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Norah Vincent wrote Self-Made Man about her year living as a man, and at the end of that project, she became very depressed, so she checked herself into a psychiatric hospital ward for her own safety. As a result of that experience, she decided her next major project would be to check herself into three other psychiatric wards and report her experience. She does not identify them by their actual names, but calls them Meriwether, St. Luke's, and Mobius. She does not need to be hospitalized, but she is readily accepted by these institutions anyway, which is no great surprise: sane people do not normally try to get in under false pretences, and so long as there is money to pay for the say, they are ready to take it. Besides, Vincent has been a legitimate mental patient in the recent past, and she aims to get benefits from the treatment programs available at the places where she stays. So this is not straightforward undercover reporting; rather it is the reflection of one person already quite familiar with the psychiatric establishment on her experience of three places.
Vincent's treatment at the three places is varied, which is why she chose them. The first is on the east coast, and is the most typical sort of psychiatric ward. Just about all the patients are on medication, and are expected to be so. The toilets are filthy and most of the therapy was meaningless. Vincent was utterly relieved to get out. The second place required a plane trip, but she does not say to where. Her experience there was much better: she found a therapist who was not wedded to the use of medication, and allowed her substantial freedom. She was able to leave the ward and go into town to the gym so she could work out, which made her feel much better. The third place was even more alternative, incorporating all sorts of unorthodox practices. There she found a therapist she really related to, and she found her stay very helpful in understanding the causes of her depression and dysfunctional behavior, and in finding ways to stop repeating the same patterns. Even after leaving, she remained in contact with her therapist.
One of the messages of the book is how many psychiatric wards are run badly, are too dominated by the use of medication as the only therapeutic model, and could be a great deal better. She also emphasizes how important it to take responsibility for one's own treatment and mental health; she argues that no one else can do it for you, and you will only succeed if you are ready to work on your own life. She notices many patients who are in the wards because they are forced to be, due to family pressure or a court order, and she observes that they are simply not motivated to work on their own mental health. As soon as they leave, they return to doing exactly what they did before. So for many patients, it makes no difference how good the mental health treatment is, since they are not willing to take responsibility for their own lives.
So there are interesting ideas here. Given that they were based on short term observation and were purely subjective, they don't count as evidence. However, that's not what is disappointing about the book. Its problem is that it isn't vivid enough, and we only get a sketchy idea of what each place is like. Compare it to the 2001 HBO documentary Bellevue: Inside Out directed by Maryann DeLeo (unfortunately hard to find). In about 90 minutes, this gives a compelling portrait of an inner city psychiatric ward. Once one has seen it, one does not forget it. It follows several patients through their stays and lets them speak for themselves, and we also see the doctors and nurses doing their work, talking to each other, and talking to interviewers directly. They are charismatic and memorable. Yet in Vincent's book, there are no memorable characters -- she doesn't even say much about her own life, and although we get some sense of her troubled childhood and persistent problems as an adult, we learn very few details. Vincent writes about some other patients, but we get only the most impressionistic sketches of them. None of the characters in the book is followed long or deeply enough for the reader to get a good understanding of who they are, what their problems are, or how they could really be helped. We are left with the basic message that some psychiatric wards are better than others, or at least, some suit some patients and others suit other patients. Voluntary Madness falls between two stools. If Vincent wants to do journalism, then that's what she should do, giving us facts, figures and revelations. Is she wants to write a personal memoir, a reflection on her own experience, or stream of consciousness, then she should do that, revealing more about herself and her own view of the world. As it is, we don't get enough of either.
Link: Norah Vincent home page
© 2009 Christian Perring
Christian Perring, Associate Professor of Philosophy, Dowling College, New York.