I Never Promised You a Rose Garden - Hannah Green

I Never Promised You a Rose Garden is a good example aof a novel that suffers from poor synopses. It is generally billed as the story of Degborah Blau, a young woman whose life is divided between the relaity of a mental institution and the fantasy realm of Yr.

Superficially, this is accurate, but it strongly implies that Yr is a Narniaesque place of adventure and magic, where Deborah goes to fulfill the destiny denied her in the real world. Whereas the Yr reflected in the book is far less tangible. Its few physical features are scarecly mentioned at all, and generally only in recolleciton between Deborah and her psychiatrist, Dr. Fried. We the reader spend basically no time in Yr at all. Instead, we see it through her discussions with Dr. Fried and her own internal struggle. Yr is less a place than a pantheon of Gods that has grown increasingly oppressive, and a language in which Deborah’s scrambled thoughts can be more clearly articulated.

The split in the novel is thus not really reality versus fantasy, but internal versus external, as Deborah struggles to permeate the barrier without destroying herself in the process. We also spend more time with her family than I’d expected, who are portraying wit ha refreshing level of nuance. Her mother and father are flawed people, and subject to a less than perfect family dynamic marred by the outsized personality of her grandfather, but they all care about her deeply, and the root cause her illness is not foisted upon them. There’s no single breakthrough that brings Deborah back to the real world—another common cliche in books about mental illness—but a gradual paring back of thought and memory. All told, it paints a nuanced and accurate portrayal of therapy, which is perhaps not surprising, given the the novel is semi-autobiographical and concern’s the author’s actual experiences.

The book was perhaps not what I expected to be, but is ultimately stronger for defying those expectations. The writing is rich and eloquent, with evokative imagery that never feels stilted or excessive. Deborah’s whiz kid dialogue, clotted with witticisims, seemed a bit much, but this receded over the course of the book, and was likely meant to show her defense mechanisms. I found it jarred wit hthe otherwise naturalistic dialogue, but it wasn’t a fatal flaw.

The Shame of the States - Albert Deutsch

The Shame of the States is not the book I’d pictured it to be. Having come across a reference to it in Edward Shorter’s A History of Psychiaty, I’d imagined it as a kind of proto-gonzo journalism in the vein of Black Like Me, where Deutsch would masquerade as someone with mental health issues in order to expose the deplorable conditions of insane asylums. To be sure, there is an exposé element to The Shame of the States, but it is not one reach through duplicity. Deutsch announced his intentions to every one of the asylums he visits, and stresses that in the majority of cases he was welcomed with open arms.

That is not to say that the conditions he saw were favorable, or that he pulled any punches in his reporting. Rather, it speaks to the desperation in which asylum administrators found themselves—hopelessly underfunded and overworked, with barely trained staff and annual turnover rates approaching 100%—that they willingly exposed the foetid underbellies of their institutions in the hopes that learning of their appalling conditions would shock the public out of complacency, and that their outrage would trickle down to the politicians holding the purse strings.

I can’t say whether Deutsch’s book was successful in that regard, though I can say the picture he paints is vivid and heartbreaking, full of people in restraints or slumped in chairs, of beds filling a room so completely there is no space left to walk around them, of crumbling walls and ceiling bubbling with rot. Deutsch brought a photographer with him to every asylum he visited, and the photos he captured further underscore the squalid conditions of most of these institutions.

Though writing with the restrained, clinical prose of a seasoned journalist for most of his observations, Deutsch cannot restrain his seething anger at the state of affairs he witnesses, and the book contains a number of passages in which he allows himself the freedom to editorialize. The case studies make up the bulk of the text, but the book has other facets as well, making it part history, part journalism, part treatise.

Deutsch’s compassion for his subjects cannot be denied, though the age of the book means that some of the language he uses can be jarring to a modern reader. He refers to people with mental disabilities as “mentally defective” and “feeble-minded,” and regularly throws about the term idiot as a descriptor. People with Down Syndrome are referred to as “Mongolian Idiots.” I admit I cringed a bit at some of these passages, though it’s worth reiterating that Deutsch employs these terms without malice, and that the phrases he uses were at the time blandly clinical. He even makes a point of distinguishing between morons, imbeciles, and idiots, terms that signified increasingly severe levels of cognitive delay. “Idiot” and “moron” have been so thoroughly expunged of their clinical roots, that it is almost impossible to hear them as anything other than insults. Seeing them presented this way is an interesting reminder of how language changes over time.

One Flew Over the Cuckoo's Nest - Ken Kesey

I first read One Flew Over the Cuckoo’s Nest when I was maybe 19. It made a strong impression on me at the time, and remained at the back of my mind as an example of a Great Novel. Picking it up again at 33, I realised how much of my recollection was on the broad strokes of the plot, and on Randle Patrick McMurphy as a character. McMurphy is a solid character, a prototypical 60’s system-bucking hero, and it’s not surprising that we would become the focal point of the novel for most readers. But as I read through the book a second time, I found my attention drifting more and more to the narrator, Chief Bromden.

Books like Cuckoo are written in what we creative writing workshop dorks call “first person pedestal.” This means that the narrator is a character in the story, but unlike a standard first person novel, the narrator and the hero are not the same person. First person pedestal works to give an intimate portrait of an exceptional person from someone who knows them well, but whose own light shines a little less brightly. The Great Gatsby and To Kill a Mockingbird are probably the two most famous examples. Cuckoo is another.

But while Nick Carraway and Scout Finch can never match the allure of Gatsby and Atticus, I actually found Chief Bromden to be an even more interesting character than McMurphy. Kesey drops in details of the Chief’s past life with elegant restraint, and paints an evocative picture of his madness. A lesser author would take the fact that he pretends to be a deaf-mute as a simple narrative device and make his thinking otherwise normal, but it is clear that Bromden really does suffer from some sort of psychological ailment, quite possibly schizophrenia. Much of the narrative richness comes from Bromen’s interpretation of emotional states as affected by the Combine, a nefarious mechanism that controls everything it touches. The recurring images of machinery and fog play into common tropes among schizophrenic patients. It is interesting that Bromden’s paranoia seems to heighten rather than obscure his perception—we don’t question that Nurse Ratched controls the ward, even if we don’t take Brmden’s insistence that she does so through a fog machine literally. This device might not be medically accurate, but it makes for very rich prose.

A History of Psychiatry - Edward Shorter

The premise of Edward Shorter’s A History of Psychiatry is interesting. The brain remains the one piece of human anatomy whose inner workings we have not yet fully understood, and so an overview of our efforts to treat neurological illnesses seems like it would lead down some dark and intriguing alleyways. And so it does. Shorter provides a thorough chronicle of the different stages of psychiatric medicine, from the first efforts to house the mentally ill in asylums to the wonders of modern pharmaceuticals. The description of these phases was interesting, but strangely the least engaging aspect of Shorter’s chronicle was the human element. Shorter treats the book like a Who’s Who of psychiatric history, and the litany of names drone out paragraph after paragraph, each tagged with a brief description of the individual’s accomplishments before stepping aside to make room for the next shout out. Some names reappear pages later, vaguely attributed, leaving you scratching your head and wondering which of the 50 people you’ve just learned about this one is. I can’t fault Shorter for wanting to cite those responsible for psychiatry’s various accomplishments, but a more in-depth study of fewer players would have gone down a lot easier.

The cluttered prose is an inconvenience, but my biggest issue with the book was its editorializing. Shorter admits early on that he has a certain slant, which is admirable, but a history should strive for some level of objectivity. By contrast, Shorter’s preference for some schools of thought over others is apparent throughout the text—every figure associated with biological psychiatry, however slight their contribution, gets a solid 300 words, while major figures of psychotherapy are glossed over. Carl Jung is mentioned perhaps twice, both times in passing, and without any regard to his work or theories.

This editorializing by omission descends into something almost resembling a rant once it reaches the modern day. His dismisses patients with PTSD, anorexia, and moderate forms of depression, anxiety and OCD as little more than whiners who foisted their diagnoses on a hapless DSM committee through political strong-arming. There remains some validity to his criticisms of how the DSM was and is put together, but his cavalier dismissal of serious illnesses—some of which I’ve witnessed firsthand—was pretty gross. He walks this dismissal back in later pages, making it difficult to discern his exact stance on them, but either way the entire final chapter felt far too editorial in tone.