When I was twenty-four years old and a doctor persuaded me that I had not been poisoned by a foreign implant just below my jawbone, that it had not been placed there by God, nor by some demon, nor by my roommate, who I also suspected had hidden tiny cameras in my room and planned to kill me, that all of these beliefs, and a great number of other problems in my life—the erratic moods, the difficult behavior, the way I seemed to trouble everyone around me and alternate between anger and withdrawal and resentment and despair—were best explained by mental illness and that the medication I had begrudgingly agreed to take for the past few weeks was the only reason I was open to this explanation at all, the only reason I seemed calmer and no longer felt so paralyzed by fear that I was unable to eat more than a meal a day or sleep more than four hours a night or speak more than a few words at a time, and that, if I did not want to feel that way again I would need to continue taking this medication and possibly several other medications for the remainder of my life, I wasn’t looking for consolation in my madness. I wasn’t looking to feel inspired or recognized or comforted or understood, to make common cause with a community of “people like me.” I was looking for any reason to believe it wasn’t true, and failing that, to forget entirely. I avoided learning or reading anything about it. I told almost no one. I took the medication (most of the time) and saw doctors (irregularly) and made routine returns to the hospital for the better part of five years before I relented and began to attain what a psychiatrist would call real insight. This is not an unusual response to discovering that you have spent years of your life coming in and out of sanity. You take the medication and decide it’s over now and never needs to be spoken of again.
But the mad do speak, of course, and write. We have had autobiographical accounts of madness for nearly as long as we’ve had autobiography, but after germinating in relative obscurity for much of the last two centuries, autobiographical accounts of insanity rode the more general memoir boom of the 1980s into a run of bestsellers that established the mad memoir as a staple of American literature. These titles are the easiest to find, the most likely to be recommended by psychiatrists and therapists and the search algorithm on Amazon; they are the ones I was told to read, when I finally relented and began to admit some curiosity about the experiences of others. What I found were that these hits had been expecting me. They declared their intentions to do things like push back against stigma, to help bring mental illness out of the shadows, to help others understand a difficult to understand disease, and to show others that what we need isn’t fear, but support.
“I’ve written this book hoping that my story can help others the way I was helped,” writes Lori Schiller on the final page of 1994’s The Quiet Room. The preceding 265 pages suggest that Schiller was mainly helped by prolonged institutionalization and antipsychotic medication, but her book is here to help by inspiring others with her “life and experiences.” In a 1995 memoir, An Unquiet Mind, Kay Redfield Jamison also appears to want to help others in offering “a somewhat different perspective on a disease that had been well-described by many.” The perspective—derived, in principle, from Jamison’s dual role as both a manic-depressive and a clinical psychologist—is that mood stabilizers are wonderful and all patients ought to take them with enthusiasm, a perspective that no doubt explains why the book is such a popular recommendation among psychiatrists and therapists who are trying to help newly discovered lunatics cope with their diagnoses. “People with thought disorders do not keep a list of famous and successful people who share their problem,” Elyn Saks says in her 2007 memoir, The Center Cannot Hold. “They can’t, because there is no such list.” But now there is, and Elyn Saks is on it.
These memoirs might have aesthetic ambitions, but they were not written in pursuit of literary triumph, nor even to satiate the idle curiosity of the public about the business of going crazy. These authors did not just want to move the reader; they wanted to change the world—or at least the part of it devoted to thinking about, and often deciding the fates of, the insane. In this, they were only following a tradition in mad writing that predates the formal psychiatric memoir—even literary memoir—itself. The mad memoir has always taken its purpose to be political, its goal, at least in part, to produce social effects somewhere beyond the text itself. But the particulars of the mad memoir’s social ambitions have changed over the centuries, and in the decades since the genre’s late-twentieth-century apex, it has found itself carrying its radicalism like a vestigial organ, a reflex firing long after the conditions that trained it.
In or around 1420, the English poet Thomas Hoccleve recognized how often the most enduring pains of madness were not its private torments but the public consequences of being known as mad. In his Complainte, he lamented how, although his “wit” had returned after a prolonged period of unspecified insanity, “men wolde it not so undirstond or take with [him] to dele.” His “olde frindshipe” were shaken off; the world met him with “a straunge countinaunce,” which his “herte sore gan torment.” Hoccleve proposed no reforms and did not ask his reader to do anything, but he missed his friends, and Complainte was perhaps the first work of literature in English to deal with what would now be called “stigma.” The reading public of the fifteenth century was quite small, and Hoccleve knew that his call to action would be clear enough to his true, intended readers: please come back.
The mad memoir ossified into a proper genre in the early 1800s. The authors of these books also knew what they wanted from their readers. They told the reader explicitly and never let them forget. “I wish to stir up an intelligent and active sympathy, in behalf of the most wretched, the most oppressed, the only helpless of mankind,” wrote John Perceval in the first chapter of his 1838 Narrative. By “detailing and explaining his sufferings, his complaints, and his difficulties,” he hoped to spare others “the errors which were unfortunately committed” by his own family. His difficulties were many: in 1812, when he was nine years old, Perceval saw his father, Spencer Perceval, Prime Minister of the United Kingdom, assassinated in the lobby of the House of Commons. In 1830, after joining the military, quitting the military, enrolling in Oxford, dropping out of Oxford, traveling to Scotland and declaring himself a vessel for the Holy Spirit, leaving Scotland, becoming a teetotaler, moving to Dublin, becoming an atheist, and receiving mercury treatment for a venereal disease contracted from an Irish prostitute, Perceval was held captive by his friends until his elder brother could retrieve him and return him to England, where he was committed to asylum: first Brislington House and then Ticehurst House Hospital in Sussex.
During his three years in the hospital, Perceval labored under the constant demands of ghosts and other spiritual presences. But psychosis, while difficult, was not his complaint; those “delusions of a religious nature,” he wrote, had “unfortunately deprived” him “of the use of reason,” but his “soul survived.” No, his suffering had come at the hands of doctors, those “men of little education, and of low origin” whose “needless tyranny” had subjected him to food deprivation, cold water shocks, ritual humiliation, twenty-four-hour restraints, and at least one surgical effort to sever his temporal artery. Their “habitual cruelty” and “charlatanism” were “the severest part of [his] most severe scourge.” Asylums were inhumane. The doctors were “tormentors and destroyers.” Reform was needed. New laws were needed. What Perceval wanted from his readers was action. “In the name of humanity,” he wrote, “in the name of modesty, in the name of wisdom, I intreat you to place yourselves in the position of those whose sufferings I describe. . . . Feel for them; try to defend them. Be their friends.”
In 1860, the United States produced its first celebrity mad memoirist in the form of Elizabeth Packard, an Illinois woman whose husband Theophilus, tired of Elizabeth’s interest in Swedenborgianism and abolitionism and perhaps tired of Elizabeth in general, had her committed to Jacksonville Insane Asylum. Elizabeth remained there until 1863, when she managed to secure a legal declaration of her sanity, separate from her husband, and embark on a new life as an anti-asylum activist. She produced half a dozen memoirs, most famously 1868’s The Prisoners’ Hidden Life, Or Insane Asylums Unveiled. Like Perceval, Packard told the public what she wanted. The “object of the writer in giving her narrative to the world” was “to fasten the public eye” upon a “great evil,” to shake the conscience of the nation, to redress an ill that was, following the recent abolition of chattel slavery, the most pressing moral abomination of the age. “The legalized usurpation of human rights is the great evil underlying our social fabric,” Packard wrote. “From this corrupt center spring the evils of our social system.” The government had to act, and the reader must compel it to do so.
Packard never conceded that she belonged in the asylum at all. She maintained her sanity for the rest of her life, and unlike Perceval, whose cause was the better treatment of true lunatics, Packard took the “legalized usurpation of human rights” to be a defining premise of psychiatry; “treatment” of any kind was merely a kind of medical mystification designed to legitimize legal kidnapping and warehousing of undesirables, a theoretical position to which she beat Michel Foucault by the better part of a century. The fact that a sane woman could be the first great American mad memoirist is not as strange as it might seem. As Hoccleve well knew, the torments of madness are only partly located in the fact of being mad.
The rest is found in being seen that way, being designated a madman by the world. An undiscovered lunatic does not suffer stigma; they do not suffer the institution or the tyranny of doctors. They do not produce mad memoirs because they are not understood to speak for the mad, a position that puts them behind even those who have been diagnosed in the absence of true madness. It is not enough be psychotic; to write a book about going mad, you must be socially recognized as insane. John Perceval heard voices. Elizabeth Packard did not. But they are both titans in the history of the genre because the social element of madness is inseparable from the task of writing about it—more inseparable, it turns out, than the business of actually being insane. It shouldn’t surprise us that the mad memoir has always taken itself to have a social role to play.
In the nineteenth century, the point of the mad memoir was obvious. It’s a mistake to speak about the “beginning” of the genre’s social ambitions at all; in the beginning, mad memoirs were not literary works that underwent a political turn but writing in service of a cause, produced by writers who did not see themselves primarily as authors but as activists. Perceval and Packard didn’t simply make their demands in print and leave it for their readers to bring them to fruition. In 1845, Perceval helped found the Alleged Lunatics’ Friend Society, and in his capacity as the group’s honorary secretary, he began to refer to himself as “attorney general for Her Majesty’s madmen.” In 1868, Packard proposed founding an “Anti-Insane Asylum Society,” which would “serve as a nucleus of a humanitarian reform in this most needed department of human rights”; she spent decades advocating for asylum law reform, meeting with then-President Ulysses S. Grant in 1874. Both campaigned for decades; both died still active in their cause.
They were not alone. The nineteenth century saw a surge in tracts, essays, and articles by lesser-known lunatics and patients, nearly all of them dedicated to exposing the abuses of the asylums and calling for explicit reform. “I have witnessed the most cruel and barbarous treatment . . . that could be inflicted on a human being,” Ebenezer Haskell reported in his 1869 A Brief Sketch of the Mode of Treatment of Lunatics. Patients were stripped, choked, beaten, “stretched out flat on [their] back, with a strap around the bedstead . . . [their] legs pulled wide apart . . . the arms are pulled out straight from the body and strapped down”; one man, kept in such a position for three straight days and nights, only found peace on the fourth day when “death relieved him of his agony.” In 1849’s Five Months in the New-York State Lunatic Asylum, the anonymous author recalls laying all night on knees and elbows “covered with sores, the blood spirting out and running quite freely, sometimes [filling] my shoes half full.” “It is thus to be treated like swine that you send your friends from their own houses to the asylum?” the author asks. “That Institution professes to the world to be a home for the suffering insane, but to them it is hell!”
The full and formal transformation of madness into mental illness in the early decades of the twentieth century did not improve the lot of Perceval and Packard’s heirs. Insanity was no longer a bizarre affliction of debatable origin to be managed by families, communities, and the occasional doctor, but a matter of public, and therefore political, concern. It had to be studied, managed, and perhaps solved by experts reaching standardized conclusions and doctors trained to implement new public health policies. The result was eugenics, forced sterilization, electroconvulsion, prefrontal lobotomy—and these were only the approved procedures of this new era. In the dozens of public psychiatric institutions built in the late nineteenth and early twentieth centuries as an apparent triumph of social concern for the pitiable insane, conditions had so deteriorated—death and deprivation and abuse had become so common—that in 1948 journalist Albert Deutsch wrote in Shame of the States that American psychiatric wards put him in mind of nothing less than “the Nazi concentration camps at Belsen and Buchenwald.” Even those lunatics who avoided the madhouse fared little better: most wound up imprisoned or homeless, seeing psychiatrists or therapists in secret if at all, becoming the shame of rich and poor families alike and with little to no efficacious treatment available, even if the worst social consequences of insanity could be avoided.
The memoirs of this era were often angrier, more vivid and horrifying. Gone was the hemming and hawing about what might be “becoming” for the narrator to share. While the mad memoirists of the nineteenth century hewed closely to reform—more stringent commitment laws, better conditions upon commitment, the end of railroading for the sane—those of the early twentieth century suggested, sometimes implicitly, sometimes explicitly, that the reader ought to demand the end of madhouses entirely, ought to be suspicious of psychiatry itself. The power of this new generation of memoirs came in part from the superior literary capacity of many of their authors. The tracts and pamphlets and testimonials continued to appear, but alongside them were Jane Hillyer’s Reluctantly Told (1926), Anna Kavan’s Asylum Piece (1940), and Barbara O’Brien’s Operators and Things (1958), books that took structure, scene, dialogue, and immersive detail far more seriously than their predecessors. If the mad memoir began as a straightforward political project for the mad, it was during this era that it began to mature as memoir. Perceval and Packard, neither of them writers by trade, were succeeded by Charlotte Perkins Gilman and Mary Jane Ward, poets and novelists who made the mad memoir a genre of literature.
These new literary ambitions, combined with somehow worsening stigma against the insane, led some authors to disguise their memoirs as novels. The Snake Pit, Ward’s 1946 account of her schizophrenia and subsequent institutionalization in Rockland State Hospital, never calls upon the reader to act on the basis of its testimony because its plot allegedly happened to a “Virginia Cunningham,” a patient at the fictional Juniper Hill Hospital. The book disorients the reader: Virginia begins in Ward Three, then moves through Wards One, Two, Five, Twelve, Fourteen, and Thirty-Three—the titular snake pit, where “incurable” patients are largely abandoned to their squalor—without ever quite understanding the reasons for her movements, much less her progress or hope for a cure. Ward’s rendering of psychosis is an early triumph of the ever-vexing problem of mimetically representing an experience that defies easy explanation, sense, or metaphorical equivalence. Its politics are on display in the relationships between its cast of characters: power, in the form of doctors and nurses, is inscrutable and cold. The few moments of hope in the novel come in scenes of understanding and solidarity between patients, often in explicitly socialist terms.
Ward never turns to her reader and declares the doctors charlatans or tyrants, but there are no breakthroughs in this book, only depictions of bizarre, unhelpful, and often excruciating “treatments”—most famously a brutal series of electric shocks—rendered by pompous and vaguely hostile doctors and nurses. The novel never explains the origins of Virginia’s madness; in the end, Virginia is released without any indication that she is any saner than she was when she was committed. Nevertheless, The Snake Pit is perhaps the best remembered and most influential mad memoir of this era because it fulfilled many of the ambitions of those earlier, more explicitly political testimonials. It raised the “social consciousness” of millions of readers, as the prominent critic Elizabeth Donaldson later noted; it garnered “public support for reforms in psychiatric institutions” not in spite of its aestheticized disguise but in virtue of it. If Perceval and Packard’s generation had established the point of the psychiatric memoir, Ward and her contemporaries established the means by which the political goals of the genre could reach the wider public.
The introduction of literary technique, combined with a growing international interest in matters of mental health and illness, brought the mad memoir to the mainstream. Of course, not every new reader was politically inclined or looking to be stirred to action. This new generation of mad memoirists no longer demurred when it came to describing the spectacular and fascinating symptoms of insanity itself. Many readers were simply curious about what it was like to go crazy. Others were drawn to the lurid promise of insanity: the strangeness and danger of madness that has always provoked a vaguely prurient interest and goes some way toward explaining why mad memoirs by women, particularly younger women, have tended to be the most widely read. The middle of the twentieth century saw an explosion in accounts of insanity, and some were happy to indulge these voyeurs.
But many, like Ward, used these points of interest to lure those readers in where they could be brought around to the real point of the text. After the overnight success of The Snake Pit, Ward was quickly outed as the real “Virginia.” In the aftermath, she, like Packard before her, threw herself into activism, visiting hundreds of hospitals and writing dozens of articles in support of mental hospital reform and abolition. But by 1955, after only a decade, Ward quit the activist scene. Soon after, she published Counterclockwise, a second autobiographical novel, in which a thinly veiled Ward—now named Susan—has achieved success as a mad memoirist and social reformer but must return to the psychiatric hospital after suffering another breakdown. There, the reform fruits of a decade’s efforts are laid bare: rooms filled by naked, incontinent patients, beset by chronic lice infestations, as bad as anything ever was in The Snake Pit. The mad memoir had pursued a single, concrete end from the early nineteenth century to the mid-twentieth: legal reforms, improved conditions, better laws, better treatment. But despite the genre’s growing literary sophistication and corresponding commercial growth, it hadn’t won yet.
Until, suddenly and imperfectly, it did. In the middle of the twentieth century, two events radically altered the condition of lunatics in Western society and with them the direction and purpose of the mad memoir. In 1949, the Australian psychiatrist John Cade published a paper showing that lithium could act as an effective mood stabilizer—the first one in human history. Just a few years later, the first generation of modern antipsychotic drugs medicated into remission cases of schizophrenia and other psychotic disorders.
These drugs were not universally effective, nor were their side effects always bearable, but they allowed millions of people who might otherwise have lived the whole of their usually brief lives in the throes of madness to return, no matter how blearily, sluggishly, or miserably, to the ranks of the living. At the same time, the end of a hundred years of tectonic and complex political movement—some of which grew directly out of the efforts of memoir-activists, and some of which was better attributed to reactionary budget hawkery—culminated in what we now call deinstitutionalization. In 1955, more than 500,000 Americans lived in asylums. By 1980, the figure had dropped to fewer than 50,000. Involuntary commitment laws became remarkably narrow. Even voluntary patients could often be stabilized with medication and released for outpatient monitoring; if they did not stabilize, they were often released anyway. What few inpatient holds remained were typically measured in the days and weeks.
These two revolutions had two effects on the mad memoir. First, there were far more lunatics theoretically capable of writing. Previously, mad memoirs had mainly been authored by victims of railroading (like Packard), spontaneous recoveries (like Perceval), and those who, despite their madness, possessed the rare capacity to compose a coherent text (like Ward). Now, antipsychotics had returned a great number of the deeply mad to sanity, and some turned to writing. Second, deinstitutionalization robbed the mad of the central haunting symbol of their universe. While many would still find themselves committed, or commit themselves to hospitals, the landscape of insanity in the United States diffused across a broader range of issues: medication, outpatient doctors, difficulties in housing, in relationships, in work, in accessing any care at all, in the shame and stigma of being sane and free but still seen as insane and still worried that recovery might prove temporary.
The social and political purpose remained central to the mad memoir’s self-conception, but consensus about particular goals—once a clear and measurable set of laws in need of passing, hospitals in need of regulating, rights in need of enforcing—began to fracture. Some authors and activists carried on as radicals, committing themselves to the burgeoning anti-psychiatry movement or mad movement or the academy, where disability studies and mad studies departments facilitated these writers in arguing that the abolition of the asylum was only the first step in the abolition of “madness” as a social category. Others entered the mainstream, offering prosocial messages of hope and recovery to those lunatics who had not yet received the miracle of modern care. The point was still political, but its orientation, long defined by what it was against, now spoke in terms of what it was for: access, compassion, an end to the stigma that left so many patients too ashamed to seek the help they’d need.
The hopeful memoirists were the more commercially successful. Mainstream imprints, previously wary of the often controversial and polemical work of mad memoirists, were eager to capitalize on growing public interest in and compassion toward the “mentally ill”—by the 1990s, just one of so many ascriptive identities proffering their perspectives—by publishing what came to be known as “recovery memoirs.” With plot structures largely copied from the ever-popular drug addiction memoir, these books began with psychotic breaks. They indulged the danger and spectacle of madness—Schiller recounts a vivid (though ultimately false) memory of murdering a dog; Jamison documents money wasted, relationships ruined, sexual escapades regretted—but these books end, inevitably, if not with a cure then with the restoration of life itself. For Schiller, this is a gift, “the great gift I have been given: the chance to begin life again.” For Saks, it is good fortune—“not that I’ve recovered from mental illness. I have not, nor will I ever,” she writes. “My good fortune lies in having found my life.” Doctors occasionally came under criticism in these memoirs, but these villains were depicted as individual, bad examples of a profession that otherwise represented the promise of salvation. Hospitals were no longer portrayed as the site of oppressions the narrator must struggle against; they stood for the hope that the narrator must struggle to accept. If anybody was disparaged, it was the stigmatizing public, misunderstanding and rejecting the insane. The mainstream appeal of the recovery memoir was integral to its politics: You can come back to society, it said to patients. And to society it said, You ought to welcome those patients back with understanding.
But the recovery memoirists were not the only authors attempting to claim the mantle of the mad memoir’s social legacy. More radical, sometimes explicitly anti-psychiatric authors continued to dominate in the academy and in the major “mad movement” activist organizations. While the recovery memoirists claimed the firm middle brow of late-twentieth-century mad memoir production, the radicals largely claimed the extremes. On the lower end, many descended into the kind of strident, jargonistic, and self-limiting politics that resemble reactionary fantasies about the insularity of the humanities, abandoning the literary ambitions of authors like Ward and Perkins in favor of a return to the kind of browbeating politics more reminiscent of Packard’s jeremiads, now couched in the language of the academy. While the radicals still flirted with political and legal battles—accessibility policies, human rights conventions, further tightening of commitment standards—they no longer devoted much energy to calling for votes or forming societies. They made theoretical arguments. First, the radicals would prove the lie of “biomedical psychiatry.” Then, when everybody came around, they would begin to change the world. They took shots at the recovery memoirists: “As a psychiatrist herself, [Jamison] vehemently supports biomedical interventions and finds alternative models unethical,” and therefore “we cannot uncritically claim that Jamison is furthering the mission of disability studies,” wrote one radical critic of An Unquiet Mind. They devoted a great deal of time to generating the perfect name for the mad, with “psychobiosocialpoliticalbodymind” a serious candidate. But on the higher end, some radicals, unshackled by the need to deliver hopeful messages to major publishers, produced several of the most original and accomplished works yet: Shulamith Firestone’s labyrinthine and fragmentary Airless Spaces (1998); Janet Frame’s terrifying and ambivalent autobiographical trilogy, To the Is-Land (1982), An Angel at My Table (1984), and The Envoy from Mirror City (1984).
But these two new major camps among authors of mad memoirs were not so divided as they appeared. Both styles were still explicitly dedicated to social ends beyond any pleasures of the text. Bereft of a singular, concrete, and unifying legal purpose, both concerned themselves with matters of theory and culture, with matters of representation, public education, the reception of lunatics in ordinary life. The divide was over the ends of these efforts. Was madness to be exposed as a malicious means of social control, or established as a new ascriptive identity group, worthy of protection and respect? They agreed that the problem, at bottom, was something called “stigma.” Like Hoccleve six centuries before, they had been delivered from the throes of madness by new medications and the end of institutions, only to find that the world at large encountered them as strangers. The point of the psychiatric memoir entering the twenty-first century, whether hopeful or radical, predictably plotted or experimentally ambitious, was not so different from what Perceval had asked in 1838: read my story and place yourself in the position of those whose sufferings I describe. Feel for them. Try to defend them. Be their friends.
The mad have many friends these days. At the end of the twentieth century, when the political project of the mad memoir turned its attention away from laws and toward the culture, it wasn’t hard to find the stigmatizing currents. Television, film, and genre fiction still played on old stereotypes of violent lunatics, sinister malingerers, and shameful family secrets. Most Americans would tell you, if asked, that “schizophrenia” was a multiple personality disorder and that “bipolar” was a good way to describe an annoying friend. But since then, the official consensus of U.S. culture has undergone a remarkable change. The language of the clinic has colonized everyday life among our professional class. Therapy is everywhere: advertised by celebrities on television, available by app, a precondition for ideal liberal life. In 1999, Law & Order ran regular episodes featuring incurably mad killers; by 2019, it had run multiple arcs about the sympathetic struggles of the mentally ill, with hardened New York cops chiding their colleagues for calling someone “crazy.” Diagnosis has become so accepted, even alluring, that ordinary teenagers and young adults have begun to self-diagnose via the internet and embark on lucrative careers as mental health influencers.
This transformation has been remarkable, and it is perhaps due in part to the social efforts of our most influential lunatic writers. But most remarkable is that the purpose of the mad memoir appears unchanged: the radicals continue on in anticipation of widespread revelation that psychiatry is fake. Meanwhile, the recovery memoirists continue telling us that crazy people can recover and live ordinary lives, as if nobody has ever heard that before.
No mad memoir of our time has displaced the greatest hits of the 1990s because few, if any, have said anything new. The genre has calcified; to the extent that the radicals and recoverees have reconvened, it is in the odd way that so many contemporary mad memoirs are both hugely suspicious of “biomedical psychiatry” and firmly committed to their own madness as a category of protected identity. Alongside the steady supply of new memoirs, we have seen a boom in online personal essays about mental illness which strikingly resemble the mad writing of the nineteenth century: didactic, melodramatic rhetorical gambits rendered in amateurish prose by authors frequently demure—perhaps ashamed—about the details of actual mad life beyond the manageable, pitiable, slightly unusual: misunderstandings with quirky causes, stress inflicted by a stigmatizing world, at worst friendships vaguely ruined, jobs unjustly but understandably lost. At their most tedious, they take madness as a series of quirks, or worse, as a series of personality traits with no interpersonal downsides. They read for the same dull script: I’m bipolar. I’m depressed. I have OCD. Here’s why any negative associations you have with those conditions are stigma, and I’m just like you, except more interesting. Perceval and Packard were at least original, at least undertaking a genuine risk in publishing their jeremiads. Many of these new essays manage the worst of both worlds: the unvarnished hectoring of the polemic in service of a message suitable for an afterschool special.
At the risk of betraying some unfashionable elitism, I believe that mad memoirs should aspire to be good, not only as political testimonials for the cause of the insane, but as endeavors in literary nonfiction. I don’t only prefer Ward to Packard because I believe that Ward’s talents made her a more effective rhetorician for the mad, but because her talents make her a pleasure to read. So far, the most successful mad memoir of the twenty-first century is Esmé Weijun Wang’s The Collected Schizophrenias. This is in part because Wang is a serious writer, one of perhaps a dozen in the past twenty years to take the literary ambitions of the genre as seriously as the social ones. She is best in the direct, the personal, the mimetic; “Perdition Days,” Wang’s essay on the direct experience of Cotard’s delusion, a condition in which sufferers believe they are dead, is rightly seen as the collection’s strongest. The Collected Schizophrenias gains no small part of its strength from the fact of it being an essay collection; like Firestone before her and so few other mad memoirists, Wang is free to associate, to contradict, to doubt, to think without the burden of a rigid recovery plot. But The Collected Schizophrenias still labors under the burden and the limits of the contemporary social purpose. It begins with the terror of madness and ends “tethered” to life: the recovery plot isn’t entirely absent. Its narrator tells us how her madness has made her “frightening” to others, but doesn’t get into the details. It documents the way insanity forced Wang out of Yale, but lets us know she managed to graduate from Stanford. The Collected Schizophrenias inevitably addresses stigma. An entire essay, “High-Functioning,” is dedicated to the topic. In Wang’s hands, the social purpose turns inward and neurotic, becomes about the possibility that she carries stigma in her heart. “Because I am capable of achievement, I find myself uncomfortable around those who are visibly psychotic and audibly disorganized,” she writes:
I’m uncomfortable because I don’t want to be lumped in with the screaming man on the bus, or the woman who claims that she’s the reincarnation of God. I’m uncomfortably uncomfortable because I know that these are my people in ways that those who have never experienced psychosis can’t understand, and to shun them is to shun a large part of myself.
No doubt that guilt is real. But is the fear? It is difficult to imagine any reader of this book—and certainly impossible to find any reviewer—who would for a single second lump Wang in with the screaming man or the delusional woman, who would see her as anything other than an “important voice.” Once, even the son of a prime minister risked scandal by confessing to a spell of madness; now, after generations of progress, we are happy to praise the mad writer who can reassure us they have returned to liberal bourgeois life, or who decries “biomedical psychiatry” from the mannered pastures of the academic humanities—the writer whose madness interrupts their otherwise secure status as a member of the striver class. There is no more stigma for the kind of mad writer who does not have a disease so much as an identity.
Despite all our vaunted progress in academia, in media, in the words you are allowed to say among mixed company, the world is still hostile to the preponderance of the insane. For every essay written by rote about how we ought to be more compassionate toward those struggling with mental illness in the Times or New York Magazine or Vox, there is an article in the New York Post demanding that the mayor clean up the streets by personally choking every homeless schizophrenic interloper to death. Very few would endorse a return to lobotomy or cold-water shock, but as “serious mental illness” has come to explain every urban ill in the American imagination, a return to mass institutionalization is more popular than it has been in fifty years. Each year, a new state rolls back its already narrow provisions for the insanity defense in court; in New York, Daniel Penny, a man who really did choke a homeless schizophrenic man to death, was cheered at his acquittal. While the mad memoir may counter unkind stereotypes, it has not yet touched—perhaps cannot touch—the kind of stigma that manifests in incarceration, desperation, or death.
Perhaps this was inevitable. Even with three generations of antipsychotics, the lunatics like Saks or Jamison or Wang (or me) who are capable of producing a publishable text are not randomly selected from the psychotic population; the success of those late-twentieth-century recovery memoirists created a model for the kind of mad writer the public would accept. Wang’s deranged man, screaming on the bus, will likely never write a memoir even if someone calms him down.
This may be by design. When the point of the mad memoir became cultural, all the mad were stigmatized; in the intervening thirty years, the very success of the mainstream mad memoir has produced an ideal mad subject: one who is struggling but not difficult or dangerous, one who can create an opportunity for understanding without asking the public to understand too much. They have done this by defining the danger and difficulty out of madness. In their books and articles and essays, mad writers in the twenty-first century have written their paeans to openness and understanding premised on the argument, repeated so incessantly that it has become a cliché, that insanity does not really cause troubling behavior, does not make people say foolish or insulting things, certainly never leads to violence, does not provoke any moral difficulty at all for anyone but the lunatic herself. In short, the politics of the mad memoir have become the politics of respectability.
The mad are not the first group whose most secure members have been tempted by respectability politics. But the result is the production of a safe representative class—strange, but not scary; different, but not beyond recovery—speaking for a population who, on the whole, cannot really make those assurances. They have spared themselves stigma not by abolishing it but by defining the insanity out of mental illness. Ironically, this has the effect of doubly stigmatizing less reputable patients: they are still crazy, and now all their obnoxiousness and troublemaking and instability is a failing of some other part of their soul. After all, the essays explain, mental illness doesn’t make people do bad things.
Some, like Wang, know what is going on. “I cling to the concept of being high-functioning,” she writes:
As in most marginalized groups, there are those who are considered more socially appropriate than others, and who therefore distance themselves from those so-called inappropriate people, in part because being perceived as incapable of success causes a desire to distance oneself for other, similarly marginalized people who are thought to be even less capable of success.
But self-awareness does not stop The Collected Schizophrenias from playing a more sophisticated version of the game of its contemporaries, from flattering the reader who is eager to accept the respectable lunatic and imagines the social message of the text is there to intervene on someone else. They’ve believed as much, or told themselves they do, for thirty years. They are eager to do more understanding. They praise the bravery of the author then go outside and pray that somebody will haul away that troubling lunatic on the corner. They hope the jury doesn’t let that malingering defendant get away with it. They bemoan the taxes they pay to social security disability insurance for people who just won’t help themselves and keep a job. Wang is not the man on the bus, and she knows it; so do her readers, even if neither is being cynical.
I don’t believe that most mad memoirists really want this. Respectability politics are typically the result of habit and fear, not malice. But this is where we find ourselves. The truth that everybody knows, even if their position demands they don’t admit it, is that madness is not just another “marginalized group,” not just another population suffering from bigotry, although we do suffer this way. Madness is not clean, nor well understood, nor easily recovered. It is not a quirk. It is difficult, for the madman and for others. It is uncanny, baffling, displeasing; it sometimes ends in irrevocable loss, in the ruin of a life that cannot be returned to. The ordinary people who resent the schizophrenic man on the corner, the manic-depressive cousin who keeps calling in the night, the unstable spouse or friend—they may be guilty of “perpetuating stigma,” but they aren’t imagining their grievances. The very first line of Wang’s book is simple: “Schizophrenia terrifies.”
It does. It terrifies the mad and it terrifies those around them. It is not simply inconvenient. It is dangerous and strange, and no number of respectable strivers insisting over and over again that this isn’t true, that it’s stigma to say so, that it’s all television’s fault for perpetuating those lies, will ever change that. I am a respectable lunatic. I am stable. I have a job. I write. But I also came very close to murdering an old roommate. I broke into an apartment and terrified the people there. I screamed at people, scared them, was unreliable and difficult for years and although I have recovered, the plot may not end with the restoration of my life: there are decades left, I hope, and sometimes you just get sick again. This is true of every serious lunatic, and the point of the mad memoir cannot be the production of an illusory respectable lunatic class at the expense of the man screaming on the bus getting thrown beneath it.
Let me then follow in tradition and tell you directly what I want: I want the mad to chance the world’s hate again. I want the mad memoir to take the same risks that Perceval and Packard and Ward and Firestone and even Saks and Jamison did by reckoning with what the public cannot yet make peace with. I want to return to ugly things, to stigmatizing things, to ambivalence, to difficulty, to unlikeable narrators, to lunatics for whom it went too far, even if the reader really might reject them, not because these things are more interesting or titillating or lurid, but because they are true. The point of the psychiatric memoir has taken many forms, but its essence has always been in forcing the reading public to reckon with those parts of madness—its experience, its effects, its treatment, its pain, its fear—that the world does not already know. It is not to carve out a little life raft for those of us capable of concealing the worst consequences of our illness and condemning the rest to the double stigma of madness and the insistence by the respectable mad that their dysfunction has nothing to do with our disease.
Perceval worried that it might be “unbecoming” to share what little he shared of his own psychoses. What ugly truths about insanity would risk the reputations of mad authors has changed considerably since Perceval’s time, but the urgency of taking such risks has not. The mad memoirists of the future should worry about what is unbecoming and write it anyway. That was always the point. It should be the point again.
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