here is how the paragraph appears in An Unquiet Mind: Each day I awoke deeply tired, a feeling as foreign to my natural self as being bored or indifferent to life. Those were next. Then a gray, bleak preoccupation with death, dying, decaying, that everything was born but to die, best to die now and save the pain while waiting. I dragged exhausted mind and body around a local cemetery, ruminating about how long each of its inhabitants had lived before the final moment. I sat on the graves writing long, dreary, morbid poems, convinced that my brain and body were rotting, that everyone knew and no one would say. Laced into the exhaustion were periods of frenetic and horrible restlessness; no amount of running brought relief. For several weeks, I drank vodka in my orange juice before setting off for school in the mornings, and I thought obsessively about killing myself. It was a tribute to my ability to present an image so at variance with what I felt that few noticed I was in any way different. Certainly no one in my family did. Two friends were concerned, but I swore them to secrecy when they asked to talk with my parents. One teacher noticed, and the parent of a friend called me aside to ask if something was wrong. I lied readily: I’m fine, but thank you for asking. (pp. 38–39) Jamison’s minor stylistic revisions in An Unquiet Mind are instructive. She substitutes “ruminating” for “obsessed” so that she can use the word “obsessively” instead of the weaker word “often” to evoke the intensity of her suicidal thoughts. Aiming for maximum compression, she changed “I started drinking vodka” to “I drank vodka.” She captures the cyclical nature of mood disorders, the slow descent of depression, the contrast between past and present selves. The existential awareness that “everything was born to die” may lead to inevitable sadness, but in this case the awareness of mortality is symptomatic of clinical depression. Significantly, Jamison doesn’t show us in the two nearly identical passages the “long, dreary, morbid poems” she wrote as an adolescent, perhaps because she was later embarrassed by their sentimentality, but there is nothing inauthentic about her prose. The other passages that appear in the two editions of Manic-Depressive Illness and An Unquiet Mind are also identical apart from minor stylistic

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changes. Sometimes the only change is a shift from second to third-person, as when Jamison describes being in her therapist’s office. “I remember sitting in your office,” writes a patient in the textbook (p. 769); “I remember sitting in his office,” Jamison writes in An Unquiet Mind (p. 118). Other times the only change is a single word, albeit an important one: No pill can help me deal with the problem of not wanting to take pills; likewise, no amount of analysis alone can prevent my manias and depressions. I need both. It is an odd thing owing life to pills, one’s own quirks and tenacities, and this unique, strange and ultimately profound relationship called psychotherapy. (Manic-Depressive Illness, p. 725; second edition, p. 869, italics added) No pill can help me deal with the problem of not wanting to take pills; likewise, no amount of psychotherapy alone can prevent my manias and depressions. I need both. It is an odd thing, owing life to pills, one’s own quirks and tenacities, and this unique, strange, and ultimately profound relationship called psychotherapy. (An Unquiet Mind, p. 89; italics added) Jamison used “analysis” in the two textbook editions probably as a synonym for “psychotherapy,” which appears at the end of the paragraph, but she changed the word to “psychotherapy” in the memoir, despite the fact that she used the same word at the end of the paragraph. Why the change? Although “analysis” is stylistically preferable, avoiding redundancy, Jameson implies that she was saved by psychotherapy, not psychoanalysis. Throughout her writings, Jamison is wary of psychoanalysis, which she associates with narrow-minded orthodoxy, unscientific thinking, and humorlessness. Confiding her suicide attempt to a former UCLA colleague, a “soft-spoken psychoanalyst,” she feels betrayed when he declares he is “deeply disappointed” (p. 200), a judgment that earns him the sobriquet, “Mouseheart.” Jamison is also suspicious of psychoanalysts who are opposed to the use of medication in the treatment of mood disorders. Nothing arouses her ire more, both as a patient and therapist, than the belief that biological diseases like manic-depression can be treated without medication, a view that she regards as grounds for medical malpractice.

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“SEVERELY DEPRESSED. VERY QUIET” Writing about her close encounter with suicide, in light of Mouseheart’s empathic failure, must have been Jamison’s greatest challenge in An Unquiet Mind. The revelation is, by far, her most unnerving self-disclosure. She makes two statements in Touched with Fire that prepare us for the event: first, before the use of lithium in the treatment of manic depression, one-fifth of those suffering from the disease died by suicide; and second, mania quickly returns, in a more virulent and frequent form, in those who stop taking lithium. “My war with lithium began not long after I started taking it,” she admits. “I was first prescribed lithium in the fall of 1974; by the early spring of 1975, against medical advice, I had stopped taking it” (p. 92). There was never a doubt that lithium worked well for Jamison – she describes her form of manic-depressive illness as a “textbook case of the clinical features related to good lithium response” (p. 93). She stopped taking lithium not because of its ineffectiveness but because she missed the intoxicating highs of mania and hypomania. Then there were lithium’s side effects, particularly at a high dose: nausea, vomiting, impaired concentration and memory, and occasional toxicity. Millett, we recall, also missed the intoxicating highs of hypomania and similarly complained about lithium’s side effects. Jamison is quick to point out that she was taking much higher doses of lithium in the 1970s than she currently takes. A psychopharmacological “puritan,” like other members of her family, she could not accept the fact that she had a serious medical disease that required her to be on permanent medication. After ending lithium, she became floridly manic, then severely depressed. She resumed taking lithium in late 1975, but she took it only intermittently, still in denial. Fearing she would forever be insane, Jamison describes, in a chapter starkly called “The Charnel House,” her decision to take a “massive overdose of lithium with no regrets” when she was 28 years old (p. 114). After resolving to end her life, Jamison did not leave a suicide note, for reasons she doesn’t explain, but her psychiatrist seemed to have intuited the danger. His clinical notes, written the day before her suicide attempt, include the portentous words: “Severely depressed. Very quiet” (p. 113). His words convey the calm before the storm, a raging tempest she captures in a stunning passage in An Unquiet Mind that also appears in Manic-Depressive Illness:

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In a rage I pulled the bathroom lamp off the wall and felt the violence go through me but not yet out of me. “For Christ’s sake,” he said, rushing in – and then stopping very quietly. Jesus, I must be crazy, I can see it in his eyes: a dreadful mix of concern, terror, irritation, resignation, and why me, Lord? “Are you hurt?” he asks. Turning my head with its fast -scanning eyes I see in the mirror blood running down my arms, collecting into the tight ribbing of my beautiful, erotic negligee, only an hour ago used in passion of an altogether different and wonderful kind. “I can’t help it. I can’t help it,” I chant to myself, but I can’t say it; the words won’t come out, and the thoughts are going by far too fast. I bang my head over and over against the door. God make it stop, I can’t stand it, I know I’m insane again. He really cares, I think, but within ten minutes he too is screaming, and his eyes have a wild look from contagious madness, from the lightning adrenaline between the two of us. “I can’t leave you like this,” but I say a few truly awful things and then go for his throat in a more literal way, and he does leave me, provoked beyond endurance and unable to see the devastation and despair inside. I can’t convey it and he can’t see it; there’s nothing to be done. I can’t think, I can’t calm this murderous cauldron, my grand ideas of an hour ago seem absurd and pathetic, my life is in ruins and – worse still – ruinous; my body is uninhabitable. It is raging and weeping and full of destruction and wild energy gone amok. In the mirror I see a creature I don’t know but must live and share my mind with. I understand why Jekyll killed himself before Hyde had taken over completely. I took a massive overdose of lithium with no regrets. (An Unquiet Mind, pp. 113–114) It is a truism that suicide is internalized violence, but Jamison shows the truth of this statement. We can begin to understand the murderous violence she describes here, both homicidal and suicidal fury, but we can also begin to grasp her companion’s shocked disbelief. Jamison the writer goes back and forth in her descriptions of self and other in this passage, conveying not only two entirely different points of view but also the vast gulf that cannot be bridged between herself and her friend. It may be misleading,

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however, to refer to a single self here, for there are at least two selves, the one who is out of control, intent upon (self-)destruction, and the observing self, who witnesses but cannot escape from the violence – what Styron calls the “wraithlike observer.” If Jamison is a victim here of mental illness, she is also a self-victimizer. One can apprehend why mental illness was regarded as demonic possession – and still viewed this way by some fundamentalist churches that are all too willing to dismiss the existence of mental illness. Demonic possession has long been a metaphor of mental illness, but a better metaphor is the Jekyll-Hyde duality to which Jamison refers at the end of the passage. She characteristically turns to literature, in this case, Robert Louis Stevenson’s 1886 novel, to explain why, when confronted with her own monstrous words spoken and deeds committed while mentally ill, she made the decision to end her life. As a storyteller, Jamison knows what to include and exclude; for example, she leaves to our imagination why beautiful lovemaking suddenly went bad. Nor is there a need to speak the unspeakable words to her lover. Faithful to the spirit of the dark self Stevenson dramatizes, Jamison hides little about her suicide attempt, certainly not the raging emotions she experienced at the time, including toxic guilt and shame. In focusing on dueling personalities, she implies that the struggle is not between good and evil, as in Stevenson’s novel, but between health and illness. There’s little a reader can tell Jamison that she doesn’t already know – except that, contrary to her claim, she does convey the desperation and despair inside her. Tellingly, one does not read An Unquiet Mind oppositionally, as one reads The Loony-Bin Trip. Relatives and friends do not conspire against Jamison, as Millett’s relatives and friends appear to be conspiring against her. Jamison has overcome the stigma of mental illness; Millett has not. Jamison criticizes specific psychiatrists, but she does not demonize psychiatry, as Millett does. Jamison and Millett experience the same symptoms of manic depressive disease, including grandiosity, impulsiveness, sleeplessness, shame, hopelessness, and suicidality, but they reach diametrically opposed conclusions about the role of psychiatry in mental illness. Jamison discloses in An Unquiet Mind her methodical plans to take a fatal dose of lithium, including taking anti-emetic medication to prevent herself from vomiting up the pills. She then explains how she was inadvertently saved by crawling to her ringing telephone in the next room, while nearly comatose, and hearing the voice of her brother, who was part of

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an informal suicide watch despite being in Paris at the time. He called her psychiatrist, and though she doesn’t record the events that immediately transpired, she ended up feeling “sicker than a coyote, sicker than a dog, sicker than I could ever wish anyone to be.” She was “in and out of a coma for several days, which,” she explains with wry detachment, “given the circumstances, was probably just as well” (p. 116). NIGHT FALLS FAST In her next book, Night Falls Fast: Understanding Suicide (1999), published only four years after An Unquiet Mind, Jamison explores the Werther effect, the gendered nature of suicide, the complex motivation behind the decision to end one’s life, and the alarming prevalence of suicidal thinking among high school and college students. Oliver Sacks’s statement on the back cover of An Unquiet Mind is accurate: “It stands alone in the literature of manic-depression for its bravery, brilliance, and beauty.” Night Falls Fast opens with a riveting “anti-suicide pact” Jamison made on a languorous summer night with her friend Jack Ryan, a successful businessman and inventor who was credited with designing the “Barbie” doll. The two comrades had shared their experiences with manic-depressive illness with each other and resolved to be there for the other in the event of an emergency. Jamison knew, however, the futility of such promises. “Never once, during any of my sustained bouts of suicidal depression, had I been inclined or able to pick up a telephone and ask a friend for help” (p. 4). Jamison was shaken but not entirely surprised by Ryan’s suicide by gun. “Suicide is not beholden to an evening’s promises, nor does it always hearken to plans drawn up in lucid moments and banked in good intentions” (p. 5). While researching Jack Ryan, I came across a detail that doesn’t appear in Night Falls Fast. In her obituary of Ryan published in the Los Angeles Times on August 19, 1995, Myrna Oliver reported, based on information from a “family spokesman,” that he died at home after two years of severe debilitation caused by a massive stroke he suffered in 1989. Before his stroke, he had suffered a heart attack and undergone bypass surgery. Ryan’s family did not want to acknowledge the suicide, which was reported in other newspapers and in his Wikipedia entry. Suicide remains

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stigmatized, rarely spoken about or acknowledged, and underreported, which makes Jamison’s personal disclosures in An Unquiet Mind and Night Falls Fast more consequential. Night Falls Fast is essential reading for anyone who wishes to learn more about suicide and the importance of suicide prevention. Jamison does not replay the information that appears in An Unquiet Mind, but she does make a few observations that cast further light on the story. One of her central insights, made by nearly every researcher, is the rationale for suicide prevention: “Often, people want both to live and to die; ambivalence saturates the suicidal act” (p. 39). Nevertheless, this was not true for her. “I took a massive overdose of lithium,” she states candidly in the prologue. “I unambivalently wanted to die and nearly did. Death from suicide had become a possibility, if not a probability, in my life” (p. 6). Jamison learned from her experience what some therapists do not understand: suicide has less to do with courage or cowardice, selflessness or selfishness, than with hopelessness, which is usually the best predictor, along with a previous history of suicide attempts, of whether a person will choose to terminate existence. She ends Night Falls Fast with an anecdote, an encounter with another version of Mouseheart. She and her husband were having dinner with an old friend, a psychiatrist with more than 30 years’ experience. He asked her what she was working on, and she replied, a book on suicide. After a revealing silence, the psychiatrist admitted that he was once suicidal, when he was 18, but decided against it because it would be terrible for his family and friends. Jamison did not have a problem with that statement, but with the next one. “I’m a doctor. Think what it would be like for my patients. How incredibly selfish” (p. 290). The last sentence, expressed in a tone of moral superiority, rankled Jamison. After telling him about her near-fatal suicide attempt years earlier, she reminds her readers that suicide is almost always the “final outcome of a disease,” not a moral failure. Study after study in Europe, the United States, Australia, and Asia has shown the unequivocal presence of severe psychopathology in those who die by their own hand; indeed, in all of the major investigations to date, 90 to 95 percent of people who committed suicide had a diagnosable psychiatric illness. (p. 100) Sometimes, however, the psychopathology may not be detected. In June 2018, the Centers for Disease Control and Prevention, the leading national

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public health institute in the United States, released statistics indicating that from 1999 to 2016, the suicide rate has increased by more than 30% in half the states. Nearly 45,000 lives were lost to suicide in 2016 and, most disturbing of all, “more than half of people who died by suicide did not have a known mental health condition.”

THE CONTAGION EFFECT In a review of Night Falls Fast published in the New York Times in 1999, Andrew Solomon raises a question that bedevils anyone who writes about suicide: Jamison notes that suicide is catching, and avers that one death often enables many others, as localized suicide epidemics have indicated. If suicide is contagious, is not Jamison’s book itself a potential source of infection? Her evocations of the suicidal mind invite too much empathy at times; her eloquence can be dangerous, and I felt a will to self-destruction rise in me as I read on. If the material is somewhat toxic for the reader, however, it must have been more poisonous for the author. Solomon’s review of Night Falls Fast occurred while he was writing his own book about depression and suicide, The Noonday Demon. The same criticism he makes of Night Falls Fast, a potential source of infection for readers and author, can also be made of The Noonday Demon (2002). In 1978 Jamison created the UCLA Affective Disorders Clinic, which, according to its website, is still in existence, treating 325 patients a year. The clinic emphasizes the combined use of medications and psychotherapy rather than medications alone. “My own experience as a patient,” she writes in An Unquiet Mind, had made me particularly aware of how critical psychotherapy could be in making some sense out of all the pain; how it could keep one alive long enough to have a chance at getting well; and how it could help one to learn to reconcile the resentments at taking medication with the terrible consequences of not taking it. (pp. 127–128) Jamison values dynamic psychotherapy that focuses on early developmental issues, personality structure, interpersonal conflicts, motivation, and the

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unconscious. She presents compelling evidence from many studies, as well as her own personal experience, that the best treatment for serious mental illness is a combination of medication and psychotherapy.

JAMISON’S PSYCHIATRIST Jamison met her future psychiatrist at the chancellor’s garden party given each year to welcome new faculty members to UCLA. He had supervised her clinical work a year earlier when he was chief resident at the UCLA Neuropsychiatric Institute. She was struck by his kindness and expertise. He could not be more different from the psychiatrists Styron and Millett write about in their memoirs. “When I became violently manic just after joining the UCLA faculty, he was the only one I trusted with my mind and life” (An Unquiet Mind, p. 84). He suspected from the rigorous psychiatric interview he conducted that she was manic depressive and would probably need to be on lithium indefinitely, but he never forced it on her or made it a precondition for remaining in therapy. During the next several years he remained the one constant in her life, in addition to her mother’s unconditional love. He patiently addressed all of her concerns, including her secret fear that lithium might not work, a fear he intuited, as his medical notes suggest. Patient sees medication as a promise of a cure, and a means of suicide if it doesn’t work. She fears that by taking it she will risk her last resort. (p. 103) Jamison describes their relationship as initially combative, and, in a passage that appears in the two editions of Manic-Depressive Illness and An Unquiet Mind, she sketches this battle in a few vivid sentences that reveal her sardonic wit. The endless questioning finally ended. My psychiatrist looked at me, there was no uncertainty in his voice. “Manic-depressive illness.” I admired his bluntness. I wished him locusts on his lands and a pox upon his house. Silent, unbelievable rage. I smiled pleasantly. He smiled back. The war had just begun, (p. 104) Jamison offers her own perspective of this war as a patient, but she does not present her psychiatrist’s perspective apart from his perceptions and judgments as recorded in his clinical notes. Why does she exclude what must

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have been stormy transference-countertransference dynamics? Probably to guard her psychiatrist’s privacy. Apart from his physical appearance – he is six-foot-four inches tall, good-looking, with a “steel-trap mind, a quick wit, and an easy laugh that softened an otherwise formidable presence” (p. 83) – we learn nothing about his private life. Nor do we know his theoretical orientation as a psychiatrist, perhaps because, as Jamison writes in the second edition of her textbook, “no one type of psychotherapy has been demonstrated to be uniquely effective” in the treatment of manicdepressive illness (pp. 870–871). He presumably carries out all of the recommendations made by the American Psychiatric Association in 2002 for managing patients with bipolar disorder, as Goodwin and Jamison write in the second edition of their textbook: (1) perform a diagnostic evaluation, (2) evaluate the patient’s safety and determine a treatment, (3) establish and maintain the therapeutic alliance, (4) monitor treatment response, (5) provide education to the patient and family, (6) enhance treatment adherence, (7) promote awareness of stressors and regular patterns of activities and sleep, (8) work with the patient to anticipate and address early signs of relapse, and (9) evaluate functional impairments. (p. 869) Of the nine recommendations, Jamison places greatest emphasis on establishing and maintaining the therapeutic alliance. The psychiatrist’s support never wavers, and he makes no demands on her apart from strongly advising her to remain on lithium. We don’t see him providing education to Jamison’s family about the nature of manic-depressive disorder, but he most likely encouraged her to share her understanding of the disease with her relatives, particularly because of its genetic roots. Knowing that Jamison was a serious suicide risk, should the psychiatrist have involuntarily hospitalized her? Therapists may find themselves in difficult situations, caught between an increasing number of state regulations that mandate the reporting of patients who may be at risk of harming themselves or others, and what Freud calls the “fundamental rule” of psychoanalysis, the freedom to discuss anything that troubles them. Jamison’s psychiatrist’s medical notes explain his decision not to do so. “Hospitalization is totally unacceptable to her and in my view she cannot be held under LPS [the California commitment law]” (An Unquiet Mind, p. 111). At the time, Jamison was horrified at the thought of being hospitalized,

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voluntarily or not, fearing mainly that her license to practice psychotherapy would be temporarily suspended or permanently revoked. She also knew, in a sentence that highlights her strong disapproval of the rules regarding involuntary hospitalization, that because the California commitment code is designed more for the well-being of lawyers than of patients, it would have been relatively easy for me to talk my way out of an involuntary commitment. (p. 112) Goodwin and Jamison point out in the second edition of their textbook that hospitalization decreases but does not entirely eliminate the risk of suicide. One 1979 study reported that 27 percent of manic-depressive patients committed suicide while under hospital care, “although half of them were on a pass or had absconded” (p. 964). This information qualifies Styron’s statement in Darkness Visible about the “enforced safety” of the hospital environment. In retrospect, Jamison regretted the decision not to have been hospitalized, as she implies in a parenthetical comment that is hardly parenthetical: After this experience, I drew up a clear arrangement with my psychiatrist and family that if I again become severely depressed they have the authority to approve, against my will if necessary, both electroconvulsive therapy, or ECT, an excellent treatment for certain types of severe depression, and hospitalization. (An Unquiet Mind, pp. 112–113) Jamison doesn’t write about her treatment in a psychiatric hospital following her suicide attempt. We can assume that her experience was different from Kate Millett’s, who never overcame the trauma of forced hospitalization. We can assume, further, that Jamison was spared some of the indignities Elyn Saks endured when she was subjected to four-point leather restraints, along with a net over her body, in a locked psychiatric ward. Shortly before her suicide attempt, Jamison saw in the UCLA emergency room one of her patients, who a year earlier had held a knife to her throat during a psychotherapy session, being strapped down on a gurney, in four-point restraints. Jamison recalls being sickened by the sight, but she doesn’t specifically comment on whether she believes the use of restraints is medically justified.

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Significantly, Jamison doesn’t show being subjected to indignities as a psychiatric patient, but she tells us about these degrading events without offering many details. I have been physically restrained by terrible, brute force; kicked and pushed to the floor; thrown on my stomach with my hands pinned behind my back; and heavily medicated against my will. (p. 120) Why tell instead of show? The reason, I suspect, is that Jamison’s main intention in An Unquiet Mind is to convince readers that mood disorders are a medical disease that requires medication, psychotherapy, and sometimes hospitalization. She did not want to fuel the antipsychiatry movement by emphasizing abuses. Jamison doesn’t name her psychiatrist, but in the opening paragraph of the acknowledgments she warmly pays tribute to Dr Daniel Auerbach for the excellent medical care he has provided her. “I owe him not only my life, but an important part of my education as a clinician as well” (An Unquiet Mind, p. 221). Writing in the third person in the second edition of her psychiatric textbook, she extends her “heartfelt appreciation” to the same person who not only taught her how to live with manic-depressive illness but also encouraged her to study and write about it. His profound clinical understanding of the medical and psychological aspects of bipolar disorder were lifesaving; they have also strongly influenced her research, clinical practice, and writing. (p. x) She dedicates Exuberance to her father and Daniel Auerbach, “to whom I owe so much of my life and work.” She acknowledges her gratitude to him in all her books. A board-certified psychiatrist affiliated with multiple hospitals in the Los Angeles area, Auerbach graduated from the University of Southern California Keck School of Medicine in 1969; his psychiatric specialties include bipolar disorder. It’s likely that Jamison sought his permission to name him at the end of the story. He comes across as compassionate, insightful, and ethical, exemplary in every way. WRITING ABOUT HER FAMILY Writing about her family posed a different challenge to Jamison, as it does to all authors of mental illness memoirs. How does a memoirist tell

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a complex interpersonal story without intruding on the privacy of others? How does a psychotherapist, trained to respect a patient’s confidentiality, remain ethically responsible when writing about family and friends? Jamison refers briefly to her father’s struggle with manic-depressive illness (and alcoholism), along with the extent to which mood disorders appeared on his side of the family. No such genetic instability appears on Jamison’s maternal side, which is “squeaky clean.” Jamison notes early in the memoir that when she was growing up, she had a complicated relationship with her 13-month-older sister, who was a “rebel,” but not with her brother, whom she idealized. Jamison is deliberately vague about describing her sister’s mental health. “She had a charismatic way, a fierce temper, very black and passing moods, and little tolerance for the conservative military lifestyle that she felt imprisoned us all” (An Unquiet Mind, p. 14). Jamison then skillfully contrasts the ways they viewed their own black moods: when both she and I had to deal with our respective demons, my sister saw the darkness as being within and part of herself, the family, and the world. I, instead, saw it as a stranger; however lodged within my mind and soul the darkness became, it almost always seemed an outside force that was at war with my natural self. (p. 15) When Jamison became ill, her sister “was adamant that I should not take lithium and was disgusted that I did” (p. 99). Jamison’s sister comes across as stridently antipsychiatry: “she tore into me for ‘capitulating to Organized Medicine’ by ‘lithiumizing away my feelings’” (p. 99). Jamison’s doesn’t name her sister in the memoir, but she refers to her by name in the acknowledgments, Phyllis Jamison, along with the names of her two half-sisters, Danica and Kelda Jamison. In light of Phyllis Jamison’s belief that the darkness was within and part of herself, it’s ironic that she later located the darkness within lithium. Jamison doesn’t elaborate on what might have been contentious family discussions over psychiatry’s role in the treatment of mental illness, but we recall how Alexandra Styron’s memoir Reading My Father (2011) reveals a significantly different story, along with different parent-child dynamics, from the one we see in Darkness Visible. We also remember the differences between Kate Millett’s The Loony-Bin Trip and her sister Mallory’s counterstory.

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Jamison has only kind words to say about her parents. She dedicates An Unquiet Mind to her mother, Mary Dell Temple Jamison, who died in 2007 at the age of 91. She could not have known how difficult it would be to deal with madness; had no preparation for what to do with madness – none of us did – but consistent with her ability to love, and her native will, she handled it with empathy and intelligence. It never occurred to her to give up. (p. 19) Jamison’s father died on April 21, 2012, at the age of 95. An obituary published in the Richmond Times-Dispatch reported that James Marshall Jamison drew his inspiration from the nineteenth-century scientist Michael Faraday, who said, “Nothing is too wonderful to be true.” Kay Jamison must have written this part of her father’s obituary, for the same quotation appears in An Unquiet Mind (p. 17). The quotation has special significance for her, as she points out in Exuberance (2004). Her father first came across the Faraday quotation when, as a Ph.D. student, he saw it carved into an archway over the UCLA physics building. Years later, when Jamison found herself depressed and pointed out Faraday’s own history of nervous breakdowns, her father gave her a gold locket from Tiffany inscribed with the scientist’s words, a reminder not to lose hope in life. The second half of An Unquiet Mind focuses on the gift of life following a near-successful suicide attempt. After receiving tenure at UCLA, Jamison divorced her first husband, the French artist Alain Moreau, with whom she has remained on good terms, and fell in love with a psychiatrist who was a member of the Royal Army Medical Corps, Colonel David Laurie, who died suddenly from a massive heart attack at age 44. (She was 32.) His death spelled the end of some of Jamison’s most important dreams, including the wish to have children, but she did not plunge into darkness or consider suicide. Several years later she fell in love with Richard Wyatt, gave up her tenure at UCLA, and moved to Washington in 1986 to live with him. She soon received an offer at Johns Hopkins, where she continues to teach. Jamison raises a question in the epilogue to An Unquiet Mind that she has often asked herself: if given the choice, would she elect to have manicdepressive illness? If lithium were not available to me, or didn’t work for me, the answer would be a simple no – and it would be an answer

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laced with terror. But lithium does work for me, and therefore I suppose I can afford to pose the question. Strangely enough I think I would choose to have it. (p. 217) Alice Flaherty, we recall, had raised the same question in The Midnight Disease (2005), and other memoirists, including Andrew Solomon and Elyn Saks, similarly ask themselves whether they would elect to free themselves from depression or schizophrenia, respectively, if they could. Jamison’s ebullient personality shines through from the beginning to the end of her memoir, confirming, if proof is necessary, that her creativity remains undiminished.

EXUBERANCE “Exuberance is an abounding, ebullient, effervescent emotion. It is kinetic and unrestrained, joyful, irrepressible” (p. 4). All of these adjectives characterize the substance and style of Jamison’s 2004 book. If mania, or rather, hypomania, were an author, she would pen a book exactly like Jamison’s. One would never guess that the author of Exuberance had lamented sorrowfully in An Unquiet Mind over the perceived loss of creativity resulting from lithium, for there is nothing diminished about Jamison’s passion for life or magical prose. Indeed, if being on a mood stabilizer allowed an author to write a joyous and sparkling book like Exuberance, everyone would rush to the nearest psychopharmacologist. Until recently, Jamison states, psychological research has been far more preoccupied with “negative” emotions than positive ones. “For every hundred journal articles on sadness or depression, calculates psychologist Martin Seligman, only one is published about happiness” (Exuberance, p. 94). The scholarly neglect has slowly been changing, partly because of the influential positive psychology movement, founded by Seligman and others. Positive emotions like exuberance are less contagious than negative ones, but the infectious energies of exuberance “proclaim and disperse much of what is marvelous in life” (p. 4). Additionally, positive moods heighten creativity and cognitive alertness. Optimistic people live longer than pessimistic people – as much as a 19% increase in their expected life span, according to one study (p. 338). Where does exuberance end and mania begin? This question haunts Jamison’s study, and though she cannot answer it precisely – no one can – she offers a few tentative conclusions. Manic-depressive illness, in its most

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severe forms, occurs in about 1% of the population, affecting men and women equally, unlike depression, which occurs twice as often in women. In its milder and briefer variations, manic depression occurs in another 5% of the population. “If exuberance is the Champagne of moods,” Jamison remarks, in a bubbly metaphor, “mania is its cocaine. Mania is exuberance run amok” (p. 121). Jamison’s study is not only a history of a mood but also a biography of exuberant men and women who have made major contributions to politics, science, and the arts. Throughout Exuberance Jamison’s impassioned prose style captures the intoxicating ideas of the men and women in her study. She opens the book with an account of two highly exuberant men, Theodore Roosevelt and John Muir, among the country’s earliest conservationists. She then turns to Franklin D. Roosevelt and Winston Churchill, whose infectious enthusiasm, resilience, and joie de vivre led their nations to victory over Germany and Japan during World War II. As part of her research, Jamison interviewed several scientists whom she knew personally to be intensely exuberant. Their observations cast much light on the ways in which exuberance became the driving force behind their scientific discoveries. There are many similarities between manic depression and exuberance, including high moods and expansive energy, but there are also notable differences. Most exuberant people are not manic depressive, and most manic depressives are not particularly creative. Jamison urges a balance between lighter and darker moods. “Excessive lightness can be given a grace note by the dark, as melancholy and mania can give each other depth and height.” As always, she cites a literary authority to buttress her judgment, in this case, Alexander Pope’s injunction, repeated by Emerson: “Write with fury, and correct with flegm” (p. 286). Exuberance is a treasure trove for anyone interested in seeing how an illness like manic depression can be a blessing in disguise for an author capable of writing about her experience. Jamison’s words enchant and enthrall. She relies on old favorites, as when she cautions that “our beholdenness to passion assures a darker side” (p. 246), but she also uses words seldom seen in her earlier writings, as when she describes the physicist Richard Feynman as the “ultimate scientific galumpher” (p. 238), a word guaranteed to set off any spellcheck. Whether she refers to Tigger’s “highspringing, discombobulating ways” in A.A. Milne’s The House at Pooh Corner, or to Mr. Toad, a “whirligig of energy” (p. 70) in Kenneth Grahame’s The Wind in the Willows, Jamison is as insightful in her comments

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on children’s literature as in her analysis of the latest genetic research. Her language leaps buoyantly from story to story, person to person, idea to idea, in ways that delight and instruct.

NOTHING WAS THE SAME Jamison reveals, in the final paragraph of her acknowledgments in Exuberance, that her husband died while she was writing the book. I admired him enormously: he was an excellent scientist and physician, as well as a gentle, immensely curious, and quietly exuberant man. I miss him more than I can say. (p. 381) She finds the words to capture his passion, along with their deeply fulfilling marriage, in her achingly beautiful spousal loss memoir Nothing Was the Same (2011). An author’s later writings often cast light on earlier writings, either extending, qualifying, or in some cases contradicting them. Nothing Was the Same deepens our understanding of An Unquiet Mind, makes a pertinent distinction, seldom noted in spousal loss memoirs, between grief and depression, suggests how Jamison was able to write the book while she was grief-stricken, and prepares us for her monumental study of Robert Lowell. It is common to celebrate birthdays, anniversaries, and graduations, and, less common, to honor deathdays, but how does one remember the anniversary of an unsuccessful suicide attempt? No mention of this appears in An Unquiet Mind, but Nothing Was the Same opens with a letter Jamison wrote to Wyatt on September 29, 1985, in which she remarks that Thursday, October 3rd will be the anniversary of “my having almost killed myself.” It is a daring way to begin a spousal loss memoir. Jamison never allows us to forget that their marriage was complicated and occasionally threatened by her illness. “I could live with my mercurial moods, but it was not clear that someone else could, or should” (p. 19). Wyatt’s terminal illness strained the marriage in other ways. He was diagnosed when he was 33 with stage four Hodgkin’s disease, which at the time was considered a death sentence, but with an aggressive combination of radiation and chemotherapy he lived for nearly 30 more years. He regarded his recovery as a medical miracle, but as a result of the massive dose of radiation he received, he later developed Burkitt’s lymphoma and then lung cancer, to which he finally succumbed. He remained grateful for the extra time, but for the last

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three years his health was severely compromised. Both husband and wife lived under the shadow of death. Illness tested their marriage in ways that Jamison could not have predicted in An Unquiet Mind. She includes a detail in Nothing Was the Same that reveals why she felt betrayed by an act Wyatt thought was a prudent precaution. One evening, she relates, he asked her about the symptoms of neuroleptic malignant syndrome, a rare but potentially lethal reaction to antipsychotic drugs. She didn’t regard his question as ominous at first, but when she noticed his black doctor’s bag in his home study rather than in his rented office, where both of them treated patients, she became suspicious and asked to look through the contents of the bag. He reluctantly agreed, and she was horrified when she saw a syringe and a vial of antipsychotic medication. “I didn’t have to ask,” she confesses. It was for me, in case I became manic. Seeing the syringe triggered memories of being forcibly medicated after I first had become psychotic years earlier. I felt trapped and, more fundamentally betrayed. (p. 23) After a long silence, Jamison reports, Wyatt responds weakly, “Medicine is imperfect,” then, after another pause, “I am imperfect,” followed by “Love is imperfect.” His words are a defining moment in their marriage. “It was the most true, most chilling thing I had heard about dealing with the uncertainties of an illness such as mine” (p. 23). I found myself identifying here more with Wyatt than with Jamison. He was, after all, concerned about her health, taking precautions that strike me as both loving and sensible. If I were in Jamison’s situation, I would feel grateful that my husband was prepared for this emergency. But my identification with Wyatt also reveals that I have never been forcibly medicated, never been compelled, against my will, to receive unwanted medical treatment, never been treated as a mental patient. Nor have I struggled with the stigma of serious mental illness. Details like these, Jamison’s flashes of anger and perceptions of betrayal, and Wyatt’s over-caution and perhaps defensiveness, evoke the reality of living with manic-depressive illness. Another reality is the importance of sleep. As her husband lies comatose in the hospital in the late hours of the evening, with death only a few hours away, Jamison wants to remain next to him, for what she knows will be their last night together, but she also knows that she might become manic again if she doesn’t get enough sleep. “Having lost my heart, I would then

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lose my mind.” Thanks in part to her husband’s insistence over the years that she take her medication and get enough sleep, she did not become manic or depressed again after his death. “My mind was not right, but it was not deranged” (p. 168). It may feel like a betrayal for Jamison to leave her husband for a few hours, to preserve her sanity, but it’s unlikely that the reader will hold her guilty. And yet no one can presume how readers may feel when they read anything, much less an emotionally charged memoir like An Unquiet Mind, as Jamison explains in Nothing Was the Same. Despite Wyatt’s unwavering support, she worried about her decision to write the book and thus expose publicly her illness. Her family was divided over the issue, with her mother and brother strongly opposed to the project and her father supporting it. Friends and colleagues were also split. Her psychiatrist helped her to think through the implications of the public disclosure. “He made the indisputable point that it would be hard, and it was. He did not say it would be insurmountably hard, and it wasn’t” (p. 38). Jamison also had the support of the chair of the Department of Psychiatry at Johns Hopkins, Paul McHugh, who reminded her of the story of William Halsted, the first chief of surgery at Hopkins. “It was known that Halsted was a cocaine and morphine addict,” he said. “When he was impaired, his colleagues took it as their responsibility to protect Professor Halsted’s patients. But they also looked after Professor Halsted as best they could, so that he could continue to do his research, write, and train young surgeons.” He paused long enough for me to take this in. “If Hopkins can’t do that for you,” he said, “Hopkins has no business being in business.” (p. 39) But there were also “bone-chilling” responses from American and European colleagues, including a Danish psychiatrist who told her at a medical conference in Stockholm, “No Danish doctor would write what you wrote” – a comment not intended as a compliment. She received hundreds of letters from fundamentalist Christians who berated her for abandoning God and her Christian faith, “which I had not been aware I had or had not done” (p. 43). She was also attacked by those associated with the antipsychiatry movement, virulently opposed to the use of medication to treat psychiatric illness. One suspects that her sister was part of this group. Jamison never mentions her after An Unquiet Mind, though she warmly

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acknowledges the help in her following books of her other close relatives, friends, and scholars. JAMISON AS THERAPIST Unlike other therapists, Jamison doesn’t write about her own patients, but they sometimes write about her, as Martha Manning does in her 1994 memoir Undercurrents: A Life Beneath the Surface. A clinical psychologist and former professor of psychology at George Mason University in Virginia, Manning sank into a severe depression in 1990. She describes her first therapy visit with Jamison in June 1990; unaccustomed to seeing a therapist at her home, Manning is impressed with the many books in Jamison’s office. “They appear organized by theme with as many books on poetry and art as psychology, which I take as a good sign” (p. 69). Manning confesses her feeling of “hypocrisy,” helping others when she cannot help herself, but Jamison tells her that she is much too harsh on herself, reminding her, in Manning’s words, that “some of the best therapists are the ones with the most darkness in their lives and that some of the greatest artists have known the terrible torment of depression” (p. 70). Manning does not realize the darkness in Jamison’s life – An Unquiet Mind would not be published for another five years. Manning’s depression deepens, despite psychotherapy, and Jamison encourages her to consider ECT, which somehow helps to “reset the clock.” Throughout Undercurrents Jamison comes across as empathic, kind, attentive, and reassuring. She doesn’t always tell Manning what the patient wants to hear: she cautions her, for example, that people who emerge from a serious depression often panic when they encounter a setback, but this is part of the process of recovery. Deeply religious, Manning confesses the fear that God must be angry with her, to which Jamison, also a person of faith, responds, “I don’t think we’re talking about God forgiving you. I think we’re talking about you forgiving God” (p. 155). After the successful ECT treatments, Jamison sent Manning a book of poems by the early nineteenth-century German poet Friedrich Hölderlin, a volume that reveals his own recovery from an acute mental breakdown.

GRIEF, NOT MADNESS Jamison’s most original contribution to the literature of bereavement in Nothing Was the Same is her distinction between grief and madness.

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“It has been said that grief is a kind of madness,” she observes in the prologue. She disagrees. There is a sanity to grief, in its just proportion of emotion to cause, that madness does not have. Grief, given to all, is a generative and human thing. It provides a path, albeit a broken one, by which those who grieve can find their way. Still, it is grief’s fugitive nature that one does not know at the start that such a path exists. I knew madness well, but I understood little of grief, and I was not always certain which was grief and which was madness. Grief, as its transpires, has its own territory. (p. 5) Jamison explores that territory in Nothing Was the Same, reminding us of the many differences between grief and depression. “In grief, one feels the absence of a life, not life itself. In depression, it is otherwise: one cannot access the beat of life” (p. 172). Grief is not only generative but it is also sometimes the catalyst behind artistic and scientific creativity, as Jamison demonstrates in Exuberance and Nothing Was the Same. She learned, with her husband’s support, that what allowed her mind to thrive and for madness to be kept at bay was a “finely honed mix of lithium and love and sleep” (p. 24) – and work, in her case, writing a book about exuberance. She admits that nothing could have been odder than the subject of her book, yet it was also strangely appropriate, for although most of Jamison’s writings are about mood disorders, her writings are all a celebration of life. Her books are also about resilience and grit, the subject of the last chapter of Exuberance. Completing the last chapter was a challenge, she concedes, but writing allowed her to remain connected with her deceased husband and to keep his memory alive, which she accomplishes in Nothing Was the Same. Jamison is no fan of psychoanalysis, and for this reason it’s odd that she cites approvingly Freud’s 1917 essay “Mourning and Melancholia,” where he argues that one must relinquish the lost love object if one is to return to life. “There is a time limit to grief,” she states (p. 190). It would have been more accurate for Jamison to say that although there is no time limit to grief – people grieve differently, and for different lengths of time – grief changes over time. As I suggest in Writing Widowhood, contrary to showing a time limit to grief, Jamison’s spousal loss memoir affirms a new theory in bereavement, called “continuing bonds,” which argues that,

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in opposition to Freud’s injunction, the mourner does not shatter the relational bond with the deceased. People “do not decathect from the dead but find new ways to develop ‘continuing bonds’ with the deceased,” J. William Worden observes in the third edition of Grief Counseling and Grief Therapy (2002 p. 35). One of the tasks of mourning, Worden adds, is to find a place for the deceased that will enable the mourner to be connected with the deceased but in a way that will not preclude him or her from getting on with life. We need to find ways to memorialize the dead, that is, to remember the dead loved one – keeping them with us but still going on with life. (p. 35) Dennis Klass, Phyllis Silverman, and Steven Nickman develop this new theory of bereavement in their 1996 edited volume Continuing Bonds: New Understandings of Grief. Before ending Nothing Was the Same, Jamison does something rarely, if ever, done by a spousal loss memoirist: authenticate its accuracy. I, like many nonfiction writers, have been concerned about the damage done to the credibility of autobiographical writing by those who have written fraudulently about their lives. I have provided my editor at Knopf with extensive documentation for what I have written in Nothing Was the Same. (pp. 206–207) We learn from a brief biographical sketch at the beginning of Nothing Was the Same that in 2010 Jamison married Thomas Traill, a cardiologist and Professor of Medicine at Johns Hopkins. She dedicates her next book to him.

ROBERT LOWELL Jamison’s magisterial Robert Lowell: Setting the River on Fire (2017) reveals two stories, one she tells about the most famous American postwar poet, who struggled with severe manic-depressive illness throughout his adult life, the other she does not tell, about her own battle with the same mood disorder. The two stories, stitched seamlessly together, are both fascinating. Robert Lowell (1917–1977) was the major figure behind the confessional poetry movement, as were two of his Boston University students, Sylvia Plath and Anne Sexton. Lowell’s Life Studies, one of the transformative poetry volumes of the twentieth century, won the 1960 National Book

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Award. Two other poetry volumes, Lord Weary’s Castle and The Dolphin, earned Pulitzer Prizes in 1947 and 1974, respectively. Lowell served as the Consultant in Poetry to the Library of Congress, an appointment now called the United States Poet Laureate, from 1947 to 1948. He was one of the few poets to appear on the cover of Time magazine, in June 1967, where he was hailed as the “best American poet of his generation.” Lowell was born into an illustrious Boston family that included, on his paternal side, the poets James Russell Lowell (1819–1891) and Amy Lowell (1874–1925), also a winner of the Pulitzer Prize for Poetry, and, on his maternal side, the Calvinist fire-and-brimstone theologian Jonathan Edwards and the Puritan preacher and poet Anne Hutchinson. Serious mental instability affected both sides of Lowell’s family. He suffered 16 psychotic breaks, beginning in his early thirties, that resulted in prolonged hospitalizations, many of which occurred at McLean Hospital, in Belmont, Massachusetts, where, according to Jamison’s research, his great-greatgrandmother (James Russell Lowell’s mother) had also been institutionalized a century earlier. Madness was the overwhelming fear in Lowell’s life, but rather than concealing his psychiatric breakdowns, he frequently wrote about them, both to destigmatize mental illness and to show how his creativity was allied to his mercurial moods. Madness became, as Jamison demonstrates, a driving force behind his poetry. Jamison’s luminescent prose in Robert Lowell reveals her own poetic side, the metaphorical power of her language. Her book on Lowell is about “fire in the blood and darkness,” but she could have been describing herself. She focuses on a single poet, but her book is, in a larger sense, a study of poetry’s beholdenness to the fluctuations in mood brought on by psychiatric illness. Jamison not only deepens our knowledge of the interconnections between creativity and mood disorders, as she did in Touched with Fire, but she also raises questions for further research, including the extent to which writing may be a lifeline for those confronting serious mental illness. Lowell wondered about many of these questions himself. “Is getting well ever an art,” he asked, “or art a way to get well?” (p. 189). USING PSYCHIATRIC RECORDS Jamison’s book is not a biography of Lowell – two have already been written, the first by Ian Hamilton in 1982, Robert Lowell: A Biography, the second by Paul Mariani in 1994, Lost Puritan: A Life of Robert Lowell.

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Rather, her book is a psychological study that focuses on the “entanglement of art, character, mood, and intellect” (p. 5). The executors of Lowell’s estate, his daughter, Harriet Winslow Lowell, and the literary critic and founding editor of the New York Review of Books, Robert Silvers, gave Jamison permission to request and examine the poet’s medical and psychiatric records as well as to interview his surviving physicians. She thus had access to confidential records allowing her to explore aspects of a psychiatric patient’s life that seldom find their way into published studies. Jamison is not the first scholar to use a deceased patient’s psychiatric records. As we shall see in the next chapter, the Stanford biographer Diane Wood Middlebrook received permission from Anne Sexton’s literary executor, her daughter Linda Gray Sexton, to listen to three hundred hours of psychotherapy tapes that Anne Sexton’s psychiatrist, Dr Martin Orne, had made, with the Pulitzer-Prize winning poet’s permission, not long before she committed suicide in 1974 shortly before her 45th birthday. Orne was understandably reluctant to turn over the therapy tapes, along with his therapy notes and her unpublished poems, because of confidentiality concerns, but he was legally obligated to do so: in many states, the law allows a deceased patient’s family or estate access to medical records. Although Orne’s decision dismayed the mental health community, Middlebrook used the tapes judiciously; her 1991 biography Anne Sexton expands our understanding of how the confessional poet transmuted her psychiatric conflicts into art. Middlebrook, who died in 2007 at age 68, was a literature professor, not a mental health professional, and she did not seek to correlate, as Jamison does, a relationship between her biographical subject’s state of mind and artistic creativity. Nor did Middlebrook attempt to write, as Jamison does, a narrative of the psychiatric illness that bedeviled a poet. As a clinical psychologist, Jamison is sensitive to confidentiality concerns. She points out that although Lowell was unusually forthright about his history of mental illness, disclosing his experiences in his letters, interviews, and poems, some of his psychiatrists were uncomfortable making his records public. Jamison’s use of this material, which includes Lowell’s hospital admission notes, examinations of his physical and mental states, laboratory findings, medication records, and nursing notes, is exemplary. Unlike Middlebrook, she does not use any of Lowell’s psychotherapy notes, respecting the privacy of his living relatives and friends. The same respect for privacy explains Jamison’s decision to omit from An Unquiet Mind

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any discussion of her own psychotherapy that might invade the privacy of relatives and friends.

A TEXTBOOK DIAGNOSIS Lowell was diagnosed with manic-depressive illness in his early thirties. The diagnosis never changed. His symptoms fit all of the diagnostic criteria for mania and major depression, according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association in 2013. Today he would receive a “bipolar 1” diagnosis. Lowell could be frightening, abusive, and grandiose when he was manic, extolling the virtues of men like Hitler whom he despised when he was healthy (Jamison, 2017). Lowell’s affectionate nickname, “Cal,” had a darker side, alluding to the demented Roman emperor, Caligula, and perhaps to the monstrous Caliban in The Tempest. Lowell was responsible for twice breaking the nose of his first wife, the novelist Jean Stafford, the first time accidentally in 1938 when, drunk, he crashed his car into a brick wall on a dead-end street in Cambridge, the second time deliberately in an argument. Another time he tried to strangle her when he was psychotic. Lowell’s second marriage, to the writer Elizabeth Hardwick, lasted for more than 20 years, until he left her for an ill-fated marriage to the writer Caroline Blackwood, who had been previously married to the painter Lucian Freud and the composer Israel Citkowitz. “I didn’t know what I was getting into,” Hardwick later remarked ruefully, “but even if I had, I still would have married him. He was not crazy all the time – most of the time he was wonderful. The breakdowns were not the whole story” (Robert Lowell, p. 107).

TWO BIOGRAPHERS WRITING ABOUT MADNESS Lowell’s two biographers, Ian Hamilton and Paul Mariani, both acknowledge that he suffered from manic-depressive illness, but unlike Jamison, they don’t know what to make of the disease. Nor do they evaluate the impact of mental illness, including the various treatments he received, on his life and art. This is not surprising. Little was known about mood disorders when Hamilton and Mariani wrote their biographies in the early 1980s and 1990s. The biographers sometimes assume, as did Lowell’s

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fellow academics, that being a poet gave him the license to act bizarrely. Some of Lowell’s fellow poets, such as W. H. Auden and William Empson, never understood the severity of his disease, regarding his crack-ups as a moral failure. Paul Mariani is a more sympathetic biographer than Ian Hamilton, more attentive to Lowell’s mental suffering. He comments empathically on Lowell’s shifting moods, but he never gives us a larger point of view about manic-depressive illness. The disease remains a distant albeit recurrent threat in Lowell’s life, essentially foreign to his nature. Sometimes Mariani’s verbs trivialize mental illness, as when he states that shortly after Christmas of 1975, Lowell’s “mania flared up again” (p. 435), as if the biographer were describing a troublesome arthritic knee that periodically needed attention.

A STUDY OF MADNESS AND CREATIVITY Jamison insists that we must distinguish between Lowell’s normal and psychotic behavior, a distinction that is not always clear, she admits, because the early stages of mania are not usually recognized as the beginning of derangement. Jamison shows, as Hamilton and Mariani do not, the dramatic changes in Lowell’s behavior when he was in a manic rage, and his horror and everlasting regret when he returned to his right mind. Jamison never uses a moralistic tone when describing Lowell’s psychotic behavior. He tortured himself over his psychotic actions, particularly because he failed to convince himself, despite years of psychotherapy, that his illness was not a symptom of a character flaw. Jamison is not a literary critic, but her study will shape our understanding of Lowell’s poetry. “Mania took his poetry where it would not have gone, to an altitude for which, as he wrote in the first poem of Life Studies (1959), ‘there were no tickets’” (p. 4). She shows how Lowell expanded the language of suffering, how he explored psychic territories into which few poets had ventured, and from which few escaped with their lives and sanity intact. She never reduces Lowell’s work to psychopathology. Jamison’s Robert Lowell will affect how memoirists and scholars write about madness. Nietzsche taught us that He who fights with monsters should look to it that he himself does not become a monster. And when you gaze long into an abyss the abyss also gazes into you. (p. 102)

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Jamison also cautions us to approach the abyss with care but for a different reason. When I teach psychiatry residents and graduate students about psychotherapy, I stress the respect one must keep for the abyss between what one thinks one knows and what one actually knows about another individual’s mental life. That abyss, unless its existence is kept in mind, will stand in the way of empathy and clinical acuity. We have a precarious understanding of our own thoughts and emotions, much less another’s. (p. 7) Jamison’s insights into Lowell’s life are gleaned from her own experience, which she never mentions in her study. When she observes that mania was “complicated to Lowell, as it is to most who experience it; it had some attraction” (p. 128), she was also writing about herself, writing about the reason she chose to go off lithium, with near catastrophic results. When she writes about Elizabeth Hardwick’s exasperation over her husband’s behavior – “Little is straightforward for spouses who come to know mania” (p. 215) – she is writing about her own husband’s exasperation, as she admits in Nothing Was the Same: “Richard’s acceptance of me was deep, but it was not entire. At times he was enraged when I was ill; at others, he was bewildered or coolly distant” (pp. 24–25). When she declares that Lowell did most of his healing through his writing, realizing, in her words, that art “serves the writer who is ill. Not perfectly, seldom lastingly, but essentially” (p. 194), she must have been thinking how writing An Unquiet Mind and Nothing Was the Same enabled her to engage in a similar healing, not perfectly or lastingly, but essentially. And when she writes that Lowell never had the healing relationship with a psychiatrist that the poet Siegfried Sassoon had with his psychiatrist, W. H. R. Rivers, who uniquely understood the horrors created by the trauma of World War I, she must have been thinking how fortunate she was to have a healing relationship with her own psychiatrist, Daniel Auerbach, to whom she expresses once again heartfelt gratitude at the end of Robert Lowell. To argue that, in telling Robert Lowell’s story, Jamison was also telling her own is not to imply that there is something self-indulgent or self-serving in her study. Robert Lowell never comes across as special pleading. Nor does Jamison confuse Lowell’s culpability for his behavior when he was manic, and therefore out of control, with his questionable behavior when

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he was sane. Jamison doesn’t rationalize, for example, Lowell’s calculating decision, made when he was sane, to use and misquote Elizabeth Hardwick’s anguished letters to him, after their bitter divorce, in The Dolphin. That was a moral decision, Jamison points out, or perhaps an artistic decision, not a psychiatric one. She presents both sides of the case, noting, on the one hand, that writers often appropriate other people’s words into their own writings, but also acknowledging, on the other hand, the anguish Lowell’s decision caused to Hardwick and the outrage it evoked in some of his friends, including Elizabeth Bishop, who, heartbroken after reading The Dolphin (1973), told Lowell, “Art just isn’t worth that much” (p. 344). Jamison thus presents us with two narratives in Robert Lowell, the explicit biographical story of the poet’s entanglement of art, character, mood, and intellect, and the implicit autobiographical story of her own entanglement. She has gazed long and hard into the abyss of manic-depressive illness and kept her wits. Robert Lowell was called one of the best books of the year by the Boston Globe, The Washington Post, The Seattle Times, The Times Literary Supplement, and The Irish Times. The Irish novelist John Banville characterized Jamison in the Irish Times as a “writer of rare elegance, distinction, and, above all, passion,” and praised her book as a “magnificent study of a brilliant, wounded and lavishly gifted man.” Patricia Bosworth lauded Robert Lowell in the New York Times for its “wealth of fascinating research” that will serve scholars for years to come. Most valuable for Bosworth is Jamison’s personal understanding of mania: “She knows the disease from bittersweet experience.” Michael Dirda used the word “exhilarating” in The Washington Post to describe his experience reading Robert Lowell, though, like some of the other reviewers, he felt the book was repetitive. Helen Vendler, not known for effusive praise, called the study “remarkable” in The New York Review of Books, singling out Jamison’s evidence of Lowell’s resilience, courage, and strength. Vendler’s only criticism is that at times Jamison’s reverence for Lowell has a “hagiographic” tone. Craig Teicher makes a similar criticism in his review in the Los Angeles Times, though he is quick to point out that Robert Lowell is the “best book so far about one of our most polarizing contemporary literary figures.” Dan Chiasson characterized the book in The New Yorker as “groundbreaking,” a “real contribution to the literary history of New England.” His only criticism was that it “tells us a lot about bipolar disorder, but it can’t quite connect the dots to Lowell’s work.” Jamison would never use this metaphor, which implies a puzzle to be solved, in this case, an impossibility.

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Jamison’s study is not the last word Robert Lowell, but it is, to date, the most profound study, one that will likely inspire other investigators to trace the complex relationship between mood disorders and creativity. She raises many questions for further debate, such as the role of psychopharmacology in the treatment of artists. Other questions are variations of the one she raises in An Unquiet Mind. What if the prevention of psychosis or idiosyncratic cognitive styles or extreme mood states has a dampening effect on creativity or ambition? What if clinical decisions that benefit individuals are disadvantageous to society as a whole? (p. 277) These are questions for the future. For now we can say that Robert Lowell: Setting the River on Fire is a remarkable biographical and autobio­ graphical study of genius, mania, and character in two unquiet minds.

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4 “FOR BETTER OR WORSE YOU INHERIT ME”: LINDA GRAY SEXTON AND SEARCHING FOR MERCY STREET AND HALF IN LOVE

“Oh, God, therapy is a dirty mirror,” the Pulitzer-Prize winning poet Anne Sexton exclaimed in a 1961 letter to her psychiatrist, Martin Orne. “If I am real, all I have done was born out of therapy, out of our souls and our heads.” The poet’s daughter Linda Gray Sexton quotes this letter in her 1994 memoir Searching for Mercy Street: My Journey Back to My Mother, Anne Sexton (p. 229). Memoirs can also be dirty mirrors, particularly when they are filled with pain, shame, and blame. Searching for Mercy Street and Linda Sexton’s next memoir, Half in Love (Surviving the Legacy of Suicide), published in 2011, reveal how closely the daughter’s story of mental illness was connected to her mother’s. After several suicide attempts, Anne Sexton succeeded in ending her life in October 1974, a month short of her 45th birthday, when, sitting in her bright red Mercury Cougar with the engine running in her closed garage, she asphyxiated herself. Her beleaguered family and friends were stunned but not surprised. Linda Sexton was a Harvard senior at the time, trying to distance herself from her mother and lead her own life. For years she was her mother’s watchdog, gatekeeper, amanuensis, and caregiver, roles that were physically and emotionally exhausting. She was also the victim of her mother’s sexual abuse.

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Linda Sexton’s two memoirs are exceptional for several reasons. They describe with brutal honesty the private details of her own and mother’s lives, divulging secrets most people would conceal from everyone. The publication of Diane Middlebrook’s biography of Anne Sexton in 1991, which contained a detailed account of the poet’s long psychotherapy, a discussion based on the 300 hours of tapes recorded by her psychiatrist, was a sensational media event. The controversy roiled the clinical and literary worlds. Searching for Mercy Street is even more candid about the disturbing events in her mother’s life. Linda notes ruefully that whereas Sylvia Plath’s mother and husband, the poet Ted Hughes, were vilified for censoring Plath’s diaries, Sexton herself was demonized for exposing so many of her mother’s secrets. Linda Sexton’s memoirs reveal that her relationship with her mother had no boundaries. Linda’s greatest desire was also her greatest fear – separation from her mother. Despite the daughter’s repeated vows not to become like her mother, this is what appeared to happen. Searching for Mercy Street and Half in Love, published when Sexton was 41 and 58, respectively, cast light on the books she wrote years earlier: her coedition of her mother’s letters, Anne Sexton: A Self-Portrait in Letters (1977), her first book, Between Two Worlds: Young Women in Crisis (1979), and her four novels: Rituals (1982), Mirror Images (1985), Points of Light (1988), and Private Acts (1992). Sexton admits near the end of Searching for Mercy Street that in writing novels, she tried to hide behind the veil of fiction. It’s also true, however, that working through psychological conflicts in the novels prepared her for confronting the same problems and, in some cases, reaching different conclusions in her memoirs. Linda Sexton’s fictional and nonfictional writings document her ongoing efforts to come to terms with an intergenerational story of madness. Each of her books stands alone, separate and independent, but they reveal, when read chronologically, the journey toward understanding her mother’s illness and the quest for forgiveness – for both her mother and herself. As a “confessional” poet, Anne Sexton believed in truth telling, no matter how painful the truth was, and no matter the cost to herself or others. Linda Sexton demonstrates the same attitude. To reach this conclusion, however, Linda had to overcome one of her worst fears, the belief that “If you tell they will not love you anymore” (Searching for Mercy Street, p. 21). If it came to a choice between art or family, Anne Sexton asserted, she would choose art: “The writing comes first,” she indignantly told one

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of her psychiatrists, “Dr. Chase,” who rebuked her for writing a poem that wounded her daughter (Searching for Mercy Street, p. 146). Linda Sexton doesn’t resolve the conundrum of choosing between art or family, but she does her best to honor both commitments.

ANNE SEXTON: A SELF-PORTRAIT IN LETTERS Compiling a nearly 450-page volume of an author’s letters is a daunting task for anyone, particularly when one must inspect more than 50,000 pieces of paper, ranging from childhood to the days before death. Linda Sexton’s challenge became infinitely more difficult because she was coediting her mother’s letters. How does an editor retain her scholarly objectivity when annotating her mother’s suicide, or when describing her mother’s physical and sexual abuse of her as a young child and adolescent? Linda Sexton performed her editorial responsibilities with admirable professionalism, but she paid a price for her filial devotion. Linda was only 21 when her mother informed her in a letter written on July 3, 1974, that she was appointing her literary executor. Linda was hardly given a choice. Dearest pie, today nominated and legally named my literary executor (because I know you know the value, the potential of what I’ve tried in my small way to write, not only in financial potential for your future income, but maybe, just maybe – the spirit of the poems will go on past both of us, and one or two will be remembered in one hundred years …. And maybe not. (Self-Portrait, p. 417) In an earlier letter, written in 1969, Anna Sexton described Linda as “my extension. You are my prayer. You are my belief in God.” With the privilege of hindsight, we can say that nothing Anne Sexton said or wrote to her daughter was fraught with more unintentional irony than the next sentence: “For better or worse you inherit me” (p. 342).

MANIC-DEPRESSIVE ILLNESS Anne Sexton’s psychiatrists offered different diagnoses of her mental illness, ranging from hysteria to depression. Linda is convinced that her

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mother struggled with manic-depressive illness, an illness that afflicts the daughter, too, as she discloses in Half in Love (2011). Anne Sexton’s psychiatrists treated her only for depression until the late 1960s, when she was in her early forties. “Mind-numbing drugs like Thorazine muted the constant emotional pain but, because she was so sedated, took away her ability to write” (Half in Love, p. 64). She was given lithium near the end of her life, but it was ineffective because of her alcohol addiction. Her decision to go off her drugs abruptly, “cold turkey,” medicating herself only with alcohol, contributed to her suicide. Linda Sexton points out in Half in Love that 90% of the people who commit suicide suffer from a mental illness, such as depression or manic-depressive illness (p. 319). A Self-Portrait in Letters reveals Anne Sexton’s mercurial moods. In one of the earliest editorial comments, Linda remarks that, in 1948, shortly after Anne married Alfred Muller Sexton, II, “Kayo,” her new family noticed disturbing elements in her personality. “Her moods shifted at lightning speed – alternating between deep depression and extraordinary excitement within a few minutes” (pp. 21–22). Not long after Linda’s birth, on July 21, 1953, Anne began to suffer acute postpartum depression. The following summer, after the birth of her second daughter, Joyce (“Joy”), Anne felt, in Linda’s words, like she was drowning. One day, when she found Linda neatly stuffing her own excrement into a toy truck for the second day in a row, Anne picked her up and hurled her across the room. (p. 22) Linda doesn’t disclose in A Self-Portrait in Letters how she felt about this incident, though she mentions that her mother wrote about the event in the posthumously published poem “Red Roses.” Changing the sex of the child in the poem, Anne Sexton coyly denies that the act was child abuse. “Mind you, / she never laid a hand on him, / only the wall laid a hand on him.” We learn later in the poem that in the hospital “A nice lady came / and asked him questions but because / he didn’t want to be sent away he said, I fell” (Complete Poems, 1981, pp. 492–493). Linda keeps her thoughts to herself throughout A Self-Portrait in Letters, even when her mother writes about infanticide. “Linda is, I guess, just like me,” Anne Sexton admitted in 1961, “which makes me alternately adore and loathe her, depending on which me she seems like (good Anne or bad Anne)” (p. 132).

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Coediting her mother’s letters was like writing her mother’s biography. Linda Sexton felt like she was on a roller coaster, depending on which box of material she opened. Some days she felt like laughing, other days, weeping. Imagine how she felt when, though she always believed she was her mother’s favorite daughter, the one chosen to be literary executor, she came across statements to the contrary. “Something comes between me and Linda,” Anne confessed to Orne; “I hate her. I want her to go away and she knows it” (SelfPortrait, p. 209). Linda had to numb herself to read the biographical material. She felt like burning the letters but instead dutifully included them in the volume. Her view of their mother–daughter relationship was irrevocably shattered. “When I closed the boxes at the end of the day it was like trying to force a genie back into the bottle” (Searching for Mercy Street, p. 211). Anne Sexton was a difficult and demanding person. To her credit, Linda never demonizes or sanctifies her mother in A Self-Portrait. Few subjects are more vexing to write about than suicide, which provokes turbulent emotions even within psychotherapists. Linda writes with insight and balanced judgment when describing her mother’s many attempts to end her life, capturing in a few sentences Anne’s isolation during the last months. Her friends grew angry and frustrated with her midnight suicide threats, her inability to go to the dentist alone, enter a store alone, mail a letter alone. She required constant service and care, and those closest to her began to set limits in selfprotection. Anne saw these limits as unreasonable fences erected by those she loved – the ultimate desertion. (p. 389) Writing in third person, Linda includes herself among those who gradually retreated from Anne Sexton’s life. Linda doesn’t sensationalize her mother’s death. All those close to her had known that one day she would choose to commit suicide. At home in Weston on Friday, October 4, 1974, she took herself quickly and quietly. (p. 423)

A SUICIDE LETTER FIVE YEARS BEFORE THE EVENT The most heartbreaking letter in A Self-Portrait, appearing in the epilogue, was written in April 1969, when Anne Sexton imagined how the 16-yearold Linda might respond, 24 years later, to her mother’s death. The letter

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reads like a suicide note, and, in retrospect, it sounds like her mother was speaking from the grave: Dear Linda, I am in the middle of a flight to St. Louis to give a reading. I was reading a New Yorker story that made me think of my mother and all alone in the seat I whispered to her “I know, Mother, I know.” (Found a pen!) And I thought of you – someday flying somewhere all alone and me dead perhaps and you wishing to speak to me. And I want to speak back. (Linda, maybe it won’t be flying, maybe it will be at your own kitchen table drinking tea some afternoon when you are 40. Anytime.) – I want to say back. 1st I love you. 2. You never let me down. 3. I know. I was there once. I too, was 40 and with a dead mother who I still needed. This is my message to the 40-year-old Linda. No matter what happens you were always my bobolink, my special Linda Gray. Life is not easy. It is awfully lonely. I know that. Now you too know it – wherever you are, Linda, talking to me. But I’ve had a good life – I wrote unhappy – but I lived to the HILT! You too, Linda – Live to the HILT! To the top. I love you, 40-year-old Linda, and I love what you do, what you find, what you are! Be your own woman. Belong to those you love. Talk to my poems, and talk to your heart – I’m in both: if you need me. I lied, Linda. I did love my mother and she loved me. She never held me but I miss her, so that I have to deny I ever loved her – or she me! Silly Anne! So there! XOXOXO Mom (p. 424) Perhaps the cruelest irony of self-inflicted death is that the closer one is to the person who has committed suicide, the more guilt one feels. What can a 16-year-old daughter say upon reading Anne Sexton’s letter? What can anyone say? Many readers, regardless of their age, will be unable to find the words to speak back. Others, like Linda Sexton, will spend a lifetime in writing back, beginning with her first book, where she explores, albeit indirectly, the impact of maternal suicide.

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BETWEEN TWO WORLDS Between Two Worlds: Young Women in Crisis is an impressive work, especially since Linda Sexton was only 26 when the book appeared in 1979. Published only four years after her college graduation, Between Two Worlds could easily have been a doctoral dissertation in English, psychology, sociology, or women’s studies – though unlike most dissertations, the book is highly readable, mercifully devoid of academic jargon, and convincing in its ability to capture different voices. Sexton offers a probing examination of the lives of young women born between 1945 and 1955. Each woman is in a state of crisis, and each must explore the uncharted territory of the burgeoning women’s movement. Urgent choices confront their generation, and though the women recognize the need for positive role models, they find few examples among their parents’ generation. The book’s title comes from Matthew Arnold’s 1855 poem “Stanzas from the Grande Chartreuse”: Sexton’s women find themselves “Wandering between two worlds, one dead, / The other powerless to be born.” “Depression settled in.” The opening sentence dramatizes the crisis Sexton and her peer group found themselves in as they contemplated their futures. They were depressed because of the necessity to choose between having either a family or a career. Having both seemed impossible, at least according to Katharine Hepburn, who had proclaimed famously in a magazine article that she was forced to sacrifice marriage and motherhood for her film career. Other feminist icons were sending a similar message. Sexton cites Betty Friedan’s remark in The Feminine Mystique (1963) that, in Sexton’s words, “one out of every three of our mothers experienced depression or psychotic breakdown after bearing us” (Between Two Worlds, p. 19). The Feminine Mystique had special significance to Linda Sexton because, as she discloses in Searching for Mercy Street, when she was 15 her mother gave her a copy of the book, “complete with her scribbled notes across the pages” (p. 98). Sexton also quotes in Between Two Worlds Kate Millett’s ideologically charged statement in Sexual Politics that: So long as every female, simply by virtue of her anatomy, is obliged, even forced, to be the sole or primary caretaker of childhood, she is prevented from being a human being. (p. 19) Given the choice between two extremes that seemed equally problematic to her, the feminine mystique, on the one hand, which asserted home and

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hearth, and what Linda Sexton calls the feminist mystique, on the other, which affirmed career and independence, she found herself in a quandary, paralyzed by doubt and indecision. Her goal was to combine a career with raising children and being a wife – a challenge for anyone. To help her make a choice, Sexton sought to understand the consequences of her contemporaries’ choices. It was a strategic effort to educate herself on life in an age of anxiety. She interviewed 30 young female college graduates who were raised in the “various strata of the white middle and upper classes in America” (Between Two Worlds, p. 28). Using a tape recorder, she spoke with each research subject for five to eight hours, then selected 15 of the women to write about in depth. To preserve their privacy, she changed each woman’s name and background details. Avoiding composite profiles, she doesn’t tell us whether she allowed the women to read her representations of them. It was a tricky research project, capturing their essence without compromising their identity. The interviews involved personal questions such as the women’s feelings about their parents, childhoods, and sex lives. Sexton makes no effort to deny the self-interested motives behind her research. “It was, inevitably, a search for myself, and for my own answers” (p. 26). Sexton classifies the 15 women into four groups: “Like Mother, Like Daughter”; “The Waiting Game”; “Mavericks”; and “Self-Made Women.” She generally avoids “I,” preferring instead the expression “many of us.” It’s evident that she implicitly includes herself among the women who were “increasingly divided against ourselves – unable to accept the old-fashioned ideals of marriage and motherhood and yet inadequately prepared to embrace the alternative” (p. 26). Sexton offers little information about her own life. She tells us, for example, that she was “lucky enough” to have the opportunity to edit a book of letters, but she doesn’t elaborate on this – although anyone who reads the book jacket will learn that she edited Anne Sexton: A Self-Portrait in Letters. Wondering about the extent to which her career ambitions were a response to the “enormous social pressure sparked by the feminists and by my mother” (pp. 24–25), she never discloses that Anne Sexton was a celebrated poet who committed suicide. Midway through Between Two Worlds she comments on Judith Habib, whose parents were killed in a car accident. As she sketched the whole tragic story, I grew silent. I knew what it was to lose one parent – let alone two simultaneously. I knew all too well what it was like to grieve. (p. 162)

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CHRIS HASTINGS Of the 15 women in Between Two Worlds, the most intriguing is the last, Chris Hastings. Along with the other two interviewees in “Self-Made Women,” Chris eventually rejects negative parental role models. The three women escape from a multitude of disasters, Sexton observes, using one of the few overwrought sentences in the book: “Life itself was a holocaust” (p. 207). Sexton and Chris Hastings resemble each other in several ways. Both are daughters of depressed mothers who are ambivalent toward their children, have fathers with drinking problems, lack healthy parental role models, have difficulty transitioning from childhood to adulthood, and are drawn to feminism, which does not, however, solve all their problems. Perhaps the most eerie aspect of Chris Hastings is that she foreshadows events in Linda Sexton that did not develop until years later, such as cutting, suicidality, and hospitalization in a mental ward. Chris Hastings also resembles some of Sexton’s fictional characters. Both writer and research subject eventually become self-made women with the help of psychotherapy, supportive boyfriends, and fulfilling careers. The similarities between Linda Sexton and Chris Hastings suggest not that they are the identical character, the latter a disguised example of the former, but that the writer was drawn to her research subject because of shared situations. As Linda observed to me, “I may have chosen to include her as a powerful example of the strength that can develop in an individual despite a troubled, or even drastically disturbed, upbringing.” Between Two Worlds is a coming of age book, written by an author in her mid-20s. The book is a study of young women in crisis, each undergoing an early rite of passage. Linda Sexton succeeds in showing the challenges of college-age women forging their identities in the mid-1970s, but it would take a novelist to show the protracted struggle to mourn the death of a mother who remains an absent presence in her daughter’s life – a story that can best be told in fiction.

RITUALS Katharine Sinclair, “Kat,” is a portrait of the artist as a young woman. A Harvard student, she struggles to cope with her mother’s recent death, which has left her confused, bereft, and depressed. Kat’s hard-drinking

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father, Kirk, and immature younger sister, Paige, have little understanding of the depth of her grief. A literature major, Kat, like many of the women in Between Two Worlds, has avoided thinking about life after graduation, when she must find a job to support herself. Rituals is a disguised bildungsroman, a story about the growth and development of the artist. The novel is about love and loss, both of which lead to pain for Kat. Rituals represents Kat’s “crash course in growing up” (p. 265), a statement that is also true of Between Two Worlds. Rituals opens with an evocative epigraph from Robert Penn Warren’s 1946 novel All the King’s Men. Life is strange and changeful and the crystal is in the steel at the point of fracture, and the toad bears a jewel in its forehead, and the meaning of moments passes like the breeze that scarcely ruffles the leaf of the willow. Sexton might have chosen another passage from Warren’s novel, shorter and more ambiguous: “The end of man is knowledge” (p. 9). One is never sure whether the dark knowledge Kat discovers about her parents’ marriage will lead to a life-transforming epiphany or to madness and death. Kat knew, in Sexton’s words that “truth equaled danger, that to know the truth would require facing it, changing herself, her life – all those things she dreaded most” (p. 142).

LILY SINCLAIR The most enigmatic character in the novel, Lily Sinclair is a mystery enshrouded in death. Shortly before the novel opens, she died when her car struck a telephone pole in the morning. She was a few years older than Anne Sexton, on whose life she is closely modeled. Lily’s death is not ruled a suicide, but it was her fourth automobile “accident” in the year. Later we learn about her history of drunken driving. The Concord, Massachusetts police would call her husband two or three times a year when they found her passed out behind the wheel on the shoulder of the road. The police never booked her – she lived in an era when rules against driving under the influence of alcohol were rarely enforced. Instead, the police would call her husband to pick her up. “Kirk was very generous with the officers when he came down to the station” (Rituals, p. 146). The title of the novel conjures up the daily rituals of the Sinclairs’ excessive drinking, which would often

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lead to shouting matches between Lily and Kirk, followed by her storming out of the house and speeding away, only to crash or pass out in her car. Lily is also addicted to drugs. While looking through her mother’s dresser, Kat notices that it was full of pill bottles, “enough downers here,” Paige declares mordantly, “to keep my entire class relaxed for the rest of the year” (p. 25). Kat feels a rush of anger when she sees the “wholesalesized jugs of sleeping pills, pain-killers, and tranquilizers” (p. 26). She is furious at both her mother and her doctors who irresponsibly prescribed the drugs for anxiety and depression. “She’d been clever; she’d been afraid of running out, of facing the world without anesthesia” (p. 26). Lily Sinclair is not an exact replica of Anne Sexton: the novelist does not draw too much attention to the parallels between life and art. But as Linda Sexton mentions in Searching for Mercy Street, the pill bottles are taken from real life as are the shouting matches between her parents. Kat can never understand why her father did not make more of an effort to help her struggling mother. Late in the novel Kat wonders why no one in the family saw Lily’s alcoholism or drug addiction as a sickness. Kat offers several possible explanations. Why hadn’t any of them seen it before as a sickness, instead of some moral issue to be determined by willpower, or virtue? Why hadn’t her father gotten her mother the kind of help she needed? Why had he allowed her to go on in that hell which no amount of love could conquer? Was it too much of a blow to his ego? Was it that he felt, somehow, without reason, that he’d failed her, that he and he alone could rectify the wrong that had made Lily this way? Or was it an unconscious wish to keep his wife’s weaknesses equal to his own, and so control her? (Rituals, p. 210) Kirk Sinclair’s denial of his wife’s mental illness reflects Linda Sexton’s similar belief that her own father failed to acknowledge the seriousness of her mother’s mental problems. Searching for Mercy Street reveals that Anne Sexton’s extended family was dubious about her “mental illness,” believing instead that her behavior signified a “moral failure,” an “indulgence,” a lack of “willpower” – the same attitude they expressed decades later when Linda became depressed and suicidal. Kat remains her mother’s daughter, and though she does not cut or starve herself, or make a suicidal attempt, like Chris Hastings, she develops

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a serious alcohol problem that becomes both a cause and symptom of her increasingly self-destructive behavior. Lacking healthy parental role models, she is lost. Until the end of the story, Kat would fit into the category “Like Mother, Like Daughter,” drinking herself into oblivion, like Lily. Rituals succeeds in showing how Kat’s father enables her out-of-control drinking, much as he had enabled his wife’s.

OEDIPAL AND PRE-OEDIPAL DESIRE The summer before her mother’s suicide, Sexton observes in Searching for Mercy Street, she spent weekends with her father and was “in the midst of a strong fantasy indulged: finally I had Daddy all to myself” (pp. 172–173), an Oedipal fantasy that appears throughout Rituals. After Lily dies, Kirk enjoys taking Kat to dinner, where he requests cocktails for both of them – “his ritual of ordering for his wife now a ritual with his daughter” (p. 164). The family waiter’s compliment brings a smile to Kirk’s face. “‘If I did not know better,’ he said in his highly accented English, ‘I would mistake you for more than father and daughter’” (p. 165). Desperately wanting to please her father and win his approval, the inebriated Kat agrees to allow him to put a raw clam into her mouth, something that fills her with dread. “He was watching her, and in his blue eyes she saw something like a dare, something which said, ‘You will not be a woman without’” (p. 166). To win her father’s love, Kat begins dressing like her mother, imitating Lily’s “appealing vulnerability” (p. 133). Soon Kat finds herself playing the role of the “drugged and dangerous woman” (p. 146), enacting rituals that led to her mother’s death. Is Kat’s craving for her mother a yearning for death? Kat’s blackouts resemble her mother’s, and Lily’s sitting room becomes her older daughter’s cocoon. Kat cannot remember the last time she saw her mother alive, remarking to her boyfriend, Aaron Salzer, that she never had time to say good-bye to her, a detail, Linda Sexton told me, that was autobiographically true. Kat’s need for her mother, the novel suggests, is never fulfilled. “Kat craved something deeper, more intimate – the inner petals of her mother’s life.” The closeness never came. “Over time Lily had only become more and more fragile, more difficult to touch, more unreal – a human being who survived each day on a chemical cushioned relief” (Rituals, p. 44). The last sentence describes Kat, too, surviving without her mother on an alcohol

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cushioned relief. Kat’s uncomfortable closeness with her father represents, on one level, Oedipal desire, and, on another level, pre-Oedipal yearning, a desire to merge with the lost mother. The most emotionally charged scene in Rituals occurs when Kat wakes up in her parents’ home after having too much to drink and, hungover, stumbles to the bathroom where she hears a murmur coming from the sitting room. “Once more past slipped over into present,” and then follows a mystifying paragraph in which Kat recalls seeing when she was a child or teenager her father fondling the breasts of a blonde woman. For the first time she saw her father naked, as he lay there, his hand on the full breasts. She knew she should not look. But she wanted to look. She wanted to know. (p. 172)” Is this an image of the primal scene, Kat witnessing her parents having sexual intercourse, or a more terrifying scene of incest, her father having sex with his younger daughter, Paige, described as blonde and voluptuous, in contrast to the dark-haired, small-breasted Kat? Everything about the scene is bewildering, including whether it is real or imagined.

PROOFREADING There is another problematic moment in Rituals, this one minor, comic rather than tragic. After considering her career options, the literaryoriented Kat decides to become a freelance proofreader. She begins reading galleys for Little, Brown & Co., the Boston-based company that years later published two of Linda Sexton’s novels, Points of Light and Private Acts, and her first memoir, Searching for Mercy Street. Kat has not solved her drinking problem, and while searching for typographical errors, she cannot stop daydreaming about her mother, who, unlike herself, played the piano with technical perfection. Ten long years ago – was it really ten? – those intricate piano scales had been the test. Her mother sat beside her on the bench, her dress and grooming as carefully maintained as a valuable work of art: each piece of jewelry complimented the next. (p. 118) The only problem with this artful juxtaposition of past and present is that Sexton uses the wrong word: each piece of Lily’s jewelry complemented

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the next. How odd that in a passage contrasting Kat’s impatience and carelessness with her mother’s patience and precision, Linda Sexton should make a typographical error, aligning herself with the daughter’s point of view. Part of the irony of the scene is that Kat’s daydream of playing the piano for her mother is distressing, not nostalgic. She recalls making mistake after mistake while practicing for her mother. “Lily said nothing, waiting, it seemed, for the next musical travesty. Kat wanted to apologize. She wanted to feel the absolution of her mother’s cool palm against her cheek.” But the absolution never comes, and the daydream ends with a reference to “this ritual hour of mother–daughter torture” (Rituals, p. 118). A few moments later, the nonliterary Paige points out to her sister that she “missed a typo” – presumably, a different typo – a criticism to which Kat reacts defensively. In one of the most psychologically revealing statements in Searching for Mercy Street, Sexton remarks that “motherhood was a dangerous state of being” (p. 21). So is daughterhood. Kat has no one with whom she can share her conflicting feelings toward her mother. It is difficult for her to come to terms with, in effect, her two mothers, the delightful and sparkling woman who was the life of the party, and the increasingly fragile woman who lived in an alcoholic and narcotic fog. “You’re turning into a neurotic, depressed, obsessed person,” Aaron warns Kat (Rituals, p. 105), turning into, in other words, a version of her mother.

A FATHER’S WAR STORY Kat’s goal is to distance herself enough from her parents to become her own person. The challenge is, in part, a boundary issue with which she has particular difficulty. Love is a threatening force in the novel, obliterating boundaries between self and other. A striking example of this, with important biographical implications, occurs near the end of the novel when Kirk, normally a closed person, unwilling to talk about his past, confesses the most traumatic experience of his life, killing a Japanese soldier during World War II. While on an aircraft carrier in the Pacific, Kirk tells his daughter, he was moving through a doorway onto the bridge when his best friend, Alex, sensing an air attack, pushed him onto the deck and was struck and killed by machinegun fire. I was crazy with the thing. He got what should have been mine and he was my best friend, my only friend on board.

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When I got insubordinate with my C.O. they sent me to the island – alone, on a recon, to sober me up. The island was filled with Japanese soldiers, and one night, he found himself confronting an enemy sentry, illuminated by a flare. “We were almost face to face, and I had to kill him. I got his throat in my hands. I was so scared I just kept squeezing and squeezing”. He stopped for a minute and then cleared his throat. “When he didn’t breathe any more, I went onto the beach and vomited. I was twenty.” (Rituals, pp. 257–258) The event is closely based on Kayo Sexton’s experience during the Korean War when, at age 23, he strangled a prisoner of war whom he was guarding on a small boat. As Dawn M. Skorczewski observes in An Accident of Hope: The Therapy Tapes of Anne Sexton (2012), Kayo had told his wife about this experience, which she explored in her therapy with her psychiatrist Martin Orne. The experience had different meanings to Kayo’s wife and daughter. Anne Sexton was terrified of her husband’s capacity for violence, and at times she feared for her life. During some of their fights, when he choked her, she thought that he would strangle her to death, as he had strangled the Korean soldier. “How can I look at his hands and not think that they killed someone?” she told Orne. “With his own hands he choked someone till there was no more air. Someone with their hands tied” (p. 40). Linda Sexton witnessed her father’s violent temper, and she could understand her father’s terrifying war experience, as she explained in a letter to Skorczewski: I think the main difference between what she represents here [to Orne] and what [my father] said to me was the “cast” of the story: When he told it to me, he told it as if it were unfolding – the darkness all around him as he struggled to cope with his captive and his fear. Fear of the night, fear of the war, fear of the new and never-before experienced burden that had just been thrust upon him.… And, there is the added detail which is left out here, that his best friend, Jerry, also aboard the Boxer (his aircraft carrier), had been killed on the bridge on the carrier that very day while thrusting my father to one side as a bomber came in and hit them. Jerry was killed in the aftermath of that attack. My father lived because of

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Jerry’s action. My mother, till the day she died, had beside her bed a matching black china ashtray to the one my father had on his side, and she had told me that these were Jerry’s ashtrays. She then related to me the main part of the story about Jerry’s death. (p. 211) Linda Sexton’s view of her father’s war story, as disclosed to Skorczewski, is significantly different from Kat’s response to her own father’s war story in Rituals. Kat never doubts the pain in her father’s voice as he shares the story with her, nor the impact of the horror on his life, but renewed sympathy for her father complicates her efforts to tell him that she has been paying off his financial debts. She fears that: there was not enough willpower in her to fight this urge to protect him and preserve this moment of love. And she hated him for that, and she hated herself. She was trapped. Once again she would pay the ransom. Once again she would pay the price she had set. The loan must be renewed; for now, she saw no other choice. (Rituals, p. 258) By novel’s close, Kat has regained control over her life. Thanks to the help of Alcoholics Anonymous (AA), she has solved her drinking problem. She recognizes the limits of caregiving, and she learns painful lessons. In the past, she believed that “Love had been an endless debt, never to be repaid” (p. 205). Now she recognizes that solving her father’s financial problems was not her duty. With her father’s approval, Kat stops paying off his business loans. He files for bankruptcy and begins working for another person, a decision the novel supports. Rituals implies that Kat, like Linda Sexton, will succeed in the literary world: “she began to scout for material and good writers in hopes that successful pieces brought in under her name might stimulate interest among the senior editors” (p. 255). Kat converts to Judaism and marries her devoted boyfriend, Aaron Salzer, a marriage that her anti-Semitic father accepts. Paige remains a problem, “still a locked door in Kat’s head” (p. 247), but she is not responsible for her younger sister’s life. The story ends hopefully, with the father giving away the bride at her wedding – a Protestant tradition adapted to the Jewish service. Sexton describes Rituals in Half in Love as “autobiographical fiction,” a “confessional” novel, the counterpart to her mother’s confessional poetry (p. 78). Rituals ends with convincing closure, though it’s surprising that in the last pages there is no mention of Lily, a spectral figure who cannot be forgotten.

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MIRROR IMAGES Mother–daughter entanglement lies at the center of Mirror Images, Linda Sexton’s most riveting and autobiographical novel. Fourteen-yearold Miranda May Webster, “Mira,” struggles to make sense of domestic violence, incest, and madness. There are no boundaries between Mira and her mother, Vivian, a soap actress whose life is more melodramatic than the role she performs on television. Mirror Images was published in 1985, six years before Diane Middlebrook’s biography. At the time, few people knew about the damaging events in Linda Sexton’s early life. Vivian Webster is Linda Sexton’s most frightening portrait of Anne Sexton and their tortured mother–daughter relationship. Mira is aided by her psychiatrist, Eve Strauss, who must deal with her own traumatic losses. Sexton adroitly interconnects the lives of a wounded patient and wounded healer, each needing the help of the other. Linda Sexton goes out of her way to establish a connection with a fictional character by giving thanks in the author’s note to “Dr. Steven Sandler, for helping me through three miscarriages.” She then tells us, during the early pages of the novel, that Eve has suffered two miscarriages, losing Rose in the fifth month and Evan in the sixth month. Eve becomes pregnant a third time and loses that baby, Max, near the end of the novel. Sexton educates her readers about the plight of daughters whose mothers took the synthetic estrogen diethylstilbestrol (DES) in the 1950s when they were pregnant, as Anne Sexton did. Eve’s gynecologist informs her about the consequences of DES exposure. “Women who were exposed to the drug in utero may possibly have more complicated pregnancies, and their abortion rate may be higher” (Mirror Images, p. 203). Eve turns out to be an “habitual aborter,” a woman who has three or more miscarriages. Why does Sexton make explicit the autobiographical parallels with Eve’s life, which have the unintended effect of diminishing the novel’s suspense? One reason, as Sexton explains in Searching for Mercy Street, is that although she had three miscarriages, she was pregnant a fourth time while she was writing Mirror Images. “Unconsciously I believed that if I created a story about miscarriage – if I lived it through Eve – perhaps it wouldn’t have to happen to me again” (p. 245) – an example of writing/righting wrong. Another reason was perhaps to shift attention away from a more disguised and troubling connection with Mira’s life.

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Eve Strauss always wanted to become a writer, perhaps because of her father’s influence. He owns a bookstore in Brookline, a Boston suburb, and he prides himself on drawing an intellectual clientele. “He was a man who took depression seriously,” and he featured authors who “did justice to the bleak ironies of modern life” – Kafka, Beckett, Borges, and Malcolm Lowry (pp. 63–64). Eve herself is a reader of serious literature, and while in her office, Mira looks at the bookshelves, “which held no fiction – only psychology, history, and, surprisingly, poetry” (Mirror Images, p. 171). While musing over Mary Cassatt’s 1893 painting “The Bath,” Eve thinks of a line from a poem that she had once read somewhere, “I made you to find me” (p. 201). Eve cannot recall the title of the poem, but the meaning of the line troubles her. Despite her love for writing, Eve followed her mother’s more practical recommendation to become a physician, choosing child psychiatry as her specialty. Serving as a consultant to Breton Hall, a private coed school in Manhattan, Eve comes into contact with Mira Webster, whose grades began plummeting when her father died a few months earlier. Did Stewart Webster die from a heart attack, as Mira claims, or from an “accident,” as she inadvertently admits? The ambiguity is not resolved until the end of the story. Sexton’s decision to make Eve into a child psychiatrist has several advantages. Sexton dramatizes the therapy sessions with the depressed teenager, using the insights gleaned from her own therapy, when she was a disturbed teenager, trying to separate from an emotionally controlling mother. Sexton develops the irony of a psychiatrist desperately trying to have a baby counseling a pregnant teenager who is considering an abortion. “After two miscarriages, just talking about a conscious termination of life brought her sharp, irrational pain” (Mirror Images, p. 25). After three miscarriages, Eve can barely function, personally or professionally. Sexton shows the commonalities between mothering and healing – figuring out how to help and guide one’s children, and patients, respectively, without controlling their lives. A SIGNATURE DAUGHTER To meet Mira Webster is to recall Chris Hastings. Mira’s parents not only engage in violent quarrels with each other, as did Chris’s, but Mira is caught in the crossfire, paralyzed by fear. Mira’s situation demonstrates the truth of Eve’s statement to Vivian, “Sometimes family matters cannot be solved

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by families” (p. 55). Chris assaults her mother with a hammer at age five; Mira imagines shooting her mother with a gun. Both Chris and Mira then internalize their murderous rage, attempting or fantasizing suicide. Chris has a nervous breakdown in college; Mira’s nervous breakdown occurs earlier, when she is a young teenager. Both girls sexually act out as a form of rebellion and low self-worth. Both are upstaged by their mothers. When Vivian discovers, from reading Mira’s secret diary, that her daughter has slept with one of the television actors, who is only a few years older than Mira, Vivian promptly seduces him. Mira is furious with her mother, with whom she is locked in bitter, protracted competition. Like Chris and many of the other women in Between Two Worlds, Mira believes that she lacks a choice about anything in her life, including whether to have an abortion. Mira wants to keep the baby, and probably would have if her father, her ally, were alive, but Vivian, whose first abortion occurred when she was 16, demands that Mira abort the baby, and the 14-year-old reluctantly complies. Reflecting Anne Sexton, both Chris and Mira have mothers who are emotional chameleons. Eve recognizes one of Vivian’s most paradoxical qualities, apparent to those who knew Anne Sexton. “Somewhere, underneath the beauty she wielded as defensively as a razor blade, there had to be a vulnerable spot” (Mirror Images, p. 162). Both Chris and Mira are eventually taken away from their mothers and cared for by their paternal grandmothers, who provide them with the healthy role models they need. Many of the details of the embattled mother–daughter relationship in Mirror Images are autobiographically accurate with only slight fictional changes. When Vivian found out she was pregnant with Mira, she wanted to have an abortion, but her husband convinced her otherwise. She became furious when she could feel the baby kicking in her stomach. “Sometimes she smacked it back with her closed fist, but it just kept kicking – ­laughing at her” (p. 39). In an incident that recalls Anne Sexton hurling her three-yearold daughter against a wall, Vivian remembers a moment when her daughter, only eight months old, repeatedly screamed with pain in the middle of the night from newly erupting teeth. Vivian “wanted to stuff that screaming mouth with cotton batting until there was no more noise. She’d wanted to kill her” (p. 156). Linda Sexton captures the lurking infanticidal element of her mother’s personality, the fear that she would harm her children. As Middlebrook notes, “She felt she could not control these outbursts, and she began to be afraid that she would kill her children” (­p. 33).

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Recalling horrific experiences, Mira often dissociates, entering into what resembles a fugue or trancelike state. These dissociations, along with blackouts of memory and capacity for autohypnosis, occurred frequently in Anne Sexton’s life. Mira functions mainly as a portrait of Linda Sexton as a child, but sometimes Mira represents Anne Sexton’s life, either as a mother or a daughter. Throughout the novel Vivian attempts to “own” her daughter, who both craves and increasingly resists this possessive, claustrophobic love. Like Mrs Morel in D. H. Lawrence’s novel Sons and Lovers, Vivian is a smother-mother, violating the boundaries between self and other, and trespassing into every aspect of her daughter’s emotional and sexual life. Again like Mrs Morel, Vivian is alternatingly overprotective and underprotective. Vivian enlists Mira as her personal assistant in her professional life, relying on her daughter to manage her career and soothe her in times of crisis. Mira plays other roles as well, including that of best friend and caregiver. In the most disturbing reversal of roles, Mira has been forced to mother her mother, in the process, sacrificing her childhood and identity – as Linda Sexton was forced to do.

TWINNING AND PLAYING NINE When Mira is not Vivian’s mother, she is her sister. Vivian invents a new game of “twinning,” dressing her daughter and herself as sisters, mirror images, a game that denies her daughter the opportunity to be a separate person. Vivian’s ritual of twinning evokes Anne Sexton’s childhood relationship with her beloved Great-Aunt Anna Ladd Dingley, “Nana,” whom Sexton regarded as her “twin” (Middlebrook, p. 14). Vivian’s ritual of twinning may also refer to Anne Sexton’s desire to “play nine” with Linda: Playing nine means that I – the real nine-year-old – slide up in the bed and she slides down, puts her head on my chest while I pat her head. “Now you be the Mommy,” she says. “And I’m your little girl.” (Searching for Mercy Street, p. 58) As a young child, Mira may have enjoyed being her mother’s sister, but as a young teenager, she bitterly resents it. Mira is caught between the desire for closeness with her mother, on the one hand, and the need for separation and individuation, on the other, a dilemma that becomes the central issue in her therapy.

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The self-preoccupied Vivian thinks only about her loss of privacy and inconvenience when Mira begins therapy. What narcissism, Eve thought. Vivian Webster reflected every question in the discussion back onto herself. She could not bear to be out of the spotlight, not even for a second. (Mirror Images, p. 163) The idea of therapy threatens Vivian’s relationship with Mira to whom her mother is umbilically attached. Vivian, who has never been in therapy, does everything she can to subvert Mira’s relationship with her psychiatrist. Despite being in therapy for much of her adult life, Anne Sexton was wary of Linda’s relationship with her own psychiatrist. Anne Sexton believed that because she was paying for her daughter’s therapy, she had the right to know what her daughter said to her psychiatrist.

DOMESTIC VIOLENCE Mirror Images dramatizes the domestic violence of Linda Sexton’s childhood: her father’s volatile temper and her mother’s efforts to goad him into further violence. In one instance, Vivian brought home a fellow actor, Jack Martin, with whom she had sex on her husband’s bed. Stewart unexpectedly arrived and immediately realized their lovemaking. After Martin’s departure, Stewart’s anger turned into rage when his wife accused him of impotence. Stewart seized a gun from his night-drawer, and, further provoked – “‘That’s right,’ she said, ‘use that instead’ – at least it’s hard’” – cocked it and shoved the muzzle into her mouth. He told her that she could do whatever she wanted anywhere else, but not in his bed. Then he threw the gun down and started slapping her, pinning her shoulders with his knees so she couldn’t move. (p. 180) The Sextons’ marital fights were terrifying, as Dawn Skorczewski suggests in her discussion of Anne Sexton’s therapy tapes. Sometimes Anne Sexton would provoke her husband into striking her, reminding him that he was a “killer,” a reference to his Korean War experience, when he strangled to death a prisoner of war. It’s instructive to compare Anne Sexton’s depiction of domestic violence to her psychiatrist and her daughter’s description of it in Mirror Images – though we must remember that Linda

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Sexton wrote the novel years before she heard her mother’s therapy tapes. The violence is more graphic in the novel, and the reader understands the young daughter’s helplessness and conflicting loyalties. Anne Sexton comes across as masochistic and vulnerable in the therapy tapes; by contrast, ­Vivian appears selfish and manipulative. Mira is too young to understand the complexities of her parents’ dysfunctional marriage.

MOTHER–DAUGHTER INCEST Is anything more terrifying to a child than having parents engaged in murderous battle? Incest, to judge from Mira’s nightmares. Shifting abruptly from third to first-person narration, and using the present tense, Sexton evokes Mira’s nightmares that are too frightening to fathom or verbalize. Little was known in the 1980s about the prevalence of child sexual abuse; Mirror Images is one of the earliest novels to depict, graphically and authentically, mother–daughter incest. Mira wakes up startled in the middle of the night, and as her bed begins to move, she is frozen in fear. Some of the imagery in the flashbacks mirrors Mira’s recent abortion, but other imagery recalls the time her mother lay in bed next to her, masturbating, or, in a flashback, thrusting her tongue deep into Mira’s mouth while she is asleep – or pretends to be asleep. Middlebrook is as empathic as possible when describing Anne Sexton’s sexual abuse of Linda. Sexton never acknowledged to her daughter that she was conscious of transgression, but how could she have failed to see how wrong this was? The most generous interpretation is that she may have been very dissociated when she made sexual use of Linda. Sexton identified deeply with this daughter, through whom she relived her own psychological development. (pp. 223–224) Mirror Images reveals a similar interpretation of Vivian’s sexual transgression, but it is easier for Anne Sexton’s biographer than for her daughter to take a charitable view of this behavior. The novelist does not demonize Vivian, but Sexton presents a frightful portrait of a mother who fails to understand the ways in which she has psychologically damaged her daughter in the name of love.

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Linda Sexton recalls in Searching for Mercy Street an odd phenomenon that occurred when she began writing the incest scenes in Mirror Images. While typing, she began “quite unconsciously” using the first person and the present tense, despite the fact that the rest of the novel was written in the third person, past tense. “Why did I feel so mesmerized by, so submerged in, my young character’s pain? Why did my body feel as much as hers?” (p. 265). She doesn’t answer the questions, but imagining Mira’s horror jolted the novelist back into the past, two decades earlier, when she was in the seventh grade, the victim of the same experience. Writing about incest did not lay the ghost to rest, for a few years later, when Sexton became depressed following the births of her two children, she relived the incest experience in her analyst’s office, “spinning dizzily on a sea of anxiety.” She dramatizes the scene in Searching for Mercy Street, recalling for the first time the words she could not express to her mother. I want to scream – get off, get off, get off! I hate you! I’m going to throw up. Let me up! She’s following me to the toilet. I’m throwing up the poison but it burns. I’m crying and she holds my head. She’s pressing a cool washcloth on my forehead. Now she’s being my mother again. (p. 267) Assaulted by a memory of the past, Linda Sexton finds herself besieged again in the present when she asks her analyst whether she should share this experience with her husband. The analyst’s response was not what she expected. “‘Why would you want to let him know that you fooled around with your mother?’ he replied, looking appalled that I would even make such a suggestion” (Searching for Mercy Street, p. 268). It’s difficult to imagine a therapist responding so insensitively to a patient’s anguished self-disclosures, but there’s no reason to doubt her reliability as a narrator. The analyst’s cold comments only added to her shame, but in retrospect, she credits his long silences for allowing her to discover grim truths about herself. Psychotherapy and writing helped Linda Sexton deal with these torturous experiences, but the “stain of trauma remains,” she concedes in Searching for Mercy Street. “Of all the mistakes Mother made, this one was the hardest to forgive” (p. 271). The reliability of her memory was corroborated when she listened to the therapy tapes and heard her mother

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talking about her sexual feelings toward her daughters. Linda then makes a confession that seems puzzling in light of her many years in therapy. She asks herself why she did not scream when her mother was lying on top of her, as Linda screamed years later in her analyst’s office. I could not claim rape, as if she had been a strong man who gave me no choice, and this question in particular haunted me: did I have an alternative? The answer, arrived at reluctantly, but also with relief because it felt honest, was yes. I did have a choice. I chose not to push her away because my priority when I was twelve and thirteen was to minister to her desires and needs (whether she was crazy or well) rather than to my own. I would always, it seemed, be the gatekeeper. (p. 270) This is one of the few moments in Searching for Mercy Street where the reader disagrees with Sexton. Young teenagers do not have the knowledge or maturity to make such a “choice.” This is a fact recognized not only in every court of law but also in clinical therapy. It’s difficult to imagine any therapist trivializing these horrifying experiences. Linda Sexton’s arresting image of being born in reverse refers to being “twined together like roots, like tight dark roots” (p. 300), as Mira later tells Eve. Mira fears that no one will be able to cut her free from her mother. Midway through Mirror Images, Eve asks Vivian if she knows what the word antibiosis means, and when the mother remains silent, the psychiatrist offers a vivid definition. “It’s when two things or two people have grown together too tightly, too much … When they drain each other. When they suck each other dry” (p. 166). Eve neglects to mention that antibiosis is an antagonistic biological interaction in which one organism is harmed by the other.

“THE DOUBLE IMAGE” Mira becomes psychotic near the end of the story, convinced that she has fatally shot her mother. Eve’s task is to convince Mira that she only fantasized her mother’s death. The psychiatrist also helps Mira understand her ambivalence toward her mother, observing, “Don’t you think that’s part of the sickness – to love the person who abuses you?” (p. 297). Another part

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of Mira’s sickness is loving the person who has smothered her, obliterating the boundaries between self and (m)other. And now we recall the line over which Eve earlier has mused – “I made you to find me” – the last line from one of Anne Sexton’s most famous poems, “The Double Image.” Anne Sexton’s remarkable “The Double Image” has produced Linda Sexton’s no less remarkable countertext, Mirror Images. Anne Sexton’s signature suicide poem, “The Double Image” was written in 1958, shortly before her parents’ deaths. The poem, addressed to Linda’s younger sister, Joy, explores the ways in which a psychologically damaged daughter becomes a psychologically damaging mother to her own daughter. “I cannot forgive your suicide, my mother said. / And she never could. She had my portrait / done instead” (Complete Poems, p. 37). The portrait depicts the speaker smiling on the outside but seething on the inside. Sexton wrote the poem while her mother, Mary Gray Harvey, was dying of cancer. As Sexton wrote to W. D. Snodgrass in 1958, “My mother says I gave her cancer (as though death were catching – death being the birthday that I tried to kill myself, Nov. 9th 1956)” (Self-Portrait, p. 40); the accusation parallels Mira’s belief that she was responsible for her father’s death. Unable to love her mother, the speaker in “The Double Image” fears she cannot love her daughter, whom she created for her own selfish reasons. Like “The Double Image,” Mirror Images reveals frightening dependencies, injuries, transgressions, guilts, and toxic secrets, but it also affirms the possibility of breaking destructive intergenerational conflicts. With Eve’s help, Mira begins to see her mother more clearly, and there’s hope that she will not repeat her mother’s unhappy life. There’s less hope, however, that Vivian will increase her self-understanding or improve her relationship with Mira. Vivian denies at the end that her relationship with Mira has been anything other than “normal,” and, in a detail that was true of Anne Sexton, Eve began to suspect that Vivian “had simply blocked out what she did not want to remember, erased a memory that was shameful and incriminating” (p. 292). Questions remain at the end of Mirror Images. Mira is just beginning the long road to recovery, and we recall a statement Eve makes midway through the novel: “abused children have an increased tendency toward suicide” (p. 195). Mira’s creator also experienced an increased tendency toward suicide, as her later books demonstrate. Nevertheless, Mirror Images ends affirmatively. Eve begins to forgive herself for the loss of her third stillborn child, a self-forgiveness she needs despite the fact that she

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has done nothing wrong. The moving final sentences of the novel convey Mira’s growing hopefulness. My life will be my life. I wrap my arms around myself. I am cutting our tight dark roots. Mother I say, I still love you I say. Mother I say, we were born in reverse. And so I am rocked, and so I am carried, and so I am borne, out into the new light. (p. 311) Linda Sexton reinforces the affirmation by dedicating Mirror Images to the recent birth of her son: “To Alexander and his dancing face.” Mirror Images is a beautifully wrought novel that repays rereading. Both entertaining and instructing its readers, Mirror Images can be appreciated without any awareness of Linda Sexton’s life, but the story takes on added significance when we realize the extent to which she has transmuted traumatic experiences into powerful art. Anne Sexton remains the dark muse in her daughter’s life, a figure who evoked intense love and hate when the poet was alive and who in death remains the catalyst behind nearly all of her daughter’s books. One can sense the ghost of Anne Sexton in Linda Sexton’s next novel, Points of Light (1988), which, though ostensibly about the death of a young child, conjures up many of the novelist’s memories of her deceased mother.

POINTS OF LIGHT Allie Yates is a painter, not a novelist or memoirist, and her story reveals Sexton’s efforts to distance herself from her mother and the subjects of domestic violence, dysfunctional marriage, incest, and intrusive love that dominate Rituals and Mirror Images. Allie has a positive relationship with her three young children, six-year-old Anna and the two-year-old twins, Jamie and Meggie. Allie is devastated by Jamie’s unexpected death: the sleeping boy is accidentally strangled to death by the string of a tiny wooden pull-toy horse she has left in his crib. The grief-stricken mother then suffers a nervous breakdown and struggles to find a way to bring Jamie back to life. It’s at this point that Points of Life begins to resemble Linda Sexton’s earlier writings. Sexton carefully prepares her readers for Jamie’s accidental strangulation by showing us Allie’s protracted labor while giving birth to the twins. Jamie is born with the umbilical cord wrapped around his neck, and until Allie’s mother-in-law and midwife, Tobie, cuts the cord and slaps the lifeless child,

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he appears to be stillborn. He becomes Allie’s miracle child, her favorite child, precocious and impish. “He made me feel the most needed,” she admits; “he made me feel the most like a mother; he made me feel everything I did feel the most intensely” (Points of Light, p. 125). Jamie appears to be endowed with preternatural powers, and Allie assumes that when he grows up, he will become a great painter, braver than she in expressing the inexpressible.

THE KISS Sexton does not prepare her readers, however, for what next happens, the most stunning event in the novel, when, during a violent thunderstorm that has terrified the child, Allie feels him touch her. The language leaves little doubt about the sexually charged nature of his touch: He was cupping my nipple with his palm, and the skin of his hand was very soft. He was stroking me the same way he stroked his blanket against his face each night as he fell asleep. Warmth began in my skin under his hand. I remembered my husband’s caress earlier and my nipple rose erect. I started to take his hand away, uncomfortable, guilty; then I stopped. I didn’t want to call attention to his innocent gesture and make it seem something it clearly was not. Yet I was afraid of what he had summoned up in me: a response which was taboo. (Points of Light, p. 160) Sexton never hesitates to describe the erotic feelings Jamie’s touch awakens in Allie. “Mommee brest,” Jamie exclaims joyfully, and then, pulling her robe open, he points, “One brest, two brest. Mommee got two brestzz,” he said, burring his tongue over the sibilants. “I counting!” A wave of maternal love lapped at me, made me want to surrender myself to his eyes, to this bright face full of its own newfound power. (pp. 160–161) After he kisses her, and she returns the kiss, a chain of tiny firecrackers exploded, ignited under my heart like the ring of flame under a gas burner, and I knew with certainty, with finality, that I would never feel this way about anyone else – not even my husband.

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Jamie’s kiss is a transformative moment in Allie’s life. Had he lived, she might have felt the same way Kathryn Harrison did when she described in her 1997 memoir The Kiss how she felt when her father, from whom she had been estranged for the first 20 years of her life, sexualized their relationship. In years to come, I’ll think of the kiss as a kind of transforming sting, like that of a scorpion: a narcotic that spreads from my mouth to my brain. The kiss is the point at which I begin, slowly, inexorably, to fall asleep, to surrender volition, to become paralyzed. It’s the drug my father administers in order that he might consume me. That I might desire to be consumed. (p. 70) The Kiss ignited a firestorm of controversy. The two New York Times reviewers reached opposite conclusions: Christopher Lehmann-Haupt praised the hypnotic power of the prose while wondering whether a memoir “can ring too artistic for the truth.” By contrast, Maureen Dowd dismissed the memoir as an exhibitionistic display of “dirty laundry” for cash. In a long discussion of the memoir in How Our Lives Become Stories: Making Selves, Paul John Eakin questioned the ethics of such life-writing. The memoirist’s urge to confess may be therapeutic, Eakin conceded, but at what cost of privacy to the family, in this case, Harrison’s children? One can imagine their horror when reading the memoir. Eakin pointed out that the child psychiatrist Robert Coles, author of The Moral Intelligence of Children, wrote an admiring blurb for The Kiss but then changed his mind and withdrew permission for the publisher to use the blurb when he discovered that Harrison had young children. Given the relational nature of identity and the impact of startling disclosures on the memoirist’s family, Eakin muses, “it is difficult not only to determine the boundaries of the other’s privacy but indeed to delimit the very otherness of the other’s identity” (p. 176). Sexton must have pondered the same troubling questions about privacy, and she decided to fictionalize the kiss in Points of Light, which perhaps spared her family some of the pain that might have occurred had the erotic embrace appeared in a memoir. Decades after the publication of Points of Light, incest remains a fraught topic for memoirists, as can be seen in the 2017 memoir The Incest Diary by “Anonymous.” As the first-person narrator explains in the Author’s Note, “I ask the reader to respect my wish to remain anonymous.”

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The Incest Diary reads like a gothic horror story, but at the end, no one rescues the narrator from the psychic injuries she has received from her unrepentant father. The daughter remains irresolvably ambivalent toward her father, who is both her lover and torturer. In one of the most disturbing sentences in the memoir, she describes how she wants her father to think she is sexy while at the same time she wishes to mutilate his body and feed his corpse to dogs. Points of Light could have omitted the two-page description of Allie’s taboo love for her son. The novel’s depiction of love and loss would still be powerful, and Allie’s emergence as a serious painter would still be convincing. We would still be able to understand Allie’s reluctance to make love with her husband after Jamie’s death. Why, then, did Sexton include the descriptions of transgressive love? To document, almost certainly, the long-lasting impact of incestuous love, which creates psychological complications most readers cannot imagine. Sexton doesn’t discuss this scene in Searching for Mercy Street, but after admitting the stain of sexual trauma, she acknowledges that: [t]o this day, I sometimes feel the irresistible pull of my sons’ unconsciously provocative behavior. A rain of tiny kisses from my child’s soft sweet-scented mouth can tempt me, tender unlike any other caress. Her body, she continues, “like any body, an odd collage of instinctual drive and continually engageable nerve endings, can still react on a level purely biologic, even in the most inappropriate of situations” (p. 269). Unlike her mother, “I draw lines none of us can cross: as a family we cuddle plenty, but with pajamas on, and only at the children’s invitation” (p. 269). Incest remains the most dangerous act in Linda Sexton’s world, awakening a storm of conflicting feelings. We recall the mystifying paragraph in Rituals in which Kat sees or imagines her naked father making love to either her mother or sister. We recall Mira’s horror when, pretending to be asleep, she sees her mother, in one incident, masturbating next to her and, in another incident, thrusting her tongue deep into Mira’s mouth. Incest awakens only revulsion and confusion in the 14-year-old. Now, however, in Points of Light Sexton allows herself to express more positive feelings associated with incest, under the throes of maternal love. Allie’s situation is far enough removed from Linda Sexton’s relationship with her mother that the novelist can evoke a fuller portrait of forbidden love, including feelings

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of intimacy, protectiveness, and union. The positive feelings associated with incestuous love inevitably become problematic when they are acted upon.

REUNION WITH THE DEAD Is it fanciful to see Jamie as an avatar of Anne Sexton? Jamie has a mysterious essence that has eluded Allie, and he has special powers. “He had grasped the abstract; he had grasped the infinite; he had grasped reality” (Points of Light, p. 9). Jamie is different from Allie’s other children, different from every character in the story. Mother and son share a nonverbal understanding of each other, a mystical bond that continues after his death. Sexton endows the boy with Anne Sexton’s poetic power, the gift of evoking sibilant sounds. Allie infers from her son’s fingerpainting that he will become a great artist. She appears merged with him, believing that he has completed her portrait “Death of Her Twin.” Their relationship illustrates a complementarity that exists in life and death. The toddler’s plaintive cry that Allie hears after his death, “Mommeecum” (pp. 211 and 219), echoes the similar cry that Linda Sexton expressed in the days following her mother’s death: “Mommy, come back” (Searching for Mercy Street, p. 200). Allie does not have a psychiatrist to help her work through her sexual guilt, but she expresses herself through painting. She is aided by Rebecca Shardick, a woman in her fifties under whose tutelage Allie learns to allow the unconscious into her paintings. Praising one of Allie’s early paintings for its suggestion of “layers of reality, something lurking behind what we see,” Rebecca acknowledges that “it’s a little bit derivative – but that’s not unusual. We’re all derivative from time to time” (p. 132). The same evaluation may be made of Points of Light. Sexton’s novel is not entirely original, but it deepens our understanding of bereavement. Allie’s grief following Jamie’s loss recalls Paul Morel’s devastation over his mother’s death at the end of Sons and Lovers, from which Sexton quotes. Other moments of Points of Light, when Allie sees her dead son alive, sightings confirmed by none of the other adults in the story, recall Henry James’s ghost thriller The Turn of the Screw, where the governess’s sighting of the dead Peter Quint is open to both psychological and supernatural interpretations. And still other moments of Points of Light recall Virginia Woolf’s To the Lighthouse. Sexton quotes a passage describing Lily

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Briscoe’s completion of her painting. “It was done; it was finished. Yes, she thought, laying down her brush in extreme fatigue, I have had my vision.” Allie has achieved her own vision at the end of Points of Light, when she completes “Death of Her Twin,” a portrait of Meggie. Points of Light dramatizes the tension between holding on and letting go of love. By novel’s end, Jamie has said his final good-bye to his mother, and she has made her choice: “I had let him go” (p. 308). Forsaking magical thinking for the magic of art, she continues to paint, calling her latest work “Reunion,” an image that reveals her desire for a family reunited. Allie is left with her visions of the living and the dead, confident enough to reveal them to the world. Linda Sexton’s dedication of the novel to her mother, “who taught me to listen to the sound of the word,” acknowledges the inspiration behind Points of Light.

PRIVATE ACTS Linda Sexton’s fourth and to date last novel, Private Acts, was published in 1991, a time when she was immersed in the world of Wall Street, where her husband was an investment banker. The novel’s cast of characters includes bankers who have made it to the top – OnePerCenters before the term became fashionable. Showing us what happens behind corporate doors and bedroom doors, Sexton limns a “Lucratocracy” where mergers-andacquisitions sharks prey upon those lower in the food chain, a world of power lunches and casual affairs, life in the dangerous fast lane. The novel’s most sympathetic character, Sexton’s authorial character, is Maggie Whitten, a former fiction editor of Esquire magazine who has been married for 12 years to Seymour Whittenberg, Sy Whitten, whose father dropped the last four letters of his name in deference to clubs that still have a policy of N.J.A.: No Jews Allowed. Sy hopes to become managing director of his bank, First Boston, though the promotion never comes through. Maggie reluctantly gave up her fulfilling position in publishing to raise her children, Kate and Mikey, but she is now trying to regain her career and jumpstart her life. Maggie and Sy have had a good marriage, but it is now imperiled: she feels unfulfilled, and he is too preoccupied with his career to notice her unhappiness. The paperback edition of Private Acts opens with advance praise from several writers, including Robert Barron, author of The Official MBA

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Handbook, a clever satire of the Harvard Business School that spent 16 weeks on the New York Times bestseller list in 1982. Much has been written on mergers, junk bonds, and the bonus babies of Wall Street in the “roaring eighties.” Private Acts tells the less-told tale of home-front victims and victors – from the bedroom to the boardroom – with the certain knowledge of one who has been there. It’s unlikely that many readers of Private Acts knew that Robert Barron (robber baron?) is the pen name of one of the coauthors, David Porter. The other coauthor, Jim Fisk, is the pen name of John Freund, Linda Sexton’s husband, to whom the novel is dedicated. Linda Sexton and John Freund met when they were both sophomores at Harvard, and they began living together shortly after graduation. They married in 1979: a wedding announcement in the New York Times identified them as Harvard graduates who were editors of The Harvard Crimson. Sexton dedicated Between Two Worlds to him: “Because he was watchdog of the word and a real mensch.” He reciprocated, dedicating The Official MBA Handbook “to Linda, wordmonger.” Freund graduated Harvard Medical School but decided not to become a physician, like his father, a New York City surgeon. Instead, John Freund received an MBA from Harvard Business School and began his career in 1982 at the investment bank Morgan Stanley, a world satirized in Private Acts. After the births of their sons, Alexander and Nicholas, the family moved to California in 1989. In 1997, Freund founded Skyline Ventures, a nationally known venture capital firm that specializes in healthcare companies. Publishers Weekly called Private Acts a “time capsule of a particular ’80s lifestyle.” The novel is also a time capsule of Linda Sexton’s darkest feelings about her mother. Private Acts is not a roman à clef, a novel with a key that unlocks the identities of the author or characters, but Sexton uses disguises to distance herself from Maggie, a writer whose literary career is on hold. We have no way of knowing the extent to which the Whittens’ marriage and family life resembles Sexton’s at the time – Private Acts is a novel, not a memoir. Nor do we know whether Sexton’s exploration of troubled aspects of Maggie’s sexuality represents conflicts in the novelist’s own life. We can see, however, that Private Acts prepares us for Sexton’s next book, Searching for Mercy Street, her journey back to her mother.

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SEARCHING FOR MERCY STREET Linda Sexton’s writings before Searching for Mercy Street demonstrate the truth of a statement she makes early in Half in Love when, recalling life with her mother, she admits that there were more “downs” than “ups.” Nearly everything we learn about Anne Sexton in Linda Sexton’s earlier books supports this observation: the downs affected us more deeply than the ups and thus were remembered with greater clarity and pain. The ups were part of the legacy, but they were the forgotten part. (p. 64) Linda Sexton’s goal in Searching for Mercy Street was to discover the ups without ignoring the downs – a task she had never attempted in her previous nonfictional and fictional books. To succeed, she had to create a three-dimensional portrait of her mother, a woman who could not be reduced to psychopathology. Given her relatives’ opposition to selfdisclosure, she tells a story of madness they didn’t wish to hear. Searching for Mercy Street doesn’t change the largely negative legacy Anne Sexton bestowed to her daughter. Linda Sexton’s portrait of Anne conjures up the netherworld, where a spectral mother continues to haunt her daughter. But for the first time, the daughter seeks to understand the roots of her mother’s mental illness – and her own. We see an intergenerational story of a family beset by mood disorders. In revealing the struggle to uncover and decode family secrets, Linda Sexton speaks in her own voice. She does not hide behind the veil of fictional characters, as she does in Rituals, Mirror Images, Points of Light, and Private Acts. As Helen M. Buss remarks, “memoirs have become the literature of survivors, including the survivors of sexual and physical abuse.” The difference between “writing a memoir that further victimizes the writer and writing one that can lend her more agency in her own survival,” Buss adds, “lies in the way the memoirist takes on the challenges of authorship” (p. 19). Linda Sexton takes on the challenges of authorship in Searching for Mercy Street, affirming, in the process, the memoirist’s survival. Searching for Mercy Street focuses on Linda Sexton’s quest for her identity as a memoirist. Ironies abound. “Don’t be a writer, Linda,” her mother had warned her (p. 95). Rejecting her mother’s advice was an act of filial rebellion. The literary daughter, however, was closely following in her mother’s footsteps. Anne Sexton was a confessional poet, Linda Sexton,

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a confessional novelist. Linda’s rhetorical question about her mother is no less true about herself: “Was not her obsessive need to display her life the driving energy behind her poetry?” (p. 231). How would the daughter forge her own literary identity? “I am determined not to be like my mother, spilling secrets like water from a cup, writing out a family’s shame. I will lock our dirt up tight” (p. 41). And yet the disclosure of shameful secrets appears throughout Searching for Mercy Street. The search back to her mother uncovered disturbing information that Linda Sexton did not want to know. She learned while reading her mother’s correspondence, diaries, and manuscripts that Anne had been released from the hospital many weeks before Linda was allowed to return home from her long exile to her Aunt Blanche’s home, an exile that felt like imprisonment. She learned from reading Middlebrook’s biography about her mother’s efforts to choke her to stop crying. And she learned from listening to the therapy tapes sexual details that sickened her. In the hands of a lesser author, Searching for Mercy Street might have become lurid and sensational, but Linda Sexton avoids these problems by striving to understand the split between her loving mother, the pioneering poet, and the mentally ill woman who was far sicker than anyone guessed.

THE MEANING OF THE TITLE Anne Sexton’s last volume of poetry was called 45 Mercy Street (1965), a place where, in her daughter’s words in Searching for Mercy Street, “past and present reconciled, where confrontation joined hands with forgiveness” (p. 9). The poet hoped she would achieve reconciliation and self-integration during her 45th year. The hope proved illusory for Anne Sexton, but the structure of Searching for Mercy Street shows the daughter’s movement toward her own reconciliation of past and present. The memoir’s last line, “Here is Mercy Street, at last” (p. 303), and the title, “Back to My Mother,” imply that she has reached the promised land of forgiveness, which was the goal of her book. What she had not yet reached, and still struggled with years later, while writing Half in Love, was forgiveness for her mother’s suicide. Searching for Mercy Street begins appropriately with Linda’s childhood, part of which was spent in geographical and psychological exile that she could not understand at the time. The memoir depicts Anne Sexton’s

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growth as a poet, a maker of myths: a positive legacy for which her daughter remains grateful. The memoir captures Anne Sexton’s charismatic power in a way that never happens in Linda Sexton’s novels. Seeing her mother give a poetry reading in a packed theater at Harvard is a revelation. I looked upon her with wonder: how captivating she was, how slender, burning with excitement, her voice a drowsy rasp, her sexuality palpable in the way she draped herself against the podium, her arms bewitched sirens calling to us all. (p. 161) The memoirist doesn’t stop there; she then describes the conflicting feelings that assail her as she watches the expressions of awe on the faces of her friends and fellow students. Rapture. And I was jealous, unspeakably jealous. In that moment I hated her and her power absolutely. In that moment I loved her and her power absolutely. She stood before us, her voice pure thunder. (p. 161) Part of Linda Sexton’s ambivalence toward her mother arose because they were both writers and thus competitors. “What happens when a daughter chooses to make her mark in the same field as her mother?” (p. 81). When Anne began writing poetry, Mary Gray, Linda’s maternal grandmother, started to write poetry herself, “as if goaded by her daughter’s ambitions.” Their styles, Linda adds, were at times “eerily similar” (p. 80). Linda felt the same fierce competition with her mother. The daughter chose to write fiction instead of poetry to avoid competing with her mother. The best passages of Searching for Mercy Street demonstrate Linda’s own inimitable prose style, richly evocative, metaphorical, unspeakably honest. The language in Searching for Mercy Street is highly polished, a worthy complement to her mother’s lapidary poems. Linda Sexton wisely avoids resolving her love-hate ambivalence toward her mother. She offers dueling perspectives throughout the memoir, Anne’s as a young mother, Linda’s as a young child. Each perspective is complex and ever-shifting. A fifth person lived with this family of four, Anne Sexton’s mentally ill double, and one never knew in advance which Anne Sexton was present. Sexton implied in an interview with A.R. Silverberry that she was more interested in narrative truth than historical truth in her two memoirs. “I basically feel that my memories are my own. I don’t represent them to

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be factual or an exact truth.” A memoir, she continues, is not a biography, written by an impartial observer. I like to use the metaphor that a remembered event is often totally recalled differently, even when two people have experienced the same thing. It is as if they have entered the same room, but through different doors, and thus have a different perspective on what they see. Sexton is right about a memoir’s subjectivity, yet it’s noteworthy that she always strives for historical truth in her memoirs. She points out in Searching for Mercy Street that hearing the therapy tapes corroborated her memories of her mother’s inappropriate sexual behavior. Without this objective confirmation, she might never have known whether her memories were accurate.

WRITING AS RESCUE It was wrenching for Linda Sexton to know that writing came first for her mother, implying that family came second, but writing was always associated with psychological health. Anne Sexton was rarely crazy when she was writing. What took her away from us was not her desire to write, but her depression: when depression descended, she did not – could not – write much. (p. 92) Searching for Mercy Street is a hymn to the therapeutic benefits of writing, for both mother and daughter. Linda discovers what her mother had long known: “writing is magic because it harnesses the energy generated by the chaos within. Writing works better at cleaning up the mess than doing laundry or making beds” (p. 95). Anne Sexton and Linda Sexton both knew that writing is a way to master experience. The two activities that were the most healing to Linda immediately following her mother’s death both involved writing. She wrote her undergraduate thesis at Harvard on the subject of Lily Briscoe’s artistic vision in To the Lighthouse, arguing that she was the center of the novel, not Mrs Ramsey, as most readers believe. Linda’s thesis was so convincing that she graduated magna cum laude. She also immersed herself in writing A Self-Portrait in Letters, “plunging myself into a world of words.”

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Writing is not a panacea, however, and there were three writing-related problems that bedeviled Anne Sexton. The first was prolonged writer’s block. Sexton, like Hemingway, believed that artistic creativity was the best therapy, and she became despondent when the words refused to flow. Artistic silence felt like suicide to her, as it did to Hemingway. “It doesn’t matter that I don’t write for a day or a year or ten years as long as the knowledge that I can write is solid inside me,” Hemingway confided to A. E. Hotchner. “But a day without that knowledge, or not being sure of it, is eternity” (pp. 328–329). The second problem confronting Anne Sexton was harsh literary criticism of her work. She was mortified by James Dickey’s cruel review of her 1962 poetry volume All My Pretty Ones. Other writers would have tried to ignore the criticism; Sexton, instead, had a one-night stand with Dickey and kept a copy of his scathing review in her pocketbook, which Linda discovered after her mother’s death. The third writing-related problem, as Linda reveals in Searching for Mercy Street, was Anne’s recognition of her loss of creativity. She knew at the end of her life that the quality of her work had diminished. The old tricks of expansion and identification worked less and less as the poetry lost its center of gravity and began to spin out of control. Soon even the old black art brought no comfort to its creative witch. (p. 295) Linda Sexton is honest enough to admit in Searching for Mercy Street that the same problems tormented her. The two novels she wrote after Private Acts were both rejected by publishers. One of them, Bedside Manners, was a “story of a female serial killer who retaliates for the sexual abuse she endured as a child” (p. 284). The rejection of the two novels resulted in a crisis of self-worth. She confesses feeling threatened by her mother’s literary reputation. “Mother’s star was once again in the ascendancy; mine was in the gutter” (p. 285). The self-evaluation may have been unduly harsh, but depression overcame her, deepening writer’s block. Linda Sexton may have felt that her career as a novelist was over, but her career as a memoirist was just beginning. Searching for Mercy Street ends with her decision to write about her tangled relationship with her mother, a decision she hopes will enable her to exorcise her demons. “I would be my own witch doctor” (p. 296). The last chapter, “Mercy Street,” reveals a dream in which she completes a sketch of her mother followed by hearing her speak at a poetry reading. Linda then wakes

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up and imagines handing her memoir to her mother, implying a longdesired resolution of their conflict. The ending is convincing, yet in light of subsequent events in Sexton’s life, an earlier sentence in Searching for Mercy Street is portentous: “Resolution of my emotions about my mother may be unobtainable, however much I crave it, perhaps reached only when death forces it upon me” (p. 8). Searching for Mercy Street is unprecedented in its double focus on two acclaimed writers, mother and daughter, whose lives – and illnesses – were mirror images. “What makes this memoir so powerful and affecting,” Michiko Kakutani wrote in The New York Times, “is its candid, often painful depiction of a daughter’s struggles to come to terms with her powerful and emotionally troubled mother.” Searching for Mercy Street was named a New York Times Notable Book of the Year. The memoir turned out to be, however, a prelude to a more harrowing story.

HALF IN LOVE Published 17 years after Searching for Mercy Street, Half in Love is a more disturbing memoir, one that was more difficult to write – and to read. Sexton never fully realized when she was writing her first memoir the implications of her mother’s grim legacy of suicide, which now seems to be her own as well. As she writes in Half in Love, the daughter’s “need to know” results in the assumption that “whatever happened in her life would undoubtedly happen in mine” (p. 27). Half in Love illustrates what the psychiatrist Colin Murray Parkes calls the existence of an “assumptive world,” a strongly held set of assumptions about the world of the self which is confidently maintained and used as a means of recognizing, planning, and acting.… Assumptions such as these are learned and confirmed by the experience of many years. (p. 132) Part of Linda Sexton’s assumptive world, in the years following her mother’s suicide, was that she would share the same fate; the assumption grew stronger when she began developing her mother’s illness and repeating her behavior. Unlike Searching for Mercy Street, which focuses on Anne Sexton’s history of depression and suicide, Half in Love emphasizes Linda Sexton’s

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own history of mood disorders, cutting, and three suicide attempts, one of which was nearly fatal. To date, a “suicide gene” has not yet been discovered, but suicide runs in families, including both sides of Linda Sexton’s family. After Anne Sexton’s suicide, her older sister Jane took her own life, as did the sister of Anne’s father, Ralph Harvey, who himself often threatened suicide. In addition, Anna Ladd Dingley, Anne Sexton’s “Nana,” suffered a mental breakdown and spent the rest of her life in a hospital. Few families are willing to talk about the legacy of suicide; many deny that a self-inflicted death is, in fact, a suicide, preferring an explanation that carries no stigma. THE LIMITS OF DISGUISES How does an author write about the impact of his or her history of mental illness on loved ones without violating their privacy? A biographer’s or memoirist’s freedom of expression invariably clashes with a relative’s or friend’s right to privacy. Middlebrook did not use many disguises in her biography, though she did conceal the name of the psychiatrist who sexualized therapy with Anne Sexton, referring to him as “Dr. Zweizung,” a name which means “forked tongue” in German. Anne Sexton’s extended family objected to some of Middlebrook’s characterizations, particularly the suggestion that the poet’s father may have sexually abused her. Linda’s first cousin, Lisa Taylor Thompson, expressed the family’s outrage that their privacy was invaded and felt shamed by the disclosures. Linda Sexton used few disguises in Searching for Mercy Street. For example, she named the mother’s transgressive psychiatrist, Frederick Duhl, who had first been “outed” by New York Times reviewer Alessandra Stanley. Sexton also referred to her relatives by name, mainly because they had publicly identified themselves in the New York Times. She writes about being sent as a child to the home of her mother’s sister, Blanche, and her husband, Ed Taylor, described as an alcoholic who cruelly punished his children, wife, and Sexton herself with a strap. To avoid further pain, Sexton announces in the author’s note to Half in Love that she used disguises to protect the privacy of those she discusses in her second memoir. Nevertheless, Half in Love shows the problematic nature of disguise in mental illness memoirs, particularly when the memoirist has written earlier books in which she refers to the same people by their real names. Like Middlebrook, Sexton discovered that she could

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not write probingly about family members without hurting and angering those still alive. Blanche is now “Alison” in Half in Love, and Ed is “Henry.” It’s not clear why Sexton changes the name of her main psychiatrist in Searching for Mercy Street, “Dr. Adele Shambough,” to “Dr. Bauman” in Half in Love: she is described sympathetically throughout both memoirs. “I shyly grew to love her,” Sexton writes in Searching for Mercy Street, “and the more I loved her the more I resented my mother” (p. 132). Sexton found an ingenious way to disguise her former husband’s name in Half in Love. She had dedicated two of her books to her husband, John Freund: Between Two Worlds and Private Acts. Additionally, an extended discussion of her gratitude to him appears in Searching for Mercy Street. But by the time she wrote Half in Love, their 18-year marriage had come to a sad end, a result of her husband’s anger and resentment over her suicide attempts, which he regarded as a betrayal. They divorced in 1998. Throughout the memoir she refers to him as Jim Fisk, without telling us that this was his pen name when coauthoring The MBA Handbook. She also changed the names of her two sons. Sexton could not disguise the name of her sister, Joy, with whom she had had a conflicted relationship. Their relationship was not helped by the acidic portrait of Kat’s younger sister, Paige. Rituals, however, is a novel, not a memoir, and one cannot assume that the novelist’s portrait of Kat’s sister is based on her own sister. Sexton tried to be protective of Joy, but she decided to identify her by name in the two memoirs because not naming her would have resulted in a conspicuous gap in both stories. Moreover, Joy Sexton was well known as the younger daughter of Anne Sexton and had given interviews about their relationship. Naming her, though, complicated an already fraught relationship. The sisters felt strikingly different about self-disclosure: one was highly self-disclosing; the other, along with her father and their extended family, was averse to any self-disclosure, believing that family secrets should not be exposed to the public. Joy resented her sister’s many books on their mother, beginning with Anne Sexton’s appointment of Linda as her literary executor. Joy believed that Linda had appropriated their mother’s story for her own purposes. Another reason for their tension was Joy’s limited ability to empathize with Linda’s depression and suicidality, illnesses that hit too close to home. Linda is forthright about the conflicts with her sister. Shortly after Anne’s death, Linda resolved, as the writer in the family, to keep her mother’s

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writing desk, a decision that angered Joy. Their relationship was further damaged by Linda’s books on their mother. Upon reading the galleys of Searching for Mercy Street, Joy felt that, unlike Linda, she had made a “narrow escape,” a comment that Linda could never forget. A terrible silence lasted for the next 13 years. Joy was “not comfortable” speaking to Linda on the telephone after her second and nearly successful suicide attempt. Nor was her father able to speak with her. “Linda, I thought we were all through with this” (Half in Love, p. 208), he reprimanded her. Once again, Linda concluded, “mental illness and depression were on the list of unmentionables” (p. 211). Sexton reaches a life-transforming insight near the end of Half in Love, the realization that Joy regarded her sister’s and mother’s behavior as a moral or characterological failure rather than as a life-threatening disease, such as cancer. At last I had my answers, even if they were unsurprising ones that hurt. I saw clearly how the issue for Joy was so complex: dominated by her own history of pain, she could neither give, nor forgive, in this particular direction. She hadn’t forgiven our mother yet – how could she forgive me? At least I finally knew how little and how much I could ask for – and how far I could go without threatening her. (p. 302)

SEXTON’S PSYCHIATRISTS Most mental illness memoirs contain one or more unsympathetic psychotherapists whose treatment is either ineffective or harmful to the benumbed patient, and a kind, understanding therapist whose treatment proves to be life-saving. Half in Love is no exception. Throughout her four years of high school, Sexton was treated by Dr Bauman, who characterized the mother– daughter relationship as a “destructive symbiosis” (p. 16) and encouraged Sexton’s efforts to distance herself from her mother. Years later, after the move to California, Sexton went into therapy with Dr Benjamin Berns, a psychiatrist in his early seventies. She found him initially to be a “gentle, wise, nurturing soul” (p. 99), but when she began harming herself, he made her sign a contract stating she wouldn’t do anything self-destructive, like cutting herself. The contract had the unintended effect of forcing her to hide her feelings from him. In an act that she found unconscionable, he

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“fired” her after her second suicide attempt. Then came a physician who was board-certified in psychiatry and neurology. Ultimately, Norman did not cure me of my headaches or my bipolar disorder, but over the course of the two years I saw him, he lightened my pocketbook by tens of thousands of dollars. (p. 104) Norman was useful in one way, however: he gave Sexton a new diagnosis, bipolar II, which proved to be a turning point in her treatment. She then educated herself about the illness by reading a “thick tome, newly published, and hailed by the medical establishment to be the current bible on bipolar disorder” (p. 105). She doesn’t name the book, but it was ManicDepressive Illness, coauthored by Frederick Goodwin and Kay Redfield Jamison. Both Goodwin and Jamison wrote enthusiastic blurbs that appear on the back cover of Half in Love. Sexton found Jamison’s memoir An Unquiet Mind mesmerizing, but like Jamison, she was so depressed during her years of depression that she lost the ability to read. “I felt my head buzzing with the letters, keeping them from becoming words” (p. 227). Linda Sexton’s most effective psychiatrist was Barbara Ballinger, who practiced verbal therapy and also prescribed powerful psychotropic drugs. The Stanford University psychiatrist, a graduate of the University of South Carolina School of Medicine, was not intimidated by suicidal patients, as many other therapists are. She accepted Sexton for who she was at the time – an extremely disturbed patient; moreover, Ballinger did not force her to sign a contract prohibiting her from cutting or suicide. Patient and doctor agreed to Freud’s fundamental rule: Sexton could tell her anything, including being suicidal, without adverse consequences, such as being abandoned or involuntarily hospitalized. The pact, Sexton concedes, was risky for Ballinger: she could have been “excoriated by her peers and colleagues.” Sexton’s freedom to talk about her self-destructive feelings allowed her to express and work through violent feelings that might have otherwise led to another suicide attempt. Sexton was given a new diagnosis, borderline personality disorder, which made sense to her. Now she could understand her intense fear of abandonment, to the point of paralysis; she could also understand her tendency to idealize loved ones and then devalue them when they failed to give her what she needed. Half in Love ends with recovery. One of the best developments in Linda’s life has been a strengthened relationship with her sister. Linda pointed out

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to me that before writing Half in Love, she “interviewed” Joy by asking her to speak uninterruptedly into a tape recorder about her feelings regarding Linda’s suicide attempts. Although what she said was very painful to hear, it was also cathartic for her and enabled us to heal and once again grow closer. When I wrote about her in the book, I was able to use her own words exactly so that there could be no confusion about where she stood. Linda moved to Annapolis, Maryland, where her sister lives, and they spend the weekends together, “having become close once again, just as we were as children – best friends.” This detail is important to note, Linda added, because “it demonstrates that family can forgive mental illness and suicide attempts – just as I have forgiven my mother (though not forgotten the pain).” Linda also asked her sons to use a tape recorder to share their thoughts about her for the memoir. “That was also part of our healing and forgiving process.” There have been other positive developments in Linda’s life: her marriage to Brad, to whom she dedicates the memoir, in 2009, and their delight together on their cruising sloop, aptly named Mercy Street. Like others who take potent psychiatric medication for many years, Sexton experiences side effects, including weight gain and trembling hands, but she leaves no doubt that the benefits are worth it. The final chapter, “Hope,” brings an earned resolution, esthetically and psychologically satisfying. In a 2015 interview with Emma Eden Ramos, Sexton noted that it took her 10 years to write Half in Love. Many people email me to thank me for being so candid with the story of my depression, my suicide attempts, my reentry into the world – as it helps to hear that someone else felt the same way you do, and still survived. There’s a lot of hope tucked in between the pages of that book.

THE LEGACY OF SUICIDE Many memoirists write about the grim intergenerational legacy of suicide. To cite only one example, apart from Linda Sexton, Christopher Lukas’s 2008 memoir Blue Genes chronicles the pervasiveness of manic depression

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and suicide in his family. His mother, Elizabeth, whose life had been governed by wild mood swings, disappeared after the birth of her first child, the memoirist’s older brother, and tried to kill herself. She succeeded at age 33 when she slashed her wrists and throat. Her brother, Ira, who had been receiving treatment for the same disorder, “in an anguished replication of his sister’s suicide forty years earlier, cut his throat.” Christopher Lukas describes himself as aghast, unable to believe that “history could repeat itself so directly” (pp. 209–210). Lukas coauthored a book with his psychoanalyst friend, Henry M. Seiden: Silent Grief: Living in the Wake of Suicide (1987). It was about all the aftereffects: depression, anger, guilt, anxiety, replication of the act itself. We warned survivors that if they did not receive intervention in the form of comfort, therapy, and grief counseling, they, too, might end up as suicide statistics. (p. 211) But Lukas’s ordeal was not over. His only sibling, J. Anthony Lukas, a celebrated writer for the New York Times and recipient of two Pulitzer Prizes and the National Book Award for Nonfiction, hanged himself in 1997 at age 64. In the epilogue to Blue Genes, Lukas admits to his inability to forgive his brother. He did not kill himself to hurt me and the others who were his friends – though his way of going could not help but hurt. It is that final hurt that makes me unable to forgive him. I know that he did not choose to spurn me in his death any more than he choose to spurn me in his life. But I cannot let go of the fact that by leaving without saying good-bye, he left me, once more, all alone. (p. 244) Lukas is honest enough to admit that every morning, for years, he has awakened, thinking, “I’m ready to kill myself.” Then, afraid of those words, I soften the language. I think, “My God, this could be the day,” a mournful, fear-filled expression of trepidation, a caution to myself that something terrible could happen, ignoring the fact that the worst thing that could happen had already happened, many years before. (p. 240)

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CRITICAL REVIEWS Half in Love “looks into the workings of the suicidal mind in a way that isn’t easily forgotten,” Maria Russo concludes in her New York Times Sunday Book Review, “raising provocative questions about how we approach and treat the severely mentally ill.” Russo’s praise was qualified, though. There is, however, no getting around the fact that Sexton never becomes as compelling a character as her mother was, making this book a kind of bleaker postscript to Searching for Mercy Street. Bleaker, yes, but hardly a postscript. Sexton’s second memoir reads like an epilogue that brings a degree of resolution to an unforgettable story. The memoir’s unflinching honesty remains stunning. Children of confessional poets do not fare well. Nicholas Hughes, an Alaskan fisheries biologist who was the son of Sylvia Plath and Ted Hughes, hanged himself in 2009 at the age of 47; according to his sister, he had been deeply depressed. The reader is grateful that Linda Sexton has learned to live with her dark legacy, enlightening us with her cautionary tales. GHOSTS AND ANCESTORS In an illuminating 1960 essay, the psychoanalyst Hans. W. Loewald distinguishes between ghosts and ancestors to show how trauma, like depression, evokes the image of haunting. Those who know ghosts tell us that they long to be released from their ghost-life and led to rest as ancestors. As ancestors they live forth in the present generation, while as ghosts they are compelled to haunt the present generation with their shadow-life. (p. 29) One senses that Linda Sexton has transformed her ghosts into ancestors, changing her assumptive world. Her most recent memoir, Bespotted, published in 2014, describes her family’s love affair with Dalmatians. It is a story about unconditional love, the survival value of humor, and living with the dead. During her wedding ceremony, she and her husband reserved two empty chairs for their deceased mothers. “My mother had been gone for thirty-five years, but on a day like this, I missed her” (p. 164), a statement that brings to a fitting close a complex maternal inheritance that the daughter has put to excellent use.

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5 “TRUTH IS BENDABLE”: LAUREN SLATER AND LYING

“When all is said and done,” Lauren Slater admits in the afterword to Lying: A Metaphorical Memoir, her 2000 account of the early history of her mental illness, there is only one kind of illness memoir I can see to write, and that’s a slippery, playful, impish, exasperating text, shaped, if it could be, like a question mark. (p. 221) Exasperating, indeed! Lying raises so many vexing biographical, psychological, and literary questions that the reader may be tempted to reject the entire story as a falsehood, a slick postmodern fabrication, as many irritated reviewers of the memoir have concluded. To dismiss the story as mere trickery would be a mistake, however, for lies may sometimes contain elusive truths that cannot be expressed in any other way. How can a memoir titled Lying claim to be a nonfictional account of the author’s struggle with mental illness? What are a writer’s ethical obligations to tell the truth in a memoir that purports to be truthful? Why begin a memoir of mental illness with the confession, “I exaggerate,” state repeatedly that “truth is bendable,” raise the possibility that the memoirist suffers from a psychological disorder that results in factitious illness, and then include a published case study of the memoirist’s psychosurgery that turns out to be false? How can readers distinguish between an unreliable narrator and an unreliable writer? If Lying were Slater’s only account of her psychiatric history, readers would be left in a quandary, lost in a funhouse of fabrications. But by looking at Slater’s

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earlier illness memoirs, Welcome to My Country (1996) and Prozac Diary (1998), and her later memoirs, Love Works Like This (2002), The $60,000 Dog (2012), Playing House (2013), and Blue Dreams (2018), we can begin to understand why she classified Lying as creative nonfiction.

WELCOME TO MY COUNTRY Slater began her literary career with the publication in 1996 of Welcome to My Country, which she wrote shortly after completing a master’s program in psychology at Harvard and a doctoral program in psychology at Boston University. Subtitled A Therapist’s Memoir of Madness, the book focuses on six patients suffering from chronic schizophrenia who live in an all-male Boston residential unit, where Slater conducted group therapy. She states her therapeutic and literary strategies in the preface, where she comments on finding vector points between her patients’ lives and her own. These, then, are not just stories of my patients; they are stories as well of myself, of interactions and conflicts, of the way one psychologist watches her past meet her present, coming to see herself in the complicated lattice of her patients’ lives. These are stories of reflections and routes, including the route I have traveled to cope with my own psychiatric difficulties. (pp. xii–xiii) Aware of the paradox that most psychotherapists remain wary of revealing too much of themselves while at the same time encouraging their patients’ self-disclosures, Slater vows to strip off the mask to reveal the “lovely and mysterious alchemy that comprises the cords between people, the cords that soothe some terrors and help us heal” (p. xiii). Slater is understandably ambivalent about a culture that abounds in “marketplace confessions.” This trend, she believes, “trivializes suffering and contributes to the narcissism polluting our country’s character” (p. 179). She singles out Oprah Winfrey, who extracts admissions from the soul like a dentist pulls teeth, gleefully waving the bloodied root and probing the hole in the abscessed gum while all look, without shame, into the mouth of pain made ridiculously public. (p. 179)

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Admitting that her own self-confessions might satisfy a “narcissistic need” to have “some of the spot light,” Slater hopes that her self-disclosures will convey not self-absorption but the intimacy and love she feels for her patients. The most powerful chapter in Welcome to My Country is the last one, “Three Spheres,” where Slater describes treating a 37-year-old woman, Linda, with a long history of suicide attempts and self-mutilation. The patient is hospitalized at “Mount Vernon,” a large old public institution in Massachusetts where Slater herself was hospitalized, on five separate occasions, from the ages of 14–24. Returning to the hospital, this time as a 31-year-old therapist, she is overwhelmed by painful emotions she can share neither with her patient nor the staff. Present and past converge eerily, and as she passes through a hospital door with the ominous warning sign – “ENTER WITH CAUTION. SPLIT RISK” – one recalls the i­ nscription at the entrance of hell in Dante’s Divine Comedy: “Abandon hope, all ye who enter here.” One may also recall Betty Berzon’s 2002 memoir, Surviving Madness: A Therapist’s Own Story. The narrative opens with the future writer, 22-years-old, entering a locked psychiatric ward outside of Los Angeles in the late 1950s, under a suicide watch, unable to fathom the events befalling her, and then returning to the hospital a year later, now working as an aide, her recovery in progress. Slater doesn’t mention Berzon in Welcome to My Country, but the two patients-turned-therapists have much in common, including using memoiristic writing to search for an understanding of how they became severely depressed – in Berzon’s case, because of the shame of being a lesbian, surrounded by homophobic relatives and friends – and how they used writing to reconstruct their lives. Slater’s patient, Linda has been diagnosed with borderline personality disorder, a grim diagnosis, the therapist adds professionally. “Borderlines are thought to be pretty hopeless, supposedly never maturing from their ‘lifelong’ condition.” She then reveals that when she left the hospital for what she somehow knew would be the last time, she asked for a copy of her medical records and received the same diagnosis as Linda. “This young woman displays a long history marked by instability in her interpersonal and intrapsychic functioning,” my record read. “She clearly has had a long career as a mental patient and we will likely encounter her as an admission again in the future.” (p. 187)

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This is a brazen self-disclosure, perhaps resembling the “ridiculously public” confessions on Oprah that Slater has earlier criticized. She reveals elsewhere in Welcome to My Country her long history of eating disorders and obsessive desire to be thin: she was 88 pounds when she completed college. She relates her psychiatric history mainly to demonstrate her ability to identify with and understand Linda’s situation, but also, we suspect, to hint at personal problems she will explore in greater detail in later memoirs. Lauren Slater is not the only writer who has acknowledged publicly a diagnosis of borderline personality disorder. In her 1993 memoir Girl, Interrupted, Susanna Kaysen admits having the same diagnosis, and she includes near the end of the book the description of borderline personality disorder that appeared in the third edition of the Diagnostic and Statistical Manual of Mental Disorders. Joan Didion reveals in her 2011 memoir Blue Nights that her daughter had received the same diagnosis. Heartbroken over Quintana Roo Dunne’s death from a cerebral hemorrhage in 2005 at age 39, Didion implies that the psychiatric diagnosis meant her daughter was untreatable. This may have been true decades ago, when the diagnosis was viewed as perhaps the most “maligned and misconstrued” form of mental illness (Burland, 2007), but contrary to Didion’s pessimism, much progress has been made in the treatment of borderline personality disorder. The University of Washington psychologist Marsha Linehan has pioneered a new therapeutic approach called dialectical behavior therapy, or D.B.T., which has proved successful in the treatment of the disorder. The 68-yearold Linehan stunned the clinical world when she announced in 2011 that she has struggled with the disorder since she was 17. “So many people have begged me to come forward” Linehan told New York Times reporter Benedict Carey, “and I just thought – well, I have to do this. I owe it to them. I cannot die a coward.” Slater may not have felt cowardly for concealing her stigmatized psychiatric diagnosis, but, in Goffman’s terms, she felt compelled to disclose her “spoiled identity” to readers. As a practitioner of talk therapy, Slater encourages her outpatients to begin at the beginning, inquiring into their past, searching for childhood wounds that might account for present behavior. Slater’s own childhood wounds all seem related to her mother, who is fleetingly referred to several times near the end of Welcome to My Country. We never learn why Slater’s father fled from his family to move to Egypt or why her mother, feeling lonely and abandoned, then left when Slater was 14, forcing her into a foster home. “‘I can’t handle you anymore,’ she’d said to me, spit at me.

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‘I no longer want you in my house’” (p. 190). The mother appears to be clinically depressed and filled with rage, as Slater intimates when she recalls being 10 years old, “sitting under the piano, as my mother, her face a mask of pain, pummels the keys” (p. 181). Slater suggests in all of her mental illness memoirs that the fraught ­mother–daughter relationship was built on anger, abuse, and betrayal. We saw a similar conflicted mother–daughter relationship in Linda Sexton’s two memoirs. Indeed, there are several similarities between Lauren Slater and Linda Sexton. Sexton, we recall, was also diagnosed with borderline personality disorder. Slater intimates in Welcome to My Country that her mother may have been guilty not only of physical abuse but also sexual abuse – again, like Linda Sexton. Both memoirists imply that their mood disorders may be traced to mentally ill mothers: The sins of the mothers dominate the daughters’ writings. Boundaries in the mother–daughter relationship appear to be nonexistent, and the daughters are overwhelmed by fearful secrets they can share with no one. In the most ambiguous and emotionally charged moment in Welcome to My County, Slater remembers lying in bed, hearing her mother murmuring a Hebrew prayer. “I imagine her hands exploring me, and a darkness sprouts inside my stomach” (p. 182). From this darkness, which seemed to conceal a terrible story of sexual violation, emerged the beginning of her history of self-mutilation and suicidality: A pain grows like a plant, and when I was twelve, thirteen, I decided to find the plant, grasping for its roots with a razor blade. Stocked solid with the romance of the teenage years, with the words of the wounded Hamlet and the drowned Virginia Woolf, whom I adored, I pranced on the lawn of my school, showing off the fresh gashes – Cordelia, a dwarf, a clown, Miss Havisham. I loved it all. I wept for the things inserted into me, the things plucked out of me. And I knew, with the conviction of adolescence, that pain confers a crown. I was removed to the hospital, then a foster home, then the hospital, again and again. Later on, in my late teens and early twenties, I starved myself, took pills to calm myself down, wanted a way out. And finally I found one, or one, perhaps, found me. (p. 182) How do we interpret this haunting passage? The use of the word “imagine” suggests that this might be a fantasy, not reality, but a few sentences

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later she “wept for the things inserted into me,” a statement that appears to be based on an actual memory. Are we dealing with narrative truth or historical truth here? An experience that awakens desire or fear? It’s likely that the preceding either/or binary is both/and. There is no ambiguity over the razor blade, and in several of her books Slater mentions cutting herself as an adolescent. Does her reference to “I loved it all” relate to her fascination with doomed suicidal characters and authors, or to her fascination with flouting her identity as a troubled teenager, proudly showing off her wounds? Has she been infected by literature’s dark power, or has her reading of authors like Shakespeare, Dickens, and Woolf allowed her to uncover aspects of herself that she has not previously known? Does “I love it all” refer to the pleasures of being ill, as she states unambiguously in Prozac Diary: “I loved my illnesses” (p. 21)? We cannot be sure. A few pages later in Welcome to My Country she recalls seeing her mother again, “her face coming to me clearly, her eyes haunted with loneliness and rage. I feel her fingers at my breasts and flinch” (pp. 190–191). Slater attributes her recovery to the good fortune of being placed in a foster home for four years, where she was lovingly cared for by foster parents who believed in her despite the trouble she caused them. “That steady acceptance must have had an impact, teaching me slowly over the years how to see something salvageable in myself” (p. 194). Gladly would Slater learn from her foster parents, and gladly would she teach this acceptance and kindness to her patients. Welcome to My Country ends with Slater giving the stunned Linda, contrary to hospital policy, a set of keys to open a locked interview room. Trust the patient, the memoir implies, to initiate her own healing. Tellingly, before sitting down with Linda in the interview room, Slater remarks that she sometimes misses her mother. Therapist and patient then look at each other, each trusting and being trusted by the other. The memoir ends with the words, “This is where we begin” (p. 199). Most of Slater’s patients in Welcome to My Country are chronic schizophrenics, including Joseph, but he suffers from compulsive writing, hypergraphia, which is a syndrome, she tells us, “usually found in patients with temporal-lobe epilepsy” (p. 86). This early reference to epilepsy prepares us for Slater’s later use of epilepsy as a metaphor of her own mental illness in Lying. Slater obtained written consent from the patients whose stories appear in Welcome to My Country.

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In all cases, patients were eager to have aspects of their suffering, however disguised the form, shared with the wider world in the hopes that others might come to a better understanding of their plight. Curiously, Slater asserted in a 2002 interview with Alys Culhane, published in 2005, that the patients who read her book were not moved by it. They read it but it didn’t seem to have much of an effect on them. They didn’t care much about my writing, or my life, which was totally appropriate. My book is about their lives. (p. 163) Slater’s only explanation for this counterintuitive finding is that the memoir is more about her patients’ lives than her own, but this explanation doesn’t entirely account for their lack of interest in it. One would think that patients would be eager to read about their lives, seeing themselves in a different way, particularly since Slater’s sympathy for them is apparent. For example, all of Irvin Yalom’s current patients seek out treatment with the existential psychiatrist because they have read one or more of his clinical stories. Slater has long admired Yalom, as I have, and her comments about him in “One Nation, Under the Weather,” published in Salon in 2000, reveal what she tried herself to achieve in Welcome to My Country: As a psychologist, one of my favorite theorists to read is Irvin Yalom. He writes beautifully about existential psychotherapy and group psychotherapy, and he’s one of the few in the field who has really been able to articulate what the healing principles of group psychotherapy might be. Yalom claims that universality is a core healing component of the group therapy process. In other words, patients in group therapy learn that they are not the only ones who feel this way, that they are not aberrant, or perverse, and this in itself is deeply healing. One would imagine that Slater would feel proud of Welcome to My Country, which received highly favorable reviews. The back cover of the paperback edition is garlanded with an endorsement from the Los Angeles Times Book Review, which praised the book as “relentless in its maskstripping, yet instead of indulgence the act of revealing is handled with beauty and bravery.” Other reviews published in the Boston Globe, San Francisco Chronicle, and Newsday were equally glowing. Surprisingly,

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Slater later came to dislike the book, for an unusual reason, as she told Culhane. Critics welcomed the book because it doesn’t have much of an edge to it – Welcome to My Country is a book about kindness and compassion and it’s hard to fault a book like this. I’m really likable in this book – and I think it’s caused me trouble career-wise because people decided that I’m this lovable, compassionate psychotherapist. I’m sometimes likable and compassionate, and at other times I’m not. In the other books I’ve written I’ve explored other aspects of myself that are less likable. (p. 164)

PROZAC DIARY Published in 1999, Prozac Diary is an edgier book, the only one Slater said she regretted writing, partly because of the title. The publisher, Random House, rejected her original title, “Half Life,” which contains an intriguing double meaning: the period of time required for a drug to lose half of its pharmacological power, and the feeling that one has lost a vital aspect of oneself, including sexual desire, as a result of a drug’s serious side effects. Perhaps another reason Random House chose the present title was the influence of Elizabeth Wurtzel’s bestselling Prozac Nation. But the publisher’s choice of a more commercial title displeased Slater. Another reason she regretted writing Prozac Diary was the sudden over-popularity of the genre, to which she, of course, has contributed. “The memoir backlash is getting to me,” she complained to Culhane. “I now suspect Prozac Diary is just too self-centered.” The reviewers of Prozac Diary did not share this criticism, largely because, as the Boston Globe observed, Slater’s writing is “confessional without being sentimental.” D. T. Max lauded the book in the New York Times Book Review as a “gentle, illuminating memoir,” observing that the “life she has gone on to have with Prozac as her constant companion is remarkable.” Despite the title, the memoir is no hymn to what Peter Kramer, the author of Listening to Prozac, called “cosmetic psychopharmacology.” Prozac Diary chronicles Slater’s dependency on a drug that has been both a gift and a burden, with side effects that include tremors and a loss of libido. Slater’s “love affair” in the memoir is not with Prozac, which she continues to take, after more than a decade, but with

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storytelling. Unlike Prozac, which eventually stopped working at low dosages (because of its infamous “poop-out” problem), and which must be taken in ever-­increasing dosages, storytelling becomes Slater’s treatment of choice that has sustained her throughout adulthood. Central to the story of Slater’s life is her illness identity. Illness, for me, had been the explanatory model on which my being was based. Since I had spent much time in mental hospitals, illness had also been something I’d learned, like a skill, like spelling. (p. 50) The psychiatric information she offers about herself in Prozac Diary is consistent with what we see in Welcome to My Country. She cites a detailed psychiatric evaluation she had received in 1988, when she was 26. According to the evaluation, the patient has a “long history of psychopathology” that includes a suicide attempt, self-mutilation, and anorexia. The evaluation includes the dates of her hospitalizations: 1977, 1979, 1983, 1984, and 1985. In addition to the primary diagnosis of borderline personality disorder, which she was given when she was nineteen, as well as severe and recurrent major depression, she has developed a secondary diagnosis of obsessive-compulsive disorder, including compulsions to “count, check, and wash” (pp. 15–16).

A TRAUMATIZING MOTHER As in Welcome to My Country, Prozac Diary implies that Slater’s psychiatric difficulties are a product of dysfunctional family dynamics. Nearly everything we learn about the unnamed mother suggests her traumatic impact on her daughter. “I couldn’t reach her,” Slater confesses near the beginning of the memoir. I was never able to reach her. Maybe she moved at a pace too fast. Maybe she was too sad. She held herself stiff, a lacquered lady. I think because I couldn’t feel her, I couldn’t feel myself. (p. 16) The mother irons her daughter’s clothes with “fast, angry strokes,” and, in an ambiguous sexual image, Slater recalls feeling “not only how intensely but how erotically she wanted to erase me. I shivered. The iron was on my thighs, moving up the silver zipper of my crotch” (p. 18). Slater identifies

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her mother with psychotic energy, a woman “whose scalp prickled with manic intensity” (p. 82). The manic intensity becomes murderous at times, directed toward her. Taking her future husband, “Bennett,” in the memoir, to her old home, which is now vacant, Slater uncharacteristically begins to praise her mother, describing her as “talented,” “an artist, really,” but Bennett reminds her of a story she had told him about the time when her mother “forced you to swallow ….” Slater then recalls the event, using the third person, which gives her greater narrative distance. “Yes,” she says, and then she can feel, again, the detergent’s stinging in her throat, and she is surprised by how well he has heard her, how he can recall the precise geography of her family’s rage. (p. 142) Prozac represents to Slater a “plug to stopper some hole in my soul,” a hole that might have come from a “neuronal glitch” or perhaps from the hole that “was between my mother and me.” There’s no indication that the mother took an antidepressant, but Slater suggests sardonically that the drug would have been ineffective. “Nothing was ever enough, for there was no plug to stopper the hole in her soul, no pill” (Prozac Diary, p. 9). Slater associates her mother literally and metaphorically with panic. Indeed, the mother orders an expensive alarm system installed in her home, with panic buttons spaced 13 feet apart on every wall, drilled into the house’s supporting studs. “From then on, in my mind, it was not the studs but our alarm that held up the house” (p. 72). Once the mother activated the system in the evening, when the children went to bed, they were not allowed to leave their beds without first calling her – maternal control that transformed the home into a veritable prison. According to one of Slater’s later psychiatric evaluations, her mother’s behavior “points to possible Axis II diagnosis, with secondary diagnosis of agitated …” (p. 71). Axis II diagnoses are generally life-long personality disorders that arise in childhood, unlike Axis I disorders, which may develop later in life, such as depression. Sometimes the mother slapped her daughter, “hard, across the cheek”; other times, “she came up to me and rubbed her hand across my burgeoning breasts, a look of tightness – disapproval and desire – on her face” (p. 83). Once again there is a hint of the mother’s sexual violation of her daughter – and once again Slater refuses to provide additional information. During moments of tenderness, the mother would say that of her four children, Lauren was most like her. “You have a great drive. That is why we clash” (p. 83).

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Slater does not talk much about her older or younger sisters, but she acknowledges in “A Conversation with Lauren Slater” at the end of Prozac Diary that although her mother “adored my younger sister and treated my older sister with respect,” the two sisters “did not escape the trauma that comes from witnessing the cruelty she inflicted on myself and others. Their scars are different, but, I’m sure, deep.” Slater seldom refers to her brother in Prozac Diary, who, we learn in a later book, became a physician. She characterizes her father as passive, ineffectual, and absent, similar to the way she describes him in Welcome to My Country. One of Slater’s psychiatrists in Prozac Diary refers to her father as “dysthymic” (p. 71) – mildly, chronically depressed. While hospitalized, Slater received from a social worker a geneagram that revealed significant mental illness in her extended family. She doesn’t elaborate on this pictorial display of her family’s psychiatric history except to say that the geneagram tree contained “every family member’s name and diagnosis boxed in its branches.” Seeing the branches extending out and out in “flaring illness,” the social worker laughs and says, “The simplest cure might be to just cut it down” (p. 141). Slater cannot alter her family’s geneagram, but she can write about it. She remarks in “A Conversation” that her desire to be an autobiographical writer predated the “memoir craze” that occurred near the end of the twentieth century. Because she grew up in a “home of lies and denial,” she craved art that is “balder and somehow more stripped.” Yet she acknowledges that her memoir writing has been influenced by the new popularity of the genre. “There is, perhaps, an ever-increasing sense that our world is warped, a place of funhouse mirrors and ever-shifting ground.” But she was not ready to expose her readers to this place of funhouse mirrors and competing truths in her first or second memoir. Slater never aspires to write about mental illness without using metaphor, as Susan Sontag attempted to do in her 1978 manifesto Illness as Metaphor. Sontag, known as the “Dark Lady of American Letters,” urged authors to avoid figurative language when writing about cancer and AIDS, believing that illness is not a metaphor and that the “most truthful way of regarding illness – and the healthiest way of being ill – is one most purified of, most resistant to, metaphorical thinking” (Illness as Metaphor, p. 3). Surely Sontag must have known, however, that we cannot avoid metaphors in our writing and thinking; the best we can do is to choose our metaphors wisely so that patients will not be blamed for their illnesses. Sontag indeed

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blamed herself for developing breast cancer, as I suggest in Dying in Character. Sontag modified her radical position to demetaphorize the nature of illness; she admits in the first paragraph of AIDS and Its Metaphors (1989) that “one cannot think without metaphors” (p. 93), an admission that she never makes in Illness as Metaphor. Slater, by contrast, revels in metaphorical writing in Prozac Diary, particularly when she describes depression, an illness that conjures up her most powerful figures of speech. “Is it the air inside a bubble, the darkness in a pocket, snow?” (p. 16). She never misses the madness of obsessions, but she sometimes laments Prozac’s ability to make her depressions disappear, for they were “as familiar to me as dense fog and drizzle, which has its own sort of lonely beauty, as does a desert or the most mournful music” (p. 44). She likens the prolonged impact of an antidepressant to the feeling of being left empty and drained. In the long run, the cure called Prozac doesn’t fill your mind so much as empty it of its contents and then leave you, like a pitcher, waiting to be filled. (p. 81) How does one describe the sexual dysfunction produced by Prozac, a side effect of 40–50% of those who take the drug, including Slater? To answer the question, she offers a contrast between past and present. She recalls all those jubilant juiced-up raunchy times when I had made such good use of my skin – fifteen, sixteen, eighteen, twelve, lying on my bed, a Sidney Sheldon book propped up on my prepubescent belly, wetness puddling at the base of my vagina, drawing the slickness out until I became a singular sensation, a crest. Through her sexuality, she always felt in contact with an “essential self, something unalterably true and female.” Now, however, thanks to Prozac, she has lost that essential self. She feels bereft, in a foreign territory that is psychologically ambiguous, where she must exchange one self for another. As she notes in “A Conversation,” Slater wanted Prozac Diary to be a memoir about cure, not illness. The hardest part of writing the book was the fear that she had lost “some of the honesty and intensity” of her illness. None of the reviewers of Prozac Diary voiced this criticism, but she invokes one of Freud’s most prescient statements in “Mourning and

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Melancholia”: those who suffer from depression have a “keener eye for the truth than other people who are not melancholic”; “we only wonder,” Freud adds, “why a man has to be ill before he can be accessible to a truth of this kind” (SE, vol. 14, p. 246). Slater mourns the loss of her sexuality, but she never suggests that choosing to remain on Prozac is a devil’s pact. Using richly evocative metaphorical language, she likens the pill to “pearl and nipple, which makes me so many many metaphors.” She is, finally, grateful for the antidepressant, which has given her more than she has lost. Prozac Diary implies Slater’s belief in a non-postmodern “essential self.” She explicitly rejects the belief voiced by an MIT friend that authentic identities are “illusory remnants of the romantic age and that the truth is no truth at all” (p. 195). Such extreme relativism, Slater insists, has no appeal to her. She concedes, though, that subjective self-reports of illness, “especially when they draw on memories of things far past, and when they are colored by a person’s present pain, are unreliable, to say the least” (p. 190). There are moments in Prozac Diary when she doubts the accuracy of her own memory. She refers once to a psychological disorder she misspells, “Munchhaussen’s” syndrome (p. 50), a word she spells correctly in her next memoir, where she raises the possibility that she has been deliberately and repeatedly lying about being mentally or physically ill. Even before she began taking Prozac, however, Slater questioned her identity. Noting that she had tried to activate her parents’ alarm system one night, when everyone was sleeping, she did a jumping jack – and the alarm failed to go off. Did that mean she lacked an identity, a self? “I started to narrate myself as she – she – the most distant and impenetrable of the persons,” one who is “slippery” (p. 131) – the same word she uses to describe the kind of illness narrative she wanted to write in her next account of her life. Despite these hints of the untrustworthiness of memory and identity, Prozac Diary is artful without resorting to artifice, a statement that cannot be said about her most (in)famous memoir. LYING Lying (titled Spasm: A Memoir with Lies in the edition published in the United Kingdom) opens with an introduction, followed by four parts, and closes with an afterward. The structure of the memoir parallels the development of Slater’s illness, moving from “Onset” (Part One), to “The Rigid Stance” (Part Two), to “The Convulsive Stage” (Part Three), and finally to

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“The Stage of Recovery” (Part Four). Each part contains from one to three chapters, all of which are titled. Lying tells two intertwined stories, the history of Slater’s illness, and the writing of the memoir. Lying begins with an introduction by Hayward Krieger, a philosophy professor at the University of Southern California, who points out that Slater’s refusal to reveal which aspects of her disease, in this case, epilepsy, are factual, symbolic, or fantastic requires us to confront a “new kind of Heideggerian truth, the truth of the liminal, the not-knowing, the truth of confusion” (p. x). Krieger’s academic prose, including his use of obscure words such as “liminal,” an adjective that means borderline or transitional, will impress some readers and confuse or annoy other readers. Does his sentence about a new kind of Heideggerian truth represent philosophical wisdom or academic gobbledygook? Krieger’s reference to Slater’s first book, Welcome to My Country, establishes his familiarity with her work, though we may wonder why he fails to mention Prozac Diary. Krieger acknowledges that what makes Slater’s memoir so “entertaining and disturbing” is its “refusal to state the facts of the illness about which she writes.” Few will dispute Krieger’s statement that Lying is a “daring meditation on creative nonfiction.” He correctly points out that we do not know at the end of the story whether Slater suffered from epilepsy or used it as a “meaningful metaphor” to convey otherwise ineffable experiences. He also recognizes that whereas the use of metaphor as a literary technique is not new in fiction, it is original and unsettling in a work that purports to be autobiographically true, as Lying paradoxically claims to be. Krieger ends the introduction by describing the memoir’s impact on himself – and others, too, including myself: “I have been disturbed, widened and exhilarated by my reading of it.”

A PHILOSOPHY PROFESSOR WITHOUT ONTOLOGICAL EXISTENCE Krieger’s introduction to Lying is realistic and convincing – until one discovers that the philosophy professor is fictional, a figment of Slater’s imagination. There’s no way we can be certain that Krieger is fake unless we contact the University of Southern California philosophy department to authenticate his existence, which is what a skeptical staff writer at The New Yorker did. Rebecca Mead was not amused when she found out that

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no one by that name was on the faculty. “‘Lying’ reeks of fat from the very first page,” Mead asserted indignantly in a scathing review published in the New York Times on July 16, 2000. I was on the telephone to U.S.C. to confirm my suspicion that there is no such person as Hayward Krieger before I’d even begun the first chapter. This is the kind of thing that might appeal to a dedicated deconstructionist; others, though, will find it unrewardingly wearing. “Lying: A Metaphorical Memoir” wants to be as charismatic and infuriating as an epileptic, which is a risky strategy, because when it does this most successfully, it is also at its most alienating. It’s a tricky book – a sick book, even, metaphorically speaking. Apart from the curious reference to “charismatic” and “infuriating” epileptics, Mead conceded that Slater is a “gorgeous writer,” one who describes with “beguiling beauty” and “seductive grace” the dissolving hallucinations of epilepsy. The other New York Times reviewer, Janet Maslin, was not impressed even by Slater’s lyrical prose in Lying. Maslin condemned the memoir for being self-absorbed and unrealistic. It is not likely that the reader’s interest in Ms. Slater’s medical and philosophical condition will rival her own. And this book winds up working best as an imaginative coming-of-age memoir, one that exerts considerable narrative pull even if it should turn out to be science fiction. Maslin’s attack provoked Slater’s witty, self-parodying counterattack. In “One Nation Under the Weather,” she writes about her efforts to telephone Maslin, conceding that the reviewer “has it right. I am a part of, alas, the once-fashionable, now-fading brat pack of illness memoirists, and we can be a tiring bunch to read.” Slater makes other confessions, including being an inveterate writer of illness memoirs. I now have three, count them, three, books on the market in which psychiatric illness figures prominently. To make matters worse, I have a fourth on the way. This is an embarrassment. As it turns out, Slater never reached Maslin – assuming that she actually attempted to contact the reviewer – and one can only imagine how the

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telephone conversation would have played out. Slater’s article, however, is insightful, particularly her observation that the best illness memoirs “are tussling with the great human themes in an utterly contemporary context.” She also remarks that “We do not fall into illness. We fall from illness into temporary states of health.” Slater did not help her cause either with Mead or Maslin by insisting, shortly after the publication of Lying, on the reality of Krieger’s existence, as she unrepentantly recounts in her interview with Alys Culhane. Slater offers new details that only embellish the lie, and then claims that she never believed anyone would take the deception seriously. But they did, and the story grew more bizarre. The question of Krieger’s ontological existence did not end there. The New York Times hired an investigator who contacted first the publisher and then Slater herself, who finally admitted that she had invented Krieger. The newspaper published a follow-up article in 2000, written by David D. Kirkpatrick, characterizing Slater as a “self-professed liar” who made up Hayward Krieger. Despite the negative publicity, Slater did not regret perpetrating the hoax. “It was a lot of fun” (p. 168). In her desire to be a sleuth, Mead never points out the clues in Lying that call into question the philosophy professor’s existence. In a medical case study that discusses the consequences of psychosurgery performed on an epileptic patient named “LJS,” the coauthors speak about their patient’s purported correspondence with the professor. “However, we have been unable to locate or confirm the existence of any Hayward Krieger.” Nor does this surprise the coauthors, given the fact that 60% of patients with temporal lobe epilepsy (TLE), display psychological profiles that include “emotional lability; mythomania, with all its attendant exaggerations and untruths; tendency toward melodrama, hypergraphia and hyper­ religiosity” (p. 98). Ironically, there is nothing in Krieger’s three-paragraph introduction that is untrue except his identity. One can imagine many academics, deconstructionists and non-deconstructionists alike, who would be eager to make similar observations in an introduction to the memoir. Who can object to Krieger’s insistence that the book “requires courage, along with an open and flexible mind?” As Slater points out in her interview with Culhane, there’s a long tradition of unreliable narrators that goes back to the early twentieth-century British novelist Ford Madox Ford in The Good Soldier. Joseph Conrad also experimented with unreliable narrators in Lord Jim, as did Philip Roth in Portnoy’s Complaint. There’s also a tradition of

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beginning a novel with a mock introduction by a speaker who pretends to make expert professional judgments that may or may not be true. Perhaps the most notorious example is Nabokov’s “John Ray, Jr., Ph.D.,” the fictional clinical psychologist who introduces the case study of Humbert – the story of Lolita. Unlike Nabokov’s obtuse psychologist, who fails to cast a ray of light on the story he introduces, Slater’s Krieger respects her interdisciplinary efforts to craft a new kind of mental illness memoir, one that makes new demands on readers. Reviewers of Lying have failed to comment on Slater’s transfer of a relatively common frame narrative device from fiction into memoir. We cannot read Lying in an ordinary way. One must look below the surface of Lying to unlock its truths.

THE ETHICS OF LYING Lying has been criticized for other reasons. G. Thomas Couser argues that although Slater has the right to create a metaphorical and even deceitful memoir about mental illness, she “commits herself to an essentializing and mystifying characterization of a still stigmatic disability” (p. 132). Couser criticizes Slater for ignoring the rights and interests of people with epilepsy, who suffer from the remystification of a condition still in the process of being demystified. Her disregard for the larger community of people with such conditions is all the more remarkable, and culpable, in someone who is a professional therapist. (p. 142) Couser’s criticisms are true if one reads Lying as a literal representation of Slater’s struggle with epilepsy, a disease that affects millions of people. But if one sees Slater as suffering from other illnesses that are at times impossible to diagnose precisely, such as clinical depression, obsessivecompulsive disorder, and borderline personality disorder, and if one understands her ambivalence over self-disclosure, particularly when the people she writes about are still alive, then Couser’s criticisms become less troubling. The challenge, then, in reading Lying, which might be called a trickster memoir, is to see what it has in common with Slater’s earlier and later books, and to speculate on why, in this story alone, she chose a

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postmodern framework. Can we find the facts and experiences that involve both narrative truth and historical truth? Can we conjecture why, as Slater admits in the opening sentence of the afterword, she has written a book “in which in some cases I cannot and in other cases I will not say the facts” (p. 219)? The story of Slater’s illness involves, to a great extent, the story of her problematic relationship with her mother, the most maddening figure in the writer’s life. Slater’s mother remains a spectral figure, as elusive in her own way as Anne Sexton was to her daughter Linda, or as Aurelia Schober Plath was to her daughter, Sylvia. Slater returns in nearly all of her writings to her mother, but it is a return that precipitates flight – and fright.

“I EXAGGERATE” Chapter One consists of two words: “I exaggerate.” To exaggerate is not necessarily to lie, and the reader’s task is to determine where the truth about Slater’s mental illness ends and exaggeration begins. The reader must also locate the distance between the two Lauren Slaters, the young girl who narrates the story and the adult memoirist. Sidonie Smith and Julia Watson propose even more “I”s in autobiographical writing: “the ‘real’ or historical ‘I,’” “the narrating ‘I,’” “the narrated ‘I,’” and “the ideological ‘I’” (p. 22). Regardless of the number of “I”s, many people do not realize when they exaggerate; few writers, even when they know they exaggerate, acknowledge this in their writings. Slater thus puts us on notice. Scrutinize her truth claims. Read between the lines. Discover the core truth of an exaggeration.

“THREE BLIND MICE” Chapter Two, “Three Blind Mice,” introduces us to details about Slater’s parents that harmonize with those we obtain from Welcome to My Country and Prozac Diary. Her father is a Hebrew school teacher who also has a bakery business. Loving and supportive, he is nevertheless absent from her life. Her mother, for the first time named – Anita – is a woman of “grand gestures and high standards” who “rarely spoke the truth” (p. 5). Is Slater’s tendency toward exaggeration, we wonder, part of her maternal identification? Everything we learn in Lying suggests that Slater had a contentious

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relationship with her mother. If epilepsy represents a “clenched metaphor” (p. 6), the origins of Slater’s illness leads back to her mother, who, metaphorically, exerts a chokehold on her daughter’s life. Slater tries her best to avoid demonizing her mother or sanctifying herself. Both mother and daughter are involved in an unspoken, undeclared war in which each betrays and wounds the other. At the time, neither can reflect on the bitter implications of this strife. Slater, who was in her late thirties when she wrote Lying, has the added perspective of a patient who has now become a therapist. It’s unlikely, we suspect, that Slater would have chosen the postmodern structure of Lying had she not written Welcome to My Country and Prozac Diary. Inventing a new form of an illness narrative enabled her to elaborate on her earlier memoirs while at the same time calling attention to the overdetermined nature of mental illness, the continuing stigma of mood disorders, the ambiguity of psychiatric diagnosis, and the uncertainty over treatment. Anita Slater’s desperate unhappiness with her husband and with her own life is evident in Chapter Two. While vacationing in Barbados, the family attends a New Year’s Eve party at their hotel at which a pianist is performing. To the family’s acute embarrassment, Anita Slater loudly insults the pianist, declaring, while she scowls at her husband, that “a man should have thunder.” Lauren’s father remains silent, but the pianist, stung by the criticism, glares back at Anita and then dares her to show off her own pianistic virtuosity. She warily accepts his challenge, but, “stuck in a lie,” she performs the only song she knows, “Three Blind Mice.” Her mortified 10-year-old daughter has her first epileptic seizure that night. We recall Slater’s description in Welcome to My Country of being 10 years old, sitting under the family piano, while her mother, “her face a mask of pain, pummels the keys.” Unlike depression, which often begins so imperceptibly that one cannot tell its unwelcome arrival, an epileptic seizure is palpable. By implying that her first seizure occurs immediately following her mother’s humiliation of the family, Slater causally links the two events. Equally significant, Slater’s father, not mother, comforts her in the Barbados hotel. Sometime during the night my father must have told her; he must have woken her and said, “She’s had a seizure,” and so I waited, but she never appeared to nurse me that night, and this is a grudge I still hold. (Lying, p. 20)

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While flying home with her family the next day, Slater experienced a throbbing in her head. “Someone was playing the piano in my head, and the wooden notes kept bonging my brain” (p. 20). The piano incident remains a central incident in Slater’s life. How did she feel about the event? “Shrinks have been asking me that question for decades now, as though the origin of whatever mental miseries I might have are linked to that first fall down” (p. 20). She tells us a few pages later that “depression and epilepsy often go together” (p. 33), which is the reason she takes Prozac as an adult. Epilepsy is also an “existential illness” (p. 34), widening the significance of the “clenched metaphor.” As in Welcome to My Country and Prozac Diary, Slater hints in Lying that her mother may have sexually violated her. The night the family returned home from Barbados, her mother stood over me in my bed for a while, and she seemed entranced. Or maybe it was I who was entranced. No, I think it was her, actually. She stood over me, her eyes roving me from head to foot – this daughter of hers, this grand mal, this big badness – and then, finally, she touched my head like it was hot. (p. 21) We cannot be sure whether this description conveys narrative truth or historical truth, but the erotic implications of entranced and roving and the feeling of grand mal and big badness evoke the guilt arising from forbidden sexual acts or thoughts. Childhood sexual abuse awakens intense guilt and shame: children believe they are complicit in the act. Childhood sexual abuse also awakens confusion, particularly if the child is young and doesn’t understand what is happening. Children often deny that they have been sexually abused, particularly when the abuser is a family member. Incest, researchers agree, reflects a dysfunctional family; abused children find themselves under intense pressure not to disclose the crime for fear of breaking up the family and losing the abuser’s love. It took years before Linda Sexton was ready to acknowledge in her own voice – as opposed to the voices of her fictional characters – that she was the victim of child sexual abuse by her mother. Complicating the self-disclosure is that the child may experience guilty pleasure from the incestuous act. Why should we expect that a similar self-disclosure is easier for Lauren Slater? If anything, the self-disclosure is more problematic for Slater because her mother is still alive.

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We don’t know whether Lauren Slater worried that her mother would attempt to block the publication of her daughter’s books or threaten her with a lawsuit for defamation of character, but we can imagine how a memoirist might fret over these possibilities. Another unspoken fear is that exposing dark secrets precludes the possibility that mother and daughter might attempt to repair their fractured relationship in the future, which, as we shall see, was the case with Slater. She never asserts unambiguously that she was the victim of her mother’s sexual abuse, but we recall the passage in Welcome to My Country in which she “wept for the things inserted into me.” There are no other hints in Lying that the mother may have inappropriately touched or gazed at her daughter’s body, but there is a curious passage that implies Anita Slater had a sexual relationship with her female editor. With her 10-year-old daughter waiting impatiently alone in the car, the mother drops off some work and disappears into her editor’s massive home. What felt like a long time later she emerged, smoothing her skirt, her hair slightly mussed – or did I just imagine that? – smiling now as she stepped down the path, and when I said, “It’s been hours, Mom,” she said, “It’s been minutes, Lauren.” (p. 68) Slater finds the incident confounding, as does the reader. Some of Slater’s other statements in “Three Blind Mice” are perplexing. What does she mean when she says, after being taken to Beth Israel for examination, that “through illness” she realized she could give her mother “good food” (Lying, p. 22)? On a surface level, the comment refers to a lobster dinner that her kosher father refused to allow the family to eat in Barbados, but on a deeper level, is she giving her mother a gift by falling ill? This possibility is strengthened on the next page when Anita, whispering on the telephone that Lauren has epilepsy, proudly associates the disease with van Gogh. Looking at the results of her daughter’s electroencephalogram, the mother “seemed to almost like the illness” (p. 23). Does Slater’s illness make her “special” to her mother – and, if so, is that good or bad? Is Slater referring to what Freud calls the “secondary gain from illness,” the hidden advantages gained from illness that may prevent a person from seeking cure? The mother’s love for her daughter does not increase after the diagnosis, nor does her treatment of her

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daughter improve. If Slater’s greatest desire in life as a child is to please her mother, as is suggested by the unpunctuated refrain, “My mother my mother please let her be pleased my mother” (p. 12), then the gift of illness remains unappreciated.

“LEARNING TO FALL” “I was my mother’s girl” (Lying, p. 28), Slater recalls at the beginning of Chapter Three, “Learning to Fall.” Their relationship appears so close that she felt like a marionette, and some huge hand had – my mother’s hand? – held me up, and for a reason I absolutely could not predict, that hand might let the strings go slack, oh, God. (p. 31) Slater intimates that her mother was both overprotective and underprotective. Slater’s anxiety that her mother will let the strings go slack, causing the marionette to fall, foreshadows her literal falls in the memoir, when she develops epilepsy, known as the “falling illness.” Thoughts of her mother inevitably produce anxiety in Slater, reminding us of the ubiquitous panic buttons in Prozac Diary. One could imagine Slater titling her illness memoir “Marionette”, though that might imply she was a victim, something she doesn’t want to suggest. Slater characterizes her mother as a woman who had fought her entire life to “stay on the surface of things – to not argue with my father in public, to cover her emotions with a flashy smile” (Lying, p. 56). Slater implies that her mother sought to live vicariously through her, demanding that her child excel in academics or athletics; when that failed to happen, both mother and daughter were crushed, each suffering from a narcissistic injury. “For me,” Slater confesses, “the adolescent years were not about ripenings. Instead, I felt used up and dependent. If others did not admire me, I thought I would disappear.” The mother has similar “popularity” – self-esteem – issues. “Once, she had thought I might do it for her, be a skating star or a genius. Now, however, I was just a person with a disease” (p. 62). When her daughter’s seizures worsen, Anita Slater takes her to a psychologist who works at an epilepsy clinic an hour’s drive from home. Dr Swan asks Anita about the stressors that produce her daughter’s seizures.

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“My daughter has no stressors,” Mrs Slater claims, to which the therapist responds firmly: This is not psychotherapy. I am a behaviorist. I have neither the time, nor you, I’m sure, given the cost of this treatment, the money, to dismantle your denial. Every child has stressors. (Lying, p. 35) According to her mother, Lauren had a “bad fall” when she was three that was caused by her father’s “rage,” an accusation that Lauren cannot recall and that her divorced father, now living in a Florida retirement community, says is “simply untrue.” Lauren sees Dr Swan three times a week but cannot disclose her feelings to the therapist. “I felt to speak would be to betray my mother, especially because, at the end of every session, she grilled me about what had happened in the office” (p. 37) – a grilling that recalls Anne Sexton’s efforts to force her daughter Linda to admit what she spoke about in psychotherapy. The embattled mother–daughter relationship in Lying evokes Nancy Friday’s 1977 book My Mother/My Self, a study of how daughters simultaneously love and hate their mothers while having difficulty separating from them. Lauren wants to reveal the truth about her mother – “Oh, I hate her! Oh, I love her!” (Lying, p. 37) – but these words are too dangerous and confusing to express. The boundaries between the mother and daughter are blurred, and Lauren’s separation from her mother is fraught with dark emotions, including betrayal and rejection. Anita Slater’s unhappiness with her own life may explain her overinvestment with her daughter’s life. “The reason so many women do not let go of their daughters,” Friday explains, “is that they have little else in their lives, nothing of their own” (p. 164). Slater’s portrait of her mother recalls many of Otto Kernberg’s observations in Borderline Conditions and Pathological Narcissism (1975). The mother of a child suffering from narcissistic injuries functions well on the surface but remains cold and spiteful, indifferent to the child’s welfare. The mother overinvests herself in her child’s life, regarding the child mainly as an extension of herself, a way to fulfill her own needs. Children of such mothers grow up believing they were not loved for their own sake but for the ways they could please their mothers. Love, when received, is conditional on fulfilling the parent’s expectations. All of these observations characterize Slater’s perception of her own mother in this and her other illness memoirs.

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The wounding mother–daughter relationship in Lying anticipates the central conflict in Daphne Merkin’s 2017 memoir This Close to Happy: A Reckoning with Depression. Both memoirs identify the mother as the major source of the daughter’s unhappiness. Merkin’s mother was not “overtly negligent or crazy,” but everything she conveyed to her daughter was “poisoned with envy and disparagement” (p. 21). Merkin struggles to explain her mother’s insidious cruelty: […] her wish to “eat her own,” as one sibling’s psychiatrist once dramatically put it, a kind of pathology undetectable by others because she seemed to be so different on the surface. (p. 20) Both Slater and Merkin suggest, in the latter’s words, that their mothers were a “monster-in-hiding” (p. 20). Slater could have written the following sentence that describes Merkin’s feelings about her mother in This Close to Happiness: “She has imbued me with a savagery toward myself that no external source can match” (p. 252). There are other similarities between the two writers. The fourth of six children, Merkin implies, as does Slater, that she has been the most wounded of her siblings. Both express anger toward fathers who failed to protect them from their mothers. Slater has transformed the murky boundaries often symptomatic of borderline personality disorder and pathological narcissism into the structure of Lying, where there is no clear distinction between fact and fiction. With a mother in denial and an absent father, the daughter cannot know where the truth lies. Truth telling is especially challenging for the female confessant, as Kate Cantrell and Elizabeth J. Donaldson have pointed out in their articles on Lying, because confession leads to the further erosion of boundaries in the enmeshed mother–daughter relationship. “I wanted to make my mother happy,” Slater tells us, “that should come as no surprise” (Lying, p. 5). It doesn’t. Nor is it a surprise later when she longed for her mother’s love after Anita Slater had given permission to a surgeon to perform psychosurgery on her daughter. Looking out a hospital window the morning of surgery, Slater can’t help musing over where her younger self has gone. She then wonders where her mother has gone. And then I felt what I had not allowed myself to feel, the longing for her love, and the longing for a younger, braver self, a self who had once said a definite yes to living in the world. (pp. 95–96)

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Slater knows that she cannot blame her illness on a mother who “didn’t love me well enough” (p. 147), but she cannot help feeling that much of the emptiness of her life arises from the loss of maternal love.

THE SUPERMARKET INCIDENT The most traumatic mother–daughter confrontation in Lying occurs in a scene enveloped in ambiguity. Dr Swan has recently informed Anita and her 10-year-old daughter of a new technique to prevent epileptic seizures. If you recognized a seizure coming on, you were to grab the person, shake her hard by the shoulders, and scream “No!” It was called the Startle and Shake Response, and it had, supposedly, gotten some good results across the country. (Lying, p. 41) Not long afterwards, mother and daughter are in a supermarket. Anita is “disgusted” by her daughter’s appearance: she has bruises on both sides of her face from falling, and her lips are crusty from biting them during seizures. Suddenly feeling sick, Lauren reaches for a grapefruit and begins to peel it. Disregarding her mother’s stern reprimand to stop what she is doing, Lauren becomes fixated on the grapefruit: “‘fruit fruit fruit,’ I was saying to myself, and I wanted to wreck every piece of that stinging citrus stuff.” As Lauren raises both hands, her mother shakes her, yelling, “No! No! No!” Is Anita using the new psychiatric technique to avert a seizure, as she has been instructed to do, or is she violently overreacting to her daughter’s temper tantrum? The onlookers in the supermarket are appalled, particularly since Lauren’s body bears the bruises suggestive of domestic violence. A woman with a baby in her stroller glared at us, and then walked away. I saw the butcher holding his knife. “Someone help that child,” he bellowed. But no one moved. (Lying, p. 42) Horrified by the appearance of physical maltreatment, Anita helplessly utters, “it’s, people, it’s not what – and begins to cry.” Two policemen approach, stating that they must arrest her for child abuse, and when Anita asks her daughter to confirm that she was having an epileptic seizure, the child defiantly refuses to answer, aware that her silence is a betrayal. “I’m sorry, Mom, I kept saying inside my head, but then I also had this little odd feeling of excitement, like there was mourning and happiness both” (p. 44).

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Later, social services officials conclude, after a home visit, that the child does have epilepsy, but the mother–daughter relationship is irrevocably changed. There is no Startle and Shake Response to prevent an epileptic seizure, but Slater’s invented detail dramatizes the lurking violence in the ­mother– daughter relationship. Slater shows in this scene how the mother was simultaneously guilty and not guilty of physical abuse. The metaphor of epilepsy allows Slater to express her own violence in the form of involuntary seizures, and the mother’s violence in the form of a Startle and Shake Response. Anita is in a rage for days, and Lauren now realizes that it is possible to rebel against her mother, a discovery she finds both troubling and liberating. The adolescent spends a month at Saint Christopher’s Convent, an epileptic clinic in Topeka, Kansas, where she learns how to be “bendable, not brittle,” a lesson her mother never grasps. Attending Saint Christopher’s teaches Slater to be “muscular in a new way” (p. 47). She refers to Leonard Kriegel’s 1991 volume of essays, Learning to Fall, from which she has “so generously borrowed” in the writing of her memoir. Slater doesn’t explain how Learning to Fall influenced Lying, but she must have been attracted to what Kriegel calls the “unstifled rage” that lies behind each essay in the book, a rage “born of absence and framed by longing” that depicts the “cripple’s condition as a paradigm for the state of modern man” (Learning to Fall, p. xiv). Having lost the use of his legs during the polio epidemic that swept the eastern part of the United States in the summer of 1944, Kriegel, then 11, began a long and strenuous period of rehabilitation in which he learned to fall without incurring serious injury by wearing unwieldy leg braces and using a cane. I am a man who has lived all but eleven of his years here on earth as a cripple, a word I prefer to the euphemistic “handicapped” or “disabled,” each of which does little more than further society’s illusions about illness and accident and the effects of illness and accident. For to be “disabled” or “handicapped” is to deny oneself the rage, anger, and pride of having managed to survive as a cripple in America. (p. 61) “Falling into life” for Kriegel was not a metaphor; “it was real, a process learned only through doing, the way a baby learns to crawl, to stand, and then to walk” (p. 8). Learning to fall allows Kriegel to exorcise the dark emotions associated with his disability and regain control over his life. “In falling, I had given myself a new start, a new life” (p. 13).

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By contrast, learning to fall for Slater is not literally true but metaphorically true, a survival strategy for coping with mental illness. Learning to fall represents a way for her, as a marionette, to cut the strings from the maternal hand that controls her, and to create a new identity based on her own wishes, allowing her to express her own rage, anger, and pride. As the chapter closes, Slater pays her mother a rare compliment, thanking her for the “special kind of grit” the daughter learned from her. Lying appears to have a happy ending and would thus be what Kathlyn Conway calls a “triumph narrative” – but it is too soon to celebrate. “SINCERELY, YOURS” Chapter Four, “Sincerely, Yours,” is written in the form of a letter to the reader. The narrator’s voice and tone do not change, but there is a new self-referentiality and narrativity. Slater urges her readers to rush and buy copies of her first two memoirs to familiarize themselves with the lifelong “mental problems” that have plagued her. We learn additional details about her mother. She has turned into a writer of maxims, but her literary submissions are always rejected by publications like Hallmark and Good Housekeeping. It’s unclear whether “Sincerely, Yours” refers impersonally to the ending of the publishers’ rejection letters or to Slater’s farewell to her own readers, but she implies a connection between the love she failed to receive from her distracted, dejected mother and the beginning of Slater’s career as a thief. The word epilepsy, she reminds us, having done her etymological homework, comes from the Greek word epilepsia, which means “to take, to seize” (Lying, p. 71). Slater begins to steal when she is 13, a symptom of her deepening descent into illness. She stashes the stolen items in the toolshed her father never uses, mainly because, as her mother hisses scornfully, “He can’t even figure out how to use a hammer” (p. 71). Slater never took anything valuable or useful, and her career as a thief did not last long, but she remains troubled by this period in her life. Stealing led to lying and then to Munchausen disorder, the psychiatric condition of faking illness. It is easy to fathom why Slater believed she was suffering from Munchausen disorder. Growing up with a mother who never acknowledges the truth of her ambivalent feelings about her husband and middle daughter, Lauren Slater began to feel that she, too, was dishonest, even to the degree of faking an illness from which she knows she suffers. She feigns having not

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only epilepsy but also cancer, which she tells a bemused friend is caused by epilepsy. When, after brain surgery, Slater tells her mother that she has been seizure-free for eight months, the latter replies, looking irritated, “Well, I’m not surprised. I always knew you didn’t really have epilepsy. I always knew these seizures were just a thing you had to grow out of” (p. 189). How can a daughter not feel that her illness is fake when her mother denies its existence? Slater learns to trigger seizures whenever she experiences rage, as when she fantasizes stealing a baby. “I didn’t want the baby,” she confesses, “but to be the baby.” Seeing the mother swoop up the child, Slater becomes furious, thinking fuck fuck fuck, and brings on a seizure. Slater’s ability to make herself ill heightens her belief that her illness is not real, again leading her to Munchausen disorder. Perhaps I was, and still am, a pretender, a person who creates illnesses because she needs time, attention, touch, because she knows no other way of telling her life’s tale. Munchausen’s is a fascinating psychiatric disorder, its sufferers makers of myths that are still somehow true, the illness a conduit to real pain. (Lying, p. 88) Slater includes in the Chapter Three fictional case studies from authenticsounding psychiatric journals, the last of which describes a patient, Jean Levy, who “had absolutely no physiological evidence of any epileptic activity” yet who “masterfully succeeded in convincing people that she suffered from temporal lobe seizures, to the point where she wrote and published an account of her illness.” The patient, the article concludes, is “well versed in what Adorno so aptly called ‘the jargon of authenticity’” (p. 90). Slater may pretend to suffer from Munchausen syndrome, but she has accurately characterized the essence of feigned illness. Marc D. Feldman’s 2004 book Playing Sick?: Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering & Factitious Disorder describes the underlying motivations for assuming the sick role. The paradox of those who play sick, Feldman suggests, is that in most cases their suffering is indeed genuine, but it is not the physical suffering of cancer or the grief of a lost loved one. It is the emotional suffering that comes from a profound perception of being unloved and unlovable. (p. 2)

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One of the most fascinating elements of Munchausen syndrome is pseudologia fantastica, also known as monomania. Typified by enduring stories that are often built upon some element of truth and that become self-aggrandizing, pseudologia fantastica is seldom used for profit or material gain, but for the kind of intangible benefits that underlie Munchausen disorder. (p. 38) Pseudologia fantastica differs from pathological lying, which is used for material gain. Factitious disorder is “unique among mental disorders in that only by virtue of faking being patients do individuals become patients” (p. 75). Feldman makes one additional observation that is consistent with Slater’s story: the majority of patients who exhibit Munchausen syndrome also suffer from borderline personality disorder.

A CORPUS CALLOSTOMY Chapter Five, the clinical case study titled “The Biopsychosocial Consequences of a Corpus Callostomy in the Pediatric Patient,” summarizes details presented earlier in the memoir. The two coauthors, a neurologist and physical therapist, generally avoid psychobabble and reductiveness in discussing their patient, who has undergone a corpus callostomy, a surgical procedure that involves separation of the right and left hemispheres of the brain. They view temporal lobe epilepsy (TLE) as a complex phenomenon, “as both a seizure and a personality disorder” (Lying, p. 99). Patients with a TLE personality profile “display cortical scarring in the temporal amygdalan areas of the brain” (p. 99). Patient LJS developed “eliopathic epilepsy in her tenth year” (p. 100) and received a corpus callostomy on February 15, 1979, at age 13. The number and severity of her epileptic seizures decreased, we are told, though there was no change in her personality style, which was dysfunctional both before and after surgery. Of special note, the coauthors remark, is that the patient enjoyed little family support. “Her mother appeared to suffer from a narcissistic disorder, while her father, as is typical of this type of family constellation, remained in the largely passive role” (p. 103). Why does Slater include the case study if it adds little new information about her illness or treatment? To demonstrate her penchant for lying. The redundancy of the lead author’s medical degree in his name,

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“Dr. Carlos Neu, M.D.,” alerts us to the fictionality of his existence, but there are other internal clues indicating the paper is not real, as a Brandeis psychologist later tells Slater. “There is no such part of the brain,” he said, “as the temporal amygdalan area.” There is no such thing as, and he pointed to the second page, “eliopathic epilepsy.” The psychologist’s exposure of the fraudulent paper is so upsetting that Slater begins to cry, calls him a “bad man,” and then, when he accepts her bluff to touch the scar on her scalp from the surgery, she vindictively reports him to the clinic for being a “pervert.” The clinical paper enacts the “truth of confusion” of which Hayward Krieger speaks, the impossibility of determining where fact and fiction meet. Slater’s fictional study is largely credible, notwithstanding the medical solecisms, but it lacks the human interest of the stories in Welcome to My Country. The coauthors make no effort to capture their patient’s subjectivity or to bring her to life. Nor does the prose style sparkle. Tellingly, there is no mention in the case study of some of the most striking psychosocial dynamics of the patient’s family life, including the obscure boundaries between mother and daughter, the erotic entanglement of their relationship, the mother’s chronic anger and spitefulness, and the rivalry between them, one an unsuccessful writer of maxims, the other, a future writer of acclaimed memoirs and psychological case studies. The patient displayed during the rehabilitation period “some disturbing depressive tendencies” (Lying, p. 105), for which the coauthors recommend twice-weekly psychotherapy, but Slater glosses over the insights gleaned from talk therapy. The clinical paper refers to the patient’s “intense fixation with writing” but not her ferocious literary ambition. More salutary than the talking cure in LJS’s recovery is the discovery of the writing cure, an activity that gives birth to mythomania and Lying.

“THE CHERRY TREE” Before she writes Lying, however, Slater pens “The Cherry Tree,” the title of both Chapter Six and the nonfiction story that is accepted for publication. The longest chapter in the memoir, 49 pages, “The Cherry Tree” covers the years of Slater’s mid-adolescence, when she “appeared to grow more normal” (Lying, p. 110). Following surgery, she had fewer seizures but

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more auras, which she associates with her awakening creativity. Slater’s attraction to epilepsy as a metaphor of her own illness derived partly from its connection with many artists, a discovery she made later in life. Slater subtly demonstrates the link between auras and literary creativity when, in response to Dr Neu’s statement that he has never heard of auras without a seizure following, she exclaims, “Write me up” (p. 110). Slater writes herself up, first in Welcome to My Country, then in Prozac Diary, and now in Lying. “The Cherry Tree” is devoted to Slater’s birth as a writer and her participation, the summer before her freshman year in college, in a 14-day writers conference at the famed Bread Loaf School of English, sponsored by Middlebury College, in Vermont. Characteristically, her mother is initially opposed to her daughter’s decision. “I have a hard time believing a place which calls itself a loaf of bread has anything worthwhile to offer” (p. 113). Lauren hasn’t helped her cause by disparaging her mother’s failed career as a writer of maxims. “Mom, what happened to you? You used to sizzle?” Despite the barb, the mother, who is now taking an antidepressant, gives her the money to apply to Bread Loaf. Slater submits a short story but receives a rejection letter, inviting to apply at a later date, when she is more “mature.” Undeterred by the rejection, she telephones Bread Loaf and learns that one reader is still reviewing manuscripts. She resubmits the same story, using a fake name, Jean Levy, the same name she used in the fictional case study in Chapter Four. She lies about her age, claiming she is 19, the minimum age of application, not 17. This time she is accepted. The conference initiates Slater into the profession of writing and represents the beginning of her life as a sexually experienced woman. Slater doesn’t tell us the name of the famous writer who seduces her, but she makes no effort to disguise Bread Loaf. The officials associated with the iconic writer’s school could not have been happy when one of Lauren’s fellow students tells her that “a lot of people … come to the conference just to fuck” (Lying, p. 120). This was not true of Slater, but her burning desire for literary recognition created a vulnerability that her writing instructor soon exploited. “Christopher Marin,” a late middle-aged Southern writer who admits he is sexually compulsive, makes one prescient observation about Slater’s writing, remarking that her work “has an effect. It has, sometimes, an unhealthy effect, and I think you should know that” (p. 122). What does an “unhealthy effect” mean? She had talked to her fellow students about her intention someday to write a “whole book about my epilepsy and my

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surgery, a book called Lying” (p. 119), but it’s unlikely that she had imagined the postmodern structure of her third illness memoir when she was in her mid-teens. Did Marin mean that Slater’s stories awaken dark emotions within readers? Did he fear that his sexual exploitation of her would one day find its way into print? He tells her that although she will never be a New Yorker writer, she will “break literary ranks,” a prophecy that comes true. Slater’s erotic relationship with him turns out to be a disaster, as she confesses to us. Nevertheless, her literary career is launched.

“HOW TO MARKET THIS BOOK” Of all the mental illness memoirs in my study, Lying is most committed to narrative truth. Peter Brooks’s observation about the power of narrative truth in the psychoanalytic process applies to Slater’s aim in Lying: narrative truth has the power to create “patterns of connectedness” and to “persuade us that things must have happened this way, since here lies the only explanatory narrative, the only one that will make sense of things” (Brooks, p. 59). In Chapter Seven, “How to Market This Book,” written to her Random House editor, Kate Medina, Slater acknowledges the many troubling questions about whether Lying is memoir or fiction. Slater offers four ways of reading her memoir, the last of which is the most plausible: I have neither Munchausen’s nor epilepsy nor a TLE personality style, but I did grow up with a mother so wedded to denial, so inclined to twist and even outright lie, that I became confused about reality and also fell in love with tall tales. (Lying, p. 161) Did Kate Medina anticipate the critics’ denunciations of the slippery nature of the memoir, their indignation that Slater was toying with them? In three of her books, we should point out, Slater pays tribute to her editor, Kate Medina: Welcome to My Country, Prozac Diary, and Love Works Like This. Lying anticipated by 13 years the publication of BOOM! Manufacturing Memoir for the Popular Market (2013). Julie Rak never mentions Lauren Slater, but she examines in depth Random House, the publisher of two of Slater’s memoirs, Welcome to My Country and Love Works Like This. BOOM! Focuses on the production, marketing, selling, and consumption of memoirs, subjects that Slater raises in “How to Market This Book.”

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One senses that had Rak been aware of Lying, it would have been the perfect text for her to discuss the many troubling ambiguities implicit in memoiristic writing.

BREACH OF NARRATIVE PROMISE? Few authors who intentionally deceive warn their readers in advance about trickery, and from the beginning to the end of Lying Slater places us on notice. It’s impossible to miss her cautionary statements. For this reason, one cannot accuse her of a “breach of narrative promise,” an accusation that the English critic and novelist Julian Barnes made about Joyce Carol Oates’s 2011 memoir A Widow’s Story, perhaps the bleakest spousal memoir. Her account of Raymond Smith’s death in 2008, at the age of 77, with whom she was married for nearly half a century, reads like a horror story. Oates was so distraught over her husband’s sudden and unexpected death that it seems impossible she had the fortitude to write the story of unmitigated woe. She never anticipated the strident criticism that erupted from her failure to disclose her remarriage at the end of the memoir. And yet Oates must have suspected, when referring in A Widow’s Story to living in an “era of full disclosure,” that readers would expect her to acknowledge her remarriage before her memoir was published. Oates defended her decision to exclude this information, arguing that she wrote a memoir, not an autobiography. She conceded, however, that she should have included this information. In retrospect I can see that I should have added something like an appendix, to bring my personal history up to date; yet – (I hope this doesn’t sound disingenuous!) – I would not have thought that my personal history in the aftermath of early widowhood was so very relevant to the subject. The debate over disingenuousness applies to Lying as well as to A Widow’s Story. Slater’s stated purpose in providing multiple views of reality is not to conceal the truth of her illness but to show the various ways its origins, symptomatology, and meaning can be interpreted. An illness narrative, Slater implies, is inherently ambiguous. She quotes Kierkegaard’s paradoxical observation that “The greatest lie of all is the feeling of firmness between our feet. We are at our most honest when we are lost” (p. 163).

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“AMAZING GRACE” The final chapter of Lying, “Amazing Grace,” nearly as long as “The Cherry Tree,” begins the “Stage of Recovery.” Slater’s depression intensifies when she’s in college, partly because she felt lost after the affair with Christopher Marin ended. In a self-interview modeled after The Paris Review Interviews, Slater observes, in an unambiguously true statement, that writing is her way to reach out to others, a connection that is an antidote to the loneliness and isolation of mental illness. She then describes her involvement with an AA support group, benefiting from its community. A member of AA explains to her the idea of acting as if: “Act as if you are feeling good, and productive, and, eventually, it will become that way” (Lying, p. 185). Slater realizes that the metaphor, which resembles in cognitive psychology the use of self-talk, is a way to transform fictions into facts, and thus a postmodern truth. “Amazing Grace” reprises many of the earlier events in the memoir, but it also shows something new in her life, her spiritual growth, which parallels her mother’s growing commitment to Zionism. Slater mentions the theologian Paul Tillich’s belief that our lives are “defenses against emptiness” (Lying, p. 196). She tells us about her leave of absence from Brandeis and then offers us a glimpse into the future. Two years later I would go back, ten years later I would get a graduate degree, fifteen years later I would be a psychologist in my own white office, stuffed animals and puppets sitting on the shelves for children to hold. (p. 198) She also reminds us, not that we have forgotten, of the metaphorical meaning of Lying. “Alcoholism can stand in for epilepsy, the same way epilepsy can stand in for depression, for disintegration, for self-hatred, for the unspeakable dirt between a mother and a daughter” (pp. 203–204). Foreshadowing the critics who disliked Lying, the members of her AA support group fail to appreciate Slater’s use of metaphor, and she is accused of being in denial when she confesses she doesn’t have a drinking problem. But one need not be an alcoholic, she suggests, to experience a hole in the soul. Slater ends the chapter by escaping from the AA meeting, feeling hate as a result of her unwelcome confession, but she doesn’t want to conclude negatively, and so she thanks the people who have helped her, including

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the most haunting figure in her life. “Oh, Mom, I miss you. Give me a kiss good-bye. Cheer for me madly” (p. 216). She refers to her mother again in the three-page afterword, remarking that she has been finally able to tell a tale that has eluded her for years, the story of my past, of my mother and me, the story of the strange and fitful illnesses claiming most of my moments, the humiliating birth of my sexuality, my love of myths and proclivities toward deceit. I have told it all and it is a relief. A relief to put it to rest. (p. 220)

LOVE WORKS LIKE THIS But not quite at rest. Motherhood is the subject of Slater’s next book, Love Works Like This, published in 2002. The biggest shock awaiting her readers is not her decision to stop taking antidepressant medication during the first trimester of her pregnancy but her mother’s reemergence into her life. In her acknowledgments, Slater thanks her mother, who reentered my life after a very long hiatus literally as I labored to bring my own child into the world. Her ability to tolerate my written explorations of our relationship is exemplary. She has modeled for me flexibility and forgiveness; I will try to emulate these qualities as I navigate the motherhood that is now mine. Slater’s mother may have forgiven her, but the daughter’s forgiveness is more problematic, as Love Works Like This demonstrates. It’s true that in a noteworthy conversation with her sister, Slater implies that she no longer believes her mental illness was caused by her mother. Nor, in another passage, does she want to reveal what her mother did in the past. “What I want to hang on to in my mother are the moments when her second self appeared” (Love Works Like This, p. 23). Yet her mother is never far from her mind, even when she refuses to allow herself to speak her mother’s name, as when Slater tells a psychologist about her history of mental illness. “‘I have anxiety and depression,’ I say, ‘or maybe an agitated depression, which seems to be rooted in my ambivalence …’” (p. 26). Unable to complete the sentence, she observes to us, when she telephones her mother during Passover after a long silence, that her mother “has much contempt

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for me; this is nothing new.” Responding to her mother’s accusation that her daughter thinks only of herself, Slater remarks that she hears the familiar sound of rage, the origins of which I have never understood – a biochemical mishap, a hidden trauma, a rape? I often think my mother was raped. What else could account for the hard dots of hatred in her eyes? (p. 79) Slater cannot help being mistrustful of her maternal grandmother, who lives near her and whom she never visits. “‘What did you do to my mother?’ I have often wanted to say but won’t, can’t; quiet, that is who we are” (p. 87). The unanswered question lingers, as does another question about her identity as a young mother: can a mentally ill woman be a good mother? “I still don’t know the answer” (p. 183).

THE $60,000 DOG Published in 2012, when Slater was 49, The $60,000 Dog is mainly about her unconditional love for animals, but it is also about growing up with a severely depressed woman whose fury was directed for unknown reasons toward her middle daughter. After we were all supposed to be asleep my parents argued, and sometimes they said my name – Lauren, Lauren – so I knew I was part of the problem, but which part, and which problem? (p. 8) Slater never answers the two questions, but she describes her terror over being singled out and, perhaps most troubling of all, her fear of inheriting later in life a form of her mother’s illness: She aimed her eye on me much more than on my siblings, who either faded from her view or grew as proportionally precious to her as I was wrong. All wrong. Sometimes she sunk her nails into my skin and I dreamt they went right through me, her hands entering my entrails, pulling them out, string by string. At home, I began to be scared all the time. My older sister whispered to me that my mother was ill and would soon be going to a hospital. What at the age of nine did I know about mental illness and the genetic liability she passed on?

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I believed I’d found an escape. I had no inkling that over time my mother’s grief would become mine, and that eventually, years hence, I’d lose the capacity for comfort only to find it again, when I was a mother myself. (p. 14) Slater tries to enter into her mother’s point of view, to understand her grief and rage, to fathom why her mother, called “Barbara” in the memoir, is so unhappy with her husband. Barbara Slater is physically abusive, striking her daughter so hard on the side of her face for accidentally spilling milk that a bruise formed on her cheekbone. The mother also seems responsible, deliberately or not, for causing the family dog’s death by giving him Nyquil. Hospitalized in the early 1970s for what appears to have been severe depression, Barbara Slater returned home four weeks later feeling improved, but the anxious family could not mention to her the deceased dog, “afraid that a memory might send her down the slide, back to blackness again” (p. 34). There is nothing postmodern about The $60,000 Dog, but there is a passage that is almost as startling in the author’s shift of attitude as the claims of exaggeration in Lying. For a long time, much later on, in my therapy-believing stage, I blamed my mother for all my fears, and then I blamed my brain, and now I don’t have time to blame anyone or anything, because my mandate is just to manage. (p. 78) She implies that she has acquired over time the wisdom and detachment to move beyond blaming anyone or anything for the vicissitudes of life. Slater observes at the end of The $60,000 Dog that she has the “shape and shrewdness” of her mother but that the similarities end there: “I do not have her rage, her huge and negative capacities” (p. 248).

PLAYING HOUSE But Slater has the understandable fear of becoming like her mother, especially when she has her own children. What should she say, she muses in the preface to her 2013 memoir Playing House: Notes of a Reluctant Mother, when her 13-year-old daughter wonders why she has never seen her maternal grandmother? “How do you tell her that, in truth, you did not learn to love as a child, and thus have come to the task of mothering with deep

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deficits?” (p. xi). Playing House focuses on Slater’s life as the mother of a daughter and son. Playing House is not an illness narrative, but with each memoir, Slater offers more information about her stormy relationship with her mother. Slater is not psychoanalytically oriented, but she believes, with Freud, that the past is prologue to the present. To describe her reluctance as a mother, she must first describe her ambivalence as a daughter. Lying reveals the disquieting similarities between Slater and her mother, but Playing House elaborates on this destructive symbiotic relationship, where the sins of the mother continue to shadow the daughter. Motherhood “went against my nature,” Slater confesses, which is “brooding and acerbic and self-consumed” (Playing House, p. 33). Motherhood also went against her mother’s nature. My father had told us that before my mother had children she was “a different woman, really,” but that the pressures and conflicts of motherhood had done her in, changed her irrevocably and for the worse. (p. 66) We never see the mother before she has children, and, therefore, we cannot verify the father’s statement, nor can we verify that Slater has accurately quoted her father. In Prozac Diary, we recall, one of Slater’s psychiatrists believed that her mother’s behavior pointed to a possible Axis II diagnosis, implying a childhood psychological disorder – a problem that long preceded her experience as a mother. Playing House implies, as does Love Works Like This, that Slater’s mother was psychologically damaged by Slater’s maternal grandmother. “My mother, I knew, had been a good girl, exceedingly good, and because of that, she hated my grandmother” (p. 4). The mother appears in Playing House as a fragile and unstable woman suffering from mental illness, the exact nature of which remains unclear. “I never knew exactly why having children caused her undoing, her mad chatter and terrible violence, but not knowing made it all the more potent, more possible” (p. 66). The chatter is “mad” in a double sense, angry and psychotic. A social worker told Slater when she was 14, and temporarily placed in a psychiatric unit, much to her relief, that she would not return home. My mother, who has become psychotically paranoid over the years, says, “You have abused me past what I can imagine,” a classic example of projection. I nod, not knowing what else to do.

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Playing House contains the most damning statement found in any of Slater’s writings. Precipitating my removal from the home was the fact that my mother tried to push me down a gorge in Vermont. I survived, saved by the soft snow. I remember standing where I had slid, hearing the sound of her receding footsteps in the forest, tasting the cold on my tongue. I was fourteen then and had just begun to bleed. The trees were black, scarred. I saw them, and I understood that my mother wanted to kill me, that she always had. What was different, today, now, post-push, was that I wanted to kill her too. This, I saw, was what it meant to be a daughter, a mother. It is about blood and all the steep slopes. (p. 71) Slater’s revelation raises more questions than answers. Why did she wait 17 years, the period of time between her first book, Welcome to My Country, and her eighth book, Playing House, to disclose that she was almost the victim of filicide? Was this the reason Slater was taken out of her home at age 14 and placed into a foster home? How did she break the cycle of intergenerational violence? “Use your will to get out of this,” Slater’s mother exhorts her in Lying (p. 23), suggesting that one can overcome epilepsy – or mental illness – through an act of will. Sheer willpower, however, failed to stop her epileptic seizures in Lying. Slater cites William James’s distinction between two forms of will: will as a form of agency, and will as the ability, in her own words, “to take on life’s terms as opposed to putting up a big fight.” The second form of will, the ability to be “bendable, not brittle” (Lying, p. 53), is something her mother never taught her. Slater suggests in Playing House that she was able to leave the psychiatric hospitals, where she spent much of her adolescence and early adulthood, through an act of will, but success was qualified: one day I swore I’d never go back. And I did not. I have not. I found my place and people. But still, the symptoms come, no matter what my will or situation. (p. 33) Regarding herself as a “woman with a handicap, plain and simple” (Playing House, p. 49), Slater has been able to live with serious mental illness thanks to her steely will and powerful medications, but these drugs

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have forced her to make compromises. “I am, after all, a writer and a depressive, both of which require downtime for their practice” (p. 48). The downtime, she reveals more than 100 pages later, is that, apart from the times her medication unexpectedly stops working, throwing her into a psychiatric crisis and a search for new medication, each day begins with a state of depression that doesn’t abate until the late afternoon, followed by the same depression descending the next morning. The cycle results in a foreshortened day. I’m not complaining, or if I am I don’t mean to be. Thanks to antidepressants, I now have seven hours more or less of good clear time, and I try to use it well, ticking off items on my todo list, trying to tie up my business, so when disability comes at least my things will be in order. Still, seven waking hours is not a lot, a mere fraction of the 15 or so most “normal” people have in a day. (pp. 156–157) Daphne Merkin’s complaint that memoirs like Susanna Kaysen’s Girl, Interrupted and Jamison’s An Unquiet Mind “tend to bracket the episodes of breakdown or incapacitating depression within unimpeachable demonstrations of the writer’s otherwise hyperfunctioning existence” (p. 15) is untrue of Slater. Describing her mental illness as “obsessive-compulsive disorder, with a dash of depression thrown in” (Playing House, p. 32), Slater refers wryly to the miracle of “polypharmacy.” She lists the medications she is presently taking: Effexor, 300 mgs; Wellbutrin, 300 mgs; Vyvanse, 90 mgs; Suboxone, 4 mgs; Klonopin, 1 mg; and, last but not least, the fattening drug called Zyprexa, its zippy little name not to be confused with its stuffy side effects. (p. 97) Effexor and Wellbutrin are both antidepressants; Vyvanse is a stimulant used to treat attention deficit hyperactivity disorder in adults; Suboxone is used to treat narcotic addiction; Klonopin is anti-seizure medication used in the treatment of epilepsy and panic disorder; and Zyprexa is used for the treatment of severe depression (which Slater describes as a “horrific depression” she experienced a year earlier) as well as schizophrenia and bipolar disorder. Earlier in Playing House she describes taking lithium, a mood stabilizer used in the treatment of bipolar disorder. These drugs have saved Slater’s life, but they have also caused her to gain over 50 pounds,

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dangerously raised her triglycerides and cholesterol, and made her a candidate for type 2 diabetes. Yet she is able to write about the situation with mordant humor. I, for one, for now, have chosen my mind over my body, with the result that I often feel as if I live hunched up in my head, which has to drag this offending, unfamiliar carcass all around town, the carcass being, of course, the me I have had to disown. (p. 101)

OPENING SKINNER’S BOX Slater’s interviews of several prominent psychological researchers in her 2004 book Opening Skinner’s Box: Great Psychological Experiments of the Twentieth Century resulted in fierce criticism. In one chapter, “On Being Sane in Insane Places,” the title of a legendary psychological experiment, Slater deliberately used deception to determine whether a pseudopatient could fake psychiatric illness. She knew that given her psychiatric history, it would be a potentially risky experiment – and therein lies the intriguing nature of the challenge. She mentions briefly in Opening Skinner’s Box her psychiatric history for readers unfamiliar with Welcome to My Country, Prozac Diary, or Lying. Using the same expression that appears in the title of Kate Millett’s 1990 memoir, Slater notes that in 1976 she was a patient “in the ‘bin’ – as I came to call the hospital almost affectionately.” Psychiatric illness is painfully real to her. She gives few details about her five separate psychiatric hospitalizations except to say that “I, for one, got sicker in the bin, the same way staph infections spread in a hospital” (Opening Skinner’s Box, p. 75). Slater never discusses in Opening Skinner’s Box her experience as a postmodern trickster in Lying, but she relished the opportunity to create a fake psychiatric history. Slater proves to be a master trickster, and in all nine interviews, at nine different hospitals, she convinced experienced psychiatrists that she is mentally ill. Some opined that she suffered from depression with psychotic features, others, that she suffered from post-traumatic stress disorder. None of the psychiatrists believed she should be hospitalized, partly because she denied being a threat to others or herself, but on the basis of her statement that she heard a voice saying “thud,” they all gave her prescriptions – a total of 25 antipsychotics and 60 antidepressants. In pointing out that

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psychiatric diagnosis is “suffused with subjectivity,” Slater doesn’t indict the entire profession. Rather, she points out that psychiatry is a “fledging science.” Who can disagree? The good news, she is quick to point out in Opening Skinner’s Box, is that she was admitted into none of the nine hospitals. “I was mislabeled but not locked up. Here’s another thing that’s different: every single medical professional was nice to me” (p. 89).

ALL IN THE FAMILY Tracy Slater’s 2015 memoir The Good Shufu offers another perspective on growing up in the Slater family. Most of her descriptions of her sister Lauren are consistent with what we learn from the latter’s books. The one child – my middle sister, Lauren – with whom my mother never seemed to bond and who for years slid into a depression that wouldn’t quit; the other child – me, the baby – crowned my mother’s favorite, the difference so obvious that even my father proclaimed I was her chosen one. (p. 29) Tracy also bears scars, from when she once cut herself as an adolescent, but her psychological problems were never as serious as Lauren’s. Their family had been “wealthy but ‘kind of screwed up’” (p. 29), and their parents’ marriage broke up when Lauren was in the psychiatric ward of Mount Auburn Hospital, called “Mount Vernon” in Welcome to My Country. There’s no indication in Tracy Slater’s memoir that her mother was clinically depressed, suffered from a personality disorder, or was physically or sexually abusive. Nor does she seem fragile or unstable. But she comes across as demanding and opinionated, and there’s something pretentious about the monogrammed stationery bearing her name, “From the Desk of Charlotte Slater,” later changed, after her second marriage to a wealthy banker: “From the Desk of Charlotte Rosen.” Tracy is proud of her sister who survived “crippling depression and the indelible effects of her childhood pain” (The Good Shufu, p. 31), but she does not elaborate on the family history of mental illness, though she refers in passing to how everyone reacted to a psychological crisis. For us, depression was considered less a feeling than a dreaded guest whose very existence caused endless hand-wringing,

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actual arrival brought intense agitation, and occasional loitering spawned an all-out expectation of the end times. (p. 186) She recalls her mother’s voice “taut and severe” while they still lived as a family. Throughout The Good Shufu Tracy Slater is loyal to both her mother and sister, which readers of Lauren Slater’s books will find a near-impossibility.

BLUE DREAMS The book jacket of Blue Dreams describes Slater’s 2018 study as the “explosive story of the discovery and development of licensed narcotics, as well as the science and people behind their invention.” Blue Dreams is not, as the book jacket continues, a “groundbreaking exploration” of psychiatric medication, if only because Slater’s research relies heavily on several earlier groundbreaking investigative and clinical studies: Peter Breggin’s Talking Back to Prozac (1994), Daniel Carlat’s Unhinged (2010), Irving Kirsch’s The Emperor’s New Drugs (2009), Joseph Glenmullen’s Prozac Backlash (2000), Edward Shorter’s A History of Psychiatry (1997), Eliot Valenstein’s Blaming the Brain (1998), and Robert Whitaker’s Anatomy of an Epidemic (2010). Slater’s achievement is that she narrates two interrelated stories: the medical and social history of psychopharmacology and her own personal history of psychiatric medications, about which she remains, as in her earlier writings, profoundly ambivalent. In a book that is exactly 400 pages long, fewer than 60 are devoted to her own psychiatric experiences, but the personal accounts are compelling. Throughout Blue Dreams Slater uses her own experiences with psychiatric medication partly as a narrative device to keep us reading about the history of psychopharmacology, partly to authenticate her first-hand knowledge of the subject, partly to bear witness to the spectacular successes and failures of powerful life-transforming drugs, and partly to establish a connection with her readers, who may be among the one-out-of-five Americans who are currently taking a psychiatric drug. Blue Dreams reveals new information about Slater’s life. She’s 54, she tells us, but feels like an octogenarian as a result of being on 12 different psychiatric drugs over a period of 35 years, resulting in failing kidneys, weight gain, diabetes, and memory loss. No one has conveyed more vividly than Slater the love–hate relationship with psychiatric medication.

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It would not be an overstatement to say that on the one hand, psychiatric drugs have healed me, while on the other, they have taken my life and my health and ruined me, drawing death near. (p. xi) No writer has described better the difficulty of weening oneself from drugs that take a terrible toll on the body. At age 10, Slater began seeing her first psychotherapist, a woman named Dr Sugarman – apparently a pseudonym. But Slater uses the real name of her second therapist, Dr Miriam Mazor, a psychiatrist who lived in the Orthodox Jewish section of Brookline, Massachusetts. Dr Mazor was in her thirties when Slater began seeing her three times a week from the age of 13 to her mid-20s. Slater cannot understand why the psychiatrist kept her on imipramine – although there were no other antidepressants at the time – despite the fact that all it made her do was to weep and sweat. Googling the psychiatrist’s name, I discovered that Dr Miriam Bonita Dushman Mazor (1940–2014) studied at Barnard College and MIT before receiving her medical degree from Harvard. She specialized in child and adolescent psychiatry. According to her obituary, she was an “aspiring writer,” a detail that must have appealed to Slater. Yet insofar as nearly all of Slater’s comments about Dr Mazor are negative, one suspects that the main reason Slater made public her name was to express disapproval of the psychiatrist’s treatment, or mistreatment, of her. By contrast, Slater doesn’t name her McLean psychopharmacologist whom she visits once a month to manage her medications. Slater’s description in Blue Dreams of her depressed, physically abusive mother resembles the portraits appearing in her earlier books. There’s no mention, however, of being diagnosed with borderline personality disorder. Nor does she recall the controversies swirling around Lying. She does point out, though, in the Author’s Note that everything in the book is true, but she adds a significant qualification. I have made every effort to be accurate while also acknowledging that memories are friable, delicate webs held together by neuronal connections and chemicals we do not yet fully understand. Perhaps the biggest surprise in Blue Dreams is Slater’s disclosure that she was diagnosed with manic depression, a diagnosis that doesn’t appear in her earlier writings. Her last breakdown occurred in 2011 when, floridly

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manic, she stopped sleeping and became obsessed with collecting rocks. Her language becomes exuberant as she describes staying up all night polishing her treasures with an electric grinder. The problem with mania, she dutifully notes, is that it inevitably leads to depression. The more manic you are, the more depressed you will get, as if there is some law, or even some kind of divine punishment, for going up so high, because you will then go down proportionally so low and for the same period of time. (Blue Dreams, p. 75) Slater doesn’t cite Kay Redfield Jamison, who makes a similar observation in An Unquiet Mind about mania inexorably spiraling into black depression. Slater states in the afterword to Lying that she takes anticonvulsant medication, from which Couser speculates that she might have a history of mild seizures, but the reason for taking the medication appears in Blue Dreams. “Numerous anticonvulsants – drugs used to treat epilepsy – were repurposed in the 1980s and ’90s as drugs to treat manic depression, otherwise known as bipolar disorder” (p. 112). Unlike Jamison, Slater did not respond well to lithium, and she was forced to take other medications, including Zyprexa, the “name of which sounded to me like a musical instrument” (Blue Dreams, p. 77). The drug caused her to gain a great deal of weight, leading to diabetes. Zyprexa proved effective, and within three days the florid mania and abysmal depression lifted. She describes her gratitude for having her life back, but she remains on guard, knowing that sooner or later the drugs will stop working. “My adulthood has been marked – marred – by periodic depressions preceded by stupid, inane manias. This is who I am, like it or not” (p. 78). To her credit, Slater embraces the uncertainty principle throughout Blue Dreams. As a result of her psychiatric history, she has come close to madness, “too close for comfort but not nearly close enough to really comprehend” (p. 56). Wondering whether she would take a pill that could magically cure her of depression, she remains equivocal. Perhaps there is a part of me that likes my madness, in measured drips, the dreams of rocks and black hats and girls of swirling sugar. Perhaps I like my drugs too. (p. 114) She chose her psychiatric drugs, but it also seemed that the drugs chose her. She knows from her experience as a patient, therapist, and researcher

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that there is no real scientific understanding of why and how psychiatric drugs work – or why they stop working. She knows that psychiatry has both sickened and saved her, leading, paradoxically, to a state of dying to live, but she doesn’t label this as a Faustian pact. She cannot prevent breakdowns, but she has learned to have them in the comfort of her home rather than in a cheerless psychiatric hospital. She cites disturbing statistics that “reported incidences of depression have increased a thousandfold since the introduction of antidepressants,” adding, a “cynic might say the pill to cure depression was in fact causing it” (p. 164). She is not necessarily cynical, but she remains understandably skeptical. Blue Dreams captures the ambiguities of the alluring hopes and broken promises of psychiatry. Slater has done her homework in reading the burgeoning research on psychiatric medication, narrating the stories of the proponents and opponents of biological psychiatry. She knows that forced institutionalization of mental patients created many horror stories, as did the deinstitutionalization movement decades later. She offers nuanced discussions of observer bias, diagnosis drift, and both the placebo and nocebo (a remedy intended to cause harm, such as voodoo death) effects. She recognizes the difficulty of weening oneself from an antidepressant. The longtime use of antidepressants has led to a growing and unanticipated problem, as Benedict Carey and Robert Gebeloff reported in the New York Times a few months after the publication of Blue Dreams: “Many who try to quit say they cannot because of withdrawal symptoms they were never warned about.” Slater sees little difference between those who are addicted to illegal street drugs and those who, like herself, are dependent on legal pills. She frets over the fear of diminished creativity arising from psychiatric medication: “to this day I sometimes worry that I have forever lost some wattage to the pill” (p. 182). She recognizes that the longer people take antidepressants, the greater the incidence of sexual dysfunction. She cites figures in Blue Dreams that between 60% and 75% of patients report sexual dysfunction, a significantly higher incidence than appears in Prozac Diary, published 20 years earlier. Slater points out the extensive research indicating that all schools of psychotherapy appear to work equally well provided that both patient and therapist are committed to the process of therapy. It’s odd that Slater, who loves storytelling, neglects to mention that the psychological finding of the importance of the therapeutic alliance has been dubbed the “Dodo bird effect”, an allusion to Lewis Carroll’s 1865

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novel Alice in Wonderland, in which the dodo bird declares famously, following a race, “Everybody has won and all must have prizes.”

LEAVING READERS WITH QUESTION MARKS How do we finally view Lauren Slater? No mental illness memoirist remains more controversial. A close reading of all her books, however, confirms her statement in Lying that nearly everything she reveals is narratively true, or at least narratively consistent with the body of her work. She has documented, in greater detail than any other writer, the everyday challenges of living with serious mental illness, and she has demonstrated in book after book how these challenges change over time, from early childhood, through adolescence, to early and late middle life. Her writings reveal her multiple roles and subject positions – patient, therapist, memoirist, fairy tale author (author of the 2005 book Blue Beyond Blue), and investigative reporter, not to mention daughter, wife, and mother. A provocateur, she is willing to make polarizing statements, subvert conventional wisdom, and transgress literary boundaries. Christian Perring observed in a favorable review of Lying that Slater has resisted the pressure to end her memoir on an upbeat note. She has also resisted the pressure to limit herself to a single illness memoir. A century and a half ago, Charles Dickens left his serial readers guessing over the next installment of his novel-in-progress. Slater similarly leaves her readers wondering about the revelations of her next illness narrative. Her memoirs are, at their best, question marks, requiring, as one of her best readers, Hayward Krieger, remarks, courage along with an open and flexible mind.

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6 “I CANNOT SEPARATE HER HOMOPHOBIA FROM MY OWN”: ANDREW SOLOMON AND THE NOONDAY DEMON

“Why, people kept asking me, why are you writing a book about depression?” Andrew Solomon raises this personal question near the end of The Noonday Demon: An Atlas of Depression (2001). The question is complicated enough to require several answers, including his desire to contribute to an understanding of the subject, his belief that writing is an act of social responsibility, his need to inform people how to care for those who suffer from depression, and, truth be told, two less noble motives: his admission that he received a “generous book advance” and his wish to be “famous and beloved.” Only after he had written most of the book did he realize his deepest motive: an awareness of the “shattering vulnerability of depressed people” and the “complicated ways that particular vulnerability interacts with personality” (p. 428). Solomon does not explicitly mention that writing the book was an effort to understand his own history of depression, though he does concede, a few pages later, that he needed to have been depressed before he could write the book (p. 436), adding that when he experienced his third breakdown, a “mini-breakdown,” he was in the late stages of writing The Noonday Demon (p. 438).

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TRAINING IN ENGLISH AND PSYCHOLOGY Born in New York City in 1963, Solomon majored in English at Yale University, graduating magna cum laude in 1985. He received a Master’s degree in English at Jesus College, Cambridge, the only foreign student to earn the top first-class degree in English in his year as well as the University writing prize. After an interval of several years spent writing and writing, he received a PhD in Psychology at Cambridge in 2013. Solomon is currently a Professor of Clinical Psychology at Columbia University Medical Center, Special Advisor on lesbian, gay, bisexual, transgender (LGBT) Affairs for the Yale University Department of Psychiatry, and a Distinguished Associate of the Centre for Family Research at Cambridge University. In 2015, he was elected as the President of PEN American Center. Solomon has earned dozens of awards and prizes for his books and humanitarian efforts, including the Humanitarian Award from the Society of Biological Psychiatry and the Wellcome Prize. The Noonday Demon became an immediate bestseller, earning seven national awards, including a 2001 National Book Award for Nonfiction. It was a finalist for the Pulitzer Prize and was included in the London Times list of the 100 best books of the decade. Encyclopedic in its scope and nearly 600 pages long, The Noonday Demon is a highly synthetic book, exploring depression’s impact on biology, chemistry, psychology, philosophy, history, biography, literature, and art. Solomon could have written The Noonday Demon without revealing his own private battle with the disease, but the book would have lacked the wry humor, startling candor, and moral urgency that arise from its autobiographical elements. The Noonday Demon is not exactly a memoir, largely because Solomon’s personal recollections of his experience with depression are interspersed with the immense scientific and medical information he provides. There are scores of “objective” textbooks on mood disorders, most acknowledging that the disease continues to be cloaked in stigma and secrecy, but by chronicling his own struggles, Solomon shows how we can best learn about a subject through storytelling. Solomon received over a thousand letters from readers after he published in The New Yorker in 1998 an article about depression. In responding to the flood of mail, he asked several people if he could interview them and present their stories in his book. Many agreed, and he includes their experiences in the present book, sometimes using pseudonyms, as they requested. The Noonday Demon tells two stories, one about the history

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and nature of a mood disorder that strikes as many as 10% of all Americans, 15% of whom will eventually commit suicide, the other about his own torturous experience with depression. The second story is the one with which we are most concerned. Solomon doesn’t dramatize his therapy sessions, but he represents himself to his psychiatrists with self-mocking irony and interjects gallows humor “in a peculiar effort to charm the ones who treat me, people who do not in fact wish to be charmed” (p. 106). He represents himself in the same way to his readers, sometimes making shocking confessions that he knows will disturb his audience. Readers may not be charmed, but they will be struck by the power of his truth-telling. Throughout The Noonday Demon Solomon demonstrates the unvarnished truth about reckless acts that many other writers would discreetly omit, including trying to contract HIV as a pretext for killing himself.

A STONE BOAT Several of the themes Solomon writes about in The Noonday Demon appear in his lightly fictionalized debut novel A Stone Boat, published in 1994. The novel, a bestseller and runner-up for the Los Angeles Times First Fiction Prize, focuses on the dying and death of his beloved mother, Carolyn Bower Solomon. Diagnosed with metastatic ovarian cancer, she endured two years of surgery and several rounds of chemotherapy and then made the fateful decision, with the reluctant support of her husband and two sons, to end her life on June 19, 1991, at age 58. A novel mainly about love, loss, and bereavement, A Stone Boat hints at the underlying conflicts in the mother–son relationship that later contributed to Solomon’s depression and suicidality. His participation in his mother’s suicide, along with the publication of the novel, had unintended consequences. A Stone Boat and The Noonday Demon are complementary texts, each casting light on the other. Few novels reveal a closer, more intimate mother–son relationship than A Stone Boat. Harry, the bildungsroman hero – neither the family’s last name nor the mother’s first name is mentioned – is in his mid-twenties, a classical pianist rather than an author, like Solomon himself. (Solomon’s first book, The Irony Tower: Soviet Artists in a Time of Glasnost, which he dedicated to his mother, appeared in 1991.) Harry lives in London, partly in an effort, not wholly successful, to separate from his mother, the love

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of his life. Harry’s father, Leonard, is a bank president, and his younger brother, Freddy, is a medical student. Both characters are modeled on Solomon’s father and brother, respectively. Howard Solomon was the former chair of the pharmaceutical company Forest Laboratories and the founder of Hildred Capital Partners, a family firm that invests in a wide range of securities. Andrew Solomon’s brother, David, is a lawyer who is involved in the same investment company. Harry doesn’t comment on his family’s wealth and privilege, but after his mother becomes ill, his father becomes a benefactor of the hospital where she is treated, and she is given the finest room in the institution, “a room unlike any other hospital room on earth, the size of a small recital hall, with windows on three sides looking out at the stately East River” (p. 103). A Stone Boat opens with Harry’s desperate desire to write everything he can about his mother’s struggle for life before time inevitably diminishes his memory of her. The dialogue has a frenetic quality, conveying the race against time. “Whatever happens to me,” Harry’s mother says, whatever this illness may do to me, however grumpy or difficult or unpleasant I become, I want you to promise that you and Freddy will always remember me as I have been until today. (p. 18) Even before receiving the results of the medical tests, she does not deceive herself about the seriousness of the situation, and she remains lucid to the end. Remembering his mother becomes even more urgent to Harry because he fears that if she dies, he will die too, perhaps by his own hand. Solomon never sentimentalizes the mother. Harry acknowledges that she couldn’t bear the idea of his vanity even though she contributed to it by teaching him the importance of style: the right clothes to wear, the way to wear them, and how to have his hair cut. Harry loves his mother deeply, passionately, single-mindedly. Solomon never implies that his mother favors him over his father or brother, but the novel shows a special bond between them. Her world rose and fell by me: for I was as vast to my mother as she was to me. My mother wanted me to have a perfect life, more perfect even than hers, because she sincerely believed that the surest way to be happy was to be perfect. (p. 25)

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HOMOPHOBIA The mother’s notion of perfection, however, does not include having a gay son. Solomon doesn’t use the word “homophobic” to describe her in A Stone Boat, but he never conceals her disappointment over Harry’s sexual identity and his preference for male lovers. She repeatedly expresses her disapproval over his relationship with his British paramour, Bernard; she believes that Harry is destroying any possibility of future happiness by remaining with Bernard. The mother’s homophobia helps explain her discomfort when Harry lightens his hair with lemon juice: “Men do not dye their hair” (p. 33). Solomon never tells us whether Harry’s father or brother shares his mother’s homophobia. Harry realizes when he is young, perhaps even before his teenage years, that he is attracted to men, and he knows that he can do nothing more terrible to his mother than act on his homoerotic desire. Internalizing her revulsion with him, he begins hating her – and himself. I can remember that this secret was my unacknowledged revenge on her. I would lie in the silence of my own room and imagine the pain I would later cause my mother, and I would exult in the appalling longings, in which, for all that I too hated them, there was power such as I had never before known. I believed at an early age that I could destroy her life; I had thought that I would use my desire someday to punish her. (p. 33) Aware that her son is hurting both her and himself, she tells him, prophetically, “you can tell the whole story to a psychoanalyst someday, and say how your impossible mother ruined your life. But that’s not going to make you happier” (p. 36). Attuned to her son’s feelings and fantasies but nevertheless unable to accept his sexuality, she accuses Harry of “giving her cancer” (p. 33), the same accusation Anne Sexton’s mother made to her. The statement devastates Harry, and although she later apologizes for the accusation, he never overcomes the fear that he has indeed destroyed her life. Not that they are an unhappy family. Reversing one of the most celebrated opening sentences in literature, Solomon insists that it is “not the case that all happy families are the same.” Disagreeing with Tolstoy’s Anna Karenina, Solomon maintains that there are

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thousands of happy families, but they are too private to earn the documentation tragedy claims as its due, and every one is so radically unlike every other, so frighteningly particular, that language itself shrinks from the task of describing them. (p. 80) Elizabeth Wurtzel makes a similar point in Prozac Nation: “Happiness is infinite in its variety, and happy people, happy families, can find their joy in so many different ways” (p. 223). Solomon’s language in A Stone Boat documents the tragedy of the mother’s death. The novel captures the mother’s ironic sensibility that her son inherits. “The boys are keeping a deathwatch over me,” she says acerbically to her friends; “I keep telling them to go out, but they don’t want to miss a minute of the fun” (p. 47). In the presence of her sardonic wit, Harry can only remain silent, but he is his mother’s son, and he sees her endless visits to physicians as an example of the American way of death, the “way of death we come upon when we suppose that all things may be cured with enough logic and enough pragmatism” (p. 44). Harry’s voice is the dominant one in the novel, evocative and allusive, but sometimes he is given to excess; he mordantly admits to speaking in the “rhetoric of melodrama” (p. 58), a statement consonant with Solomon’s admission in The Noonday Demon that he is “melodramatic by nature” (p. 78). Contrasting Harry’s authorial voice is that of his closest friend, Helen, who embodies practical wisdom, helping Solomon to achieve narrative distance from his first-person narrator. Harry attempts to love Helen, knowing how happy his mother would be, but when he is unable to do so, he relies upon his friend’s counsel and support. “Keep a grip on yourself” Helen warns him when he begins to unravel over his mother’s illness. You have not destroyed your life to help your mother. If you’re mad, then go home and smash a mixing bowl or something. If you’re sad, then cry …. But stop being hysterical. It’s not helping anyone at all. (A Stone Boat, p. 108) Harry cannot heed Helen’s good advice. Functioning as Harry’s therapist, she points out to him that he is doing everything he can to comfort his mother, words that help him feel “noble” instead of “dutiful.” Sometimes Helen makes perceptive observations and then silently bears the brunt of his anger. Confessing that he unfairly hates his father for becoming dependent on him during the family crisis, Harry now hates Bernard too. Hating

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both of them, he confides to Helen, makes it easier to love his mother. Perplexed by his logic, “Helen told me I was really hating myself. When she said that, I hated her” (p. 140). Harry travels back and forth between London and New York to spend as much time with his hospitalized mother as possible. She tells him, when her friends come to visit, that he must be a good listener. Two of Solomon’s later books, Far from the Tree (2012) and Far and Away (2016), are filled with hundreds of interviews, and he proves to be an excellent listener, thus taking his mother’s advice to heart. He also takes to heart Helen’s insights about listening empathically to ill people without being judgmental, a trait Solomon demonstrates in all of his writings. Knowing that his mother, a deeply private person, would not want him to disclose the details of her illness, Harry respects her privacy even as he paradoxically invades it, as writers invariably do. His self-disclosures focus mainly on his relationship with his mother; we learn little about his father and brother, both of whom remain minor characters. A Stone Boat succeeds in depicting the mother’s quiet fury. Solomon evokes the indignities of her inexorable decline: the gradual wasting away from the spreading cancer; the loss of her hair, which was like the “loss of herself”; and the erosion of her will to live. She is silently outraged over the friends who visit her and then leave “with an ennobling awareness of their own concern” (p. 48). It matters little whether she is right or wrong to feel this way: this is how the dying often feel about the unfairness of death. Solomon understands the impossible dilemma in which the dying may find themselves, when they are expected to cheer up those who offer comfort. When Harry asks his mother how she feels one morning, she responds, “I feel terrible,” to which he replies, in a harmless bantering tone, “What ever happened to, ‘Fine, thank you, and how are you?’” The mother’s anger is grating to Harry, but she has a point. You’re the family. You’re supposed to be the ones to whom I can say how terrible I feel. And when I tell you, you’re supposed to comfort me and not criticize me. (p. 94) We empathize with both characters here; Solomon convinces us that he understands how illness bedevils patients and their loved ones. Harry does his best to comfort his mother, but he recognizes the complexity of motivation, including motives that often remain unacknowledged. “I did

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everything a perfect son would have done, but I did it in a spirit of largely unarticulated peevishness. I wanted credit all the time” (pp. 98–99). There are as many joyful moments between Harry and his mother as there are sorrowful ones. She never fails to support his blossoming career as a classical pianist, always believing in his talent. Her faith that he is exceptional remains a constant in their lives. Her “essential softness,” which seemed to disappear for a time after her diagnosis and first round of chemotherapy, returns when her cancer is in remission, and she regains her humor. When Harry tells her that she looks good in a wig, having lost all her hair during chemotherapy, she quips, “Either you’re becoming a very accomplished liar … or your standards have been slipping in England” (p. 87). In an event that Solomon explores in greater detail in The Noonday Demon, Harry admits that as a way of distracting himself over his mother’s dying, he starts to pick up young men on busy streets and have brief liaisons with them. The “dangerous thrill of anonymity” (A Stone Boat, p. 144) is momentarily comforting. He’s startled by the depth of his passion and untroubled by any untoward consequences. He begins a relationship with a new lover, Nick, attracted to “his feckless smile, and his crazy laugh, and his powerful body” (p. 153). Helen is not impressed. “He was like someone who was imitating a person” (p. 159). Harry concludes that his frantic search for love was part of his “deferred adolescence,” a response to his mother’s impending death. The result was that he found himself “dwindling into the sum of my losses, as difficult to know or to love as the spaces between the stars” (p. 148).

ASSISTED SUICIDE A Stone Boat abounds in insights on mortality, including an observation I have never seen elsewhere. “The verb ‘to die,’” Harry declares shortly before his mother ends her life, “is one of the few that is only readily usable in the past and future tenses” (p. 202). It’s true: we almost never read the sentence, “He or she dies.” Sometimes, Solomon continues, the verb “die” is synonymous with the verb “to age,” something that happens slowly and imperceptibly to most people. Harry’s mother, by contrast, dies in front of our eyes. Nietzsche famously observed in Beyond Good and Evil (1886) that the thought of suicide is a great consolation: “by means of it one gets through many a dark night” (p. 103). This is true of Harry’s mother in A Stone Boat.

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Strong-willed to the end, she never doubts that her suicide will be both timely and appropriate, ending her and her family’s suffering. She expresses her intention to commit suicide relatively early in her illness, when she is asymptomatic but mortified by the idea of terminal cancer. “Can’t you see,” she cries hoarsely following the news that chemotherapy has failed to destroy all the cancer cells, “that the person you loved is already dead?” (p. 110). Nothing the family says or does can change her mind. “If you won’t help me to kill myself here and now,” she said, “then I’ll kill myself when I get home, and it will be worse and messier for all of us.” (p. 113) Only after exhausting every possibility of treatment, stoically enduring the ravages of the disease until there is nothing left but palliative therapy, does she take the situation into her own hands. Without using the words “rational suicide,” the novel implies the correctness of her decision. “Everything that had been intolerable to my mother was made tolerable when she got those pills,” Solomon writes in The Noonday Demon, “by the sure knowledge that when it became really intolerable, it would stop” (p. 273). Many readers, regardless of their positions on end-of-life care, will sympathize with her decision, though what seems rational for the person who chooses suicide may not be rational for a relative. Moreover, as Solomon observes in The Noonday Demon, what is rational is not always straightforward. All his life, Harry explains to us in A Stone Boat, he has feared his mother’s death, and he has little choice but to accept her decision to end her life. He cannot imagine life without his mother, and her decision to commit suicide infects him with a desire for his own death. “I imagined it as though it were a form of vengeance” (p. 141). Neither Harry nor his mother believes in an afterlife, and thus there is never the hope of reunion after death, but he assumes that suicide will free him from the anguish of life without his mother. The thought of suicide also mitigates survivor guilt. In one of the most poignant moments of A Stone Boat, Harry’s mother asks him to take care of his father after she is gone: you have to encourage him to find someone and get married and get on with his own life. That will be better for you and for him. Whomever he finds – it won’t be, but it will be someone. He should live for a long time, and he shouldn’t be alone. (p. 136)

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Harry hears this with tears running down his face, and readers will react in the same way. Later, she tells Harry that what happened to her was “genetic” and thus not caused by stress, meaning that he was not responsible for her illness, a statement he does not entirely believe. Harry’s mother remains startlingly composed when she swallows the lethal cocktail dutifully prepared for her by her husband, and she remains dry-eyed, in contrast to her family. Solomon does not include the ingredients of the toxic brew, though in The Noonday Demon he reveals that his mother swallowed an overdose of the barbiturate Seconal. Harry’s mother hated grand opera, yet the death scene in A Stone Boat is memorable in an understated way. She says goodbye to her husband and sons, expressing to each her undying love, though her words to Harry have a sharp edge. You’ve been letting yourself go to pieces these last few months. You’ve got to get your life in order and get on with it. Everyone’s mother dies, sooner or later. (p. 219) The death scene in A Stone Boat recalls the ending in D. H. Lawrence’s 1913 autobiographical novel Sons and Lovers when Paul Morel gives his comatose mother, her body riddled with cancer, a fatal dose of morphine. There are, to be sure, noteworthy differences in the two mother–son relationships. Paul chooses to end his dying mother’s life without her consent in an act that combines both euthanasia and matricide, unlike Harry and his family, who prefer to let nature take its course. Throughout Sons and Lovers Mrs Morel plays favorites, valuing her first-born child, William, above the others and then, after his early death, investing all her love in Paul, encouraging him to usurp his father’s position in the family. Harry’s mother never plays favorites. Lawrence grew to despise smother-mothers, and his later novels contain characters who are caricatures of his own strong-willed mother, betraying the novelist’s misogyny, a development that does not occur in Solomon’s writings. Notwithstanding these differences, there are striking similarities between Sons and Lovers and A Stone Boat. Paul and Harry are closer to their beloved mothers than to any other people in their lives; both sons, talented artists, live to please their mothers. Like Paul, Harry cannot watch his sleeping mother suffer without feeling compelled to end her life. “I wanted to wake my mother up, but I also wanted her dead, wanted

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it almost enough to kill her, because I couldn’t stand any more waiting” (p. 222). The Oedipal theme in both novels is palpable. Paul and Harry are both bisexual, struggling to come to terms with their attraction to men. Both novels end with the sons seeking to forge new lives for themselves following maternal loss. Both novels end affirmatively, but the novelists later made statements that called into question their autobiographical heroes’ fates. Sons and Lovers concludes with Paul Morel walking “towards the faintly humming, glowing town, quickly,” the final word conjuring up vitality. In a 1912 letter, however, Lawrence stated that Paul is “left in the end naked of everything, with the drift towards death” (Letters, vol. 1, p. 477). So, too, does Solomon end A Stone Boat positively, reminding us that Harry grew up in the “constant radiance” (p. 239) of his mother’s affection. Harry has internalized her love, a love made of bricks, rather than of straw or sticks, a love powerful and inviolable enough to withstand every one of the disasters of which any life is made. (p. 172) With Solomon’s approval, Harry wants us to believe that the conflicts he had with his mother were largely resolved with her death, but he knows that the question of forgiveness is complicated. Is forgiveness ever fully conscious? Insofar as it is, I forgive my mother here and now for whatever she may ever have done that I may have failed to forgive, even for her death. (p. 236) But it is easier for Harry to forgive his mother in the abstract than to forgive her for conveying a judgment that undermines a central aspect of his identity. She never softens her homophobia, not even near the end of the novel when she assumes that her two sons will marry and give their wives her jewelry. How can Harry overcome his homophobia if his mother, with whom he is connected in a myriad of ways, cannot? He has internalized his mother’s homophobia as deeply as he has internalized her love. The difference is that whereas her brick-like love is strong enough to withstand any disaster in life, her antigay prejudice is the disaster that threatens to undermine his life after her death. We see hints of Harry’s self-hatred in A Stone Boat, but Solomon was not yet ready to grasp the long-term selfdestructive consequences of homophobia.

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THE NOONDAY DEMON Scholarly yet compulsively readable, The Noonday Demon gives the impression that Solomon has read everything written on depression. Solomon states that he has a “poor memory” (p. 41), but one marvels how a person with a bad memory can hold so much information in his mind. The footnotes and bibliographical citations at the end of the book are 90 pages long, an indication of the breadth and depth of Solomon’s scholarship. The Noonday Demon is unique among mental illness narratives in that it first tells the author’s own story of depression; then the stories of others suffering from the mood disorder, including those whose depression resembles and differs from his own; and finally, to illustrate cultural differences, the depression stories of those who live in Cambodia, Senegal, and Greenland. “One has the advantage during one’s own breakdown of being in it, where one can see what’s happening” (p. 81). Solomon uses this advantage to offer an inside account of depression. The Noonday Demon has both an anecdotal and statistical quality that is rare for a memoir. Despite the increasing number of public figures who have revealed their own depression, such as Mike Wallace, Art Buchwald, Tipper Gore, and William Styron, stigma continues to surround depression. Consequently, Solomon had trouble finding interviewees who would entrust him with their stories. Nevertheless, he believes in the value of breaking the silence of depression. “Having secrets is burdensome and exhausting, and deciding exactly when to convey the information you’ve kept in check is really troublesome” (p. 365). Solomon discovered while interviewing scores of people the “curious intimacy that comes of swapping breakdown stories” (p. 92), an intimacy that readers also experience.

SEEKING INSIGHTS FROM LITERATURE AND PHILOSOPHY The literary and intellectual richness of The Noonday Demon derives partly from scores of references to (and apt passages from) playwrights, novelists, poets, memoirists, and philosophers. To give only a few examples, Solomon quotes from Virginia Woolf’s suicide letter and passages from two of her novels, Jacob’s Room and The Waves, the latter of which contains words that characterize Solomon’s own experience of depression: “Take notes … and the pain goes away” (The Noonday Demon, p. 103).

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At the beginning of his chapter on the stupefying number of treatments for depression, Solomon quotes Chekhov’s droll insight: “If many remedies are prescribed for an illness, you may be certain that the illness has no cure” (p. 135). Solomon offers a detailed history of the expression the “noonday demon,” which derives from several biblical sources. He refers to the great eighteenth-century writer Samuel Johnson, who memorably referred to depression as the “black Dog,” an expression later credited to Winston Churchill, who also suffered from depression. Solomon cites passages from poets John Donne, John Milton, Emily Dickinson, and T.S. Eliot, along with three Shakespeare plays: Hamlet, The Merchant of Venice, and The Winter’s Tale. Solomon’s discussion of the long history of depression abounds in references to poets who wrote about mental illness and were often themselves afflicted with mood disorders. Solomon is never dismissive of fellow memoirists who have written on mental illness. Writers are not always generous when referring to each other, but he cites memoirists with genuine respect and admiration. As an example, he refers to Martha Manning’s “beautiful and surprisingly hilarious book called Undercurrents” (p. 121), which chronicles her experience with electroconvulsive therapy. He cites Jamison repeatedly, and he also interviewed her: in response to his question about the need for long-term preventive treatment to avoid the devastating consequences of depression, she “thumps the table when she gets going on this subject” (p. 57). In the Notes Solomon lists some of the “excellent general books” on depression that influenced his own book: Peter Whybrow’s dignified and accessible A Mood Apart, Kay Redfield Jamison’s moving An Unquiet Mind and Night Falls Fast, Julia Kristeva’s impenetrable but episodically brilliant Black Sun, Rudolf and Margot Wittkower’s Born Under Saturn, and Stanley Jackson’s rigorous Melancholia and Depression. (p. 445) He also refers to Styron’s “elegantly written first-person memoir Darkness Visible, which was one of the first open modern portraits of depressive illness” (p. 491). In Far from the Tree he refers to “the law professor Elyn Saks [who] has written movingly of her redeeming experiences with psychoanalysis in her battle with schizophrenia” (p. 317). These memoirists are not competitors or rivals, Solomon implies, but fellow travelers.

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POETIC PROSE Solomon has always been a highly metaphorical writer, which gives his prose a poetic quality. The title of his novel refers to Harry’s unrealistic expectations of a perfect family that prove burdensome in his day-to-day life, as Helen explains: it’s as though you’d chosen a boat carved from diamond with sapphire masts and sails of rubies and emeralds for your journey across the sea. It’s breathtaking to watch it cutting through the waves, but it’s a stone boat. You have to be crazy to choose a stone boat. Anything else would be easier to sail, Harry. (A Stone Boat, p. 183) One doesn’t usually associate a stone boat with glittering precious jewels, but the metaphor conveys another meaning: Harry’s life is both eased and complicated by his family’s wealth. The mother’s love for Harry is part of this precious legacy that weighs him down after her death, nearly sinking him. A central metaphor in The Noonday Demon is the comparison of depression to a vine that chokes a tree. The metaphor occurred to Solomon when, recently returning to a wood in which he had played as a child, he saw a 100-year-old oak tree nearly smothered by a vine. Newly recovered from a major depression during which he found himself estranged from others and himself, he could now see how a vine had seized hold of his identity, suffocating his existence. At the worst stage of major depression, I had moods that I knew were not my moods: they belonged to the depression, as surely as the leaves on that tree’s high branches belonged to the vine. (p. 18) Solomon develops the tree-and-vine metaphor for six paragraphs, concluding that drug therapy helped him to hack through the vines, restoring the imprisoned oak. The Noonday Demon consists of 12 chapters: “Depression, Breakdowns, Treatments, Alternatives, Populations, Addiction, Suicide, History, Poverty, Politics, Evolution, and Hope.” The Noonday Demon most resembles a traditional mental illness memoir – though there is not a long tradition of the subgenre – in the chapters on depression, breakdowns, treatments, and suicide, in which Solomon relates his own experiences. By contrast, there are no

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self-disclosures in the chapter on poverty. Nor is this surprising, given the family’s wealth. Nonetheless, in the chapter on politics, which contains a discussion of the public policy implications of mood disorders, Solomon points out that depression is “one hell of an expensive disease” and then discloses how much his first breakdown cost him and his insurance company: $4,000 worth of visits to the psychopharmacologist, $10,000 of talking therapy, and $3,500 for medication. This was in addition to losing the income of five months of work.

THE TIMING OF SOLOMON’S DEPRESSION One of the ironies of Solomon’s acute depression and suicidality is that both occurred three years after his mother’s death, a time when, he wryly admits, his life was “finally in order and all the excuses for despair had been used up” (p. 39). One can understand depression arising from sudden trauma, a life gone awry, or the prospect of endless suffering, but this was not true in his case. Solomon was sad and angry in 1991, when his mother died, “not crazy.” He did not experience depression until he had largely “solved” his problems. He then recounts the events that culminated in his first major breakdown and suicidal crisis. Following his mother’s death, he entered psychoanalysis and fell in love in early 1992 with a woman who became pregnant and then had an abortion, after which the two agreed mutually to break up. The publication of A Stone Boat in 1994, when he was 30, brought little pleasure for reasons that he doesn’t explain until hundreds of pages later. During the worst of his depression, he was too sick to consider harming himself, but when the gloom began to lift, he climbed to the top of his six-story apartment building in Manhattan one evening and thought about throwing himself to his death. He stayed on the roof until about six in the morning, when he climbed down. “My own awareness that depression is maudlin and laughable helped to get me off the roof,” he admits (p. 68), along with his recognition that his father would be crushed by the act. His use of the words “maudlin and laughable” to label his suicidal thinking is surprising, since he never uses these harsh words to describe others’ suffering. The “rooftop episode,” as he calls it, convinced him that he did not want to commit suicide, at least not without a reasonable explanation. He then resolved to become HIV-positive. He did not wish to die slowly of AIDS; rather, he intended to commit suicide with HIV as his excuse.

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In psychoanalysis, Solomon explored his past in great detail, concluding that his mother’s “blessed rage for order” was her way to avoid depression and breakdown. There is often a genetic predisposition to depression, and he speculates that if he has “depression genes,” they came from his mother (p. 282). He links his strong optimism, on the other hand, to the paternal side of his family. As in A Stone Boat, Solomon describes his mother’s suicide as the “cataclysm” of his life (p. 268), and though he never regrets his assistance in her death, he could not have predicted while writing his novel how the event would almost doom him to the same fate. Much of Solomon’s research on depression and suicide arose from a counterphobic motive, an attempt to understand his own mood disorder. Throughout The Noonday Demon he writes from the dual vantage point of observer and participant. He never questions the connection between his mother’s suicide and his own suicidality. Clinical research repeatedly confirms that a family history of suicide heightens one’s own risk. Solomon is an advocate of suicide prevention programs, but he points out a disturbing paradoxical truth. At the moment, evidence suggests that even the bestintentioned suicide-prevention programs often introduce the idea of suicide to a vulnerable population; it seems possible that they actually increase the suicide rate. They are helpful, however, insofar as they make people aware that suicide is often the result of mental illness and that mental illness is treatable. (p. 251) Another disturbing truth is that suicide may be contagious even when the motives behind self-inflicted death are different. It is not savory, in political terms, to conflate suicide in the face of psychiatric illness with suicide in the face of physical illness, but I think there are surprising similarities. (p. 280) Here as elsewhere in The Noonday Demon Solomon betrays no reluctance in being an unsavory writer. Truth-telling, we may add, is also unsavory, especially when it involves exposing feelings and thoughts fraught with pain, blame, and shame. Solomon repeats in The Noonday Demon many of the details of his mother’s suicide that appear in A Stone Boat, but there are new revelations. After his mother’s death, Solomon was so angry at his father that he left

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messages on his father’s answering machine: “I hate you and I wish you were dead” (p. 47). He also reveals the impact of his mother’s suicide on his father’s life. After her death, Solomon threw away the remaining Seconal pills in her bathroom, but the act enraged his father because he was planning to use them in the future if he became terminally ill. “Our one comfort in the face of our loss of my mother,” Solomon adds, “was to plan to repeat her departure on ourselves” (p. 279). Solomon is a proponent of rational suicide, but he points out that no one can predict its long-range consequences on loved ones. Nor can one predict, as Paula Span points out in “A Debate Over ‘Rational’ Suicide” in the New York Times in 2018, whether there will be a shift from a “right to die” to a “duty to die” if the elderly view suicide as legal or desirable.

THE INTERNALIZED MOTHER With the help of psychoanalysis and Freud’s seminal 1917 essay “Mourning and Melancholia,” Solomon began to understand the link between his mother’s suicide and his own depression and suicidality: At the time of my first breakdown, I was devastated by my mother’s death, and in dreams and visions and writing I most certainly incorporated her into myself. The pain of losing her made me furious. I also regretted all the pain I had ever caused my mother and regretted the complex mixed feelings that persisted in me; full closure in this relationship was forestalled by her death. I believe that internal systems of conflict and self-reproach played a large part in my falling apart – and they centered on my publication of my novel. I regretted the sabotaging privacy that I had developed because my mother so highly prioritized reticence. I decided to publish anyway; and this gave me some feeling of being freed of my demons. But it also made me feel that I was acting in defiance of my mother, and I felt guilty about that. When it came time to read aloud from the book, to declare publicly what I was doing, my self-reproach began to eat into me; and the more I tried not to think about my mother in this situation, the more the “internalized love-object” of my mother obtruded. (The Noonday Demon, pp. 325–326)

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Solomon fears that the above is a “somewhat reductive” analysis, but most readers will be struck by its psychological sophistication. He is quick to acknowledge the principle of overdeterminism: there were other causes of his breakdown and suicidality, including the end of a romantic relationship. But this was secondary to the loss of his mother and internalizing her condemnation of his sexuality. How does one escape from what appears to be a lose–lose situation? By remaining quiet about being gay, he respected his mother’s silence but disrespected the truth of his life. By going public, he respected the truth of his identity but defied and disrespected his mother’s image of himself. One can escape from a mother’s disapproval if she dies, but how does one escape from a mother’s judgment that has become internalized and thus part of oneself? This was truly a Solomonic dilemma. Following his mother’s death, Solomon appears to have experienced, as we saw with William Styron and Linda Sexton, “pathological or complicated grief,” the intensification of grief to the level where the person is overwhelmed, resorts to maladaptive behavior, or remains interminably in the state of grief without progression of the mourning process towards completion. (Horowitz, Wilner, Marmor, & Krupnik, 1980, p. 1175) The only solution for Solomon was to confront the monstrous shame of his life. Indeed, his analysis in The Noonday Demon of gay depression focuses on virulent shame. Solomon rejects the idea, proposed by some scientists, of a genetic link between homosexuality and depression. His own theory for the relationship between the two is the destructive psychic consequence of homophobia. “Gay people are more likely than a general population to have been rejected by their families” (p. 202). Solomon doesn’t mention Betty Berzon’s memoir Surviving Madness in The Noonday Demon – one of his few omissions – but she would confirm his theory. “Internalized homophobia lurks everlastingly in the nooks and crannies of even the most liberated gay or lesbian brain” (Berzon, p. 215). Gay shame is ubiquitous, leading to self-hatred and self-destructive behavior. Solomon is never reluctant to point out the unintended consequences of well-meaning organizations, such as the gay pride movement, which finds gay shame shameful. If you are gay and feel bad about it, pride-o-files will jeer at you for your embarrassment; homophobes will jeer at you for being gay; and you will be left genuinely bereft. We do indeed internalize our tormentors. (p. 205)

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“CURING” HOMOSEXUALITY Solomon reveals details in The Noonday Demon about his sexual identification that do not appear in A Stone Boat. Fearing her son might be homosexual, his mother took him when he was in the fourth grade to a psychiatrist; years later she told her son that the doctor apparently did not suspect he was gay. “I am sure that the benighted therapist would have received a commission in short order to straighten out the problem of my sexuality had he assessed it more accurately” (p. 206). Consumed by a terrible secret he could share with no one, Solomon came to believe that his entire life was lie. He then makes a statement that helps to explain why Harry’s mother accused him of being responsible for her cancer. Later, I believed my sexuality was somehow implicated in my mother’s suffering during her final illness; she hated what I was so much, and that hatred was a poison in her that seeped into me and corrupted my romantic pleasures. I cannot separate her homophobia from my own, but I know that they have both cost me dearly. (p. 207) This insight also helps to explain why Solomon courted death through AIDS. “It was just a way to make the internal tragedy of my desires into a physical reality” (p. 207). For the next three months, while suffering from agitated depression, Solomon had unsafe sex with men whom he assumed were infected with the AIDS virus – until he realized, to his dismay, that he might be infecting others. Upon receiving the results of a medical test indicating he was HIV-negative, Solomon recalled with gratitude Gatsby’s line from Fitzgerald’s novel: “I tried hard to die but have an enchanted life.” Solomon was not ready to confront the dark implications of his mother’s homophobia in A Stone Boat, but he was ready in The Noonday Demon. His love for his mother never wavers, but now for the first time he acknowledges the hateful aftermath of her antigay prejudice. Rejecting continued silence, he embraced writing as a countershame act: writing/ righting wrong. Solomon must have anticipated that some readers of The Noonday Demon would be appalled by his irresponsible sexual behavior. How could it take him so long to realize that he could be infecting his sexual partners if he had the AIDS virus? He had, he recalls, as many as 15 unsafe episodes. Solomon doesn’t defend his behavior, but his commitment to

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truth-telling, no matter how unsavory, is paramount. Nor is this the only time he chooses brutal truth over discretion. He describes several violent episodes that occurred when he was depressed, including nearly killing a lover who had betrayed him. I attacked him with a ferocity unlike any I had experienced before, threw him against a wall, and socked him repeatedly, breaking both his jaw and nose. He was later hospitalized for loss of blood. Splitting himself into the observer and the observed, Solomon remarks, When people expressed horror at my attack on him, I told them almost what the batterer told me: “I felt as though I was disappearing, and somewhere deep in the most primitive part of my brain, I felt that violence was the only way I could keep my self and my mind in the world.” (The Noonday Demon, p. 179) Solomon is not a later incarnation of Norman Mailer, glorifying instinctual violence and machismo sensibility. Rather, he describes the desperation he experienced when he was acutely depressed, a time when his anger could explode into homicidal or suicidal rage. He doesn’t rationalize his behavior, but he does try to explain it, both to himself and his readers. One recalls the Roman playwright Terence’s observation more than two thousand years ago: “I am human; I consider nothing human alien to me.” Solomon’s humanness – and his humanity – contribute to his achievement in The Noonday Demon. If, as he argues, depression may be the biggest killer on the planet, he never loses faith in the hope of treatment. He embodies the resilience required for recovery. A wounded storyteller, his humor never fails him, not even during the most strained situations, as when, heading for his second major breakdown, he interviewed eleven therapists in six weeks. For each of my eleven, I rehearsed the litany of my woes, until it seemed that I was reciting a monologue from someone else’s play. Some of the potential therapists seemed wise. Some of them were outlandish. One woman had covered all her furniture with Saran Wrap to protect it from her yapping dogs; she kept offering me bites of the moldy-looking gefilte fish she was eating from a plastic container. I left when one of the dogs peed on my shoe. (p. 105)

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Speaking to those readers who may be contemplating therapy, Solomon remarks in The Noonday Demon that “Your therapist matters more than your choice of therapeutic system” (p. 110). As always, he cites his own extensive experience in therapy and then the voluminous published research on the subject. He quotes from a 1979 study, by Hans H. Strupp and Suzanne W. Hadley, indicating that all forms of therapy are effective if certain criteria are met, such as the patient’s belief that the therapist is knowledgeable and acting in good faith. In Solomon’s words, The experimenters chose English professors with this quality of human understanding and found that, on average, the English professors were able to help their patients as much as the professional therapists. (p. 111) Slater cites the same 1979 study in Blue Dreams.

PSYCHOPHARMACOLOGY Because his father has worked in the pharmaceutical field, Solomon admits that it is difficult to write about psychopharmacology without bias. Nevertheless, throughout The Noonday Demon he offers a balanced discussion of his own and other depressed persons’ experiences with drug therapy. Since his first visit to his psychopharmacologist in the mid-1990s, he has been “playing the medicine game”: following his physicians’ orders in seeking the best medication for depression. He attests wryly to the “hell of experimentation”; trying out different medications made him feel like a dartboard. Like Lauren Slater, he tells readers which drugs worked and did not work for him, and the dosages of each medication along with the inevitable side effects. In the chapter on addiction, Solomon cites his own use of illicit drugs and excessive alcohol, noting, as he always does, the crucial role of culture in determining norms. Living in Russia while he was working on his first book, he drank a quart of vodka a day. “To have stuck to my U.S. drinking standards would have been not only rude but also peculiar in these circles” (p. 227). Unlike Kate Millett, Solomon never comes across as defensive or apologetic about the medications he continues to take. He quotes a statement by John Greden, then director of the Mental Health Research Institute at the University of Michigan and now Founding Chair of the National Network of Depression Centers, about the harmful effects of an off-again, on-again approach to medication for the treatment of severe depression.

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“This illness has an eighty percent relapse rate within a year without medication, and an eighty percent wellness rate with medication” (The Noonday Demon, p. 80). Other researchers agree, and Solomon emphasizes that the side effects of these drugs are easier to live with than the disease itself. He reaches the same conclusion that Kay Redfield Jamison, Lauren Slater, Linda Sexton, and Elyn Saks reach in their memoirs. To my mind, I am no longer independent. The medications are expensive, though they are at least regularly and conveniently supplied. I don’t mind the idea that I am reliant on them, nor the idea that reliance is a cousin of addiction. So long as they work, I’m pleased to take them. (p. 237) Like most experts, Solomon believes that a combination of talk therapy (psychoanalytic, interpersonal, or cognitive) and drug therapy works best for most people rather than either therapy alone.

NDEUP: “YOU ARE FREE OF YOUR SPIRITS” But alternative treatments for depression sometimes work mysteriously, as Solomon describes in a lively section of The Noonday Demon. His insatiable curiosity and willingness to try almost anything, no matter how bizarre, are apparent in his discussion of ndeup, an animist ritual in Senegal that probably predates voodoo. Writing like a cultural anthropologist as well as a patient eager to search out the oldest or newest cures for mental illness, Solomon is told by an elderly woman who conducts the ndeup that his depression is caused by some of his spirits who are jealous of his sexual relations with his living partners. After haggling about the price – about $150 if he acquires the necessary ingredients for the ndeup, including two chickens and a ram – he was surrounded by five drummers while a radio played the theme music from Chariots of Fire. Dozens of onlookers witnessed the spectacle. Wearing only a loincloth, Solomon lay down on a grass mat and was told to hold the legs of a ram while dancing women kept striking both of them with a red cockerel. Soon the ram’s throat was slit, and as the blood poured out, the women then rubbed it over Solomon’s body. “My loincloth was soaked through and thousands of flies began to settle all over me, drawn by the smell of the blood.” With comic wit and verve, he devotes five pages to the ritual exorcism. After invoking the spirits with the words, “Leave me be; give me peace; and let me do the work of my life.

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I will never forget you,” he is finally pronounced free and participates in the celebratory dancing. Solomon’s evocation of ndeup could have been condescending or dismissive, but he has a surprise for his readers. The ndeup impressed me more than many forms of group therapy currently practiced in the United States. It provided a way of thinking about the affliction of depression – as a thing external to and separate from the person who suffers. He compares the ritual to jolting one’s brain into overdrive – “a kind of unplugged ECT” (p. 170).

ACKNOWLEDGING FATHER Solomon dedicates The Noonday Demon to his father, “who gave me life not once, but twice.” (Solomon had dedicated A Stone Boat to his father and brother.) It was his father who reassured him, when he lost confidence in himself and his ability to finish the book, that he would regain his health. His father took care of him when he couldn’t take care of himself. My recovery from depression was for my father a triumph of his love and of intelligence and will: he had tried to save one member of the family and failed, but he was able to save another. (p. 280) Solomon continues to offer heartfelt thanks to his father in later books. In Far from the Tree (2013), he refers to Howard Solomon as his most loyal reader. In an allusion to the mythic Icarus who, disregarding the advice of his father, Daedalus, flew too close to the sun and plunged to his death in the sea, Solomon refers to his father in Far and Away (2016) as “still my first and most loyal reader, and has been there with arms outstretched whenever I’ve flown too close to the sun” (p. 497). Solomon also pays tribute in his last two books to his stepmother, Sarah Billinghurst Solomon, thus demonstrating to readers of A Stone Boat that Harry’s father accepted his dying wife’s advice to remarry.

FAR FROM THE TREE We learn more about Solomon’s story of depression in his next book, Far from the Tree, which won many awards, including the National Book

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Critics Circle Award for Nonfiction. The book was made into a 2018 documentary directed by Rachel Dretzin and starring Solomon. The rage for conformity characterized not only Solomon’s own life – he thought he would have to die if anyone found out that he was gay – but his mother’s as well. She did not want to be the mother of a gay son, and she did everything she could to change this aspect of his identity. But she could not “fix” him. Solomon reveals another aspect of her intolerance: her belief that it was undesirable to be Jewish, a prejudice she had inherited from her father, “who kept his religion secret so he could hold a high-level job in a company that did not employ Jews” (p. 10). Solomon gives two examples of his mother’s Jewish anti-Semitism. She would see people who fit certain stereotypes and say, “Those are the people who give us a bad name.” When I asked her what she thought of the much sought-after beauty of my ninth-grade class, she said, “She looks very Jewish.” (p. 10) Tellingly, there is no mention of Harry’s mother’s anti-Semitism in A Stone Boat. The novel, which offers no hint of Harry’s family religion or ethnic origins, has a WASP cultural ambience that evokes an elite social class, despite being set in ethnically diverse New York City. Solomon reports in Far from the Tree that although his mother married a Jewish man, “she carried the anti-Semitism within her.” It’s not clear why Solomon did not disclose any of these details in his novel – perhaps he could imagine only one stigmatizing prejudice at a time. Perhaps he did not wish to reinforce anti-Semitism in England, the country in which his novel was published. Or perhaps, as Solomon suggested to me, A Stone Boat was a novel and not an autobiography, and some details of his family’s life did not serve the purposes of fiction. Whatever the explanation, we realize that life-writing, particularly when about mental illness or vulnerability, is entangled with social, familial, and relational networks. In Far from the Tree Solomon reveals that both his parents were uncomfortable with his gayness, something we do not see in the novel. Solomon lauds his supportive Horace Mann high school teachers who helped him come to terms with being gay (despite the fact, he admits sorrowfully, that years later some of the same teachers were accused of predatory abuse of male students while he was studying there): “Their implicit acknowledgment of my sexuality helped me not to become an addict or a suicide”

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(p. 12). Their support did much to avert the “tragic narrative” (p. 16) his parents feared would be inevitable. As part of his research for Far from the Tree, Solomon interviewed more than 300 families, producing nearly 40,000 pages of interview transcripts. The book itself is almost one thousand pages long. Each of the 12 chapters focuses on a different aspect of the search for identity: “Son, Deaf, Dwarfs, Down Syndrome, Autism, Schizophrenia, Disability, Prodigies, Rape, Crime, Transgender, and Father.” Most of the autobiographical comments appear in the first and last chapters. The book’s central thesis is that families who accept their children help promote their children’s self-acceptance. “Our parents are metaphors for ourselves: we struggle for their acceptance as a displaced way of struggling to accept ourselves” (p. 26). The book’s conundrum, Solomon admits, is that “most of the families described here have ended up grateful for the experiences they would have done anything to avoid” (p. 47). Solomon is a paradoxicalist with respect to difference, celebrating its healthy qualities, minimizing its harmful qualities, and highlighting the troubling ambiguities that lie in the middle. Indeed, irony, paradox, and ambiguity inform all his writings. He combines both idealism and realism. My own battles with depression have contributed to a meaningful identity for me, but if I were choosing between a depression-prone child and one who would never suffer such ravages, I’d go with option B in a heartbeat. Even though the illness would probably become a locus of intimacy for us, I still wouldn’t want it to happen. (Far from the Tree, p. 31) Solomon is not afraid to change his mind. He ended The Noonday Demon with the statement that he loved his depression – “because it had tested my mettle and made me into who I am” – but now he believes he could have gained the same benefits in other ways, such as from having a child with Down syndrome (DS). “It is not suffering that is precious, but the concentric pearlescence with which we contain it” (Far from the Tree, p. 43). Solomon understands the difficulty of embracing difference. Unsettlingly, those who are in one identity group are not necessarily sympathetic to those in another group. “Almost everyone I interviewed was to some degree put off by the chapters in this book other than his or her own” (p. 44). Solomon is a mental health and gay rights activist, but he is never a mouthpiece for the ideological left. Seldom embracing unambiguous

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truths, he notes that the attempt to dictate black-and-white policy about a spectrum condition like autism, which is both a disability and sometimes a rewarding difference, is inherently flawed. He understands why cochlear implants, which allow the deaf to hear, are regarded by some as a liberation and others as a form of genocide, comparable to a “final solution.” He recognizes that eliminating births of any subclass devalues them. A society in which fetuses with DS are routinely aborted believes that being born with DS is a “grave misfortune” (Far from the Tree, p. 189), which contradicts the experiences of families who love their DS children. Solomon knows that compassionate sympathy can be a noxious prejudice. “I do not care to spend time with people who pity me for being gay, even if their sympathy reflects a generous heart and is offered with egregious politesse” (p. 190). BECOMING A FATHER The final chapter in Far from the Tree, describing Solomon’s successful efforts to become a father, is a tour de force, illustrating his finest writing. He opens the chapter on an epigrammatic note. “I started this book to forgive my parents and ended it by becoming a parent. Understanding backward liberated me to live forward” (p. 677). The idea of children saddened him for years, reminding him of the “tragedy” of being gay and his parents’ repeated exhortations to marry a woman and have a family. Now, thanks to advanced reproductive technology, he has fulfilled their wish though not in a way his mother could have imagined. Solomon began working on Far from the Tree around the time he met his future husband, John Habich, who, as a sperm donor, had one biological child with a coworker, Laura Scher, and would soon have another. Long interested in becoming a father, Solomon and a female college friend, Blaine Smith, decided to have a child together. An essential difference between Habich and Solomon threatened to sabotage their relationship. Whereas Habich was merely the sperm donor to his two children, largely uninvolved with their development or with their mother, Solomon intended to have an explicitly paternal relationship with his child. Habich feared that Solomon’s relationship with his child and her mother might “lethally triangulate our relationship.” The protracted discussions among the two men and the mother escalated to “Balkan intensity” (p. 690). It took three years to resolve the fraught negotiations. A “leery convert” to gay marriage,

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Solomon admits that one of the reasons he decided to enter into a formal relationship with Habich was to demonstrate the depth of his commitment. The pregnancy was achieved through an IVF clinic; the baby, Blaine Solomon, was delivered by cesarean section on November 5, 2007. Solomon also wanted to have a baby with John Habich Solomon, whom he had married the previous June. The two agreed that Solomon would be the biological father, but the search for a woman who would provide the egg involved the same vexing quasi-eugenic implications – the married couple’s standards of intelligence, character, health, and appearance – that Solomon calls into question throughout Far from the Tree. Solomon’s research on identity and difference sensitized him to knotty ethical questions, and he worried how his history of depression would affect him as a father. Another fear involved being a gay parent. Feeling oppressed as a child, would he become an oppressive father? How would Solomon feel if his child turned out to be straight? Laura Scher, the mother of Habich’s two biological children, offered to carry the pregnancy. Solomon, Habich, and Scher decided not to have amniocentesis, largely because they wouldn’t know how to respond if the test indicated a potential abnormality. “My research had shattered that clarity, so I succumbed to avoidance” (Far from the Tree, p. 693). Solomon and Habich’s son, George, was born on April 9, 2009, and for a time it appeared that he had serious birth defects. His irregular muscle tone suggested the possibility of brain damage, and his head was unusually large, symptomatic of hydrocephalus or brain tumors. Suddenly Solomon was confronted with tortuous questions regarding how to respond to a “deformer baby.” He raises these thorny questions while deftly creating dramatic suspense as the baby undergoes one medical test after another. Nature is no stranger to irony, Solomon realizes, and he cannot stop ruminating over the possibility of producing a disabled child. Solomon agonizes over the stories he had heard from the 500 parents he had interviewed for the book. We recall the haunting line from T. S. Eliot’s poem “Gerontion” that he had cited earlier: “After such knowledge, what forgiveness?” George turns out to be healthy, and Solomon ends Far from the Tree with a feeling of profound gratitude. “Tragedies with happy endings may be sentimental tripe, or they may be the true meaning of love” (p. 701). We hear in these words an echo of Solomon’s statement in A Stone Boat that happy families are not all alike. Solomon describes himself on the penultimate page of Far from the Tree as an “historian of sadness,” but

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now he becomes a chronicler of love. Whereas The Noonday Demon is an atlas of depression, Far from the Tree is an atlas of the singular varieties of attachments that were, until recently, stigmatized. The Solomons’ new family becomes the final example of the hundreds of exceptional families appearing in Far from the Tree. Solomon doesn’t allude to A Stone Boat, but we recall the mother’s dying words to Harry: The best tribute you can pay to me as a mother is to go on and have a good and fulfilling life, and to love someone who deserves and returns your love. (p. 219) A Stone Boat and Far from the Tree are bookends, and Solomon’s fulfillment in love and work is a heartfelt tribute to many people, especially his mother. The title of Solomon’s book about parent–child relationships and the search for identity inverts the popular adage and takes on ironic significance. The son, now a father, is the apple that has fallen far from the tree, but the tree always remains within sight and is loved dearly.

FAR AND AWAY Solomon’s most recent book, Far and Away: How Travel Can Change the World, is an anthology of his extensive travel writings (2017), most of which appeared earlier in Harpers & Queen, The New Yorker, the New York Times Magazine, Travel + Leisure, and the New Republic. Solomon observes dryly that when he was promoting his two previous books abroad, he was struck by the different cultural attitudes toward depression. In Spain, almost every journalist who came to interview me began the conversation by saying, “I have never been depressed myself, but …,” and off we went, as I quietly wondered why these allegedly cheerful people had chosen to interview me in so much detail about mental illness. In Japan, every interviewer commented on his or her own depression but asked me not to mention it to anyone else. (p. 32) Far and Away is contiguous with Solomon’s two earlier books on psychology and family dynamics. All three books explore the psychic forces that shape difference and identity. Solomon now rarely mentions his earlier depression breakdowns and suicidality, suggesting that he has remained psychologically healthy, demonstrating ongoing recovery and resilience.

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WRITING Psychoanalysis, psychopharmacology, and a large support system of relatives and friends saved Solomon’s life. Nothing was more important to his recovery, however, than writing. Early in The Noonday Demon he cites Graham Greene’s observation: I sometimes wonder how all those who do not write, compose, or paint can manage to escape the madness, the melancholia, the panic fear which is inherent in the human condition. (p. 12) Surprisingly, one page later Solomon denies that writing The Noonday Demon was cathartic, though he adds a noteworthy qualification. Writing on depression is painful, sad, lonely, and stressful. Nonetheless, the idea that I was doing something that might be useful to others was uplifting; and my increased knowledge has been useful to me. I hope it will be clear that the primary pleasure of this book is a literary pleasure of communication rather than the therapeutic release of self-expression. The distinction between the therapeutic and esthetic benefits of writing collapses, though, in Far from the Tree, where Solomon admits that one of the surprises writing the book was that it “largely cured” his sadness. Another surprise was that although he began his research on the family “aggrieved” over his parents’ meddling into his life, he completed the book “forbearing.” His parents, he adds, always forgave him, and now he forgave them. “Writing has been a lesson in absolution, because I have seen the valiance love takes” (p. 46).

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7 “SOMEONE ACTS THROUGH MY BRAIN”: ELYN R. SAKS AND THE CENTER CANNOT HOLD

Elyn R. Saks’s 2007 memoir The Center Cannot Hold: My Journey Through Madness is extraordinary, “the most lucid and hopeful memoir of living with schizophrenia I have ever read,” as Oliver Sacks enthused in his blurb. Sadly, there are relatively few first-person accounts of schizophrenia, but that is precisely the point. About 1% of the population has schizophrenia, and only about 20% of this population are able to live a “normal” life. Living with schizophrenia brings with it special challenges; hence the quotation marks. As Saks remarks ruefully, “Comparatively few schizophrenics lead happy and productive lives; those who do aren’t in any hurry to tell the world about themselves” (p. 329). To write lucidly and hopefully about schizophrenia is only one of Saks’s achievements. A graduate of Vanderbilt University and Yale Law School, Saks is a chaired professor at the University of Southern California Gould School of Law. She is the author of several books about the intersections of law and psychiatry. She has a second career as both an adjunct professor of psychiatry at the University of California, San Diego and a faculty member at the New Center for Psychoanalysis. Saks received a MacArthur “Genius” Award in 2009 for her work as a legal scholar and mental health-policy advocate. She used the $500,000 grant to create the Saks Institute for Mental Health Law, Policy and Ethics, a think tank that fosters interdisciplinary research around issues of mental health. Her achievements become more

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stunning in light of living with paranoid schizophrenia, regarded as the most disabling form of mental illness.

SAKS AND MILLETT There are striking similarities between Kate Millett and Elyn Saks. The latter’s experiences with hospitalization, forced medication, the use of four-point restraints, and authoritarian psychiatrists were no less brutalizing than the former’s. Like Millett, Saks has been profoundly affected by the trauma of psychiatric hospitalization. All of her writings reveal her ongoing efforts to come to terms with this trauma, not to undo the past, but to expand the rights of others affected by mental illness. Some of the descriptions of The Center Cannot Hold evoke those of The Loony-Bin Trip, as when Saks recalls her hospitalization when she was a first-year law student. The memoir opens on a jarring note as Saks, studying in the Yale Law Library with two classmates late in the evening in 1992, began to speak gibberish and suddenly climbed through a window onto the roof of the building. Scaring her classmates, she reluctantly returned inside, but the next day, panic-stricken, she asked one of her professors for an extension on a paper. Sensing she was in a crisis, Professor M. invited her to his home for dinner, but not before she once again climbed to the roof of the law library, where she fashioned a belt made out of telephone wire and discovered a 6-inch nail to which she clung for protection. She then spent the next hour laughing, singing, and babbling. Later, during dinner, Professor M. drove her to the emergency room of the Yale-New Haven Hospital, where she explained that people were trying to kill her. When The Doctor comes in, he brings backup – another attendant, this one not so nice, with no interest in cajoling me or allowing me to keep my nail. And once he’s pried it from my fingers, I’m done for. Seconds later, The Doctor and his whole team of ER goons swoop down, grab me, lift me high out of the chair, and slam me down on a nearby bed with such force I see stars. Then they bind both my legs and both my arms to the metal bed with thick leather straps. (p. 3) Like Millett, Saks hesitated to write about her experience because of the shame and stigma surrounding mental illness. She feared that friends, colleagues, and students would look at her differently as a result of having

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schizophrenia. As Benedict Carey reported in an interview with Saks published in the New York Times on October 22, 2011, Her husband was against it; the risks were too high. Academic colleagues warned her that coming out with a disorder as serious as schizophrenia could only harm her. ‘You want to be known as the schizophrenic with a job?’ one said. Her closest friend, Stephen Behnke, while supportive, told her that she needed to make sure she was ready for such a perilous self-disclosure. “It was like she was about to jump off a cliff.” There were other reasons for not coming out, as she revealed in a “Conversation” with Robert A. Burt appearing in American Imago in 2008: “stigma is powerful, and people might see my work in mental health law as ‘special pleading’ or ‘unobjective’” (p. 311). Saks concluded that penning a personal account of mental illness, writing/righting wrong, would reach a far wider audience than authoring another scholarly book on the subject. The benefits, she felt, were worth the risks. Stigma is so powerful that it continues to prevent relatives from using their own name when writing about a family member’s schizophrenia. For example, one of the reasons the pseudonymous “Sarah Rae” wrote her 2013 memoir The Fog of Paranoia: A Sister’s Journey Through Her Brother’s Schizophrenia was to destigmatize mental illness. Her memoir is a probing study of her family’s experience when her brother was diagnosed with paranoid schizophrenia in his mid-20s. Her use of a pseudonym is understandable: to protect the privacy of her brother and family. The pseudonym nevertheless testifies to the lingering power of stigma even when one wishes to overcome it. “Anna Berry” also uses a pseudonym in her 2014 memoir Unhinged: A Memoir of Enduring, Surviving, and Overcoming Family Mental Illness. By contrast, Saks uses her own name, a decision that represents a victory over stigma. Saks resisted for years taking medication, partly because she didn’t believe she was mentally ill, and partly because she didn’t like the nasty effects of the potent drugs, which included weight gain; grogginess; fatigue; and the possibility of developing tardive dyskinesia, involuntary movements of the lips, tongue, and face associated with the long-time use of antipsychotic medication. Every time Saks attempted to cut back on the medication, however, the frightening psychotic symptoms returned: hallucinations, delusions, and violent thoughts. For years she struggled against

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taking antipsychotic medication, fearful that by doing so, she would admit to having a “brain disease.” Saks writes eloquently about the dehumanizing consequences of the psychiatric coercions to which she was subjected, particularly the overuse of mechanical restraints and forced hospitalization. “Perhaps I am an unusually shame-prone person,” Saks observes, in a statement that Millett could have made, but I recall instances of forced treatment – particularly longterm mechanical restraints for up to twenty hours – as being extremely traumatic. I had nightmares for years about this. Forced treatment causes feelings of shame and degradation, humiliation, and helplessness (there’s nothing you can do to stop it). (“Conversation,” p. 324) It’s unlikely that anyone who reads Saks’s accounts of forced treatment will regard her as unusually shame-prone. She may be unusually courageous, however, in writing about treatment that most people would not be willing to disclose. Unlike Millett, who was fiercely antipsychiatry, rejecting the use of hospitalization and medication even in extreme cases, Saks defines herself as “very pro-psychiatry but very anti-force” (“Conversation,” p. 324). She has played a key role in expanding the rights of mental patients. She has also become the country’s most impassioned advocate of the use of psychoanalysis and psychopharmacology for the treatment of serious mental illness. She has, in a Faulknerian sense, not only endured but also prevailed – largely as a result of effective antipsychotic medication; prolonged psychoanalysis; a large network of relatives, friends, and colleagues; an accommodating and stimulating workplace; and her indomitable personal qualities, including courage, fortitude, and, as she is quick to add, stubbornness.

THE HIDDEN PERSONAL ELEMENT BEHIND SCHOLARSHIP All of Saks’s books reflect her successful struggle with mental illness, though one can see this only in retrospect, after the publication of The Center Cannot Hold. Her first book, coauthored with Stephen Behnke, Jekyll on Trial: Multiple Personality Disorder and Criminal Law, published in 1997, explores the relationship between criminal responsibility and

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self-division, a vexing subject for those whose personality is shattered by serious mental illness. Schizophrenia is different from multiple personality, but both clinical disorders raise intriguing psychological, philosophical, and legal questions about the nature of identity and personhood. Two years later came Interpreting Interpretation: The Limits of Hermeneutic Psychoanalysis (1999), where, after examining different psychoanalytic approaches, Saks concludes that psychoanalysts have a duty to the truth with their patients. Her next book, Refusing Care: Forced Treatment and the Rights of the Mentally Ill (2002), is, apart from The Center Cannot Hold, the most personal, yet she doesn’t acknowledge the full extent of her firsthand experience with the subject. “Even more than my first two books,” she writes in the acknowledgments of Refusing Care, this book has deep personal meaning for me. I have worked in mental health law for years: as a legal advocate for the mentally ill, as a volunteer at a psychiatric hospital, as a therapist, and as a teacher. I care about the issues immensely. And I find them very difficult. What follows is my attempt to come to terms with these issues. Only after the publication of The Center Cannot Hold can one recognize the extent to which Saks has lived these issues as a patient.

“A FEW LITTLE QUIRKS” The title of Saks’s memoir comes from Yeats’s apocalyptic poem “The Second Coming”: “Things fall apart; the centre cannot hold; / Mere anarchy is loosed upon the world.” The poem dramatizes the violence of the Great War, but it also conjures up the madness of a disintegrating self. Born in 1955, Saks experienced what might have been early signs of mental illness when she was eight. She developed a “few little quirks,” such as lining up the shoes in her closet, shutting off the bedroom light only when the books on her shelf were organized in a particular way, and washing her hands repeatedly. Around the same time, she feared she was disappearing, a phenomenon she called “disorganization,” the collapse of a core self. “The ‘me’ becomes a haze, and the solid center from which one experiences reality breaks up like a bad radio signal” (p. 13). She found herself unable to sleep at night, terrified that a stranger lurked outside her

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bedroom window. These experiences were unnerving. She learned to hide her hallucinations and delusions by developing “masking skills” that turned out to be one of the central consequences of living with schizophrenia. Saks experimented briefly in high school with marijuana and mescaline, but she didn’t like the experience of altered consciousness, and “with equal parts of paranoia and bravado” she told her parents about smoking pot. Alarmed, they sent her to a drug addiction treatment center called Operation Re-Entry near her home in Miami. The rehab experience was largely positive, but it had an unexpectedly harmful influence on her, teaching her to avoid all drugs, a lesson that years later stiffened her resistance to taking antipsychotic medication when she experienced a more terrifying form of altered consciousness in the form of schizophrenia. She also had to overcome another life lesson taught by Operation Re-Entry, the belief that every battle can be won through heroic willpower. She discovered that some forces of nature, such as severe mental illness, cannot be overcome by fierce determination alone. Throughout The Center Cannot Hold Saks portrays her parents in a nuanced and candid way, a formidable task in light of her knowledge that they, along with their relatives and friends, will read the memoir. Saks is always judicious in her characterizations, a quality of temperament as well as her legal training. Her father is loving but strict, insisting during her adolescence when she appeared to be developing an eating disorder that she have three meals a day. She describes the vague threat of “steps” he used to “bend my will to his” (p. 25). He was the “boss” in the family, a man who “could be quite absolute in his opinions and reactions” (p. 9). Later in the story, her parents are concerned and supportive when she reveals her hospitalizations at Oxford, but they cannot mask their deep worry, which results in her steely determination to reveal as little of her psychological crisis as possible. One can imagine the depth of their anxiety and of her own. Saks reveals that a “wall of appropriateness” separated her from her parents; “we’d spent years carefully constructing it, I on one side with my particular set of tools, they on theirs, with the tools they’d chosen” (p. 118). Always careful to explain her actions, Saks offers three reasons for her decision early in her adult life not to confide the details of her illness or therapy sessions with her parents. First, I was ashamed; surely someone of my intelligence and discipline should be able to exert more power over myself.

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Second, I didn’t want to worry them; they had two other children, a business to run, and their own lives to lead …. Third (and this is the most sensitive of my reasons), I did not want them interfering in my life. (p. 153) Saks learns to distance herself from her parents, for both their sake and her own. Saks rejects two influential beliefs commonly held about schizophrenia in the mid-twentieth century: Frieda Fromm-Reichmann’s theory of the “schizophrenogenic mother” who supposedly was responsible for a child’s development of the disorder, and Gregory Bateson’s theory that children caught in a “double bind,” hearing contradictory statements such as “Come here, go away,” later develop schizophrenia. Neither explanation has withstood the test of time. Saks never suggests that her parents’ behavior was responsible for her illness, though she does acknowledge a genetic predisposition for the disease in her extended family. Saks graduated from Vanderbilt University in 1977 with a perfect academic record and was class valedictorian. Her mind was the source of great intellectual pleasure and the site of betrayal and terror. Her college years were largely uneventful, apart from her struggle with “self-care skills,” which are often an early precursor to mental illness, and a troubling incident where, daring herself, she swallowed an entire bottle of aspirin and then, horror-stricken, made herself vomit. In college she fell in love with ancient Greek philosophy and began to realize that philosophy and psychosis have much in common: “each is governed by very strict rules. The trick is to discover what those rules are, and in both cases, that inquiry takes place almost solely inside one’s head” (p. 40). After college Saks received a prestigious Marshall Fellowship to pursue graduate work in philosophy at Oxford University, beginning in the fall of 1977. Within the next few months she broke down twice. Believing she was evil and didn’t deserve to live, she burned her hands, developed anorexia, and grew obsessed with suicide. Twice she was hospitalized at the Warneford, which houses Oxford University’s Department of Psychiatry but remains an independent hospital governed by a National Health Service (NHS) trust. These experiences were frightening, but unlike American psychiatric hospitals, there were no locked doors at the Warneford, which meant that she could leave at any time. British psychiatric hospitals use

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restraints far less often than their American counterparts, and psychiatric institutionalization in the United Kingdom is usually voluntary.

THE QUESTION OF CONFIDENTIALITY Saks’s first hospitalization at the Warneford lasted for two weeks, the second, nearly four months. Diagnosed as suffering from severe depression – the schizophrenia diagnosis came years later – Saks decided to go into psychoanalysis with “Elizabeth Jones.” As Saks observes at the end of The Center Cannot Hold, I do not name my four analysts (I use pseudonyms in the text), because doing so could complicate their relationships with past and current patients. I owe my success and wellbeing – a debt I can never truly repay – to the work in psychoanalysis we have done together. (pp. 339–340) There is nothing in the rules of confidentiality that prevents patients from writing about their therapy. Jamison, we recall, named her psychiatrist in An Unquiet Mind, as did Linda Sexton in her two memoirs. Therapists, on the other hand, cannot do so unless they use heavy disguise or receive their patients’ permission. The issue of patient confidentiality is the subject of Saks’s 2013 book Informed Consent to Psychoanalysis: The Law, the Theory, and the Data. Paul Mosher and I discuss the same issues in our 2015 book Confidentiality and Its Discontents: Dilemmas of Privacy in Psychotherapy, which Saks reviewed in the Journal of the American Psychoanalytic Association in 2016. The rules of confidentiality do not prevent scholars from identifying a writer’s therapists if that information is already public. It’s unlikely that at the beginning of her professional career Saks considered writing a memoir about her experience with schizophrenia, for in an earlier publication she revealed the names of the first three of her analysts “who, through their generous and skillful attention, have helped me to love and to work” (p. x). Two of these analysts are now deceased, and consequently, I see no danger in revealing their identities: Martha Harris and Stanley W. Jackson. The third analyst is still alive, and I honor Saks’s decision to grant him anonymity, though I will refer to his publications, which point out ironies about their therapeutic relationship.

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“ELIZABETH JONES”/MARTHA HARRIS Saks’s portrait of “Elizabeth Jones” accurately reflects in every detail the life and work of Martha (Mattie) Harris (1919–1987), a British psychoanalyst of children and adults. Harris was responsible for child psychotherapy training at the famed Tavistock Clinic in London from 1960 to 1980. After the death of her first husband, Roland Harris, in 1969, she married an American medical psychoanalyst, Donald Meltzer, described in The Center Cannot Hold as a “transplanted American named Dr. Brandt” (p. 113). The married couple saw patients at their two residences in Oxford and London, though Meltzer was “absolutely convinced that an analyst who works at his own home places a useless burden on his patients, a burden of feelings of exclusion, curiosity, and confusion” (Sincerity and Other Works, 1994, pp. 553–554). There’s no indication in Saks’s memoir that she felt burdened by receiving treatment at Harris’s home. Martha Harris was known not for being a theorist but for her inspiring work as a clinician and teacher. Colleagues referred to her warmth, generosity, and resilience, qualities that appear throughout her therapy with Saks. “Though I never knew much about Mrs. Jones’s life,” Saks states in The Center Cannot Hold, I came to know her well from the way she reacted to me in the consulting room: with tolerance, patience, and understanding. Her voice was calm and soothing; she clearly didn’t frighten easily. At the same time, she was both extremely empathic and rigorously honest. She was also the first accomplished professional woman I had come to know. (p. 91) Influenced by the British psychoanalyst Melanie Klein, who emphasized the role of “primitive” (infantile) fantasies of aggression and envy, Martha Harris believed that Saks’s therapy should focus on the interpretation of her deepest anxieties, and this is what she proceeded to do throughout the analysis. Saks notes dryly that “Kleinian analysts can sometimes sound just as crazy as their patients do” (p. 90). She saw the analyst for three years, five times a week. Reparation is central to the depressive position in Kleinian analysis. “My psycho-analytic work has convinced me,” Klein writes in her 1937 book Love, Guilt and Reparation,

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that when in the baby’s mind the conflicts between love and hate arise, and the fears of losing the loved one become active, a very important step is made in development. These feelings of guilt and distress now enter as a new element into the emotion of love. They become an inherent part of love, and influence it profoundly both in quality and quantity. (p. 311) Making reparation, in Klein’s view, is a fundamental element in love and in all relationships. Saks’s analysis with Harris reveals the central roles of aggression, envy, and guilt during psychotic episodes. No less important, Saks’s gratitude toward Harris affirms the role of reparation. One can see the connection between Melanie Klein’s view of reparation and reparative mental illness memoirs, which seek to repair or heal intrapsychic and interpersonal conflicts. Eve Kosofsky Sedgwick, best known for her work on queer theory, wrote about reparative practices in her 1999 book A Dialogue on Love, in which she reveals her battle with breast cancer, to which she succumbed in 2009 at age 58. Memoirs like The Center Cannot Hold also reveal reparative practices and strategies for living with serious mental illness. Saks reproduces in The Center Cannot Hold a typical session to dramatize how Mrs Jones interprets psychotic statements that others might dismiss as mad ruminations: Mrs. Jones: “Tell me about your difficulties at university.” Me: “I’m not smart enough. I can’t do the work.” Mrs. Jones: “You were first in your class at Vanderbilt. Now you’re upset about Oxford because you want to be the best and are afraid you can’t be. You feel like you are a piece of shit from your mother’s bottom.” Me: “I’m closing the curtains from now on because people across the street are looking at me. They can hear what I’m saying. They are angry. They want to hurt me.” Mrs. Jones: “You are evacuating your angry and hostile feelings onto those people. It is you who are angry and critical. And you want to control what goes on in here.” Me: “I am in control. I control the world. The world is at my whim. I control the world and everything in it.” Mrs. Jones: “You want to feel in control because in fact you feel so helpless.”

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Me: “I had a dream. I’m making golf balls out of fetuses.” Mrs. Jones: “You want to kill babies, you see, and then make a game out of it. You are jealous of the other babies. Jealous of your brothers, jealous of my other patients. You want to kill them. And then you want to turn them into a little ball so you can smack them again. You want your mother and me to love only you.” (p. 92) With Harris’s help, Saks realizes that her fantasies enable her to avoid the pain of separation. Psychotic people who are paranoid do scary things because they are scared. And when you’re both psychotic and paranoid, it’s like that sweaty midnight moment when you sit bolt upright in your bed from a nightmare that you don’t yet know isn’t real. (p. 97) Saks learns that her paranoid perceptions are projections; yes, the world is a frightening place, but not as frightening as her own mind. Part of the significance of the sessions with Martha Harris is that although Saks did not receive a schizophrenia diagnosis at the time, she established a strong transference relationship with the analyst, a phenomenon that Freud believed was impossible with psychotic patients. Indeed, Saks established intense transference relationships with all of her analysts, contradicting the conventional wisdom that psychotic patients cannot be treated psychoanalytically. “I think it is demonstrably false that people with psychosis don’t develop transferences,” Saks wrote in an article published in a 2011 issue of the Journal of the American Psychoanalytic Association. “It’s just that they develop psychotic transferences” (“Psychoanalysis and the Psychoses,” p. 61).

THE FUNDAMENTAL RULE Martha Harris serves as a container or “holding environment” for Saks’s terrifying fears, particularly aggression, which is alternately projected outward and inward in the form of homicidal and suicidal threats, respectively. Harris encourages Saks to express all of her feelings, no matter how crazy or violent they sound. This is the “fundamental rule” of psychoanalysis, in which Freud urged patients to verbalize all of their thoughts.

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Act as though, for instance, you were a traveller sitting next to the window of a railway carriage and describing to someone inside the carriage the changing views which you see outside. (“On Beginning the Treatment,” SE, vol. 12, p. 135) But sometimes the fundamental rule is more honored in the breach, as Saks later discovers. She realizes the classic bind of psychiatric patients. They’re struggling with thoughts of wanting to hurt themselves or others, and at the same time, they desperately need the help of those they’re threatening to harm. The conundrum: Say what’s on your mind and they’ll be consequences; struggle to keep the delusions to yourself, and it’s likely you won’t get the help you need. (The Center Cannot Hold, pp. 161–162) What is perhaps more important than Harris’s clinical insights are her calmness and presence. “So calm, so reasonable, no matter what bizarre words and images she or I used” (p. 93). One suspects that had Harris used an entirely different psychological explanatory system, while at the same time displaying the same patience and support, the result would have been as therapeutic. Recall Doris Lessing’s observation in A Small Personal Voice about her own psychotherapist. I couldn’t stand her terminology, but she was a marvelous person. She was one of those rare individuals who know how to help others. If she had used another set of words, if she had talked Freud talk or aggressive atheism, it wouldn’t have made a difference. (p. 68) Saks has complete trust in the analyst, knowing that no matter how much rage she expresses toward her, Mrs Harris will listen empathically without judgment or condemnation. One can only imagine how daunting it must have been for the analyst to be the recipient of her patient’s frenzied statements. “Not everybody is suited for the loneliness of working with the psychoanalytic method,” Martha Harris observed in a 1979 paper: a paradoxical loneliness because one is also working intimately with another person. One is attempting to bear and take a degree of responsibility for parts of the patient’s personality

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which no-one has been able to bear before, yet having to realize that ultimately one cannot do anything to relieve him of those parts – that in the end each individual is alone and has to bear his own pain. (“The Experience of Analysis”) Martha Harris’s Kleinian orientation led her to accept Freud’s injunction for the analyst to be a “surgeon, who puts aside all his feelings, even his human sympathy, and concentrates his mental forces on the single aim of performing the operation as skilfully as possible” (“Recommendations to Physicians Practising Psycho-Analysis,” SE, vol. 15, p. 115). Switching metaphors, Freud suggests a few pages later that the analyst should be “opaque to his patients and, like a mirror, should show them nothing but what is shown to him” (SE, vol. 15, p. 118). Saks appears to accept this theory, which was the classical psychoanalytic position, though tellingly, Freud never practiced what he preached: he was never a blank screen to his patients. As Peter L. Rudnytsky pointed out in 2008, Freud’s espousal of a surgical model of psychoanalysis was a “wrong turn” in psychoanalysis “from which it is only now finally being rescued” (p. 3). One of the main developments in psychoanalysis has been the rise of intersubjectivity, patient and analyst sharing aspects of their lives with each other. Saks is careful not to tell the reader much about her analysts outside of her sessions with them, and while she is willing to analyze her transference relationships with them, she remains silent about their countertransference responses to her. In a 2012 volume of essays titled Enabling and Inspiring: A Tribute to Martha Harris, James Gammil likened the British analyst to Nadia Boulanger, who had the “gift of stimulating creativity” in some of the most eminent early twentieth-century composers of music. Another colleague, Gabrielle Crockatt, recalled a piece of advice Harris gave her that Crockatt passed on to generations of trainee child psychotherapists. “It is no use trying to combat omnipotence with omnipotence.” This idea has been helpful to me in so many ways, at work and in life, and I believe that Mattie lived by this precept. The depth of her knowledge and experience was enormous, but she wore it lightly, and was always open to new experiences, ready to listen to the most inarticulate and faltering of students with an ear for something alive and real in what they might be trying to convey. (p. 212).

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This is how Harris comes across in the portrait of Elizabeth Jones in The Center Cannot Hold. No references to Elyn Saks appear in Enabling and Inspiring, but there is a curious coincidence. In a tribute to her mother, who was a scholar of English literature and a teacher before becoming a psychoanalyst, Meg Harris Williams comments on Yeats’s “The Second Coming,” citing the line “the centre cannot hold.”

TERMINATION Near the end of the third year of analysis, Harris and Saks agreed that it was time for her to return home to the United States and resume her life there. The thought of separation was terrifying, and it became a central issue of therapy. Analysands describe the end of a long therapy as a death that often results in painful mourning, but few terminations were as traumatic as Saks’s when, holding onto the heating pipes lining the wall of the analyst’s waiting room, she was literally dragged screaming out of Mrs Jones’s office by her husband: “I’m not going!” I cried, and tightened my grip. In a gesture that made me feel like I’d been struck by lightning, the two of them suddenly grabbed hold of me and tried to pull me away. But I was taller than both of them, and had the added advantage of the pipes. Dr. Brandt was trying to loosen my grip, and Mrs. Jones was pulling me by the hair. We were all completely out of control, and I was sobbing and screaming wildly. How could this be my Mrs. Jones, yanking at my hair and ignoring my cries for her to stop being so unkind? (The Center Cannot Hold, p. 114) Many articles and books have been published about the difficulty of psychoanalytic termination, a word that is fraught with images of finality and death, as Glen O. Gabbard observes in the Foreword to Judy Leopold Kantrowitz’s Myths of Termination: What Patients Can Teach Psychoanalysts about Endings (2015, p. xiii). No description of termination, as far as I know, evokes the intense sadness, grief, and terror of Saks’s ending with Martha Harris. Kantrowitz cites Roy Schafer’s observation that termination is one of life’s “tragic knots” because, in Kantrowitz’s words, it involves “losing one of the most special relationships a person has ever

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had, while simultaneously recognizing that prolonging it is not realistic or productive” (p. 15). Schafer’s metaphor of “tragic knots” is especially appropriate for Saks, for her termination nearly results in her unraveling. Saks returned the next summer to Oxford for another two months of analysis with Martha Harris. That was the last time Saks saw the British analyst in good health. The following year Harris was in a car accident that left her with horrendous physical and psychological injuries. Saks returned twice to see the increasingly fragile analyst. Harris began weeping during their last visit, and when Saks asked if she had said anything to hurt her, the therapist’s reply is heart-breaking. “‘I’m sorry,’ she softly cried. ‘But I just don’t remember you’” (The Center Cannot Hold, p. 186). The only negative detail about Harris in the entire memoir occurred when Saks saw her for the first time. “She was, without question, the ugliest woman I’d ever seen” (p. 87). As Saks said farewell to her for the last time, “it occurred to me how truly beautiful she was.”

“JOSEPH WHITE”/STANLEY W. JACKSON Saks began law school at Yale in 1982, but within a few weeks she suffered a major psychotic breakdown and was hospitalized, an experience that has remained the most traumatic event in her life. Saks’s description of being placed in restraints with a net over her body at the Yale-New Haven Hospital conjures up the horrors of One Flew Over the Cuckoo’s Nest. Saks’s experience, however, was real. I screamed at the top of my lungs and struggled against the group of hands pinning me down, but I was no match for them, and soon the bands were fastened tight. Then it got worse, since apparently binding my arms and legs wasn’t enough. They arranged a net over me – an actual net – from the top at my neck to the bottom at my ankles, covering my legs, my torso, my chest. And then they pulled it snug at the four corners. I couldn’t move at all, and felt like all the breath was leaving my body. (The Center Cannot Hold, p. 149) Nothing at the Warneford traumatized her as much as this procedure, which, she adds, speaking as a researcher, results in between one and three deaths a week in American hospitals. She remained in restraints for

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nearly 30 hours, a brutal experience she never forgot. These moments of the memoir read like a Gothic horror story, evoking not only Kesey’s therapeutic nightmare but also Mary Jane Ward’s 1946 novel The Snake Pit. Saks’s analyst during her law school years was “Dr. Joseph White,” a senior member of the Yale medical faculty whose “scholarship also extended to the humanities.” She felt immediately comfortable with him. “White was distinguished-looking, with an almost patrician reserve” (p. 188). His theoretical orientation was different from Saks’s previous analyst. Where Mrs. Jones might discuss my envy, White discussed how my being overly admiring of someone allowed me to avoid my envy of them. He’d wait, listen, say a word or two, then wait and listen some more. White helped Saks realize that her violent thoughts were a response to feeling cornered. “The violence is your defense against fear,” he told her reassuringly. “You are safe here” (p. 190). Despite White’s relative silence, nothing escaped his attention. He also gently but firmly set limits, which included his requirement that she stop pacing in his office. “I need you to talk about what you are feeling,” he explained to her. “I need you not to act.” Saks describes White as her “co-pilot” who gave her the major responsibility for making crucial decisions, such as cutting back on her medication, but he urged her to increase her dosage after she became floridly psychotic again. We don’t witness their therapy sessions together in The Center Cannot Hold, but Saks tells us that he helped her understand that her psychosis “played a role in my psychological life – the unconscious mind serving as a defender of the conscious mind” (p. 213). White offered astute psychological interpretations of Saks’s psychotic symptoms. On one occasion, she became paranoid when a professor expressed high praise of a classmate’s work. “Someone’s trying to kill me,” she exclaimed to White. “He’s a friend, he’s an enemy, and he sent soldiers to the front where I was to explode my brain. I’m scared.” White reassured her that she was worried about her competitive feelings toward her classmate. “It’s sometimes easier to feel attacked than to feel angry or sad” (p. 190). Saks never discusses Freud’s theory of the “omnipotence of thought,” the belief that one’s thoughts are all-powerful. Freud was convinced that the omnipotence of thought plays a major role in the inner lives of

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children as well as in certain psychological disorders. The “omnipotence of thought,” Freud writes in Totem and Taboo (1913), the overvaluation of mental processes as compared with reality, is seen to have unrestricted play in the emotional life of neurotic patients and in everything that derives from it. If one of them undergoes psycho-analytical treatment, which makes what is unconscious in him conscious, he will be unable to believe that thoughts are free and will constantly be afraid of expressing evil wishes, as though their expression would lead inevitably to their fulfillment. (SE, vol. 12, p. 87) Saks implies that the omnipotence of psychotic thought is particularly powerful in schizophrenia. Her first two analysts remind her that thoughts do not have magical power to effect external reality. It’s hard to exaggerate the importance of Saks’s discovery of the omnipotence of psychotic thought. “It had simply never occurred to me that others didn’t also kill people with their thoughts” (p. 191). Over time she learns that she is responsible only for her behavior, not her fantasies. Saks was grateful that White, like Mrs. Jones, never hospitalized her despite occasions when he might have done so. He encouraged but never demanded that she remain on medication. For all my intense ambivalence about taking drugs, I nevertheless did take them most of the time – because in White, I had a medical professional who actually listened to me, trusted me, and rewarded my trust in him. (p. 214) There were two difficult moments during Saks’s analysis with White. The first occurred when he changed his initial diagnosis of her as suffering primarily from depression, not schizophrenia, to that of “schizoaffective disorder, depressive type.” The new diagnosis caused her temporarily to unravel. The second difficult moment came when White announced his retirement, though he later postponed it, which relieved her greatly. Like the earlier portrait of Elizabeth Jones, Saks’s characterization of Joseph White is based meticulously on her own analyst, in this case, the Yale psychiatrist Dr Stanley W. Jackson (1920–2000). An obituary in the Yale Bulletin & Calendar noted that Jackson’s work focused on

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the areas of psychotherapy, group work, psychoanalysis, the history of psychiatry and the history of medicine. His scientific articles covered such subjects as melancholia and depression, the etiology of schizophrenia and psychological healing, among others. In his 1986 book Melancholia and Depression, which, we recall, Solomon praises in The Noonday Demon, Jackson comes across as both scholarly and compassionate. Reviewing Melancholia and Depression in the New York Times, Robert M. A. Hirschfeld complains that Jackson’s accounts are “encyclopedic, sometimes to a fault,” but he concludes by thanking Jackson “for reminding us that depression is a serious, often devastating, clinical syndrome.” We can see from the concluding paragraph of Jackson’s book why Saks trusted him: However objective we may become about depression or about a particular depressed person, however carefully we may manage to identify neurophysiological and neurochemical factors in clinical depressions, someone else’s depression, defined as clinical or otherwise, is ultimately going to come home to us as a fellow human being who also has needs, who also knows something about personal losses, disappointments, and failures, who also knows something about being sad and dejected, and who has some capacity for distressed response to such a distressing state. With such distress, we are at the very heart of being human. (p. 404; Wolpert quotes the same paragraph in Malignant Sadness [25]) The same scholarly and compassionate approach may also be seen in Jackson’s 1999 book Care of the Psyche: A History of Psychological Healing. He quotes a statement Freud makes in Studies on Hysteria about the nature of the psychotherapist, but the passage is also true of Jackson himself. One works to the best of one’s power, as an elucidator (where ignorance has given rise to fear), as a teacher, as the representative of a freer or superior view of the world, as a father confessor who gives absolution, as it were, by a continuance of his sympathy and respect after the confession has been made. One tries to give the patient human assistance, so far as this is allowed by the capacity of one’s own personality and

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by the amount of sympathy that one can feel for the particular case. (p. 6; the quote appears in Studies on Hysteria, SE, vol. 2, pp. 282–283) Jackson doesn’t suggest in Care of the Psyche that all therapy can be reduced to psychological healing, but he implies that “it is an essential aspect of therapeutics, and that we ignore it at our peril” (p. 14). He is especially interested in the healer-sufferer relationship, and he singles out the value of talking and listening. Usually the sufferer has a story to tell the healer – what hurts, what is troubling, the nature of the suffering; and the healer listens and provides [what Paul R. Fleischman calls] “witnessed significance” for the sufferer’s account. (p. 384) Everything Saks tells us about Joseph White in The Center Cannot Hold confirms that Stanley Jackson fulfilled this role to her. He listened empathically to her story and responded with the insight, compassion, and patience she needed.

A PSYCHOANALYTIC RESEARCHER In law school Saks took a yearlong course on Freud taught by Professor George Mahl (1917–2006), a Yale professor of psychiatry who was also the president of the Western New England Institute for Psychoanalysis from 1972–1974. Mahl was an authority on the evolution of Freud’s work. Though she was terrified of research papers, Saks wrote an essay in Mahl’s course on one of Freud’s most famous case studies, Daniel Paul Schreber, the chief justice of the supreme court of the German state of Saxony. Schreber’s Memoirs of My Nervous Illness, published in 1903, caught Freud’s attention, resulting in his 1911 case study Psycho-Analytic Notes on an Autobiographical Account of a Case of Paranoia (Dementia Paranoides). Without disclosing her own struggle with paranoia, Saks offers in her research paper, published in the journal Psychoanalysis & Contemporary Thought in 1991 under the title “‘Soul Murder’ as Destruction of Psychic Integrity,” a new rereading of the seminal case study. Unlike Freud, who emphasized Schreber’s castration fear and homosexual wish-fantasy, Saks highlights Schreber’s reparative efforts to “recreate the objects he has destroyed and to replenish and satisfy his God” (p. 454). An outgrowth

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of Saks’s therapy with Martha Harris and Stanley Jackson, the article is a bold and compelling reinterpretation of an iconic psychoanalytic case study. Saks’s yearlong course on Freud and research on Schreber not only helped her understand how the unconscious mind serves as a defender of the conscious mind but also heightened her desire for further psychoanalytic training that would begin in a few years. After graduating from Yale, Saks taught for two years at a small New England law school, Quinnipiac, offering courses on legal research and writing, but the position had no possibility of tenure. In 1988, when she was 32, she suffered a subarachnoid hemorrhage, a “brain bleed,” a condition with a 50% mortality rate. After her prolonged recovery, she began applying for tenure-track teaching positions and received an appointment at the University of Southern California. She knew she needed to remain in psychoanalysis, and she begin interviewing analysts in the Los Angeles area. Around this time, a member of Saks’s family took his own life. He had spent a year at the Menninger Clinic in Topeka, Kansas, and a number of months at the Institute of Pennsylvania Hospital, where Saks herself had been treated years earlier. His suicide was devastating to everyone in her family, as Saks conveys in a single sentence in The Center Cannot Hold. “Suicide almost always leaves shipwrecked survivors in its wake” (p. 242).

“KAPLAN” Unlike Saks’s first two psychoanalysts, Elizabeth Jones and Joseph White, her third analyst is identified only by his last name, Kaplan. Calling him only by his last name suggests his lack of interpersonal warmth. White recommended Kaplan partly because the latter combined a psychoanalytic approach with medication, an approach that was not true of all psychoanalysts, many of whom were suspicious of psychopharmacology, and partly because of Kaplan’s “impressive professional resume included working with many seriously ill patients at a Los Angeles-area hospital” (p. 243). Saks realized while writing The Center Cannot Hold that the real-life analyst on whom Kaplan is based would probably read her memoir. She had the freedom to reveal anything she wanted to about her therapy with Martha Harris and Stanley Jackson, both of whom were no longer alive, but she must have felt constrained writing about the real Kaplan, who was still practicing though no longer her analyst. Her challenge was to

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be as honest and fair as possible. Complicating the situation was that she was writing not only as a patient but also as a law school professor and psychoanalyst-in-training. She knew that many of her colleagues in the law school and psychoanalytic communities would scrutinize every word about her treatment with Kaplan. Upon seeing Kaplan for the first time in 1989, Saks wondered whether he was “prepared for the kind of intensity and violence my episodes sometimes contained. Maybe the man was getting more than he bargained for” (The Center Cannot Hold, pp. 243–244). She remained in analysis with Kaplan for 13 years. “He was the analyst who helped me the most,” Saks told me. Their relationship, however, was often strained and sometimes tempestuous. Her criticisms are muted, as when she says that “while Kaplan was good, he wasn’t White (any more than White had been Mrs. Jones”) (p. 247). To his credit, Kaplan never became alarmed by Saks’s psychotic symptoms, never required her to be hospitalized, never doubted her ability to weather a storm. He was also available to her day and night, including on Sundays, when he would see her in his office during a crisis. Nevertheless, Kaplan doesn’t appear as empathic as her first two analysts. Nor was he as successful as his two predecessors in serving as a container for her psychotic thoughts. Saks accepts a degree of responsibility for their problems. Describing their work together as “our years-long battle,” she comments that their relationship would become similar to almost any other relationship between two strong-minded, stubborn people who see each other often. Some days it worked well, even happily. Other days, it was an unmitigated disaster. (p. 252) Her relationship with Kaplan is the most problematic in The Center Cannot Hold, and for that reason, it is the most engrossing.

THE LADY OF THE CHARTS One of Kaplan’s beliefs was that Saks viewed herself in three distinct ways: as “Elyn,” her personal self; as “Professor Saks,” her academic self; and as the “Lady of the Charts,” her psychotic self. Kaplan never regarded her as suffering from multiple personality disorder, but he came to believe

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relatively early in the analysis that she spent too much time on the couch “gibbering” and not enough time talking about her personal and academic lives. She never openly disagreed with Kaplan’s decision to close the door to her demons during her sessions, but she implies that she needed at the time the freedom to allow the demons to emerge, even if that meant much of the analytic hour would sound like mad ravings. She needed, in short, the freedom to exercise the fundamental rule of psychoanalysis. Both Harris and Jackson had given her the unlimited freedom to say anything she wanted during the analytic hour. They had the patience to listen indefinitely to her psychotic voices. Kaplan did not. The most revelatory sections of The Center Cannot Hold capture the Lady of the Charts voice. Saks’s language is richly metaphorical, as when she admits early in the story that she feels “like a bug, impaled on a pin, wriggling helplessly while someone contemplates tearing my head off” (p. 4). She compares her mental illness to an atmospheric disturbance and then deftly develops the simile. Schizophrenia rolls in like a slow fog, becoming imperceptibly thicker as time goes on. At first, the day is bright enough, the sky is clear, the sunlight warms your shoulders. But soon, you notice a haze beginning to gather around you, and the air feels not quite so warm. After a while, the sun is a dim lightbulb behind a heavy cloth. The horizon has vanished into a gray mist, and you feel a thick dampness in your lungs as you stand, cold and wet, in the afternoon dark. (p. 35) Saks doesn’t quote John Dryden’s observation that “Great wits are sure to madness near allied, /And thin partitions do their bounds divide,” but she acknowledges the link between creativity and mental illness. The connection is seen more often in mood disorders, such as manic depression, than in thought disorders, such as schizophrenia. Saks never romanticizes psychosis, but she succeeds in conveying the poetic word salad commonly associated with schizophrenic thought, where one utters words that sound similar, sometimes rhyming, but have no inner logical connection. When asked how she feels after going off antipsychotic medication, she refers to “killing fields” and then elaborates, like a rap artist: “Heads exploding. I didn’t do anything wrong. They just said ‘quake, fake, lake.’ I used to ski. Are you trying to kill me?” (p. 129). Or she uses neologisms, such as expressing pain over impending loss when terminating with Mrs Jones: “You can’t leave.

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I won’t let you. Plupenitenary issues must be addressed. That’s a dress. Come home with me, please?” (p. 111). Saks was grateful that Kaplan never hospitalized her, but their work together became increasingly combative. One problem was Kaplan’s insistence that she needed to be on antipsychotic medication, and although he was correct about this, she felt that the forcefulness of his opinions threatened her free will and autonomy. His formulaic recommendation when she became psychotic was to increase her medication dosage rather than help her understand the stressors in her life that triggered the psychosis. Another problem was his command that she sit in a chair rather than lie on the couch. Saks inferred from his decision that he had lost confidence in the analytic process as a treatment for her. “I’m seriously thinking of quitting with you” (p. 265), she shouts, livid with anger. A third problem was his diagnosis of schizophrenia, which he delivered in a “chilling and abrupt” manner, as if he were “serving his diagnosis up with a carving knife” (p. 267). The Center Cannot Hold reveals other problems in their therapeutic relationship. He “blew a gasket” when she suggested taking antianxiety instead of antipsychotic medication. “I’m just not going to put up with this anymore,” he fumed. If you reduce your meds again, you cannot stay in treatment with me. In fact, you can’t even talk about reducing your meds and stay in treatment with me. This stops now. (p. 281) If she could not allow her malevolent forces out of the closet in the safety of her analyst’s office, where she could defuse their wrath, how could she exorcise their terrible power over her? Kaplan refused to acknowledge that she was developing the symptoms of a mild case of tardive dyskinesia, even after the movement disorder was diagnosed by a schizophrenia researcher to whom Kaplan had sent her for evaluation. Kaplan was opposed to her decision to apply to the Los Angeles Psychoanalytic Society and Institute, which later merged with the Southern California Psychoanalytic Institute to become the New Center for Psychoanalysis. “Out of the question,” Kaplan opined in response to her desire to begin psychoanalytic training, though he later softened his position. Years later, he threatened to tell the institute that her analysis was no longer acceptable, which would have ended her training. Compared to Harris and Jackson, Kaplan is much less understanding, and each time Saks reluctantly returns to antipsychotic

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medication, her sessions with him have an implicitly judgmental “I told you so” quality. Why does Saks remain in analysis with Kaplan for several more years? She never directly confronts this question, apart from implying that he was right about the necessity for antipsychotic medication. Their relationship continued through the 1990s, a decade that was a particularly stressful time for her. She was in a romantic relationship that led to engagement and marriage; and she discovered that she had breast cancer. One can hear the pain in her voice as she describes her increasing frustrations and disappointments with her analyst: I’d accomplished many successful life changes during that time. But he’d often been hard on me, and over time (Kaplan’s many strengths and his humanity as an analyst notwithstanding) it had come to feel too hard, even punishing. He’d become more restrictive somehow – for example, he didn’t want me moving around the office; he didn’t want me to cover my face with my hands during our sessions, something I’d done with all my analysts to help me feel safe and contained. He kept saying that if things didn’t change, he’d “terminate” me. “I’m going to terminate you.” It was brutal to hear that, brutal for him to keep saying it. Was he doing it to elicit some kind of response from me? I didn’t feel safe with him anymore; he was unpredictable, mercurial, even angry. Some days, I’d walk out of session feeling like I’d been beaten up. (The Center Cannot Hold, pp. 321–322)

FAILING FATHERS Saks never speculates on Kaplan’s countertransference problems in treating her, but he comes across much of the time as a stern father figure, like her own father. Saks herself makes the connection when she suggests, parenthetically, that like her father, Kaplan “has a very strong personality” (p. 324). She implies that, again like her father, Kaplan attempted to bend her will to his. An awareness of the real Kaplan’s publications reveals a striking irony in the story of Saks’s analysis, for he regards harsh fathers as a major source of patients’ pathology. In Kaplan’s clinical experience, his patients’

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fathers tend to be seductive and divisive, and, in the rare instance when the father is caring and supportive, the patient’s mother is dysfunctional or even psychotic. The real Kaplan’s discussion of punitive fathers and his repeated threats to terminate Saks is particularly ironic in light of the lines from Sophocles’ Oedipus at Colonus that he cites in one of his publications. “Speak to me, father!” Antigone pleads, “Don’t turn away from me! Will you not answer me at all? Will you/ Send me away without a word?” Like Antigone, Saks felt rejected by an esteemed father figure, but unlike the daughter of Oedipus, Saks decided to be proactive, rejecting the analyst before he could reject her. There is no evidence in The Center Cannot Hold that Saks’s parents resemble those Kaplan discusses in his publications. Both of Saks’s parents appear to be supportive. It’s true that on two occasions Saks’s mother fails to respond to her daughter’s request for assistance. The first time occurred when Saks asked her mother to travel to Los Angeles to help with the wedding preparations. [S]he hesitated for a moment and then haltingly replied that it might be best if I took care of that end of things. I was stung for about a minute, then quickly decided that it was probably better that way. (p. 310) The second time occurred when a routine checkup following breast cancer indicated the possibility that Saks had ovarian cancer. Her parents inexplicably refused to visit their daughter during this worrisome time. It turned out that Saks didn’t have cancer, but she was crushed by their refusal to visit her when she feared she was at death’s door. She philosophically concluded she was strong enough to survive without them. Apart from these two instances, Mrs Saks comes across as a good-enough mother. The inescapable conclusion is that Saks’s characterization of her parents in the memoir fails to support the analyst’s overgeneralized clinical portrait of psychopathology. Saks’s analyst acknowledges being influenced by Melanie Klein’s concept of projective identification, a primitive defense mechanism in which part of the self is split off in fantasy and projected into another person, who then becomes a persecutory object. Unlike Klein, he views aggression and envy not as primary but as secondary to unacknowledged shame. The real Kaplan has written extensively about shame, yet there are times in The Center Cannot Hold when he intensifies Saks’s shame – the only one of her

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analysts who did this. Nor could he help Saks achieve restitution, coming to terms with aggression and envy. One can only speculate on the real Kaplan’s countertransference conflicts while treating Saks. It requires unusual patience and empathy to listen to a patient’s “schizophrenic outbursts,” particularly during a long analysis. Recall Martha Harris’s observation about the analyst’s “paradoxical loneliness” when witnessing “parts of the patient’s personality which noone has been able to bear before.” In his publications, the real Kaplan has more to say about the causes of his patients’ psychopathology than about methods of treatment, and he rarely discusses countertransference issues. There’s no evidence in the memoir that Kaplan realizes he is involved in a groundbreaking treatment of a patient suffering from schizophrenia who would later become a psychoanalyst herself.

CAPGRAS SYNDROME Saks reveals surprisingly few details of her long analysis with the real Kaplan, far fewer than she discloses about her sessions with either Martha Harris or Stanley Jackson. Her analysis with Kaplan took a “new, horrible turn” when, around the time of her tenth law school reunion, as a result of going off medication, she briefly developed Capgras Syndrome, a disorder in which one experiences familiar people as impostors. She likens the phenomenon to the film Invasion of the Body Snatchers.

JEKYLL ON TRIAL Saks’s terrifying experience with Capgras syndrome ended when she increased her antipsychotic medication, but she remained fascinated with the psychological, philosophical, and legal implications of split personality, as Jekyll on Trial (1997) demonstrates. Arguing that the classic rules for insanity do not apply to multiple personality disorder, she suggests that a new diagnostic disorder requires a new way of legal thinking. She realizes that multiple personality disorder remains a controversial diagnosis, one that was rejected by many clinicians. Nevertheless, the idea of radical dividedness captivated Saks. In all her books Saks carefully presents the arguments and counterarguments of the issues. Insofar as the alters existing in multiple personality disorder can be resolved through verbal therapy,

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she recognizes the impossibility of the situation; “aside from science fiction, we simply cannot imagine putting two people together” (Jekyll on Trial, p. 61). She has, nonetheless, two recommendations for the courts: first, the law should not attempt to fit all cases of multiple personality disorder into a single category; and second, people with multiple personality are not generally responsible for their crimes. Saks makes a prescient observation in Jekyll on Trial about the role of belief in multiple personality disorder and schizophrenia. “There is a kernel of truth to the idea that beliefs may matter in the case of the multiple but not the schizophrenic.” Whereas telling schizophrenics that the voices they hear are their own unconscious projections may not cure their delusions and hallucinations, telling multiple personalities that they are a single person may be therapeutically helpful. The distinction between multiple personality disorder and schizophrenia, however, may not be as sharp as it first appears. “Schizophrenics are often reassured, at least somewhat, by being told that their scary beliefs are but delusions resulting from their illness” (p. 139). Saks admits in Jekyll on Trial that she and her coauthor disagreed on some aspects of multiple personality disorder. “Far from being a burden, however, our theoretical and clinical differences have served to crystallize and clarify each of our positions in this complicated and interesting area” (p. xiii). In all her writings, Saks embraces the idea of difference between self and other, and so it seems fitting that she and her coauthor would disagree on a contentious psychiatric diagnosis. She never engages in binary thinking, never demonizes those who disagree with her. Saks shows in The Center Cannot Hold that schizophrenia involves the use of primitive psychological defense mechanisms such as splitting, but in her academic writings she demonstrates the most rigorous form of intellectual thinking. Saks did not have much in common with multiple personality patients, but she grasped the commonalities shared by those suffering from mental illness. Jekyll on Trial remains a thought-provoking book for anyone concerned about the ambiguities of identity and the complexity of moral and legal responsibility. Although far fewer cases of multiple personality disorder are being diagnosed now than in the last decades of the twentieth century, Saks’s study reveals the arrival of a brilliant new interdisciplinary thinker who is capable of teasing out the rich implications of psychology, philosophy, and the law. Jekyll on Trial remains an essential book for anyone interested in the law’s struggle to distinguish between sickness and evil.

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INTERPRETING INTERPRETATION Two years after the publication of Jekyll on Trial appeared Interpreting Interpretation (1999), the only book that is not directly related to Saks’s experience with severe mental illness. She became involved in hermeneutic psychoanalysis, she informs us in the preface, when, after beginning psychoanalytic training, she wrote an article on the problem of competency and unconscious delusions. “As is appropriate in a psychoanalytic work,” she then adds, “I have confessed the genetic roots of my project, at least the manifest ones” (p. vii). No one can blame her for being unready to confess the deeper, latent roots of the project. The heart of Interpreting Interpretation rests on what Saks calls the “argument from patient rejection,” the belief that “patients would reject hermeneutic psychoanalysis if informed of its true nature” (p. viii). Hermeneutic psychoanalysis is, in Saks’s view, any approach that focuses more on narrative truth than historical truth. Using her rigorous training in philosophy, the law, and psychanalysis as well as her fondness for taxonomy, she analyzes five visions of hermeneutic psychoanalysis that privilege meaning over facts or causes. Psychoanalysts have a duty to be truthful, she insists, and she is skeptical of any psychoanalytic approach that dispenses with the search for historical truth, however difficult and at times impossible it may be to achieve. The Center Cannot Hold reveals Saks’s commitment to the pursuit of historical truth. She strives to understand not only the familial and environmental forces that have shaped her life but also the impact of a serious mental disease whose causes and treatments remain shrouded in mystery. All her analysts are committed to the search for historical truth, and there are never serious disagreements over whether an event happened or how to interpret it. The analysts offer interpretations that she largely accepts. The main conflicts arise over whether she should take the medications prescribed to her. To accept the necessity for these antipsychotic medications is to accept that she has a “brain disease,” a truth she resists until the end of the story. Of all the memoirists in my study, Jamison would be the one most likely to agree strongly with Saks’s insistence on historical truth as the aim of psychotherapy. Slater, on the other hand, would argue for narrative truth. Both Styron and Millett would be dubious of all psychotherapy: they never express the belief that the talking cure can yield insights into a patient’s life. Linda Sexton stated that she was primarily interested in narrative truth,

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but to judge from the fictional psychiatrist in Mirror Images, she would also be sympathetic to the search for historical truth, given her efforts to understand her mother’s transgressive behavior. Andrew Solomon, I suspect, would also value the search for historical truth, though as a novelist, he would probably concede the difficulty of distinguishing fact from fiction. Interpreting Interpretation demonstrates Saks’s ethical commitment to her two professions. She learned from her training as a lawyer to be entirely client-centered, just as she learned from her training as an analyst to be entirely patient-centered. She is particularly troubled by hermeneutic approaches that claim to benefit patients but fail to do so. She singles out for criticism the hermeneutic approaches that are content to discuss “recovered memories” of childhood sexual abuse as illustrative of “narrative truth” without attempting to discover whether they reveal historical truth. She rejects the “thoroughgoing hermeneuts [who] believe that all knowledge involves the mere construction of stories” (p. 137, n. 6). False memories of childhood sexual abuse may give patients an “‘answer’ for their pain and dysfunction and may temporarily organize them,” but the false memories are “also likely to cause them considerable pain and suffering” as well as “wreak havoc on the patient’s relationship with her family members” (p. 146). Saks notes in passing that hermeneutic analysts “tend to be relational or intersubjective or both” (p. 223). This is true, but there is no reason analysts who are committed to the clinical model cannot be relational or intersubjective. As Maura Spiegel and Danielle Spencer remark in a volume of essays devoted to narrative medicine, in relational therapy, there is a “shift from the model of seer and seen to a bidirectional interaction where clinicians recognize themselves and their patients as subjective agents” (p. 34). Relational and intersubjective approaches emphasize the role of real and imagined relationships with others, a model of psychotherapy that can be used with patients suffering from thought disorders as well as mood disorders. Additionally, the importance of therapist self-disclosure has been one of the major developments in nearly all forms of psychotherapy in recent decades, though to date Saks has not embraced this position.

TERMINATING ANALYSIS WITH KAPLAN Judy Leopold Kantrowitz observes that the patient-analyst “match” is the greatest predictor of a positive psychoanalytic outcome (p. 11). Saks’s

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match with Kaplan was never as strong as with her first two analysts. Dismayed by the many ultimatums she received from Kaplan over the years, Saks made the fateful decision around 2002 to give him one of her own: either stop threatening her with termination or she would indeed end treatment with him. “Kaplan flat-out refused to change a thing.” Stunned, Saks broke off treatment, though the two agreed to meet for four more weeks. During each session, she admits, she wept over termination. Dr. Kaplan probably helped me more than anyone else in my life, and I love him today as much as I have ever loved anyone. For a long time, I carried inside me a palpable sense of loss. (The Center Cannot Hold, p. 324) That palpable sense of loss must have been difficult for Saks to mourn and work through in her psychoanalytic training. Kantrowitz points out that non-mutual endings, unilaterally decided upon, are generally more painful for the analysand than one that ends mutually. A few analysands believe that an unexpected termination had unanticipated benefits, but this doesn’t seem to be the case for Saks. We have, of course, only Saks’s side of the story of their clinical relationship, not Kaplan’s, but he seemed to have no awareness that they were making psychiatric history by showing how a patient with schizophrenia can be treated successfully with talk therapy and medication.

REFUSING CARE Around the time she was switching analysts, Saks published her third and perhaps most noteworthy book prior to her memoir. Refusing Care: Forced Treatment and the Rights of the Mentally Ill (2002), skillfully fuses her legal and psychoanalytic training. Saks acknowledges in the beginning the book’s autobiographical significance. Writing this book has been an important experience. Even more than my first two books, this book has deep personal meaning for me. I have worked in mental health law for years: as a legal advocate for the mentally ill, as a volunteer at a psychiatric hospital, as a therapist, and as a teacher. I care about the issues immensely. And I find them very difficult. What follows is my attempt to come to terms with these issues.

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Only in light of The Center Cannot Hold do we realize the full autobiographical significance of these issues. Saks knows from personal and professional experience that psychiatrists and lawyers have conflicting assumptions about mental patients. The former emphasizes patients’ needs, the latter, patients’ rights. With involuntary treatment, the doctor predicts cure and restored autonomy, with no treatment, deterioration and diminished autonomy. By contrast, with forced treatment, the lawyer imagines psychological and physical damage, as well as insults to autonomy, with upholding the right to refuse, good psychological effects and a preservation of or increase in autonomy. (Refusing Care, p. 11) Sympathetic to both approaches, Saks seeks a Solomonic solution to the vexing problem of when to use involuntary hospitalization, medication, restraints, and seclusion over a patient’s objections. Advocating a new approach to mental health law called “therapeutic jurisprudence,” the “evaluation of legal rules in terms of their therapeutic benefits or detriments” (Refusing Care, p. 17), Saks knows that the distinction between mental health and mental illness is often ambiguous. Mentally healthy people often have “pockets of psychosis,” while mentally ill people have “pockets of sanity” (p. 55). Mental health and mental illness thus exist on a continuum. Committed to both theory and empiricism, Saks proposes throughout Refusing Care several standards to guide the courts with respect to the use of “unwanted” psychiatric treatment. She recommends forced hospitalization, absent the likelihood to harm others or oneself, only during a patient’s first psychotic break, and only when the psychotic break is serious. Some people, she adds, will be better off without hospitalization. I am thinking of people like Kaye [sic.] Jamison, the manicdepressive psychologist at Johns Hopkins University School of Medicine, who, although she certainly suffered from psychotic manias, was able to avoid hospitalization all her life by relying on caring and helpful friends who looked after her interests when she was ill. (p. 61) Both Elyn Saks and Kay Redfield Jamison are trailblazers who not only wrote riveting memoirs about their own mental illness but also used their

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experience as patients to guide their research interests. Saks has devoted her life to expanding the rights of psychiatric patients; Jamison has devoted her life to exploring the relationship between mood disorders and creativity. Both are academic superstars and recipients of MacArthur Fellowships. But their attitudes toward psychoanalysis could not be more different. Jamison affirms psychotherapy but rejects psychoanalysis, which she regards as patriarchal and unscientific; Saks, by contrast, views psychoanalysis, along with medication, as essential for her survival. Of all the questions Saks raises in Refusing Care, the one with which she has struggled the most appears in Chapter 4: “The Right to Refuse Medication: When Can I Just Say No?” Rhetorically asking how she can know why patients refuse medication, Saks points to discussions of the question in the medical literature as well as to the anecdotal evidence from her own patients and clients. She then investigates the understandable fears that patients may have about the risks of psychotropic drugs. The never-medicated patient may think he is not really ill. He is experiencing difficulties, he is feeling bad – but it’s not an illness. Or the patient admits that he is suffering symptoms of illness but thinks that he can control them volitionally; if only he would exert more effort, he could feel better. His symptoms are in that sense a choice. Finally, the patient may admit that he has been ill in the past but he feels fine now and no longer needs the medication; he may feel these things even though he remains quite ill – but just feels a bit better than before. (p. 99) All of these fears of taking psychotropic drugs appear in The Center Cannot Hold. The psychiatric treatment that evokes Saks’s fiercest indignation is, not surprisingly, the use of four-point restraints. Only as a last resort, she insists, should they be used. Without discussing her own experience, she argues in Refusing Care, in opposition to psychiatrists’ claims, that patients determined to harm themselves can do so almost as easily in restraints as out of restraints. To be graphic about it, a patient can bite herself hard if she is determined to bleed to death. Patients can fight so much in restraints that they die of exhaustion. They can bruise and

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hurt their limbs by struggling. Most importantly, they are at serious risk of unintentionally dying by aspirating their own vomit, strangling, or having a heart attack. (p. 151) Using her scholarly voice in Refusing Care, Saks enumerates these horrors; using her memoiristic voice in The Center Cannot Hold five years later, she shows how these horrors are all-too-real.

DOCTORS FREED/FRIED Saks’s fourth analyst in The Center Cannot Hold is “Dr. Freed,” a name rich in symbolism. Freed is exemplary in every way. She had seen him once when Kaplan was out of town, immediately liked him, and asked if he would agree to be her analyst. Freed told her that he could not consider the question as long as she was in treatment with someone else. He then advised her to work out her problems with Kaplan, which she was unable to do. Every detail we learn about Freed is positive. Unlike Kaplan, Freed has a certain softness and gentleness about him. At the same time, he stands his ground. He doesn’t pull his punches with me; he homes right in on what I’m feeling, and helps me to understand how I sometimes use my psychotic thoughts to avoid the ordinary bad feelings that everyone experiences – sadness, rage, garden-variety disappointment. (pp. 324–325) Additionally, Freed holds out the possibility that Saks might be able to avoid medication in the future. Living up to his name, the analyst enables Saks to achieve the psychic freedom to be fulfilled in love and work, Freud’s definition of psychological health. Dr Freed evokes the memory of an earlier homonymic avatar, “Dr. Clara Fried,” the psychoanalyst who treats 16-year-old Deborah Blau in the semiautobiographical novel I Never Promised You a Rose Garden, published in 1964 under the pseudonym “Hannah Green.” Years later the author, sensing the irony of writing a novel about psychic integration while maintaining a double identity in the form of a pseudonym, decided to use her real name: Joanne Greenberg. The iconic novel, which has sold more than 10 million copies and been made into a 1977 film directed by Anthony Page and starring Bibi Andersson and Kathleen Quinlan, describes Greenberg’s four-year psychoanalysis with Frieda Fromm-Reichmann (1889–1957) at

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Chestnut Lodge in Rockville, Maryland. In 1967, Greenberg received the Frieda Fromm-Reichmann Award from the American Academy of Psychoanalysis, the first nonphysician to receive that honor. Greenberg and Fromm-Reichmann had intended to coauthor a story about their work together, but when the analyst died unexpectedly, Greenberg decided to fictionalize the story, which remains an accurate albeit incomplete portrait of their collaboration. While researching I Never Promised You a Rose Garden for my 1985 book The Talking Cure, I discovered that long before the novel appeared, Frieda Fromm-Reichmann had published accounts of it as a case study, without disclosing the patient’s name, in her two psychiatric textbooks: Principles of Intensive Psychotherapy, published in 1950, and Psychoanalysis and Psychotherapy, published posthumously in 1959. Most readers of I Never Promised You a Rose Garden assumed, as I did, that Greenberg was writing about schizophrenia, but Carol North and Remi Cadoret challenged that assumption in their 1981 article “Diagnostic Discrepancy in Personal Accounts of Patients with ‘Schizophrenia’” appearing in the Archives of General Psychiatry. Analyzing the symptomatology of five published accounts of patients purportedly with schizophrenia, including I Never Promised You a Rose Garden, the authors suggest that it’s unlikely any of the five characters would receive a clinical diagnosis of schizophrenia based on the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), which had been published a year earlier. “There was almost no consistent, ongoing display of DSM-III-defined schizophrenic symptomatology” in the novel, North and Cadoret state. The author described no delusions of control or thought broadcasting, insertion, or withdrawal; no persecutory or jealous delusions; no incoherence, loose associations, or illogical speech or poverty of speech in the presence of inappropriate affect; no delusions; and no catatonic or other disorganized behavior. (p. 136) The authors conclude that it’s more likely Deborah Blau suffered from somatization disorder, previously known as hysteria or Briquet’s syndrome, than schizophrenia. Significantly, all of the symptoms associated with schizophrenia may be seen in The Center Cannot Hold.

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LIFE WITH AND WITHOUT A REGULATOR Schizophrenia remains a baffling disorder or disorders: many researchers speculate that there may be several forms of the illness. Saks helps us to understand what it’s like to live with the illness. As Rene J. Muller concludes in a review of The Center Cannot Hold published in Psychiatric Times, the story “draws us into the interior world of the psychotic person, territory that few clinicians attempt to access or assess.” Trying to explain why she fell apart after White announced his retirement, Saks abruptly addresses the reader in the second person. How would you maintain your sanity, she asks, if you were besieged by literally hundreds of things clamoring for your attention? She challenges us to consider the following emergency: The regulator that funnels certain information to you and filters out other information suddenly shuts off. Immediately, every sight, every sound, every smell coming at you carries equal weight; every thought, feeling, memory, and idea presents itself to you with an equally strong and demanding intensity. You’re receiving a dozen different messages in a dozen different media – phone, e-mail, TV, CD player, friend knocking at the door, ideas inside your head – and you’re unable to choose which ones come to the front and which are relegated to “later.” It’s the crowd at the Super Bowl, and they’re all yelling directly at you. (The Center Cannot Hold, p. 229) Without a regulator, we realize, we would be as lost as Saks, but if we were reading The Center Cannot Hold, we might remember two of her strategies of survival. First, she says, look for clarity. Medication might be one solution, “if your body chemistry tolerates it.” Second, make your life as predictable and orderly as possible. Your goal, she reminds us, is to eliminate surprises. “What you lose in the way of spontaneity, you gain by sanity” (p. 230). We begin to understand while reading The Center Cannot Hold what it feels like to live without a regulator. Saks conveys what the German reader response literary critic Evelyne Keitel calls in Reading Psychosis (1989) the aesthetic experience of borderline psychological states. The aesthetic response to pathographical texts is characterized by certain ambivalent feelings which surface during the

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reading process: pleasure as well as a sense of oppression, paralysis and anxiety, those very feelings, in fact, that are called forth during a psychotic attack. (p. 6) Saks evokes both the fragmented self-arising from schizophrenia, including the feelings of oppression, paralysis, and anxiety, and the more integrated self-associated with ongoing recovery. The fascination of reading The Center Cannot Hold is that it expresses, in Keitel’s terms, how the “rational and the irrational both participate in the reading process” (p. 9). One reason Saks wrote The Center Cannot Hold was for its therapeutic value. “There’s a powerful urge in each of us to talk about our traumas” (p. 289) – and living with psychosis is certainly traumatic. Another reason was to give hope to others who suffer from schizophrenia. And a third reason was to “find a way to give back – to use what I’d learned and experienced, combined with professional training, to perhaps help someone else the way I’d been helped” (p. 296). Saks never loses faith in the belief that knowledge is power. The acquisition of knowledge remains an ongoing process for her. As she observed to Burt in 2011, an important difference between me and probably many analytic patients is that while analysis is supposed to end, I think I will need to be in analysis always. I am, in a word, a “lifer.” (p. 68) At the end of The Center Cannot Hold she raises a question that a friend had recently asked her. “If there were a pill that would instantly cure me, would I take it?” Jamison, we remember, raises the same question at the end of An Unquiet Mind. Jamison’s conclusion is that because her medication, lithium, works well for her, she would choose to have her illness. Saks answers the question differently. Mania in manic depression has been described as a sometimes pleasurable high that brings with it feelings of omnipotence. But that’s not the experience of schizophrenia, at least not for me. My psychosis is a waking nightmare, in which my demons are so terrifying that all my angels have already fled. So would I take the pill? In a heartbeat. (p. 336)

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Yet Saks doesn’t wish to end the memoir so negatively, and she concludes with the following sentences. “My good fortune is not that I’ve recovered from mental illness. I have not, nor will I ever. My good fortune lies in having found my life” (p. 336).

DR KING Saks’s current analyst, she told me after reading a draft of this chapter, is Dr King: I ended up leaving Dr. Freed after a few years because he was too passive/quiet for me. I have been seeing my fifth analyst, Dr. King, for around ten years. He is the youngest analyst I have had – only a few years older than I. I rather wish he were older. He is also a kind and personable man as well as someone who is very attuned to what is going on in my mind, even when I am not. He considers himself “eclectic,” although he is quite taken by mentalization approaches to therapy, which emphasize the ability to understand the subjective mental states of the people around us. I feel he keenly “gets” me. My only complaint about him is I fantasize that he has a charmed life, with very little adversity. This is likely to be false, as it is of most people. But it makes me think, on the one hand, that he can take better care of me because he is not captured by his own pain, and also think, on the other hand, that he will take worse care of me because he doesn’t know what pain is like firsthand.

HOPE FOR THE FUTURE Since the publication of The Center Cannot Hold, Saks has continued her pioneering interdisciplinary scholarship. In her 2013 coauthored book Informed Consent to Psychoanalysis, she proposes several innovative recommendations to strengthen patients’ ability to choose the form of therapy best for them. In a review, the law professor Anne C. Dailey commends the book for offering a “quintessentially analytic solution” to the conundrum of informed consent. In her 2017 book Law and the

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Unconscious: A Psychoanalytic Perspective, Dailey lauds Saks for her application of psychoanalytic theory to law. Additionally, Saks has written and spoken in public about her life with schizophrenia. Some of her audiences have been psychoanalysts. In “Psychoanalysis and the Psychoses: Commentary on Kafka,” published in the Journal of the American Psychoanalytic Association in 2011, Saks writes as a “patient with psychosis who has benefitted enormously from psychoanalytic treatment, four or five times a week for over three decades.” She points out that neurosis and psychosis exist in a continuum, a comment that Frieda Fromm-Reichmann had also made, along with Freud. One of Saks’s most suggestive comments is that there is always the presence of an “observing ego” among patients with schizophrenia: “speaking to both the psychotic and the nonpsychotic parts makes sense and does have the best chance of reaching the patient” (p. 63). One remark seems addressed directly to the real-life Kaplan who forbade her from dwelling on the Lady of the Charts. Sometimes when I would start speaking with loose associations, my analyst would insist that this was not free association, but just “gibbering.” To me this raises an interesting question: Why isn’t gibbering just the loosest of loose associations? Isn’t it the example par excellence of the primary process overtaking the secondary? (p. 64) In her “Conversation” with Robert A. Burt, Saks expresses gratitude for the enthusiastic critical and popular reception of The Center Cannot Hold. I wish there were a way I could help people when their relatives and friends won’t accept treatment. If I knew the answer to this, I would be the second person with schizophrenia, after John Nash, to get a Nobel Prize! (2008, pp. 311–312) Nash (1928–2015), the Princeton mathematician who shared a Nobel prize in 1994 for his work on game theory, suffered from schizophrenia from the late 1950s through the 1970s. The illness prematurely ended his career. Nash’s story, brought to life in Sylvia Nasar’s 1998 biography A Beautiful Mind, differs from Saks’s in that he was one of the few people to experience a dramatic remission. Saks comments in the same article that her rejection of hermeneutic psychoanalysis and demand for

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an empirical-oriented therapy might be related to the difficulty of “reality testing” caused by schizophrenia. I continue to think there is merit to my positions. I also recognize that other patients may not have as great a need to insist on “historical truth” as I do, so that my argument that most patients will agree with me – and reject mere “stories” – is not as strong as I once thought. (p. 320) Other audiences have been the nonclinical public. “There are not ‘schizophrenics,’” Saks states in a 2012 TED Talk that has been viewed more than three-and-a-half million times. There are people with schizophrenia, and these people may be your spouse, they may be your child, they may be your neighbor, they may be your friend, they may be your coworker. She acknowledges sadly that the L. A. County Jail is the “biggest psychiatric facility” in the United States. She asks the entertainment industry and the press to avoid harmful stereotypes when portraying people with serious mental illness. “Portray them sympathetically, and portray them in all the richness and depth of their experience as people and not as diagnoses.” Over three million people in the United States have a diagnosis of schizophrenia, Benedict Carey reported in the New York Times in 2015, and the standard treatment involves the use of antipsychotic drugs that often come with unbearable side effects. The side effects are often so debilitating that nearly three-quarters of patients prescribed medications for schizophrenia stop taking them with 18 months. But a 2015 study, the most rigorous to date conducted in the United States, concluded that schizophrenia patients who received smaller dosages of drugs and a bigger emphasis on verbal therapy and family support made greater strides in recovering over the first two years than those patients who received medication alone. The study, funded by the National Institute of Mental Health, showed that one-on-one talk therapy helped those with schizophrenia to “build social relationships, reduce substance use and help manage the symptoms, which include mood problems as well as hallucinations and delusions.” By the end of the study, Carey observed, those who received psychotherapy and family support were on drug dosages that were 20–50% lower than those receiving only medication. Carey, who

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had interviewed Saks in 2011, doesn’t mention The Center Cannot Hold, but it would be fascinating to study whether reading memoirs of mental illness heightens the power of psychotherapy, providing realistic hope that although people with serious mental illness may not achieve full recovery, they can, like Elyn Saks, with effective psychotherapists, medication, and a support system, find their lives.

CONCLUSION: THE CHALLENGES OF READING MAD MEMOIRS

William Styron, Kate Millett, Kay Redfield Jamison, Lauren Slater, Linda Sexton, Andrew Solomon, and Elyn Saks all affirm the writing cure, but would those familiar with their stories affirm the reading cure? When is reading therapeutic – and countertherapeutic? If, as is commonly believed, a book has the power to save a reader’s life, might there be circumstances when a book destroys or at least harms a reader’s life? Mad memoirs raise these provocative questions, and while the stories of illness and recovery usually serve as a lifeline for readers, they may occasionally have a less salutary effect, as we must acknowledge. Of the seven memoirists, Linda Sexton probably struggled the most with these questions. In Half in Love (Surviving the Legacy of Suicide) (2011), she tells us that her psychiatrist, Barbara Ballinger, suggested she write an account of her near-fatal suicide attempt. Sexton initially rejected the recommendation, fearing it would be precarious. The suggestion nevertheless intrigued her. Would she have the strength to write about the experience? Her main worry was whether the story would be toxic for the author and the reader. Sexton then cites J. M. Coetzee’s novel Elizabeth Costello, which implies, in Sexton’s words, that some experiences “are too dangerous to be put into words – too dangerous for the reader, but even more dangerous for the writer, who may feel overtaken and undone by them” (p. 247). The 2003 novel by the South African-born Nobel Laureate illustrates the perils of writing and reading. ELIZABETH COSTELLO Of the eight “lessons” offered by Elizabeth Costello, an “old and tired” Australian writer who has been invited to lecture on a variety of topics, the one that most concerns us is her belief that certain books cast a “malign spell” 323

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for reader and author alike. Although she refers to a single book, Paul West’s 1980 novel The Very Rich Hours of Count von Stauffenberg, which chronicles the unsuccessful plot to assassinate Hitler in 1944, her comments apply equally well to mental illness memoirs like Half in Love. Elizabeth is horrified by the sadistic way in which the imagined behavior of a hangman executes the would-be plotters. Reading West’s book literally sickens her, and she concludes that the words are obscene. “To save our humanity,” she asserts, “certain things that we may want to see (may want to see because we are human!) must remain off-stage” (pp. 168–169). Comparing a book to a bottle with a genie in it, Elizabeth remarks that the storyteller releases the unruly spirit into the world. We can put ourselves in peril by what we write, or so I believe. For if what we write has the power to make us better people then surely it has the power to make us worse. (p. 171) Elizabeth goes beyond urging writers to treat certain subjects carefully; she implies that it would be best not to write about these subjects. “I take seriously the claim that the artist risks a great deal by venturing into forbidden places: risks, specifically, himself; risks, perhaps, all” (p. 173). We cannot assume that Elizabeth Costello accurately reflects Coetzee’s authorial point of view: the mask of fiction separates the novelist from his eponymous character. Coetzee distances himself from Elizabeth in several ways, including her inability to respond to a question raised by a man in the audience: how can we know whether a reader or writer is harmed by a book? Linda Sexton doesn’t directly confront any of the questions raised by Coetzee, but it’s likely that her father and sister would endorse Elizabeth Costello’s warning: they too preferred not to read her story. Sexton could understand why they reacted this way; decades earlier, she felt like burning her mother’s correspondence. Instead, in an act of steely grit, she edited and annotated the letters, in the process discovering distressing truths of her mother’s life she wished she didn’t know. There is evidence in Half in Love that supports Elizabeth Costello’s warning. Linda Sexton mentions reading, prior to her suicide attempt, Final Exit, the controversial 1991 book by Derek Humphry, founder of the Hemlock Society in California, which gives practical advice about how to end one’s life. Such how-to books make suicide more accessible. It’s likely that Andrew Solomon and his family read a book like Final Exit to learn the precise details for the mother’s suicide in A Stone Boat. “I have a booklet,” Harry’s mother tells him,

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with instructions in it. It’s a booklet for people who want to end their own lives. It says when to take the pills and so on. I’ve been studying it. (p. 140) Jamison points out in Night Falls Fast that following the publication of Final Exit, “which presented in detail a variety of ways to commit suicide (including, prominently, suffocation by plastic bag), suicidal asphyxiations involving plastic bags increased by 31 percent” (p. 144). Sometimes even literary critics refuse to read books they know will depress them. In Agewise: Fighting the New Ageism in America (2011), Margaret Morganroth Gullette, who argues that we should not associate ageing with metaphors of decay, degeneration, and decline, admits that she refused to read a self-help book that was highly recommended to her, The 36 Hour Day, while caring for her mother who was suffering from Alzheimer’s disease. “It sits dusty on the bookshelf beside my bed.” Gullette avoids books about “decline narratives” in favor of more hopeful books, progress narratives. “If this is naiveté, leave me to hoard my tiny hot spark of life” (p. 202).

THE CONTAGION EFFECT Like germs, ideas can be contagious; suicidal ideation can be transmitted, directly or indirectly, from one person to another, often by glorifying or romanticizing the act. The dark emotions of suicide are especially infectious to readers who may already be at risk. The 1774 publication of Goethe’s highly autobiographical novel about spurned love and suicide, The Sufferings of Young Werther, is a case in point. Goethe was seriously depressed during the decade preceding the novel (which corresponds to the Sturm und Drang period in early German romanticism), contemplating suicide, like his fictional hero. “He even kept a dagger at his bedside,” according to Goethe’s translator, Harry Steinhauer, “and made repeated attempts to plunge it into his breast” (“Afterword,” p. 118). Intuiting the contagious effect of Werther’s suicide on the fictional Charlotte, who was based on the woman with whom Goethe had been in love in real life, the novelist informs us on the penultimate page of the story that “Lotte’s life was feared to be in danger” (p. 96). Writing the novel was therapeutic for Goethe – though he was later embarrassed by the novel and developed an aversion to it – but reading the novel was countertherapeutic for his admirers, pushing some of them over

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the edge, an example of fatal over-identification and the dangers of art. The Sufferings of Young Werther (1774) was an international bestseller, creating a sensation throughout Europe. Priscilla Wald does not discuss the novel in her 2008 study Contagious: Cultures, Carriers, and the Outbreak Narrative, but Goethe’s story evoked a spate of copycat suicides. “Sentimental young men sported Werther’s costume,” observes Steinhauer: “blue coat and yellow trousers and vest; some lovelorn creatures followed his example and committed suicide with copies of the novel in their pockets” (p. 124). Jamison notes in Night Falls Fast that in an effort to prevent the epidemic of copycat suicides following the publication of Goethe’s novel, the book was banned in Italy, German, and Denmark (p. 278). In a classic article published in 1974, the sociologist David P. Phillips showed that suicides increase immediately after a suicide story has been publicized in the newspapers. “The more publicity devoted to a suicide story, the larger the rise in suicides thereafter” (p. 340). Phillips coined the expression the “Werther effect”; other researchers have repeatedly confirmed the phenomenon. In his 2015 book Power of Reading: From Socrates to Twitter, the British sociologist and broadcaster Frank Furedi calls into question the Werther effect, implying it is an urban legend created by the print media. With the time and energy that authors of novels and of articles in the periodical press devoted to the policing of reading and literature, it was as if the print media was warning its readership about itself. (p. 118) But the evidence indicates otherwise. After the suicides of Kate Spade and Anthony Bourdain in June 2018, there was a 25% increase in calls to the National Suicide Prevention Hotline (TooFab). My students have enlightened me about the contagious nature of cutting. In Cutting and the Pedagogy of Self-Disclosure, coauthored with Patricia Hatch Wallace, I discuss an assignment I gave to an expository writing class in 2005 on the topic of falling in or out of love. “Maryann” wrote about falling in love with cutting when she watched an episode of the television drama series “7th Heaven” in the 10th grade. “Rather than listen to the show’s message that self-mutilation was horrible, I thought, ‘I should try that. Maybe I’ll feel better’” (p. 159). Maryann describes unflinchingly the graphic details of cutting, the relief she experienced while suffering from depression, and the difficulty of ending years of self-harm.

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She allowed me to read anonymously the essay in class; I believed the essay was a cautionary tale that would be valuable for her classmates to hear. A few weeks later, I asked each student to give an oral presentation on the most memorable essay or diary of the semester. “Paige” singled out the anonymous paper on cutting. The essay was so powerful for Paige that she thought she had written it herself: she too had cut herself in high school and was now attempting, after several failed efforts, to end the self-mutilating behavior. The problem, Paige confessed, to my consternation, was that hearing the anonymous essay reawakened her craving for cutting – not the effect I had expected. There are many examples of the contagion effect. Linda Sexton acknowledges the infectious nature of ideas. She began cutting herself (something her mother never did) after hearing a young woman, Susan, ask her when they were both hospitalized, “Are you a cutter?” Mystified, Sexton learns about the phenomenon for the first time. “I cut to keep myself from killing myself,” Susan enthuses. “It feels good, doesn’t it? The pain goes away for a little while?” (p. 145). Sexton dryly remarks that she wasn’t sure she wanted to speak to Susan. Soon Sexton began cutting herself. The aching and stinging from the cutting felt good, “a release from the agitation” (p. 147). In an insight that reveals the infectious nature of violence, Sexton shows in Mirror Images how Mira’s preoccupation with the gun her father wielded against her mother fuses with the pistol she sees in the 1978 film The Deer Hunter, where the doomed Nick, traumatized from the Vietnam War, repeatedly plays Russian roulette until he succeeds in killing himself. Mira cannot stop thinking about the film. The need to die was strong, like an addiction, in this movie. Putting a gun to your head every night for money was better than race car driving or blackjack. What a rush to dare to die so many times and beat it. (p. 250) Mira soon becomes obsessed with her father’s gun in Mirror Images, and, standing in front of the glass darkly, watches herself put a finger to her forehead. She places a bullet in the chamber and wonders whether she should shoot her mother or herself in a game of Russian roulette. She pulls back against the finger. Red light to the heart. There is a loud snap like the breaking of a bone. An empty chamber. And the anger, dark and rich and deep, eats her up. (p. 270)

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Surviving this suicide attempt, she fantasizes using the gun against her mother. Anne Sexton writes about the same fatal attraction to suicide in her poem “Wanting to Die.” Sexton was infected by the idea of suicide and spread it to her readers. She admitted that Sylvia Plath’s suicide deepened her own fascination with death. Sexton’s poem “Sylvia’s death” unapologetically romanticizes suicide. Apostrophizing Plath, Sexton exclaims that the “news of your death” awakened a “terrible taste for it, like salt” (Complete Poems, p. 127). Anne Sexton’s poem “Wanting to Die” has inspired at least one suicide attempt. Elizabeth Wurtzel notes in Prozac Nation that, while awaiting hospitalization, although there was no logic to the suicide imperative, it is just something that I must do, and something I must do right now. I think of those lines in the Anne Sexton poem “Wanting to Die,” in which she says that the urge to kill herself is with her always, even when she has nothing against life, because at a certain point, it’s not about having a reason: “Suicides have a special language,” she writes. “Like carpenters, they want to know which tools. They never ask why build.” (p. 282; Anne Sexton, Complete Poems, p. 142) The only tool at Wurtzel’s disposal is a full bottle of the antipsychotic Mellaril, which she then swallows in a half-serious effort to kill herself. Many people know about Sylvia Plath’s suicide, but far less well-known is the suicide of Assia Weevil, the woman with whom Ted Hughes lived after leaving Plath. In imitation of her famous rival, Weevil asphyxiated herself (and her young child) in 1969. Styron was long interested in the contagious nature of suicide. His short story “Marriott, the Marine,” first published in Esquire magazine in 1971 and then reprinted in The Suicide Run in 2010, contains an unexpected discussion of a little-known copycat suicide. Lt. Col. Paul Marriott of the US Marine Corps speaks with the authority of a literary historian when he informs the narrator, himself a Flaubert votary, of the disturbing case of Eleanor Marx Aveling, the English translator of Madame Bovary and daughter of Karl Marx. Yes, and another strange thing about her – she was rather badly unbalanced mentally and finally became totally obsessed by the life of Bovary, by the career of this woman she’d rendered into English. Finally she killed herself and in the identical

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manner of Emma Bovary – by taking poison. It’s one of the most curious tales in the history of literature. (The Suicide Run, p. 64) In high school, Saks tells us in The Center Cannot Hold, she read Sylvia Plath’s The Bell Jar (1963), and the experience heightened her estrangement from reality. She identified strongly with Plath’s severely depressed heroine, Esther Greenwood, who suffers a psychotic breakdown and nearly succeeds in committing suicide. What made the identification more unsettling was that although Esther appears to be cured at the end of the story, Plath committed suicide shortly after completing the novel. Reading dark stories like Plath’s can be disturbing for anyone who is already depressed. Moreover, a novel’s affirmative ending can be undercut by the novelist’s self-inflicted death. The contagion effect can also apply to music. A two-act chamber opera based on The Center Cannot Hold, cowritten by Saks and the psychiatrist Kenneth Wells, an opera librettist and composer by avocation, was staged at University of California, Los Angeles in 2016, and as reported by Mark Moran in Psychiatric News, the harrowing depiction of acute psychosis and involuntary restraints terrified many people in the audience, including Saks herself. “I have to say that watching it brought back painful memories – seeing how I was treated and how scared I was being restrained” (p. 8). Julia Kristeva refers to the contagion effect in Black Sun when she warns that Marguerite Duras’s novels should not be placed in the hands of “oversensitive readers.” Kristeva saw no danger in seeing Duras’s films and plays, such as her 1959 film “Hiroshima Mon Amour”; but her novels “bring us to the verge of madness” because they “domesticate the malady of death” by fusing with it, “without either distance or perspective” (p. 227). Never has art had so little “cathartic potential,” Kristeva adds. Changing metaphors, Kristeva observes that death and pain are the “spider’s web” of a Duras novel; “woe to the conniving readers who yield to its spell: they might remain there for good” (p. 229). Much of Black Sun is “impenetrable,” as Solomon observes, but her warning about Duras’s novels is unmistakable. Daphne Merkin knows that her memoir This Close to Happy will be painful for her daughter to read. Acknowledging the many people whose support and nurturance she valued while writing the memoir, Merkin reserves the last sentence for her daughter, the most important person in her life, but the one who will not read her words. “Finally, there is my

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daughter, Zoë, who prefers not to read what I write, but whose infusions of love and wisdom keep me afloat” (p. 288). Should we say about Daphne Merkin’s daughter that she experienced what might be called reader’s block, the refusal or inability to read a story that she knew would be deeply upsetting? We recall how distraught William Styron was when he read his daughter’s novel that contained an unflattering portrait of himself. Thousands of readers have been inspired by Darkness Visible, but presumably the same cannot be said about Reading My Father, despite its insights and mordant humor.

CONTAGIOUS PSYCHIATRIC DISORDERS The philosopher and historian of science Ian Hacking argues in his 1995 book Rewriting the Soul that “transient mental illnesses,” such as hysteria, fugue states, and multiple personality disorder, arise and disappear mysteriously, often spread inadvertently by new psychiatric diagnoses that reify illness. Building upon Hacking’s idea of “semantic contagion,” the belief that publicly diagnosing an illness creates the means by which it spreads, Carl Elliott describes in his 2000 article “A New Way to Be Mad” how the Internet is the catalyst behind a once rare phenomenon that has become increasingly common: apotemnophilia, the attraction to the idea of being an amputee. “Elective amputation,” Elliott writes, was once self-mutilation; now it is a treatment for a mental disorder. Toss this mixture into the vast fan of the Internet and it will be dispersed at speeds unimagined even a decade ago. The mere description of a condition, it appears, can make it contagious.

“THE AX FOR THE FROZEN SEA WITHIN US” Literature, in general, and mental illness memoirs, in particular, have a formidable power for good or ill. No one knew this better than Kafka, who in a 1904 letter to Oscar Pollack argues that the books we need are the kind that act upon us like a misfortune, that make us suffer like the death of someone we love more than ourselves, that make us feel as though we were on the

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verge of suicide, or lost in a forest remote from all human habitation – a book should serve as the ax for the frozen sea within us. (p. 16) Anne Sexton uses this statement for the epigraph to her volume All My Pretty Ones (Complete Poems, p. 48). There are disturbing ironies in Anne Sexton’s appropriation of Kafka’s words, as I wrote in Surviving Literary Suicide. As long as she was the poet of survival, Sexton could speak about the necessity of writing books that make us feel as though we are on the verge of suicide. But when she came to believe, around 1968, that she would never permanently emerge from depression, Kafka’s words assumed a more ominous meaning. The epigraph to All My Pretty Things reminds us that if literature is the ax for the frozen sea within us, axes nevertheless remain dangerous instruments and must be wielded carefully. There are times when the frozen sea cannot be safely unlocked, times when even an icebreaker must proceed cautiously. Poetry can indeed move readers to action, but if a survival poet becomes a suicidal poet, readers may find themselves stranded on an ice floe. (p. 189)

READING OPPOSITIONALLY Sometimes we read mad memoirs oppositionally, to avoid their bleak vision, to distance ourselves from their dangerous assumptions, or to preserve our own sanity. I demonstrate an oppositional reading of The LoonyBin Trip, where my belief system is in conflict with Kate Millett’s. Despite Coleridge’s injunction for the reader to suspend disbelief, I cannot accept Millett’s demonization of psychiatry as a force that equates mental illness with crime that must be punished through mind-numbing drugs and forced incarceration. Nor can I accept her characterization of her relatives and friends as conspiring and colluding against her. After reading The LoonyBin Trip, I believe that her relatives and friends tried to help her, and although their methods may have been at times heavy-handed and even misguided, I don’t think they were engaged in a sinister plot to silence her. One can sympathize with Millett’s critique of patriarchy in Western culture

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yet still believe that most mental health professionals seek to act in their patients’ best interests most of the time. The Loony-Bin Trip challenges me to read oppositionally and empathically; readers of the present book will determine whether I succeeded or failed in this effort. I readily admit that those who share Millett’s belief system may read my own book oppositionally. They might point out my failure to recognize with Millett and Szasz the destructiveness of psychiatric labeling and the extent to which mental illness is a social construct. They might point out that many psychiatric patients have spent years in crowded institutions receiving only custodial care. They might also point out the destructiveness of psychiatric treatments such as “psychosurgery” – a euphemism for brain-mutilating lobotomy. These readers may believe that I failed F. Scott Fitzgerald’s test of a first-rate intelligence: the ability to hold two opposed ideas in the mind at the same time and still retain the ability to function. The Loony-Bin Trip succeeds in initiating some readers into a Keatsian world of uncertainties, mysteries, and doubts without any irritable reaching after fact and reason. Others, however, such as myself, might not be able to embrace Negative Capability while reading The Loony-Bin Trip. Yet regardless of one’s attitude toward Millett’s memoir, it is humbling to remind ourselves of the challenges of reading mental illness stories. One can only paraphrase Freud’s favorite quotation: there are more things in heaven and earth than are dreamt of in our philosophy.

LITERARY DETECTIVES Styron had little use for literary critics, but he observes in Darkness Visible that after his depression and suicidality, he began rereading his novels in an effort to understand what they revealed about his unconscious – “an investigation belonging to literary detectives” (p. 78). For better or worse, I am one of those literary detectives. I don’t claim that I know Styron’s writings better than he knows them himself. I don’t. Rather, I try to detect both the conscious and unconscious patterns he has stitched into his fictions, locating what Joseph Conrad called the figure behind the veil. I believe that all literary critics, or at least all psychologically-oriented literary critics, attempt to do this. Similarly, I look for evidence in the other memoirists’ books that foretell the theme of psychological illness and recovery in all their works, not simply in their memoiristic writings. Literary detectives

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look for the continuities and discontinuities throughout an author’s work, the author’s insights and blind spots, the events an author includes and excludes from a story. Literary detectives may not find a smoking gun to confirm or disconfirm an interpretation, but it is instructive to compare a memoirist’s story with a relative or friend’s story in which we see a different and sometimes conflicting version of reality. Alexandra Styron’s memoir, for example, highlights many aspects of her father’s illness that are not apparent in Darkness Visible, just as Mallory Millett’s published comments call into question her sister’s characterization of their family and her state of health in The Loony-Bin Trip. As Harry Steinhauer remarks in his Afterword to The Sufferings of Young Werther, Goethe often asserted: “All my writings are but fragments of a great confession” (p. 97). This does not imply, the translator is quick to add, that each of Goethe’s books should be read as a roman à clef. Rather, Steinhauer suggests, Goethe was a subjective writer who used the raw materials which his own life provided for him as the thematic content of his art, who created out of his own personal experience rather than from a sheer empathic imagination. (p. 106) Similarly, although it would be an exaggeration to claim that all of the writings of the seven memoirists I discuss are fragments of a great confession, they all bear the signature of creative malady. Reading chronologically all the books of the seven memoirists, one discovers that the continuities throughout their lives are striking. Though they cannot predict the future, William Styron, Kate Millett, Kay Redfield Jamison, Linda Sexton, Lauren Slater, Andrew Solomon, and Elyn Saks use their early books as a preparation for later memoirs in which they disclose their history of mental illness. The landscape of depression in Darkness Visible appears throughout Styron’s writings, including a wraithlike observer who either struggles against or decides to embrace suicide. Kate Millett’s portrait of psychiatry as an oppressive force in The Loony-Bin Trip is part of her larger attack against patriarchy that unifies all her writings from the beginning to the end of her life. In her coauthored psychiatric textbook, Kay Redfield Jamison’s anonymous case study of a 17-year-old girl who becomes floridly manic in her twenties turns out to be herself, as we discover in An Unquiet Mind. Linda Sexton’s confessions in Searching for

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Mercy Street and Half in Love about her struggle with mood disorders may be seen in her first book, Between Two Worlds, and her four novels, where she adopts a variety of voices to explore her convoluted feelings about the beleaguered mother-daughter relationship. Lauren Slater created a new form of mental illness memoir in Lying partly to convey the baffling ambiguities of depression, which she chronicles in her first two mental illness narratives. Andrew Solomon’s revelations in The Noonday Demon about the link between homophobia and depression may be seen in his early bildungsroman, A Stone Boat, where we see hints of identity and gender conflicts that worsen after his mother’s death. And Elyn Saks’s battle with schizophrenia in The Center Cannot Hold helps to explain her lifelong interest in therapeutic jurisprudence, combining law and psychoanalysis to advocate on behalf of the mentally ill. Yeats stated in his autobiography that life is a preparation for something that never happens, but for the seven authors in this book, early writings on mental illness prepared them for later disclosures in their memoirs. In addition to the continuities, there were many surprises. No one would have predicted from William Styron’s novels that he would become near the end of his life one of the country’s most eloquent advocates of suicide prevention, tirelessly responding to letters from hundreds of readers who were in extremis, like himself. Kate Millett’s admission in the Preface to the 2000 edition of The Loony-Bin Trip that she had returned to a “small prophylactic dose of lithium” contradicts the ending of the earlier edition, where she announced triumphantly that she is no longer taking medication, proof, she insists, that she was never manic depressive. Readers may be taken aback by Kay Redfield Jamison’s sting of betrayal when she discovers that her physician-husband kept a syringe and a vial of antipsychotic medication in his bag to use if she developed the symptoms of a rare but potentially fatal reaction to neuroleptic drugs. Given the convincing ending of Linda Sexton’s first memoir, Searching for Mercy Street, where she appeared to come to terms with the demons of the past that had long haunted her, nearly everything about her second memoir, Half in Love, is stunning, particularly when she came close to killing herself, leaving her two young children bereft, as she and her sister were bereft after their mother’s suicide decades earlier. Lauren Slater’s mother’s reentry into her life, after the daughter had herself become a mother, is a shock, a reconciliation one never would have predicted from the first three mental illness memoirs. The mother’s suicide in Andrew Solomon’s novel has

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unintended and unwelcome consequences, as he admits in The Noonday Demon, though he still believes in rational suicide. Elyn Saks’s decision to remain in therapy for 13 years with an analyst who eventually forbade her from the expression of her psychotic voices is also unexpected, especially in light of her emergence as the country’s leading advocate of the value of psychoanalysis, combined with medication, in the treatment of schizophrenia. Literary detectives will be fascinated by the continuities and discontinuities in an author’s work, but they must recognize their own subjectivity, the extent to which, as Nietzsche observed, every interpretation reveals something about the interpreter – indeed, sometimes an interpretation may reveal more about the interpreter than the object of interpretation. Literary detectives would do well to remember that the attempt to imagine another person’s life, the task undertaken by the biographer, is impossibly difficult and probably impossible. Biography is “the impossible craft,” as Scott Donaldson remarks in his 2015 book of the same title – an impossible craft in part because biography involves the synthesis of so many disciplines. The most important of these disciplines for Donaldson is psychology. For our hypothetical drudge-critic-artist-historian-investigative reporter-polymath must have the empathy and imagination to create a life story about which the subject’s ghost might say, “that’s as close to me as anybody else could be expected to get.” (p. 103) Mental illness memoirs explore the myriad ways in which people slowly or suddenly fall ill and struggle toward recovery. The memoirs show us the authors’ various responses to illness, the treatments that worked or didn’t work, the people who befriended or betrayed them. The memoirs demonstrate what Jonathan Lear, a University of Chicago philosophy professor and psychoanalyst, calls in his most recent book of the same title, “wisdom won from illness.” Lear refers to the ways in which philosophy and psychoanalysis promote psychic health, but his evocative expression also applies to mental illness memoirs, which show the process of falling ill and the movement toward health. The memoirs plumb the depths of the unconscious in their investigation of illness, loneliness, and despair, and then they chart the ascent back to health, documenting how the journey has changed them. The memoirs affirm the role of psychological illness in the memoirists’ lives, how illness was for each writer a driving force, a catalyst, a spur, a creative malady. “[W]here a man’s wound is, that is where his

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genius will be,” observes Robert Bly in Iron John (1990), an essential text of the mythopoetic men’s movement, but his words speak to female readers as well, particularly in the context of creative malady: Wherever the wound appears in our psyches, whether from alcoholic father, shaming mother, shaming father, abusing mother, whether it stems from isolation, disability, or disease, that is precisely the place for which we will give our major gift to the community. (p. 42) The experience of mental illness is perhaps best told by memoirists who, fusing together their demons and angels into a single work, are wounded storytellers engaged in writing/righting wrong. Mental illness did not turn the storytellers into excellent writers, but, like a grain of sand that produces a luminescent pearl, illness served to cultivate their work. Each memoirist had to overcome the shame and stigma surrounding madness; each decided to reveal a “spoiled identity”; each refused to “pass” as mentally stable. It’s likely that each felt like an “impostor,” as Sherwin Nuland did, by writing novels, literary criticism, or psychiatry textbooks about mood or disorders without divulging their own personal experience. They all took a great risk by exposing their vulnerability, but by doing so, they revealed their powers of endurance. The twentiethcentury Belgian writer Georges Simenon, author of nearly 500 novels, observed that “Writing is not a profession, but a vocation of unhappiness” (1958, p. 132). The generalization is surely untrue of all writers, but it suggests the pain and shame that memoirists must feel when they write about mental illness.

A LIFELINE Most readers will agree that all seven memoirists expand our insight into the uncharted depths of psychological illness. Indeed, they are all dark enlighteners, and they help us understand what it’s like to suffer from severe mental illness and struggle toward recovery. The memoirists take readers out of their comfort zones into a frightening and destabilizing world of madness, but they provide us with a lifeline to return to safety, changed by the reading experience. Each memoir could be called “A Study in the Conquest of Grief,” the title of Stingo’s final entries in Sophie’s Choice. Regardless of whether the conquest is temporary or permanent, and regardless of

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how the conquest is achieved, the recovery is moving both esthetically and psychologically. Readers derive pleasure from the memoirists’ recovery, along with insights they can put to good use should they find themselves in the memoirists’ situation in the future. The healing relationship Styron established in Darkness Visible, where writer and reader felt a camaraderie with each other, each needing the other for a sense of well-being, was repeated to a greater or lesser extent by the other memoirists. Their stories allow us to see the centrality of illness in the writers’ lives, not simply in their memoirs, where the demons take center stage, but throughout the authors’ other books, where the demons may not have fully emerged. The memoirists would endorse the statement made by Isak Dinesen (Karen Blixen), the Danish author of Out of Africa (1937), that “all sorrows can be borne if you put them into a story or tell a story about them” (Mohn). The poet Gregory Orr cites this remark in Poetry as Survival (2002), adding a statement with which I concur: “No quote I know more perfectly expresses the survival function of story-making: it helps us to love” (p. 21). Mental illness narratives are survival stories, strengthening our hope and resilience, showing us how to live with mood or thought disorders, teaching us how to persevere in the face of adversity. Samuel Johnson famously said that nothing concentrates the mind like the prospect of being hanged in the morning. One can say that for the memoirists in my study, mental illness played the same role, awakening their creativity and giving them a mission in life. Sickness “is the means by which an organism frees itself from what is alien,” Rilke declared in Letters to a Young Poet; “so one must simply help it to be sick, to have its whole sickness and to break out with it, since that is the way it gets better” (1984, pp. 93–94). Or to modify Rilke’s words with which I opened this book, the memoirists all wrote like angels about the devils that besieged them. Literature has the power to heal as well as to sicken: the positive side of the contagion effect is inspiration. Mental illness narratives also teach selfcompassion, allowing us to accept our flaws and imperfections, motivating us to learn and grow, to become better people. The memoirists have sharply different views of the value of talk therapy, drug therapy, and hospitalization; they also disagree over whether they would take a magical pill, if available, that would instantly cure them of mental illness. Nevertheless, they all demonstrate in their writings that we need to see darkness to see the stars.

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BIBLIOGRAPHY WORKS CITED* Alvarez, A. The Savage God: A Study of Suicide. New York: Bantam, 1973. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. New York: America Psychiatric Association, 2013. https://doi.org/10.1176/appi.books.9780890425596 Andreasen, Nancy. The Creating Brain: The Neuroscience of Genius. New York: Dana Press, 2005. Anonymous. The Incest Diary. New York: Farrar, Straus and Giroux, 2017. Avrahami, Einat. The Invading Body: Reading Illness Autobiographies. Charlottesville: University of Virginia Press, 2007. Baldwin, Marjorie L. Beyond Schizophrenia: Living and Working with a Serious Mental Illness. Lanham: Rowman & Littlefield, 2016. Banville, John. “Setting the River on Fire Review: Recuperating the Poet’s Reputation.” Irish Times, April 15, 2017. Barnes, Julian. “Letter.” New York Review of Books, May 26, 2011. Beilke, Debra. “The Language of Madness: Representing Bipolar Disorder in Kay Redfield Jamison’s An Unquiet Mind and Kate Millett’s The Loony-Bin Trip.” In Depression and Narrative: Telling the Dark, ed. Hilary Clark, 29–39. Albany: State University of New York Press, 2008. *.  As I state in the Acknowledgments, after I finished a first draft of Mad Muse, I sent emails to the memoirists (or their literary agents), asking them if they were interested in reading and commenting on my chapters focusing on their writings. Kay Redfield Jamison, Linda Sexton, Andrew Solomon, and Elyn Saks agreed to read the entire manuscript, and I have incorporated their responses throughout the book.

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INDEX “Absolute panic”, 41 Accident of Hope: The Therapy Tapes of Anne Sexton, An (Skorczewski), 173–174 Affective illness, 113 Agitated depression, 49 Alcoholism, 141 Alice in Wonderland (Carroll), 251 All My Pretty Ones (Sexton, Anne), 195 All the Finest Girls (Styron, Alexandra), 74–76 Alternatives Beyond Psychiatry (Millett), 117 Alto Rhapsody (Brahms), 66–67 Ambivalence, 114 Analysis of a Phobia in a Five-YearOld Boy (Freud), 30 Anarchic disconnections, 34 Anatomy of an Epidemic (Whitaker), 247 Andreasen, Nancy, 8 Antagonistic biological interaction, 182 “Anti-suicide pact”, 134 Anticonvulsants, 249 “Anxiety of influence”, 94 Archaic Torso of Apollo (Rilke), 31 Are depression, 29 Art therapy, 49 Artistic creativity, 9 Assisted suicide, 260–263 “Assumptive world,” 196 At the Will of the Body: Reflections on Illness (Frank), 19 Attachment theory, 55 Auerbach, Daniel, 140, 155

Autobiografiction, 30 Autobiography, 11 Autodidact in medicine, 37 Autopathography, 11 Aveling, Eleanor Marx, 328–329 Avrahami, Einat, 6 Axis I disorders, 214 Axis II disorders, 214 Baldwin, Marjorie L., 112 Balkan intensity, 278 Ballinger, Barbara, 200, 323 Banville, John, 23, 156 Barnes, Julian, 237 Basement: Meditations on a Human Sacrifice, The (Millett), 91–92 Bateson, Gregory, 289 Bath, The (Cassatt), 176 Beckett, Samuel, 176 Beers, Clifford, 4, 12 Behnke, Stephen, 285–286 Beilke, Debra, 107–108 Bell Jar, The (Plath), 35, 63 “Berry, Anna,” 285 Berzon, Betty, 207, 270 Bespotted (Sexton), 203 Between Two Worlds: Young Women in Crisis (Sexton), 26, 165–166, 190 “Bewildering sorrow”, 39 Beyond Good and Evil (Nietzsche), 260 Beyond Schizophrenia: Living and Working with a Serious Mental Illness (Baldwin), 112

361

362

Beyond the Pleasure Principle (Freud), 84 Beyond Words: Illness and the Limits of Expression (Conway), 20 “Bible of Women’s Liberation” (see Sexual Politics (Millett)) Bibliography of First-Person Narratives of Madness in English (Hornstein), 6 Bibliotherapy, 23, 50, 62 Bipolar disorder, 10 bipolar I disorder, 103 bipolar II disorder, 103 in Jamison, 123–126 Bipolar Express: Manic Depression and the Movies, The (Coleman), 9, 49 Blackburn, William, 45, 71 Blaming the Brain (Valenstein), 247 Bloom, Harold, 94 Blue Dreams (Slater), 247–251 Blue Genes (Lukas, Christopher), 201–202 Bly, Robert, 336 Body, Illness, and Ethics (Frank), 18 Borderline Conditions and Pathological Narcissism (Kernberg), 227 Borderline personality disorder, 27, 29, 200, 207–209, 213, 221, 228, 233, 248 Borges, Jorge Luis, 176 Bourdain, Anthony, 326 “Breach of narrative promise,” 30, 237 Breggin, Peter, 247 Briquet’s syndrome (see Hysteria) Brooks, Peter, 236 Browne, Ivor, 105–106 Buchwald, Art, 68, 264 Burroughs, Augusten, 12 Burt, Robert A., 285, 318, 320 Camus, Albert, 65–66 Capgras syndrome, 308

Index

Care of the Psyche: A History of Psychological Healing (Jackson), 300–301 Carey, Benedict, 250, 285, 321 Carlat, Daniel, 247 Carroll, Lewis, 250–251 Caruth, Cathy, 19 Cassell, Eric J., 6 Catch (Heller), 55 Center Cannot Hold: My Journey Through Madness, The (Saks), 28–29, 283–322 Centers for Disease Control and Prevention, 135–136 Chesler, Phyllis, 117 “Cherry Tree, The” (Slater), 234–236 Chiasson, Dan, 156 Childhood sexual abuse, 224 Churchill, Winston, 144, 265 Churchill’s Black Dog, Kafka’s Mice, and Other Phenomena of the Human Mind (Storr), 9 Clark, Hilary, 7 Coercion as Cure: A Critical History of Psychiatry (Szasz), 110 Coetzee, J.M., 323–324 Coleman, David, 9, 49 Coles, Robert, 186 Cologne-Brookes, Gavin, 38, 68, 73, 76 “Coming out”, 18 “Commitment hearings”, 117 Community Mental Health Journal (Borkin), 115–116 “Complicated grief,” 47, 270 Compulsive memoirism of mentally ill, 1–4 Confessions of Nat Turner, The (Styron), 37–38, 42, 50, 52 Conjectured madness, 24 Conrad, Joseph, 22, 36, 38, 220, 332 Conspiracy, 94–95 Contagion effect, 136–137 “Continuing bonds”, 149–150

Index

Continuing Bonds: New Understandings of Grief (Klass, Silverman & Nickman), 150 Conway, Kathlyn, 20, 64, 67, 231 Corpus Callostomy, 233–234 Countershame techniques, 21, 114–115, 271 Couser, G. Thomas, 11, 221, 249 Crack-Up, The (Fitzgerald), 13–15 “Creative malady,” 7–8, 19, 28, 333, 335–336 Creative Malady (Pickering), 7–9 Creativity, madness and, 154–157 “Curing” homosexuality, 271–273 Cyclothymia, 122–123 Dailey, Anne C., 319–320 Danaher, Mallory Millett, 82, 95–97, 100–102, 105, 116, 141, 333 “Dark Lady of American Letters” (see Illness as Metaphor (Sontag)) Darkness Visible (Styron), 4, 23–24, 29–30, 33–80, 141, 265 “Dean of American Letters”, 8 Death’s Door: Modern Dying and the Ways We Grieve (Gilbert), 21 Deferred adolescence, 260 Deinstitutionalization, 250 Depression, 4, 102, 113 Depression and Narrative: Telling the Dark (Clark), 7 “Destructive symbiosis,” 199, 242 Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 103 Diagnostic and Statistical Manual of Mental Disorders (DSM-III), 316 Dialectical behavior therapy (D. B. T), 208 Diaries to an English Professor: Pain and Growth in the Classroom (Berman), 22 Dickens, Charles, 210, 251

363

Dickey James, 195 Didion, Joan, 208 Dinesen, Isak (Karen Blixen), 337 Disgrace (see Shame) Disorganization, 287 Divided Self, The (Laing), 105 Divine Comedy (Dante), 207 “Doctors Freed/Fried”, 315–316 “Dodo bird effect”, 250–251 Dolphin, The (Lowell), 151, 156 Donaldson, Scott, 15, 335 “Double bind,” 289 Double Image, The (Sexton, Anne), 182–184 Down syndrome (DS), 277–278 Dr King, 319 “Dr. Joseph White”, 297–301 Duhl, Frederick, 197 Duras, Marguerite, 329 Dying to Teach: A Memoir of Love, Loss, and Learning (Berman), 22 Eakin, Paul John, 186 Eddy, Mary Baker, 8 Electroconvulsive therapy (ECT), 17, 76 Eliot, George, 9 Eliot, T. S., 265, 279 Elms, Alan C., 103 Embarrassment (see Shame) Empathy, 6, 12, 25, 31, 59, 101, 136, 142, 155, 308, 335 Emperor’s New Drugs, The (Kirsch), 247 Enabling and Inspiring: A Tribute to Martha Harris, 295 Epilepsy, 27, 210, 218–226, 230–236, 238, 243–244, 249 Epilepsia, 231 Essential softness, 260 Etkind, Marc, 77 “Exaggerate”, 222 Experiments in Life-Writing (Novak), 30 Exuberance (Jamison), 120, 140, 142–145

364

Fake memoirs, 11–13 Falling illness, 226 Far and Away: Reporting from the Brink of Change: How Travel Can Change the World (Solomon), 280–281 Far from the Tree: Parents, Children, and the Search for Identity (Solomon), 28, 275–280 Feldman, Marc D., 232–233 Female masochism, 87 Feminine Mystique, The (Friedan), 165 Feminism, 167 Filicide, 243 Fitzgerald, F. Scott, 13–15 Flaherty, Alice W., 1–3, 8, 17, 48–49, 80, 143 Flying (Millett), 87–89 Fog of Paranoia: A Sister’s Journey Through Her Brother’s Schizophrenia, The (Rae), 285 45 Mercy Street (Sexton, Anne), 192–194 Four-point restraints, 110, 139, 284, 314 Frank, Arthur W., 63, 114 Frankenstein (Shelley), 125 Freud, Sigmund, 4, 8, 14, 28, 30, 42, 50, 84, 115, 138, 149, 150, 200, 216– 217, 225, 242, 269, 293, 295, 298–302, 315, 320, 332 Freund, John, 190, 198 Freudianism, 60 Frey, James, 11–12 Friday, Nancy, 227 Fromm-Reichmann, Frieda, 289, 315–316, 320 Furedi, Frank, 326 Gabbard, Glen O., 296 Gary, Romain, 65

Index

Genet, Jean, 85 Gilbert, Sandra M., 21 Girl, Interrupted (Kaysen), 5, 208, 244 Glenmullen, Joseph, 247 Goethe, Johann Wolfgang von., 31, 67, 112, 325–326, 333 Goffman, Erving, 18, 63, 208 Going to Iran (Millett), 91–92 Golden Notebook, The (Lessing), 89, 109 Good Shufu, The (Slater, Tracy), 27, 246–247 Good Soldier, The (Ford), 220 Goodwin, Frederick J., 25, 120, 127–128, 138–139, 200 Graf, Max, 84 Great Gatsby, The (Fitzgerald), 14 Greenberg, Joanne, 28, 63, 315–316 Grief, 148–150 Grief Counseling and Grief Therapy (Worden), 150 Gullette, Margaret Morganroth, 325 Gynicide (Hadaller), 44 Hacking, Ian, 330 Hadaller, David, 44 Half in Love: Surviving the Legacy of Suicide (Sexton), 26, 29, 159–203 Halsted, William, 147 Hamilton, Ian, 153–154 Hampl, Patricia, 14–14 Hamlet (Shakespeare), 265 Hardwick, Elizabeth, 153, 155–156 Hardy, Barbara, 83 Hardy, Thomas, 54–55 Harris, Martha, 290–297, 302, 304–305, 308 Harrison, Kathryn, 186 Hastings, Chris, 167 Hawkins, Anne Hunsaker, 4, 6 Heaney, Seamus, 23 Heller, Joseph, 55

Index

Hemingway, Ernest, 15, 38, 45, 64–65, 125, 195 Hemlock Society, 324 Henke, Suzette, 23 Hermeneutic psychoanalysis, 287, 300–311, 320 “Hermeneutics of suspicion,” 31 History of English Autobiography, A (Vickers), 4 History of Psychiatry, A (Shorter), 247 “Hoax memoir”, 12 Homophobia, 257–260 Hornstein, Gail, 6 Horrific depression, 244 Hostile introject, 43 Hotchner, A. E., 45, 195 House at Pooh Corner, The (Milne), 144 How Our Lives Become Stories: Making Selves (Eakin), 186 “How to Market this Book”, 236–237 How We Die: Reflections on Life’s Final Chapter (Nuland), 15, 18 Hughes, Nicholas, 160, 195 Hughes, Ted, 160, 328 Humanistic psychological model, 118 Humiliation (see Shame) Hypatia (Steinbuch), 115 Hypergraphia, 3, 210 Hypocrisy, 148 Hypomania, 102–105 Hysteria, 316 I Never Promised You a Rose Garden (Greenberg), 28, 63, 315–316 Illness as Metaphor (Sontag), 215–216 Illness as Narrative (Jurecic), 4 “Illusion of Mental Illness, The”, 117 Incest Diary, The, 186–187 Indulgence, 169

365

Interpreting Interpretation: The Limits of Hermeneutic Psychoanalysis (Saks), 287, 310 Invading Body: Reading Illness Autobiographies, The (Avrahami), 6 Irony Tower: Soviet Artists in a Time of Glasnost, The (Solomon), 255 Is It Me or My Meds: Living with Antidepressants (Karp), 114 Jackson, Stanley W., 297–301 Jacob’s Room (Woolf), 264 Jamison, Kay Redfield, 119 achievements, 121–122 An Unquiet Mind, 126–127 awards, 120 bipolar disorder, 123–126 contagion effect, 136–137 Exuberance, 120, 140, 142–145 grief, 148–150 Manic-Depressive Illness, 120, 127–132 Night Falls Fast: Understanding Suicide, 120, 134–136 Nothing Was the Same, 120, 145–148, 150, 155 using psychiatric records, 151–153 psychiatrist for, 137–140 Robert Lowell: Setting the River on Fire, 120, 122, 150–151, 154–157 “Severely Depressed. Very Quiet”, 131–134 study of madness and creativity, 154–157 textbook diagnosis, 153 as therapist, 148 Touched with Fire, 120, 122–123 writing about family, 140–143 “Jargon of authenticity”, 232 Jarrell, Randall, 65

366

Jekyll on Trial: Multiple Personality Disorder and Criminal Law (Behnke and Saks), 286, 308–309 Jekyll-Hyde duality, 133 Jones, Anne Hudson, 118 Jones, Elizabeth, 291–293 Joseph Conrad: Writing as Rescue (Berman), 22 Jude the Obscure (Hardy), 54 Jurecic, Ann, 4, 6 Kafka, Franz, 49, 176, 320, 330–331 Kantrowitz, Judy Leopold, 296, 311–312 Kaplan, 302–303, 305 terminating analysis with, 311–312 Karp, David A., 114 Kaysen, Susanna, 2, 5, 208, 244 Keats, John, 14 Keir, Sophie, 92 Keitel, Evelyne, 317–318 Kernberg, Otto, 227 Kesey, Ken, 298 Kierkegaard, Soren, 5, 7, 237 Kirsch, Irving, 247 Kiss, The (Harrison), 185–188 Klass, Dennis, 150 Klein, Melanie, 291–292, 295, 307 Kleinian analysis, 291 Klonopin, 244 Kramer, Peter, 212 Kriegel, Leonard, 230 Kristeva, Julia, 265, 329 Lack of willpower, 169 Laing, R.D., 105–106 Lancet, The (Jones), 118 Landscape of depression, 37–38 Larry King Live (Buchwald), 68 Lawrence, D.H., 60, 84–85, 178, 262–263 Lear, Jonathan, 335 Learning to Fall (Kriegel), 226–229, 230

Index

“Leave of abstinence”, 14 Lehmann-Haupt, Christopher, 186 Lessing, Doris, 89, 109 Levi, Primo, 62, 80 Lie Down in Darkness (Styron), 37–46, 49, 54, 60 Life Studies (Lowell), 150, 154 Life-writing, 11 Linehan, Marsha, 208 Lithium, 62, 81–83, 91, 93, 96, 100, 106–107, 111, 113–115, 118, 131–135, 137–138, 141–143, 149, 155, 162, 249, 318, 334 Loewald, Hans W., 203 Loony-Bin Trip, The (Millett), 5, 10, 24, 29–30, 81–118, 133, 141, 284–286 Lopate, Philip, 12 Lord Weary’s Castle (Lowell), 151 Lost Puritan: A Life of Robert Lowell (Mariani), 151 Love, Guilt and Reparation (Klein), 291 Love Works Like This (Slater), 206, 239–240 Lowell, Robert, 150–151 Lucidity, 34–35 Lucratocracy, 189 Lukas, Christopher, 201–202 Lukas, J. Anthony, 202 Lying: A Metaphorical Memoir (Slater), 26–27, 29, 205–206, 217–218 “Amazing Grace”, 238–239 breach of narrative promise, 237 Corpus Callostomy, 233–234 ethics, 221–222 “Exaggerate”, 222 “How to Market this Book”, 236–237 “Learning to Fall”, 226–229 philosophy professor without ontological existence, 218–221

Index

“Sincerely, Yours”, 231–233 supermarket incident, 229–231 “The Cherry Tree”, 234–236 “Three Blind Mice”, 222–226 Mad, 9–10 memoirs, 4, 9–11 muse, 8–11, 24 Madness, 115, 127 and creativity, 154–157 Madness and Modernism: Insanity in the Light of Modern Art, Literature, and Thought (Sass), 123 Mahl, George, 301 Mailer, Norman, 85–86, 115, 272 Mairs, Nancy, 61 Malignant depression, 54–57 Malignant Sadness: The Anatomy of Depression (Wolpert), 78 Maltsberger, John, 43 Mania, 102–105 Manic depression, 4, 29, 83, 102 language of, 107–108 Manic depressive disorder, 10, 123–125 Manic-depressive illness, 141 in Sexton, 161–163 Manic-Depressive Illness (Goodwin & Jamison), 25, 120, 127–132 “Manic-depressive overtones”, 48 Manning, Martha, 148, 265 Mariani, Paul, 153–154 Marionette (Slater), 226 Marketplace confessions, 206 Marxism, 85 Masking skills, 288 Maslin, Janet, 219–220 Mazor, Miriam, 248 McHugh, Paul, 147 Mead, Rebecca, 218–219 Medina, Kate, 236 Melancholia and Depression (Jackson), 300 Meltzer, Donald, 291 Memoir (Couser), 11

367

Memoir: A History (Yagoda), 12 Memoirs of My Nervous Illness (Schreber), 301 Menninger, Karl, 89 Mental disease, 110 Mental illness, 3, 10, 169, 244 Mental illness memoirs, 3–4 characterizations, 5 difference between survival stories and triumph narratives, 20 empathy, 6 ethical and emotional engagement, 6 fake memoirs, 11–13 Fitzgerald, F. Scott, 13–15 mad memoirs, 9–11 mad muse, 8–11 Nuland, Sherwin, 15–18 pathography, 4 reason for growth of illness narratives, 6–7 writing/righting wrong, 21–23 Merchant of Venice, The (Shakespeare), 265 Merkin, Daphne, 228, 244, 329–330 Middlebrook, Diane Wood, 152, 160, 175, 177–178, 180, 192, 197 Middlemarch (Eliot), 9 Midnight Disease, The (Flaherty), 2–3, 8, 48, 80 Millett, Kate, 81–83, 119 The Basement: Meditations on a Human Sacrifice, 91–92 conspiracy, 94–95 crisis to die, 110–111 Flying, 87–89 Going to Iran, 91–92 interpreting tape-recorded conversations, 95–98 and Ivor Browne, 105–106 language of manic depression, 107–108 life after The Loony-Bin Trip, 117–118

368

Loony-Bin Trip, The, 92–93, 99–100 mania, 102–105 The Prostitution Papers: A Candid Dialogue, 85–87 reading of other accounts of mood disorders, 93–94 Sexual Politics, 83–85 shame, 111–112 Sita, 90–91 sleeplessness, 98–99 small prophylactic dose, 113–115 talk therapy, 108–109 and Thomas Szasz, 109–110 Million Little Pieces, A (Frey), 11–12 Mind that Found Itself, A (Beers), 4 Mind-numbing drugs, 162 Mirror Images (Sexton), 175, 184 A Signature Daughter, 176–178 Domestic Violence, 179–180 Mother–Daughter Incest, 180–182 Twinning and Playing Nine, 178–179 Mnemosyne, 10 Monomania, 233 Moral failure, 169 Moral Intelligence of Children, The (Coles), 186 Mother–daughter confrontation, 229 Mother–daughter relationship, 26, 29, 163, 175, 177, 199, 209, 227–228, 230 Moveable Feast, A (Hemingway), 15 Munch, Edvard, 17 Munchausen syndrome, 217, 213–233, 236 Muses in Greek and Roman mythology, 10 Music and Madness (Dwyer), 106 My Mother/My Self (Friday), 227

Index

Myth of Sisyphus, The (Camus), 65–66 Myths of Termination: What Patients Can Teach Psychoanalysts about Endings (Kantrowitz), 296 Naked and the Dead, The (Mailer), 86 Narcissism and the Novel (Berman), 6 Narrative Truth and Historical Truth: Meaning and Interpretation in Psychoanalysis (Spence), 27, 193, 210, 222, 224, 236, 310–311 Narrative medicine, 311 Nasar, Sylvia, 320 Nash, John, 52 Nature of Suffering and the Goals of Medicine, The (Cassell), 6 ndeup, 274–275 “Negative Capability” concept, 14 Nervous breakdown, 88 Neuroleptic malignant syndrome, 118, 146 Nietzsche, Friedrich, 154, 260, 335 Night Falls Fast: Understanding Suicide (Jamison), 110, 120, 134–136 “No Gun Ever Killed”, 100–101 Nocebo effect, 250 Noonday Demon: An Atlas of Depression, The (Solomon), 27–29, 253–254 “curing” homosexuality, 271–273 internalized mother, 269–270 ndeup, 274–275 poetic prose, 266–267 psychopharmacology, 273–274 seeking insights from literature and philosophy, 264–265

Index

North, Carol, 316 Nothing Was the Same (Jamison), 120, 145–148, 150, 155 Novak, Julia, 30–31 Nuland, Sherwin, 15–18 Oates, Joyce Carol, 125, 237 Occupational therapy, 9 Official MBA Handbook, The (Barron), 189–190 “Omnipotence of thought” (Freud’s theory), 298–299 One Flew Over the Cuckoo’s Nest (film), 17, 81, 99, 297 Opening Skinner’s Box: Great Psychological Experiments of the Twentieth Century (Slater), 245–246 Operation Re-Entry, 288 Orne, Martin, 152, 159, 163, 173 Orr, Gregory, 337 Paglia, Camille, 115 Paradoxical loneliness, 294–295 Parkes, Colin Murray, 196 Pathography, 4, 11 Pathological or complicated grief, 270 Pavese, Cesare, 65 Perring, Christian, 116, 251 Phillips, David P., 326 Philoctetes, 8, 18 Pickering, George, 7–8, 19 Placebo effect, 250 Plath, Sylvia, 2, 35, 61, 63–64, 65, 150, 160, 203, 222, 328–329 Playing House: Notes of a Reluctant Mother (Slater), 241–245 Playing Sick?: Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering

369

& Factitious Disorder (Feldman), 232 Points of Life (Sexton), 184–185, 186–187, 189 Polypharmacy, 244 Portnoy’s Complaint (Roth), 220–221 Positive psychology movement, 143 Post-traumatic stress disorder, 43, 245 Postpartum mood disorder, 2 Principles of Intensive Psychotherapy (FrommReichmann), 316 Prisoner of Sex, The (Mailer), 115 Private Acts (Sexton), 189–190 Proclaimed sanity, 24 Projective identification, 307 Prostitution Papers: A Candid Dialogue, The (Millett), 85–87 Prozac Backlash (Glenmullen), 247 Prozac Diary (Slater), 26, 206, 212–213, 242 traumatizing mother, 213–217 Pseudologia fantastica, 233 Psycho-Analytic Notes on an Autobiographical Account of a Case of Paranoia (Dementia Paranoides) (Freud), 301 Psychoanalysis, 60, 130, 267–268, 314 fundamental rule of, 138, 293–296 Psychoanalysis and Psychotherapy (Fromm-Reichmann), 316 Psychoneuroses, 8 Psychopharmacology, 273–274 Psychosis, 8 Psychotherapy, 130 Psychotic transferences, 293 Rak, Julie, 236 “Rare torture”, 35 Rau, Sally Millett, 82, 95, 116

370

“Reader’s block,” 330 Reading Autobiography: A Guide for Interpreting Life Narratives, 5, 12 Reading My Father (Styron, Alexandra), 68–69, 141 scandal, 69–71 writing madness, 71–73 “Reading oppositionally,” 331–332 Recommendations to Physicians Practising PsychoAnalysis, 295 Reconstructing Illness: Studies in Pathography (Hawkins), 4 Refusing Care: Forced Treatment and the Rights of the Mentally Ill (Saks), 287, 312–315 Reich, Wilhelm, 88 Remission society, 19 Reparation, 31, 291–292 Requiem for a Nun (Faulkner), 31 Rereading William Styron (Cologne-Brookes), 38 Rescue fantasy, 47, 57, 80 Rilke’s statement, 1, 1n1 Rituals (Sexton), 167–168, 170–171, 174, 177 A Father’s War Story, 172–174 Lily Sinclair, 168–170 Oedipal and Pre-Oedipal Desire, 170–171 Proofreading, 171–172 Rivers, W. H. R., 155 Robert Lowell: A Biography (Hamilton), 151 Robert Lowell: Setting the River on Fire (Jamison), 25, 120, 122, 150–151, 154–155 Ross, Dan, 58 Roth, Philip, 220 Rudnytsky, Peter L., 295 Running with Scissors (Burroughs), 12 Ryan, Jack, 134

Index

Sacks, Oliver, 134, 283 Saks, Elyn R., 283–284 Capgras Syndrome, 308 “Doctors Freed/Fried”, 315–316 Dr King, 319 Elizabeth Jones and Martha Harris, 291–293 failing fathers, 306–308 “few little quirks”, 287–290 fundamental rule of psychoanalysis, 293–296 hidden personal element behind scholarship, 286–287 hope for future, 322 Interpreting Interpretation, 310 Jekyll on Trial, 308–309 “Joseph White”/Stanley W. Jackson, 297–301 “Kaplan”, 302–303, 305 “Lady of the Charts”, 303–306 life with and without regulator, 317–319 and Millett, 284–286 Psychoanalytic Researcher, 301–302 question of confidentiality, 290 Refusing Care, 312–315 Terminating Analysis with Kaplan, 311–312 terminations, 296–297 Sanity, 105 Sass, Louis A., 123 Sassoon, Siegfried, 155 Saunders, Max, 30 Savage God: A Study of Suicide, The (Alvarez), 61 Schizophrenia, 4, 29, 287, 305, 317 Schizophrenic outbursts, 308 “Schizophrenogenic mother,” 289 Schreber, Daniel Paul, 301–302 Scream, The (Munch), 17 Scriptotherapy, 23 Searching for Mercy Street: My Journey Back to My Mother, Anne Sexton (Sexton), 25–26, 29, 159–203

Index

Sedgwick, Eve Kosofsky, 292 Seductiveness of literary theory, 3 Selected Letters (Styron), 34, 69 Self-loathing, 35 Self-Portrait in Letters, A (Sexton, Anne), 162, 194 Self-violence, 44 Seligman, Martin, 143 Set This House on Fire (Styron), 37, 47–52 Sex, Art, and American Culture (Paglia), 115 Sexton, Linda Gray, 159 and Chris Hastings, 167 critical reviews, 203 45 Mercy Street, 192–194 ghosts and ancestors, 203 Half in Love (Surviving the Legacy of Suicide), 159–161, 196–199 legacy of suicide, 201–202 manic-depressive illness, 161–163 Mirror Images, 175–182, 184 Points of Life, 184–185, 186–187, 189 Private Acts, 189–190 psychiatrists for, 199–201 reunion with dead, 188–189 Rituals, 167–168, 170–174, 177 Searching for Mercy Street, 159–161, 191–192 self-portrait in letters, 161 The Kiss, 185–188 Between Two Worlds: Young Women in Crisis, 165–166, 190 writing as rescue, 194–196 Sexual Politics (Millett), 83–85, 115, 165 Shame, 111–112 Shattered Subjects: Trauma and Testimony in Women’s Life-Writing (Henke), 23 “Sheer dirgelike solemnity”, 35 Shelley, Mary, 125

371

Shelley, Percy Bysshe, 124 Sita (Millett), 90–91 Skorczewski, Dawn, 173–174, 179 Slater, Lauren, 205–206 Blue Dreams, 247–251 leaving readers with question marks, 251 Love Works Like this, 239–240 Lying: A Metaphorical Memoir, 217–239 Opening Skinner’s Box, 245–246 Playing House: Notes of a Reluctant Mother, 241–245 Prozac Diary, 206, 212–213, 242 The $60, 000 Dog, 240–241 Welcome to My Country, 206–212 Slater, Tracy, 27, 246–247 Sleep disturbances, 98 Small Personal Voice, A (Lessing), 109, 294 Smith, Sidonie, 5, 12, 222 “Smother-mother,” 178, 262 Snake Pit, The (Ward), 298 Snodgrass, W. D., 183 Snow, C. P., 123 Solomon, Andrew, 253 A Stone Boat, 255–263 acknowledging father, 275 Far and Away, 280–281 Far from the Tree, 275–278 The Noonday Demon: An Atlas of Depression, 264–275 timing of Solomon’s depression, 267–269 training in English and psychology, 254–255 writing, 281 Sontag, Susan, 215–216 “Somewhat reductive” analysis, 270 Sons and Lovers (Lawrence), 84–85, 178, 188, 262–263

372

Sophie’s Choice (Styron), 37, 52–54, 60–61, 72, 80 malignant depression, 54–57 Stingo’s rescue fantasies, 57–59 Spade, Kate, 326 Speak, Memory (Nabokov), 10 Speaking of Sadness (Karp), 114 Spence, Donald B., 27 “Spoiled identity”, 18 Spousal loss memoir, 22, 25, 120, 145, 149–150 Sprengnether, Madelon, 11 Stafford, Jean, 153 Stigma, 18, 37, 285 Stigma (Goffman), 18 Stone Boat, A (Solomon), 27–28, 255–256, 267–268, 276, 280 assisted suicide, 260–263 homophobia, 257–260 Storr, Anthony, 9, 122 Strupp, Hans H., 273 Styron, Alexandra All the Finest Girls, 74–76 Reading My Father, 68–73 Styron, William, 119 Confessions of Nat Turner, The, 50, 52 Darkness Visible, 33–34, 38, 41, 46, 50, 56, 60–64, 68–69, 78–79 beyond expression, 34–37 fundamental question, 65–68 heart of darkness, 61–62 landscape of depression, 37–38 Lie Down in Darkness, 38–46, 49, 54 lifeline, 78–80 mirror of Styron’s childhood life, 46–47 purpose of memoir, 62–65 Set This House on Fire, 47–52 Sophie’s Choice, 52–59 “Study in the Conquest of Grief”, 59 suicide letter to his readers, 76–78

Index

“Tidewater Morning, A,” 46–47, 58, 62, 74 wraithlike observer, 43–46 about writing, 60–61 Sublimation, 45 Suicide, 37, 42 cocktail, 75 survivors, 22 Survival stories, 20 Surviving Madness: A Therapist’s Own Story (Berzon), 207, 270 Szasz, Thomas, 109–110 Talk therapy, 108–109 Talking Back to Prozac (Berman), 247 Talking Cure, The (Berman), 109 Tardive dyskinesia, 285, 305 Tender Is the Night (Fitzgerald), 14 Terminations, 296–297 analysis with Kaplan, 311–312 Textbook diagnosis, 153 The $60, 000 Dog (Slater), 240–241 “Therapeutic alliance,” 138, 250, 273 “Therapeutic culture,” 12 “Therapeutic jurisprudence,” 313, 334 “Therapeutic writing,” 15, 21, 23, 61, 194, 281, 318, 325 This Close to Happy: A Reckoning with Depression (Merkin), 228 Thorazine, 162 Three Lives (film), 100 “Tidewater Mourning, A”, 46–47, 62, 74 Tillich, Paul, 238 To the Lighthouse (Briscoe), 194 Tolstoy, Leo, 257 Too Soon to Say Goodbye (Buchwald), 68 Totem and Taboo (Freud), 299

Index

Touched with Fire: ManicDepressive Illness and the Artistic Temperament (Jamison), 25, 120, 122–123 “Tragic knots”, 296–297 Traill, Thomas, 150 Trickster memoir, 221–222 Triumph narratives, 20 Truth Revolt, 100 Turn of the Screw, The (Henry James), 81, 188 Turner, Christopher, 88 UCLA Affective Disorders Clinic, 136 Uncovering Lives: The Uneasy Alliance of Biography and Psychology (Elms), 103 Undercurrents: A Life Beneath the Surface (Manning), 148, 265 Unhinged (Carlat), 247 Unholy Ghost: Writers on Depression (Styron, Rose), 76 Unipolar depression, 35–36 “Unlikely bard of depression”, 33 Unquiet Mind: A Memoir of Moods and Madness, An (Jamison), 10, 25, 29, 94, 113, 119–157, 249 Valenstein, Elliot, 247 van Gogh, Vincent, 65, 125, 225 Vendler, Helen, 156 Vickers, Neil, 4 Voice Lessons: On Becoming a (Woman) Writer (Mairs), 61 Vyvanse, 244 Wald, Priscilla, Wallace, Mike, 68, 264

373

Ward, Mary Jane, 298 Warren, Robert Penn, 168 Watson, James D., 122 Watson, Julia, 5, 12, 222 Waves, The (Woolf), 264 Way of the Warrior, The (Styron), 36, 73, 78 Weevil, Assia, 328 Welcome to My Country (Slater), 26, 206–212 “Werther effect,” 326 West, James L. W., 34, 47, 53, 62–63, 69, 72, 75–76 Whitaker, Robert, 246 Whybrow, Peter, 265 Williams, Meg Harris, 296 William Styron Revisited (Coale), 44 Wilson, Edmund, 8, 14–15 Wind in the Willows, The (Grahame), 144–145 Winter’s Tale, The (Shakespeare), 265 Wolpert, Louis, 78, 300 Women and Madness (Chesler), 117 Woolf, Virginia, 64, 125, 188, 209–210, 264 Worden, J. William, 150 Wordsworth, William, 124 Wound and the Bow, The (Wilson), 8 Wounded Storyteller, The (Frank), 18–20, 63, 272, 336 Writer’s block, 3, 10, 36, 49, 72, 89, 115, 195 Writing madness, 10 Writing Widowhood (Berman), 149 “Writing/righting wrong,” 21–22, 63, 118, 175, 285, 326 Wrongful Death (Gilbert), 21 Wurmser, Leon, 111 Wurtzel, Elizabeth, 212, 258, 328

Index

374

Wyatt, Richard, 120, 142, 145–147 Yagoda, Ben, 12 Yalom, Irvin, 211 Yalom, Marilyn, 116

Yeats, William Butler, 10, 287, 296, 334 Zionism, 238 Zyprexa, 244, 249