A Different Look at Mental Health
Two books I’ve read recently have dealt with mental health from an “inside” perspective—through the eyes of those who are mentally ill, or at least diagnosed as such. First was Jon Ronson’s The Psychopath Test, which a friend loaned to me, saying, “it really is a fascinating story.” He was right.
After being drawn into a strange hoax, Ronson, a freelance writer, is looking through the Diagnostic and Statistical Manual of Mental Disorders (known simply as “the DSM”). Of course he is able to diagnose himself with a few things, but after looking through it, he begins to wonder how many important politicians and business leaders could actually be diagnosed as psychopaths. Along the way, he meets Tony who, in order to avoid a prison sentence, faked mental illness and was summarily admitted to a psychiatric hospital. Twelve years later, he is still stuck there, unable to convince his therapists and doctors that he is in fact sane. Ronson draws on other examples in the history of treatment for the mentally ill, not all of which are pretty. He raises questions about the validity of what is done in the name of “treatment” and whether that treatment makes things worse.
Ronson attends a workshop led by Bob Hare, creator of the PCL-R checklist, which is used to identify and diagnose psycopathy. The PCL-R checklist is a list of 20 behavioral traits such as superficial charm, grandiose sense of self-worth, parasitic lifestyle, lack of remorse or guilt, and irresponsibility. Here again, Ronson is able to identify some of these traits in himself. He then arranges to meet people like the former head of a Haitian paramilitary group and a former CEO who seemed to enjoy firing people. He listens to their stories, mentally armed with the PCL-R checklist, looking for proof that those in power are indeed psychopaths at some level. The stories are fascinating, and the people even more so, but they are frightening as well. By the end of the book, Ronson concludes that there is a fine line between the sane and the psychopath and that the people are as nuanced as the science used to diagnose and treat them. He asks Bob Hare as much about the man who faked mental illness to avoid prison: “should we define him by his psychopathy or his sanity?” This is the question that stuck with me long after I finished The Psychopath Test, and especially as I read Paul Gruchow’s Letters To a Young Madman.
When I first learned of it, Letters To a Young Madman was expected to be published in April of 2009; I have been watching for it with anticipation ever since. It finally came out in 2012, and I found it in a bookstore in Duluth this past February, the same month in which Gruchow died of a self-induced prescription drug overdose in 2004.
Gruchow suffered from depression and bipolar disorder, and this book is his memoir of “childhood trauma, the stigma of psychiatric diagnosis, and how the treatment system infantilizes patients.” It is a collection of dozens of short essays—some just a paragraph or even two sentences—in which Gruchow writes under the headings of Grief, Love, Diagnosis, Work, The Hospital, Boredom, Suicide, and others. He, like Ronson, shows the very fine line that exists between sanity and mental illness and how the system that is supposed to help patients instead drives them deeper into their illness.
I was going to write about the year I spent getting my character adjusted in twice-a-week therapy sessions, but I realize now that the experience can adequately be summarized in a sentence or two. The therapy utterly failed because I never believed in it. And I did not believe in it because I knew that I was grieving half a dozen substantial losses, all of them unresolved. Any one of them might have explained my despair. I didn’t need to be defective in character to be unhappy. But I did need to acknowledge my grief, to feel it, and to find a way through it. I didn’t need somebody to explain me to myself, or fix me or teach me how to manage myself in six easy steps. I need somebody to listen. And because I didn’t get that, I lost an entire year of my life.
Gruchow’s book can be difficult to read. Like Ronson’s, it casts a light on the nature of mental illness and how it is addressed by health professionals, and in that way, both books are troubling. But unlike Ronson, Paul Gruchow does not go home in the end with a note wishing him “good luck.” We know what happens before we start the book, but it is somehow more personal.
Before his illness became so debilitating, Paul Gruchow was a newspaper reporter, a teacher, and an author. He wrote seven books and collaborated on or contributed to numerous others. He was one of the humblest writers I have ever read, which is why I like his books immensely. The joy he expressed in writing about canoeing in Boundary Waters: Grace of the Wild or the subtle beauty of the prairie in Journal of a Prairie Year is equally balanced with his clear-eyed and sharp assessment of mental health treatment programs in this book. It is a testament to his skill as a writer that my mind and soul are lifted to great heights in reading the former and fall to equally great depths while reading the latter. Never the less, both are necessary reading.