email page print pageAll Topic Reviews
"Are You There Alone?""How Come Boys Get to Keep Their Noses?""My Madness Saved Me"10% Happier365 Days49 Up56 UpA Beautiful MindA Beautiful MindA Beautiful MindA Book of ReasonsA Can of MadnessA Child's Life and Other StoriesA Dangerous LiaisonA Fight to BeA First-Rate MadnessA Good Enough DaughterA Heartbreaking Work of Staggering GeniusA Lethal InheritanceA Lethal InheritanceA Life ShakenA Life Worth LivingA Little PregnantA Message from JakieA Million Little PiecesA Numerate LifeA Pocket History of Sex in the Twentieth CenturyA Slant of SunA Special EducationA Tribe ApartAbout FaceAddicted Like MeADHD & MeAEIOUAgainst Medical AdviceAgents in My BrainAileen - Life and Death of a Serial KillerAlgernon, Charlie and IAll Out!All Seasons PassAlphavilleAlways Too Much And Never EnoughAlzheimer'sAn Anthropologist on MarsAn EducationAn Unquiet MindAngela's AshesAngelheadAnna Freud: A BiographyAnnie's GhostsAnother Bullshit Night in Suck CityAnthology of a Crazy LadyApples and OrangesApproaching NeverlandAre You There, Vodka? It's Me, ChelseaAs I Live and BreatheAs Nature Made HimAt Home in the Heart of AppalachiaAt the End of WordsAvalancheBad BoyBad GirlBeautiful BodiesBeautiful BoyBeautiful WreckBecause We Are BadBecoming AnnaBecoming MyselfBen Behind His VoicesBequest and BetrayalBereftBertrand RussellBlackoutBlanketsBloodlettingBodies in Motion and at RestBoneBorn on a Blue DayBoyBoy AloneBoyleBrain on FireBreaking ApartBreaking the SilenceBrokenBulimics on BulimiaBuzzCamus and SartreCharles DarwinChasing the HighCheeverCherryCity of OneCluesClumsyComfortComplications Compulsive ActsConfessions of a Cereal EaterConfessions of a Former ChildConfessions of a Grieving ChristianConfessions of the Other MotherConfidingConquering the Beast WithinContesting ChildhoodCrackedCrazyCry Depression, Celebrate RecoveryDamned to EternityDancing at the Shame PromDante's CureDaughter of the Queen of ShebaDavid Sedaris Live at Carnegie HallDays With My FatherDefeating the VoicesDementia Caregivers Share Their StoriesDepression and NarrativeDescartesDetourDevil in the DetailsDiagnosis: SchizophreniaDirty DetailsDirty SecretDivided MindsDivine MadnessDon't Get Too ComfortableDown Came the RainDress Your Family in Corduroy and DenimDrinkingDriving My FatherDrunkardDryEarly Embraces IIIEarly ExposuresEinsteinEinstein and OppenheimerElectroboyElegy for IrisElijah's CupElliott Smith and the Big NothingElsewhereEnough About YouEpilepticEvery Girl Tells a StoryEverything In Its PlaceExamined LivesExiting NirvanaFaces of Huntington'sFamily BoundFast GirlFearless ConfessionsFind MeFinding Iris ChangFirst Person Accounts of Mental Illness and RecoveryFirst Person PluralFixing My GazeFlanneryFolie a DeuxFor the Love of ItFortress of My YouthFrank Ramsey (1903-1930)Franz KafkaFraudFree RefillsFreudFreudFreudFriedrich NietzscheFrom Joy Division to New OrderFumblingFun HomeFuriously HappyGalileo Get Me Out of HereGetting OffGirl in Need of a TourniquetGirl Walking BackwardsGirl, InterruptedGirl, InterruptedGirls on the VergeGoing BlindGoing Through Hell Without Help From AboveGraysonGrowing Up JungGuttedHalf a Brain Is EnoughHardcore from the HeartHead CasesHeal & ForgiveHeal & Forgive IIHeavier than HeavenHeinz KohutHeinz KohutHello from Heaven!Hello to All ThatHer HusbandHer Last DeathHigh PriceHole in My LifeHolidays On IceHolidays on IceHope's BoyHouse of Happy EndingsHouse of Happy EndingsHow I Stayed Alive When My Brain Was Trying to Kill MeHow to Lose Friends & Alienate PeopleHow to Make Love Like a Porn Starhow to stop timeHumeHunger Makes Me a Modern GirlHurry Down SunshineI Am Dynamite!I Am I Am I AmI Feel Bad About My NeckI Never Promised You a Rose GardenI Remain in DarknessI'd Rather Eat ChocolateI'd Rather LaughIf I Die Before I WakeImagining RobertIn Search of FatimaIn the Realms of the UnrealIn the Wake of SuicideInside TherapyInternInvisible No MoreIt Happened to NancyIt Takes a Worried ManJack Cole and Plastic ManJean-Paul SartreJohn Stuart MillJourneys with the Black DogJust CheckingKafkaKantLa SierraLab GirlLast Flight OutLearning to FallLet Me Make It GoodLife As We Know ItLife InterruptedLife ReimaginedLimboLincoln's MelancholyListening in the Silence, Seeing in the DarkLittle PeopleLive For Your Listening PleasureLive Through ThisLiving in the Shadow of the Freud FamilyLiving With SchizophreniaLiving with SchizophreniaLockeLonelyLong ShotLook Me in the EyeLooking for The StrangerLoose GirlLosing Mum and PupLosing My MindLove Is a Mix TapeLove SickLove Times ThreeLove Works Like ThisLove You, Mean ItLuckyLudwig WittgensteinLyingMad HouseMad PrideMadame ProustMadnessMagical ThinkingMalignant SadnessManicMarcel ProustMarcus AureliusMary BarnesMaverick MindMaybe You Should Talk to SomeoneMe Talk Pretty One DayMeaningMelanie KleinMemoirMemoirs of an Addicted BrainMemoirs of My Nervous IllnessMen-ipulationMisconceptionsMiss American PieMockingbird YearsMomma and the Meaning of LifeMommies Who DrinkMonkey MindMore, Now, AgainMortificationMy Age of AnxietyMy Body PoliticMy Brain Tumour AdventuresMy DepressionMy Father's HeartMy First Cousin Once RemovedMy Flesh and BloodMy Horizontal LifeMy Life Among the Serial KillersMy Sister LifeMy Stroke of InsightName All the AnimalsNeural MisfireNietzscheNietzsche: The Man and His PhilosophyNinety DaysNo Apparent DistressNo Hurry to Get HomeNo Impact ManNo More ShavesNo One Cares About Crazy PeopleNolaNotebooks 1951-1959NothingOdd Girl Speaks OutOedipus WreckedOf Spirits & MadnessOn Being RapedOn the Edge of DarknessOn the MoveOne Hour in ParisOne Hundred DaysOphelia SpeaksPagan TimePassing for NormalPeople Who Eat DarknessPerfect ChaosPerfect ExamplePermanent Present TensePersepolisPlanet of the BlindPlaying with FirePlease Don't Kill the FreshmanPoisoned LovePollockPOPismPortraits of Huntington'sPoster ChildProzac DiaryPsychiatrist on the RoadPsychosis in the FamilyPuppy Chow Is Better Than ProzacQuitting the Nairobi TrioRaising BlazeReasons to Stay AliveRebuiltRecovered, Not CuredRelative StrangerRescuing JeffreyRestricted AccessRevengeRewind, Replay, RepeatRichard RortyRiding the Bus With My SisterRobert Lowell, Setting the River on FireRoom For JRosemaryRough MagicRunning After AntelopeRunning with ScissorsRXScattershotSchizophreniaSchopenhauerSecond OpinionsSectionedSeeing EzraSeeing the CrabServing the ServantSet the Boy FreeSex & Single GirlsSex ObjectShakespeareShe Bets Her LifeShe Got Up Off the CouchShut the DoorSickenedSilencing the VoicesSimone de BeauvoirSinging in the FireSkin GameSlackjawSlut!SmashedSome Assembly RequiredSome Kind of GeniusSometimes Amazing Things HappenSometimes Madness Is WisdomSongs from the Black ChairSongs of the Gorilla NationSoren KierkegaardSpeak to MeSpeaking Our Minds: Revised EditionSpecial SiblingsSpentStandbyStick FigureStill LivesStretchSunset StorySurviving OpheliaSwing LowTales from Both Sides of the BrainTales of PsychotherapyTalk to HerTell Me Everything You Don't RememberTellingTelling Tales About DementiaThe Accidental BillionairesThe AddictThe Anatomy of HopeThe Anti-Romantic ChildThe Art of MisdiagnosisThe Bastard on the Couch CDThe BeastThe Bell JarThe Best Seat in the HouseThe Big FixThe Body SilentThe Boy on the Green BicycleThe Boy Who Loved Too MuchThe Boy Who Loved WindowsThe Bright HourThe Buddha & The BorderlineThe Burn JournalsThe Camera My Mother Gave MeThe Cancer Monologue ProjectThe Center Cannot HoldThe Chelsea WhistleThe Churkendoose AnthologyThe Day the Voices StoppedThe Devil WithinThe DisappearanceThe Discomfort ZoneThe Doctor Is InThe Eden ExpressThe Family GeneThe Family SilverThe Farm Colonies: Caring for New York City's Mentally Ill In Long Island's State HospitalsThe Fasting GirlThe First Man-Made ManThe First TimeThe Geography of BlissThe Glass CastleThe Good DoctorsThe Hillside Diary and Other WritingsThe Incantations of Daniel JohnstonThe Infidel and the ProfessorThe Last AsylumThe Last Good FreudianThe Last Time I Wore a DressThe Liars' ClubThe Lives and Loves of Daisy and Violet HiltonThe Lives They Left BehindThe LobotomistThe Long GoodbyeThe Looked After Kid: Memoirs from a Children's HomeThe Loony-Bin TripThe Madness of Our LivesThe Making of a PhilosopherThe Making of Friedrich NietzscheThe Man Who Couldn't EatThe Man Who Shocked the WorldThe Man Who Tasted ShapesThe Marvelous Hairy GirlsThe Maximum Security Book ClubThe Me in the MirrorThe Memory PalaceThe Mercy PapersThe Mistress's DaughterThe Mother of Black HollywoodThe Naked Bird WatcherThe Naked Lady Who Stood on Her HeadThe Neuroscientist Who Lost Her MindThe Night of the GunThe Noonday DemonThe Notebook GirlsThe NursesThe Only Girl in the CarThe Only Girl in the WorldThe Orchid ThiefThe Other HollywoodThe OutsiderThe Philosopher's Autobiography The Philosophical Breakfast ClubThe Philosophical IThe Pits and the PendulumThe Pornographer's GriefThe Private Memoirs and Confessions of a Justified Sinner The Professor and the MadmanThe Psychopath TestThe Quiet RoomThe RecoveringThe Red DevilThe Rescue of Belle and SundanceThe Ride TogetherThe Rules of the TunnelThe Secret of LifeThe Shaking Woman or A History of My NervesThe Shared HeartThe Shiniest JewelThe Siren's DanceThe Statistical Life of MeThe Story of My FatherThe Strange Case of Hellish NellThe Summer of a DormouseThe SurrenderThe Talking CureThe Thought that CountsThe Three of UsThe Undoing ProjectThe Vagina MonologuesThe Velveteen FatherThe Winter of Our DisconnectThe Woman Who Walked into the SeaThe Years of Silence are PastThe Yellow HouseThe Yipping TigerThick As ThievesThinThis Close to HappyThomas S. SzaszTiger, TigerTits, Ass, and Real EstateTo Redeem One Person Is to Redeem the WorldTo Walk on EggshellsTransforming MadnessTrue CompassTruth & BeautyTruth Comes in BlowsTuesdays with MorrieTweakTwitch and ShoutUltimate JudgementUndercurrentsUnholy GhostUnlikelyVoices of AlcoholismVoices Of Alzheimer'sVoices of CaregivingVoices of RecoveryVoluntary MadnessWaiting for DaisyWar FareWashing My Life AwayWastedWaveWe're Going to Need More WineWe're Not MonstersWeather Reports from the Autism FrontWeekends at BellevueWhat Did I Do Last Night?What Goes UpWhat I Learned in Medical SchoolWhat's Normal?When a Crocodile Eats the SunWhen Breath Becomes AirWhen Do I Get My Shoelaces Back?.....When It Gets DarkWhen the Piano StopsWhen You Are Engulfed in FlamesWhere Did It All Go Right?Where is the Mango Princess?Where the Roots Reach for WaterWhile the City SleptWhile They SleptWho Was Jacques Derrida?Why I Left, Why I StayedWhy I'm Like ThisWildWill's ChoiceWinnicottWinnieWish I Could Be ThereWith Their EyesWomen Living with Self-InjuryWomen, Body, IllnessWrestling with the AngelYou Must Be DreamingYour Voice in My HeadZeldaZor
The venerable literary genre of madness memoirs has so proliferated in the decades since the 1970s and 80s that even those with a scholarly interest must read selectively among them, and any catalogues seem doomed to incompleteness. Now, sporting a new title as examples of patient narratives of illness or"pathography," and cast as a form of therapeutic writing ("bibliotherapy" or "writing therapy"), such stories abound. And they have taught us much -- about inpatient and outpatient experiences of mental health care, of diagnosis and meds and side effects, of the ins and outs of CBT, and of discrimination and loneliness, for example, as well as about the sometimes exhilarating, often confusing and distressing experience of mental disorder itself, its horrors, and temporarily liberating certainties, its alienation and disorientingdifference from the humdrum, comforting everyday sameness most people take for granted. We have learned about not only the authors' personal stories, but their social and medical histories more broadly understood, and about institutions and attitudes. And we've admired the skill, courage, honesty and grace with which such tales are told.
There are too many of these works for us to read them all. But Barbara Taylor's is not to be missed. The Last Asylum is an extraordinarily measured, fascinating and honest account, that stands out from all but a handful within the genre.
Judged in the terms of assessment we apply to such books, Taylor's succeeds well. It falls into none of the predictable traps: there are no elements of self--pity, no hints of manic insouciance, or grandiosity; and, while the writing never gives way to the confusing or turgid, there are no efforts to paper over or rationalize earlier incoherencies in light of later, revised perspectives. But this is only one way in which we can evaluate the virtues of this book. There is a better way to see it, not as a madness memoir only, but – as suggested by the first part of its title – also as a piece of social history, documenting the demise of asylum mental health care during the years of de--institutionalization; and in addition, as a rare, revealing glimpse into the intimate world of the psychoanalytic relationship. Rather than a simple madness memoir, Taylor interweaves these three elements throughout the entire book, granting each equal prominence. In this respect, her book can more readily be compared with another brilliant, tripartite recent work by a young woman written in the UK, Helen Macdonald's H is for Hawk, which so effectively entwines a grief memoir with a primer on hawking, and an account of the troubled life of T.H.White, author of The Once and Future King. As in Macdonald's masterpiece, Taylor's complex juggling act works to perfection. None of the three ever lags, nor does any one overshadow or swamp the others. And together they form a coherent, compelling, and closely--woven unity.
Taylor's personal story is briefly told. Brought up in Canada and now in the UK, she is today a professor of humanities at the University of London, and author of several scholarly books. She found her life falling apart only after she had won acclaim as an historian for a prize--winning work of feminist history. With anxiety, panic, bodily ills and a range of other symptoms, and spiraling distress accompanied by reckless alcohol use, she finally entered (or as she puts it, fell into) the Friern Mental Hospital, previously the Colney Hatch Lunatic Asylum. But this was during the 1980s, when the old asylum system was being dismantled. Today, Friern is physically replaced by luxury housing, Princess Park Manor. For its patients, back then, however, it was to be replaced by a much--vaunted, although underfunded, system of community care. During the decades of her disorder and treatment, Taylor thus experienced the demise of Friern, and the inadequacies of its substitutes, a day hospital and later a hostel, as she careened through episodes of more and less severe dysfunction and suffering. She writes as an historian here, and seems to have managed to keep journals and notes, even during the worst times. She retained her acute powers of observation and sense of history in the making, and the book documents these enormous policy shifts at every level, including as effects on the dwindling group of inpatients at Friern, and later outpatients at other facilities. Although the network of day centers and community care arrangements that were supposed to replace asylum care were rarely sufficient (some were little more than cynical politicians' pipe dreams), some of her experiences of these substitutes were a success, providing her with the comfort and care she required. In an anomalous arrangement permitted by economic security (made possible by her parents) and official flexibility, however, Taylor was luckier than any of the other patients. She was able to continue her in--depth, intensive psychoanalytic treatment throughout these years, with the persistent, uncompromising and unflappable analyst she refers to only as "V."
That this psychoanalytic treatment provided the supportive consistency enabling the eventual return of her stability seems to be Taylor's own considered conclusion. But she does her readers an enormous favor. Threaded through the entire text are italicized transcriptions (or something approaching them), reports of these exchanges between herself and V. So we are able to decide for ourselves how much credit is due to psychoanalyst V, how much to her no--nonsense psychiatrist Dr D, how much her wry and resourceful fellow patients, about whom she writes with admirable decency and humanity, how much to her loyal and helpful London friends -- and how much to her own resilience and inner strength.
In an epilogue, Taylor offers her analysis of what ails mental health care today, quoting service workers whose emphasis is on sympathetic care relationships as instances of best practice. Required to achieve such practice, she insists, would be "reliable, open--ended care, sometimes in supportive institutional environments." She scoffs at the CBT that, as the "modern face of Anglo--American psychotherapy," has been carried to absurd extremes, she believes, in the National Health Service's computerized CBT, which flies in the face of "a host of studies" showing that "it is the quality of the relationship with the therapist that determines the outcome of…all therapeutic encounters." About what she needed at her most needy, she is clear: it was "asylum, a safe place to be." And what helped most: a costly, intensive, long--term psychoanalysis. This is not a solution, she recognizes, for less advantaged patients. Yet her final recommendation still remains something as close to it as is possible. She rightly identifies the problems. They include "a fantasy of adult autonomy" at odds with human realities; reduced funding for psychotherapy of all stripes, and especially antipathy to psychoanalysis, an obsession with time and efficiency – and a rejection, finally, of personal history as relevant to healing. The story of the Asylum Age is not a happy one, she concludes. But "if the death of the asylum means the demise of effective and humane mental health care, then this will be more than a bad ending to the story; it will be a tragedy." We may differ with her model of humane mental health care, with its exclusive focus on late--stage treatment responses to adult disorder. A more sweeping and preventive public health approach that would anticipate and attend to the societal ills responsible for those intractable adult experiences seems worth a try. (It is increasingly being recognized in response to the world--wide epidemic of depression symptoms, that cannot realistically be dealt with in any but society--wide measures of this kind.) But if we grant her premise, then we can hardly disagree.
As a work of social history, The Last Asylum is a valuable document. It reveals the cruel underside of deinstitutionalization policies that in the US, at least, have resulted in populations of the mentally ill homeless in city streets, and locked up in county jails and prisons. While she recognizes the larger meaning of these policies, Taylor also appreciates the importance of the way they affect individuals, and her depiction of the effects of asylum life and then deinstitutionalization on particular, closely--described patients in the context of one particular hospital (albeit a famous one), proves an effective way of bringing these vast historical transformations home to us. Then, in its careful and measured account of what can go wrong, and how difficult it can be to emerge from the defeating darkness of mental disorder,The Last Asylum helps us understand madness and its treatment in ways that are genuinely illuminating. Combining her report on the last asylum with her "memoir of madness in our times," Barbara Taylor is to be applauded for an important and original contribution to our understanding of such disorder and its care -- whether or not we grant her recommendations and solutions.
© 2015 Jennifer Radden
Jennifer Radden, University of Massachusetts, Boston