What’s Normal? is a collection of readings for a
course in literature and medicine taught in the weekend college at Hiram
College. It focuses on mental and
behavioral deviations from the norm, and is a complement to an earlier
collection, The
Tyranny of the Normal, designed for a course on physical
abnormalities.

The book
divided into seven sections:

1. Clinical
   and Bioethical Perspectives
2. Children
   and Adolescents with Mental Disorder
3. Mental
   Disability (Retardation)
4. Women’s
   Experiences with Mental Disorder
5. Men’s
   Experiences with War Trauma, Including PTSD
6. Men
   and Mental Disorder
7. Alzheimer’s
   and Dementia

This is a rather odd way to categorize readings about mental
disorders, and this oddness is multiplied in the choices of readings. This eccentric collection includes some
excellent pieces, but I would not recommend it as a represented survey of narratives
of mental and emotional disorders.

Of course, there are many possible
ways to organize such a book, but one would expect any such book to include
sections on depression, mania, anxiety and panic disorders, eating disorders
and self-mutilation, addiction and substance abuse, schizophrenia and
personality disorders. One might also
expect a major section on patients’ reactions to various treatments, especially
the experiences of taking psychotropic medication and being in psychotherapy. Unfortunately, What’s Normal? hardly
covers these at all.

Instead, the book provides a highly
eclectic and rather critical collection of readings concerning psychological
normality. The first section, of
clinical and bioethical perspectives, does not aim to provide a balanced
selection of views, but rather sets the tone of the book with a selection of
critical views. Among the pieces is an
extract from Seth Farber’s bizarre antipsychiatric book Madness,
Heresy and the Rumor of Angels, in which he presents some thoroughly
Szaszian cases of people diagnosed with serious mental illnesses such as manic
depression or schizophrenia. Farber
claims that these people, who did not seem to benefit from psychiatric
treatment, were not suffering from mental illness, but rather were experiencing
spiritual crises or transformations. 
Also included in this section is a selection from Ian Hacking’s book Rewriting
the Soul, about multiple personality and the diagnosis of dissociative
identity disorder. Hacking, who takes a
skeptical view of the diagnosis multiple personality, is a superb writer who
documents his claims fairly carefully, but of course multiple personality
remains an extremely rare diagnosis.

The famous article by D.L.
Rosenhan, “On Being Sane in Insane Places,” is another of the articles in this
section. Published in 1973, it recounts
an experiment in which graduate students got admitted to psychiatric wards by
going to emergency rooms and claiming that they had delusions, and then ceased
to pretend any further that they had any psychiatric problems. These “pseudopatients” were never detected
by the psychiatrists, and all but one was discharged with a diagnosis of
schizophrenia in remission. It is a
major piece of evidence for those who claim that the label of mental illness
stays with people once attached, no matter how sane they are. But it’s also a massively out-of-date
article: the length of hospitalization of these pseudopatients was between 7
and 52 days, with an average of 19 days. 
These days, unless patients are a danger to themselves or others, it is
extremely unlikely that they will be admitted as inpatients at all, and it
would be very unusual for them to be in hospitals for more than a few
days.

This is not to say Rosenhan’s
article is not still relevant, but it is astonishing that this book makes no effort
to reflect the current experience of patients dealing with managed care and the
bureaucracy of health care, where often they or their families have to fight to
get decent and consistent treatment. 
The situation of the 1970s, when patients could be admitted to hospitals
for several weeks if doctors thought it necessary, seems very attractive in
many ways. It’s a major deficit of the
book that it does not reflect in the changes in the provision of health care over
the last 30 years. But rather than suggest
that the book should include more modern discussion of the nature of health
care by historians, sociologists or philosophers, it strikes me as a mistake to
include a theoretical section in this book at all, because it is impossible to
be at all inclusive. The editors would
have done better to stick to the central theme of the book, that of
first-person and literary perspectives on the experience of emotional problems
and mental disorders.

Most of the other
sections also fail to give a picture of the experience of mental illness in
contemporary life. For example, the
most modern piece in the section on children and adolescents is by Susanna
Kaysen, from her book Girl,
Interrupted, which is a meditation on her hospitalization in the late
1960s, when she was given a diagnosis of borderline personality disorder. This section also includes an extract from
Peter Shaffer’s overwrought 1973 play Equus,
Graham Greene’s short story “The End of the Party,” and Conrad Aiken’s story
“Silent Snow, Secret Snow.” These
latter two are both from the early twentieth century, and are both unusual and
interesting choices on the part of the editors. However, for teachers who might be using this book in a course on
the medical humanities (which is presumably what this book is mainly designed
for), these are somewhat tricky stories to use as examples to educate
students. It’s far from clear how one
might relate these stories to modern health care. If teachers are comfortable explaining the background of writers
such as Greene and Aiken, they may well have success in using these stories in
class, but I know I’d be somewhat apprehensive in attempting it myself.

I’d make similar
observations about most of the other sections. 
I found it hard to relate the writings in the section on mental
disability – including Peter Nichols, Flannery O’Connor, John Steinbeck, Anne
Tyler, and Eudora Welty – to contemporary issues in the diagnosis and social
and medical treatment of the condition. 
Why the editors include a whole section on war trauma is unclear to me,
since war trauma is not a problem we have to face much today, even now that the
US is engaged in a war on terror. It
would have made more sense to fold it into the section on men and mental
disorders.

The most
successful section, in my opinion, is the last on Alzheimer’s and
dementia. It includes an imaginative
selection of authors, all of whom were new to me. These pieces help convey the experience of the progressive
dementia from a variety of perspectives, in works of great literary power. They are the most successful in
accomplishing what the book claims it sets out to do in its title, which is
provide narratives of mental and emotional disorders.

My comments have
been critical, but I should acknowledge that the task of this book is
daunting. To examine the themes of
mental illness in literature requires a good knowledge of both the history of
literature and of psychology, and anything approaching a satisfactory survey
would require a massive collection of literature. The collection of pieces in What’s Normal? is highly
idiosyncratic, so other teachers considering it for use in their courses will
find it hard to adapt to their needs. 
I’d suggest that for the purpose of conveying ethical and humanistic
issues in mental illness faced in contemporary life, it would be far more
profitable to focus on the narratives found in the proliferation of memoirs of
mental illness published in the last thirty years by patients and their family
members. (A fair number of these are
reviewed in the Memoirs
section of Metapsychology.)

© 2002 Christian Perring. First Serial Rights.

Categories: Memoirs, Ethics