TIMES CHANGE WITH THE TREATMENTS:
ON ASYLUM WRITING
This essay has three parts. Click here for the FIRST part, “IT’s A KIND OF MAGNET”. Click here for the SECOND part, “TOTALLY INSTITUTIONAL”.
29. David D. Burns, Feeling Good: The New Mood Therapy (New York: Quill, 2000), p. 48. Originally the book had the strapline, “The Clinically Proven Drug-free Treatment for Depression,” but later editions included an extensive guide to antidepressants.
30. Barbara Ehrenreich, Bright-Sided: How Positive Thinking Is Undermining America, published in the U.K. as Smile or Die: How Positive Thinking Fooled America and the World (London: Granta, 2009), p. 96.
31. Kaysen, Girl, Interrupted, pp. 150, 147, 157.
32. Styron, Darkness Visible, pp. 63, 46.
33. Sigmund Freud, The Interpretation of Dreams, trans. James Strachey (London: Penguin Books, 1991), p. 365.
34. Anne Sexton, To Bedlam and Part Way Back (Boston, MA: Houghton Mifflin, 1960), n.p.
35. Lauren Slater, Prozac Diary (New York: Random House, 1998), p. 78.
III
THROUGH THE CLOUDS
THROUGH THE CLOUDS
Diagnostic categories were thoroughly revised in the third edition of the Diagnostic and Statistical Manual, published in 1980. At the same time, pushing psychoanalysis to one side, Cognitive Behavioral Therapy began its long rise. Reinforcing the premise of an unreliable self, the best-selling Feeling Good came out that same year. In it David D. Burns defined bad feelings as fallacies that a well-trained mind could correct. Negativity was plain wrong. “The negative emotion feels realistic and in turn lends an aura of credibility to the distorted thought which created it,” he wrote. “The cycle goes on and on, and you are eventually trapped. The mental prison is an illusion, a hoax you have inadvertently created, but it seems real because it feels real.”29 The years that followed saw a flood of new antidepressant drugs. On all sides people were instructed to discredit their own negative experiences, take the world on its terms, and accept a selfhood cut down to size. The concept of mental illness joined self-help in writing off psychic pain as a malfunction to be rectified by mind-altering medication and continuous self-treatment. “Positive thinking had ceased to be just a balm for the anxious or a cure for the psychosomatically distressed,” Barbara Ehrenreich wrote in Bright-Sided (2009). “It was beginning to be an obligation imposed on all American adults,” who were coming under orders to be autonomous—though only within prescribed limits.30
Opposition to psychiatry petered out in asylum writing. Kaysen’s Girl, Interrupted was set in the late Sixties and early Seventies but it looked back through the new lens. One chapter reprinted the section on Borderline Personality Disorder from the Diagnostic and Statistical Manual. The next chapter, “My Diagnosis,” added some comments on the classification along with a disclaimer: “I’m tempted to try refuting it, but then I would be open to the further charge of ‘defensiveness’ and ‘resistance.’” She saw the trap which the diagnosis set for her as clearly as Janet Frame did, and so she learned to live with it. She contented herself with quibbles, one of which however rings out because it showed up how medical language clamped down on suffering. Keyser objected to the manual’s statement that the thus-classified person “often experiences this instability of self-image as chronic feelings of emptiness and boredom” because it betrayed her experience. “Emptiness and boredom: what an understatement,” she wrote. “What I felt was complete desolation. Desolation, despair, and depression.”31
Darkness Visible had no such qualms about psychiatric expertise. William Styron related how he was crippled by despair for months—“I did not think such anguish possible”—until he checked himself into the hospital, where he slowly recovered. He endorsed the doctors’ definition of his suffering:
Our perhaps understandable modern need to dull the sawtooth edges of so many of the afflictions we are heir to has led us to banish the old-fashioned words: madhouse, asylum, insanity, melancholia, lunatic, madness. But never let it be doubted that depression, in its extreme form, is madness. The madness results from an aberrant biochemical process. It has been established with reasonable certainty (after strong resistance from many psychiatrists, and not all that long ago) that such madness is chemically induced amid the neurotransmitters of the brain, probably as the result of systemic stress, which for unknown reasons causes a depletion of the chemicals norepinephrine and serotonin, and the increase of a hormone, cortisol. With all this upheaval in the brain tissues, the alternate drenching and deprivation, it is no wonder that the mind begins to feel aggrieved, stricken, and the muddled thought processes register the distress of an organ in convulsion.32
Reading such a statement, it begins to be conceivable that there is more freedom in the caged integrity of going with the experts and taking the treatment than there is in holding out against the system, and dreaming of escape. But then again, those names of chemicals and hormones are in a way like hospital staff and sociologists turning their noses up at a patient hiding under his blanket ...
In The Interpretation of Dreams (1900) Sigmund Freud famously regarded Oedipus Rex as a version of the psychoanalytic search for the self’s mysterious depths; Sophocles’ uncovering of the king’s inadvertent crimes pressed the audience to “recognize our own inner minds, in which those same impulses, though suppressed, are still to be found.”33 The title of “For John, Who Begs Me Not to Enquire Further” alluded to Schopenhauer’s praise for Oedipus in a letter he wrote to Goethe in 1815, which Sexton used as To Bedlam and Part Way Back’s epigraph. It stated that a philosopher had to be fearless in pursuit of truth, no matter where the quest led, and despite the handicap that “most of us carry in our heart the Jocasta who begs Oedipus for God’s sake not to inquire further.”34 It could be said that in a compliant era when mental illness is acceptable as a drug-assisted identity, Jocasta finally rules people’s hearts. Yet that is to stick with the serious, bookish frame of mind which the postwar history of psychiatry and self-help has done so much to discourage. It seemed for a long time worth going like ancient heroes into the psyche’s depths, even though it might mean coming back haunted and crooked or not at all; but times change with the treatments. “I scanned the spines, saw titles like Fear and Trembling and Man’s Search for Meaning. I had loved those sorts of books,” one grateful author wrote after the Prozac kicked in. “But, well, now I stood by my bookshelves a little lost. They were full of death and anxiety, the spines seeming to exude cold clouds. I had no desire to read Kierkegaard.”35