Why not give them more money and power?
India and Pakistan talk tough.
The Path to Peace
Elections in Sierra Leone offer a hopeful sign.
Youth activists target juvenile jails.
Minnesota Fat Cats
How extravagant can HMO waste get?
Iraq waits and worries about a U.S. attack.
The U.S. stalls as land mines kill in Cambodia.
Meatpackers charged with smuggling immigrants.
Free Market Misery
Can Ukraine save its miners--or its economy?
Politics of Fear
In Person: Gloria Mendez
BOOKS/FILM: One hundred years of Japanese cinema.
BOOKS: Memoirs of mania.
BOOKS: Joseph Stiglitz's discontent.
Love the Windsors? Why don't we swap?
June 7, 2002
The Cuckoo's Nest
Beers died on a more suitable day four decades later, having carved a two-lane path in the American landscape of the literature of mental illness: one for memoirists, the other for reporters. William Styron’s Darkness Visible, Susanna Kaysen’s Girl, Interrupted, Elizabeth Wurtzel’s Prozac Nation, Kay Redfield Jamison’s An Unquiet Mind and Andy Behrman’s Electroboy are, in order of appearance, just a few of the recent additions to the burgeoning genre of mad memoir.
Posthumously, Clifford Beers was praised for his willingness “to exploit his story—and himself—for the benefit of others,” praise which might apply to every memoirist of madness. But among Beers’ legatees, principal reasons for self-exploitation vary. Styron turned to memoir in the wake of the suicide of Italian writer Primo Levi, impelled by then pervasive ignorance about the pull of melancholy, what Darkness Visible renames “the despair beyond despair.” It was the one time, Styron says, that he revealed his private self to the public world.
Jamison, a clinical psychologist, co-authored the textbook on manic-depression (or “bipolar disorder”) and penned Touched with Fire, on manic-depression and creativity, before taking her autobiographical turn. Spurred by the recognition that the greatest danger to the life of the bipolar patient is the refusal to take medication, her memoir reads in part as a cautionary tale—told with a sympathy born of near tragedy.
Then, there are the ready-for-my-close-up monologues of interrupted girl Kaysen, Prozac nationalist Wurtzel and electroshock jock Behrman. The film adaptation of the first enabled an Oscar, that of the second is slated for release later this year—with a Wurtzel-produced soundtrack—and the third has been optioned by HBO. Not only does Andy Behrman envision Ewan MacGregor playing him on the big screen, but to stimulate media buzz, he postered Manhattan and posted electronically to at least one bipolar message board. (Its administrator nixed Behrman’s contribution, citing blatant intent to advertise.) Before donning the cape of “Electroboy ... Fighting Mental Illness,” Behrman was a PR man, representing a diet doctor, an exercise guru and a so-called artist. “I’ll represent anybody,” he explains. “I’m not very picky.” Now he is his own best client.
ure, media uptake can be an unintended byproduct of self-exploitation. But if entertainment value is the lowest common denominator of these books, then perhaps they are merely the latest forms of engagement in the age-old custom of “displaying the insane.”
Michel Foucault identified the phenomenon in Madness and Civilization, where he reported that in 1815, England’s Bethlehem asylum (a.k.a. “Bedlam”) exhibited, for a penny, lunatics on Sundays. In 2002, lunacy’s public display is confined to the performances of doe-eyed actresses paid outrageous sums to act like lunatics—the lunatics who sanction the portrayal and sometimes help write the script. Only the exhibitors have changed, and the price of a ticket.
All spectacle, Behrman’s Electroboy is comparable to others in the genre only barely. Like Jamison’s, his illness, though misdiagnosed for years, falls under the rubric “manic-depressive.” Like Wurtzel, Behrman underscores the moi in memoir. (Prozac Nation’s title has got to be the most ingenious act of deception in the genre’s history.) Behrman enacts what Kaysen calls the “velocity” of insanity—though any comparison here is a stretch. Girl, Interrupted is invested in quizzing the line between the “normal” and the “sick,” and in roundly depicting selves stamped flat by clinical labels. Electroboy is invested in, well, itself.
Finally, one can say of Behrman’s book what William James said in introducing Beers’: “It reads like fiction.” Which is not to say that it reads like good fiction. More chronicle than memoir (the “memoir of mania” subtitle was someone else’s idea), Electroboy is a hyper-detailed accounting of the events in Andy Behrman’s life: list-making, New Jersey-upbringing, compulsive hair-plucking (“my weirdness took many forms,” he admits), tuna-and-tofu-dieting, Times Square-stripping, art-dealing, cash-freezing, jetsetting, girlfriend-stalking, prostitute-hiring, self-prostituting, art-faking, time-serving, and what he generally calls “the crazies,” with little interpretation or analysis. Behrman’s infrequent ventures into explanation sound shrink-wrapped: “I developed these defense mechanisms against conflict.” The most Behrman is capable of in the way of commentary is, more often than not, “Shit.”
erhaps the unexamined-life story is the perfect approach to representing a manic experience that makes Behrman feel like the “chunk” of brain “that edits my thoughts before they become speech” has been “scooped out.” And the reader feels it, too. One longs for what Styron can do with a third as many pages.
Electroboy is mania performed. In Intoxicated By My Illness, Anatole Broyard wrote that “every seriously ill person needs to develop a style for his illness,” meaning prose style. The manic generally prefer to shop for their style, in sprees. Behrman likes Barney’s. Whatever the reason, Electroboy reads less as an account of mania than as a look at what happens when the self becomes no more than a product of the stuff it consumes.
For Andy, that self is a function of beverages preferred (Amstel Light, the occasional Pilsner Urquell, Diet Coke over Diet Pepsi, Hershey’s chocolate milk), designers worn (Armani, Calvin Klein) slept between (Ralph Lauren), shaved, shampooed and gelled with (Kiehl’s) and pharmaceuticals ingested: Prozac (against depression), Klonopin (against anxiety—Andy sprinkles them on ice cream), Ambien (for sleep), Anafranil (for OCD), lithium (for mood stabilization), Depakote (for mood stabilization—Andy takes too many), Zyprexa (against psychosis), Risperdal (against psychosis), propranolol (for Risperdal-induced tremor), Symmetrel (for Risperdal-induced stiffness), Luvox (side effect: retrograde orgasms), Paxil (side effect: no orgasms). Tegretol, Effexor, Wellbutrin, Neurontin, trazodone, Zoloft, Serzone, Artane, Ativan, Lamictal ... at one point, Behrman is on a prescribed 22-pills-a-day regimen.
“Plainly,” he writes, “I will never be able to stop taking these medications. Am I more myself on them or less? There’s no sense in trying to determine which me is the real me—in the end, I need the medication if I’m to lead a balanced life. I have a chronic illness, and I can’t survive without them.” The disposition of what psychiatrists value as a “compliant” or, in the new Psychiaspeak of stick-to-it-iveness, an “adherent” patient, yes—but 22 pills a day? (Today, he’s down to nine.)
One would wonder about Behrman’s lack of concern about drug dependency if not for his cocaine and crack affinity. (“Smoking crack is like a sport. It should be an Olympic sport. I would be very good.”) Behrman is, among other things, one sample from the ocean of souls who seek prediagnostic solace in “self-medication.” What he never wonders, even when he finds himself on a gurney headed for the shock room because the drugs aren’t working, is whether the amounts and combinations of drugs weren’t a huge part of their inefficacy. Neither does he wonder, even when he finds himself addicted to the anaesthetic preparation he is given before each of 19 shock treatments, whether all those uncontrolled substances aren’t “gateway drugs” to a lifetime of prescription meds. What Electroboy ultimately left me asking is whether the likes of Eli Lilly aren’t simply the new FDA-approved pushers of Prozac Nation, but its DEA-approved drug czars.
nter Robert Whitaker of the Boston Globe, who walks the second Beersian line of reportage and advocacy. Beers pushed for oversight and reform of the nation’s mental institutions, spearheading the “mental hygiene movement.” The movement’s associated foundation sponsored projects like journalist Albert Deutsch’s 1937 history, The Mentally Ill in America. Whitaker’s work echoes Deutsch’s in more than its title: Mad in America is the most important bit of mental health muckraking since Deutsch’s The Shame of the States was published in 1948.
Part history, part journalism and all polemic, Mad in America outlines the developments in treatment and care that have shifted the terms of debate from “restraint versus non-restraint” toward “to medicate or not to medicate.” At the ankles of a pharmaceutical industry goliath, Whitaker draws his slingshot back hard on behalf of the “mentally ill”—a category he limits, for the most part, to diagnosed schizophrenics. A moral of “take your meds” often makes sense for people with mood and anxiety disorders, but for the schizophrenic, Whitaker argues, “take your meds” can be bad advice.
Whitaker uses three studies, one from Harvard and two from the World Health Organization, as springboards into his argument rather than as definitive proofs. Respectively, the studies showed that recovery rates for schizophrenics were no better in the United States in 1994 than in 1900, and that outcomes are far worse for schizophrenics in richer countries than in poorer ones—even though 61 percent of diagnosed schizophrenics in the developed world are medicated, while only 16 percent are medicated elsewhere. If medication helps, shouldn’t the medicated group show higher rates of remission? Perhaps the significant factor is family and community support, “societal attitudes,” “childhood experiences”? According to Whitaker, the problem is “iatrogenic”—bad outcomes are a function of drug treatment.
The drugs Whitaker calls into question are of two types, one older, one newer. Traditional “neuroleptics,” a word used because it describes their function of “taking hold of the nervous system,” include Thorazine and, 50 times more potent, Prolixin and Haldol. All have been sold on the understanding that schizophrenia is a brain chemistry problem, an excess of dopamine production or uptake, that the drugs “balance.” Newer drugs, called “atypical” anti-psychotics because they vary from the dopamine-blocking “norm,” include Risperdal—the drug that causes Behrman tremors and stiffness—and Eli Lilly’s bestselling Zyprexa. These bear down on dopamine and a host of other neurotransmitters.
Whitaker’s critique of the atypicals speaks to the shameful state of commercial drug testing today. In tests run on a for-profit rather than an academic model, the atypicals were “compared” at incomparable doses—biasing results. Selectors chose inappropriate sample patients. And because testing protocols required “wash out”—abrupt withdrawal from other medications—to re-establish “active disease” in test subjects before administration of the test drug, the suicide rate among subjects jumped to two to five times the norm for schizophrenics. Plus, the move to atypicals—some of the most expensive drugs on the market—was spurred not by new scientific findings, but by the schedule of patent protection. Generics were beginning to compete with the older drugs for market share.
isturbing as that story is, Whitaker is strongest in his criticisms of traditional neuroleptics, mainly because more is known about their side-effects. They include Parkinson’s-like symptoms, an irreversible motor-function condition called tardive dyskinesia, neuroleptic malignant syndrome (rare but fatal), akinesia (an “extreme blunting of emotions” that renders patients “zombie”-like and leads to social withdrawal), and akathisia—a reaction in reportedly three-quarters of Haldol-treated patients that makes them turn violent. Statistically, the mentally ill were no more prone to violence than the general population until neuroleptics were introduced.
Moreover, the receptor-plugging effect of neuroleptics lays the groundwork for an exacerbation of the “imbalance” the drugs were supposed to stabilize. In language as accessible as any newspaper article, Whitaker explains how neuroleptic treatment alters the physiology of the brain, causing the growth of up to 50 percent more dopamine receptors. As a result of heightened dopamine sensitivity, the patient who abruptly stops treatment—like the “wash out” in the atypical studies—is virtually guaranteed to relapse into psychosis. And that psychosis is bound to be worse than if the patient never had taken neuroleptics in the first place.
In one chilling footnote, Whitaker ties just this problem to the case of Andrea Yates, the Texas woman sentenced to life in prison for drowning her five children. Whether or not she could tell right from wrong when she dragged her kids to the family tub, Yates was psychotic. And whether her psychosis was a result of post-partum depression or schizophrenia, withdrawal undoubtedly contributed to the horrors of that fatal day. Two weeks before, Yates’ psychiatrist had taken her off Haldol.
he droves of mental health professionals towing the line that “treating schizophrenics without drugs is like treating diabetics without insulin” will find Whitaker’s thesis anathema. Psychiatrist E. Fuller Torrey already has, calling Mad in America “Nurse Ratched with Footnotes.” Torrey’s reaction is particularly disheartening given his commitment to the plight of the mentally ill. In Nowhere To Go, he outlined the role of money and politics in “deinstitutionalization”—the fiscally motivated bumping of the nation’s chronically ill mental patients from state back wards to urban back streets. However, fierce in protecting the prescription-writing territory of the psychiatrist (another in the list of Torrey’s titles is Freudian Fraud), Torrey has a cataract when it comes to seeing the forces at play in shaping how psychiatrists think about drugs. Torrey’s Surviving Manic-Depression, new this year, goes so far as to tout medication for people who “lack insight” into their disease—a view whose forced-treatment ramifications smack of an all-too-nonfictional cuckoo’s nest.
More McMurphy than Ratched, Whitaker bolsters his claims—claims academic psychiatry would do well to respond to with fresh data rather than stale rhetoric—with a historical narrative spotlighting the worst in the history of psychiatry: hydrotherapies, spinnings, blisterings, cliterodectomy and forced sterilization, tooth-extractions, insulin comas, spine-cracking metrazol shocks, transorbital lobotomies, and electroshock procedures that, in their force and number, make Electroboy’s sessions look like a cake walk.
And yet Mad in America doesn’t cite a single representative of the “anti-psychiatry movement”; there’s no mention of Thomas Szasz or R.D. Laing. Whitaker sympathizes with alternatives to traditional therapies, but his sympathy is based on documented results rather than ideology. He questions the frequency of schizophrenia’s diagnosis—especially among blacks and the poor—and urges a look back at why psychiatry has been so unduly pessimistic about outcomes.
But Whitaker never calls schizophrenia a myth. And he takes schizophrenia out of the hands of French leftists like the earliest Foucault, and Deleuze and Guattari, who read the phenomenon as the ultimate human expression of alienation under capitalism. Albeit inadvertently, Whitaker turns that view on its head—by showing that the “alienated” look of the schizophrenic is less a property of the disease than a side-effect of its treatment, and by identifying the alienation peculiar to the rest of us, who, “as a society, are estranged from the ‘mad’ in our midst.”
That’s a social ill a heavy dose of reading might begin to remedy.
Edit M. Penchina, a graduate student at Johns Hopkins University, has been contributing to In These Times since 1998. Her writing also appears in issue No. 1 of Croonenbergh’s Fly.
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