Voluntary Madness: My Year Lost and Found in the Loony Bin
By Norah Vincent
New York: Viking, December 2008
Hardcover, 283 pages
Immersion journalism, as it’s called, can be kind of fun on a limited basis. In my days as a reporter, in pursuit of stories I volunteered to get Tasered and learned how to snowshoe. (The Tasering was fun for the cops who got to watch a journalist get nailed; the snowshoeing – a 5K race my first time on the things – was fun mostly in retrospect.)
Then there are immersion journalists who do it up big. Stefan Fatsis, a former Wall Street Journal reporter, became a professional Scrabble player, then a placekicker for the Denver Broncos. AJ Jacobs, an Esquire magazine editor, read the Encyclopedia Brittanica all the way through from A to Z. He followed that by spending a year obeying as many of the 613 rules of the Torah as he reasonably could, given the limitations of 21st-century life. And Norah Vincent, a former print journalist and syndicated columnist, spent 18 months dressing, living and dating as a man. It led to three stays in psychiatric hospitals – one voluntary, as she dealt with her own severe depression following her first book, and two where she felt more or less well, but played the part in the name of research.
The three hospitals Vincent admits herself to are located along the economic spectrum — a ward in an urban hospital with largely indigent, largely heavily-medicated patients; a private substance abuse rehabilitation clinic in the rural Midwest with a small psychiatric component; and an ultra-expensive “alternative therapy” private clinic that goes against most currently accepted psychiatric treatment protocols.
Of the urban hospital experience, where a nurse confiscated the pen Vincent was using to take notes, she said:
Madness is a disease of the will, of judgment. That is what is impaired. And so, in there, along with so much else, your will was taken away, like a pen, because you could not be trusted with it. Yet your will is the thing that makes you feel human. Without it you cannot be well, which is why no one in there really got well, or, arguably, much better.
This is the paradox of asylums, and their fatal flaw. Put a person in a cage and you cannot help him. But leave him to his devices and he cannot help himself, or will not. Freedom is a prerequisite for healing a broken mind. It cannot be fixed against its will. Yet a broken mind is a broken will, a freedom that does harm, even potentially serious physical harm to itself and possibly others, a freedom that can attack or maim. So, how else to heal but by force? (p. 24)
Along the way, Vincent meets a cast of characters who would be comical if they weren’t so – depressing, actually. The pseudonyms she gives them are wonderfully evocative: “Mr. Clean” is a 6-foot-3 psychotic diabetic perpetually begging Vincent to ask her visitors to bring candy. “Mother T,” a delusional 42-year-old Puerto Rican woman, had seen Jesus flying to the part of the city the hospital was in and claimed Jesus had asked her to follow. Twenty-nine-year-old alcoholic “Bunny Wags (…)looked like a hundred and fifty pounds of chewed suet, sitting there pasty, slumped, defeated. … (p.123)”
At the “alternative therapy” clinic, where clients were housed in upscale apartments, did their own grocery shopping and had nearly unlimited access to therapists, Vincent finally was able to recognize life events she’d been repressing and deal with them. But before she gets that far, she still is accurately able to describe life with debilitating depression:
People say that depression is tears and lassitude and fears and self-loathing. But they do not say it is a brain made of tacks, that it is a relentless passing of sentence.
Guilty. I am guilty.
And an equally relentless rumination and breaking down in response to it. Perhaps like autism, depression is a protective reaction to too much information. Too many thoughts.
In this context, it’s interesting to ask: Why can’t a depressive get out of bed? Because if the minute you woke up, you thought of all the ways you could die or be injured or fail or cause death or failure or harm to others in any given day, you wouldn’t get out of bed either. If you thought too long and hard about all the people who die in crosswalks, you would never cross the street. If you thought of all the people who die in car accidents, you would never get in a car. And those are only the simplest considerations.
Life is lived on ignorance, on not thinking about all the possibilities, about ignoring the most basic fact, that you are mortal and that it is unreasonable to expect a sentient, self-conscious creature to live with the idea that she is going to die. (p. 122)
Once opposed to medication, Vincent eventually decides she will take it in the lowest possible dose to help herself stay out of the abyss. But it’s not just the combination of medication and self-care that the therapists always prescribe that is the biggest takeaway from this book:
It’s all of a piece. Together, the pieces bring about the whole, and the sense of wholeness that is essential to staving off depression. … It is up to me to tend to my wholeness. I do it or I don’t. That’s it. … The success or failure is my own.
…as for cure, that’s a fantasy. You don’t finish. You continue. And you don’t do it – you are not forced to do it – because you are mentally ill. You do it because that’s how living works. Maybe depressives like me have to work a little harder at happiness. Maybe psychotics … have to work a lot harder. But everyone has to work at it.
I’m not saying that eating right and exercising, nurturing your heart and challenging your brain, will save you. It won’t. There is no saving, of course. You never “arrive.” You move. You get on with it. That’s the prescription. (pp. 282-283)
I heartily recommend this book for families, friends and caregivers of the mentally ill. It provides an unflinching look at reality. While the subject matter can be difficult, Vincent’s combination of spare language and detailed description keep the reader engaged from start to finish.