The Magazine

Asylum Seeker

Sometimes crazy ideas make a certain sense.

Apr 6, 2009, Vol. 14, No. 28 • By CAITRIN NICOL
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Voluntary Madness

My Year Lost and Found
in the Loony Bin

by Norah Vincent

Viking, 304 pp., $25.95

It is, perhaps, as good a sign of the times as any that it takes an East Village quasi-bohemian going undercover for months at a stretch and systematically wrecking her psyche to discover for the New York Times bestseller-reading public things that were well known less than 50 years ago: Men and women are very different creatures. A happy life involves some measure of personal responsibility. Mental health requires more than pills.

Norah Vincent's Voluntary Madness is a wry, inventive reprise of a truth too plain to otherwise catch our attention.

Vincent, back from her stint exploring male communities in drag for her Self-Made Man (2004), decides to do a similar project: to go incognito as a sane person in the mental health system. Presenting symptoms of major depression, she checks herself into three facilities in turn: a large public urban psych ward, a private Catholic institution in the middle of nowhere, and a Zen rehab clinic in a balmy corner of the country. The catch is that, in a series of Shakespearean switchbacks, it turns out that she is not perfectly sound of mind, body, and spirit (who is?), so for this new feat of immersion journalism she is an ill person posing as a well person who pretends to be ill to go undercover and receive treatment and learn, after all, that she is a well person responding normally to various life trials. In the heart of this confusion lies a serious problem in mental health care, the over-diagnosis and over-medication of functional individuals, who may later find themselves dependent on a drug they should not have been prescribed.

Thanks to just such an unfortunate experience, Vincent approaches her assignment with a vengeance, envisioning a blistering exposé of "the system." She finds what she's looking for at Meriwether, the public hospital, a wretched place where a stable person on the brink of sanity can hardly help but go native. Little or no thought is given to basic matters like nutrition and hygiene; the staff is alternately apathetic and domineering; and the patients, most of them psychotics, are medicated with alarmingly strong cocktails into chemical submission. A scant few hours into her self-imposed stay, Vincent, already desperate, flirts with the idea of escaping through the radiology wing. Imagining herself tearing down the street in "mad rags" she chuckles at how loony she would surely look to passersby:

But, God, it was a strong urge--run! I thought--and I had this thought many times in the coming days--who wouldn't look crazy doing that? Yet who, under the circumstances, wouldn't do it, or at least want to?

The other facilities are dreary in their own ways. St. Luke's, the Catholic clinic, is kindly staffed but overhung with deadness, for most patients a futile little haven in an ocean of despair. Mobius, the rehab resort, is agreeably designed; in fact, it seems plucked straight from fantasies she had of the "perfect" mental health center when she was a patient at the other two facilities. But no one there, it seems, is making much of an effort to get better.

Unsurprisingly, tackling private demons is neither simple nor pleasant. It dawns on her, then, that the biggest challenge in psychiatry lies where no amount of increased funding, policy reform, or new improved pharmaceuticals can touch it: in the individual's willingness to participate in his own recovery.

Nonetheless, she has some words for mental health professionals. One of her finest suggestions is for psychiatrists-in-training to repeat her stunt, disguising themselves as patients for a kind of hands-on there but for the grace of God go I. Another is to offer patients something to really do, some way of meeting one another's needs above and beyond waiting for their own to be addressed. At St. Luke's, an aged, unhinged nun named Sister Pete is furnished with a station on the grounds where she ministers in her own way to her fellow patients, "giving mad solace to the mad," providing for them a sympathetic personal connection and for her the dignity of purpose.

"I imagined how Mother T [a very religious, very mad woman at Meriwether] would have flourished in this kind of role," Vincent writes, thinking of the many other patients who, by feeling needed, might find the encouragement to rise to the occasion.

Voluntary Madness is not, as its author first intended, a polemic. Nor is it in any sense an objective analysis of modern mental health care. What it does, and does quite well, is offer up a strong reminder to view sane and disturbed alike as whole human persons. Rather than moving towards the medicalization of every human trait and passion, it would be wise, even (or especially?) with the most severely afflicted, to begin with what is most central to them--one might call this the soul--and move outwards, from their hopes and fears and aspirations to the obstacles, medical and otherwise, that stand opposed to their full
flourishing.

Caitrin Nicol is managing editor of the New Atlantis.