Book Reviews:
When Mental Illness Comes and Goes

Life Inside: A Memoir • Overcoming OCD and Schizophrenia With God in My Life • The Heart Too Long Suppressed: A Chronicle of Mental Illness

Jeffrey L. Geller, M.D., M.P.H.

Three first-person accounts, each of which takes a different perspective on healing and recovery, with a focus on ambivalence toward psychiatry, are reviewed in this month's column. Does psychiatry facilitate healing or interfere with it? Does psychiatry contribute to the improvement of one's life, or to the destruction of that life? Can—and should—psychiatry tolerate the use of alternative healing methods? And finally, is the field of psychiatry as it was a few decades ago fundamentally different from what it is today?

In the manner of Susanna Kaysen's Girl, Interrupted (1), Mindy Lewis' Life Inside is a memoir written at midlife about a woman's experiences as a psychiatric patient when she was an adolescent. As is the case with most autobiographies that attempt to capture thoughts and words of an earlier time in an individual's life, this account suffers from a mixture of the adolescent's and the adult's perspective without a distinction between the two.

Nonetheless, Mindy Lewis, born on March 4, 1952, gives the reader an interesting presentation of psychiatric care and treatment at the New York State Psychiatric Institute at Columbia-Presbyterian Medical Center in the late 1960s. Almost immediately the reader is confronted with how different psychiatric treatment was back then; one of the psychiatrists conducting the intake reassures the patient's mother, "She could be here as little as six months."

Lewis talks not only about herself but also about many of her adolescent copatients. She remarks that some of her peers had easily observable disabilities but notes that they were in the minority. "For most of us, the damage is invisible." There were those with visible stigmata secondary to high doses of chlorpromazine. "It's easy to tell who. Their faces are blotted, their skin an unnatural pink...it dries you out, sucking out all of your life force, replacing it with a chemical stupor."

Lewis provides an accurate portrayal of life in the New York City area—at least as I remember it—with her peers in the 1960s. She attended the High School of Music and Art, commuting there from Stuyvesant Town. She found places to hang out with others, where there was always "a smorgasbord of drugs" available, including amphetamine, meperidine, Seconal, mescaline, and LSD, which sometimes patients had to pay for and "sometimes [you get] for free if you're female." After Lewis' various behaviors got her suspended from high school, she had to go somewhere. That "where," in that era, turned out to be long-term psychiatric hospitalization.

Lewis has a diverse, yet profound, response to her psychiatric hospitalization. She objects to many of the staff, whom she says, "Can't even see me." She refers to them as "thought police." She explicates staff and patient struggles with a flair that makes it hard to differentiate, on occasion, between simple adolescent turmoil and what might have been psychopathology.

Lewis has both praise and condemnation for how she was treated. Sometimes she makes subtle pokes at psychiatry, such as in titling a chapter "Inappropriate Behavior." She points out that obtaining street drugs on the ward is basically as easy as obtaining the same substances on the street: if you have enough money, you simply pay an attendant.

Lewis poignantly discusses the ultimate threat at New York State Psychiatric Institute: the threat of "shipping"—that is, being sent to one of the "regular" state hospitals such as Creedmore, Rockland, or Manhattan State. These, says Lewis, are "awful institutions that warehouse chronic cases." The ultimate threat then, regularly thrown at these adolescent patients by the staff, was, "If you act out again, we might have to ship you."

By Lewis' portrayal, these adolescent patients are caught in a spider's web. The patients twist, turn, and gyrate in response to the sparing stimuli of the staff; they are then caught deeper in the web, condemned by staff, and sometimes punished. The patients exist in a dirty environment on a ward that contains 60 people. However, Lewis points out that within this atmosphere there is an "odd alliance between staff and patients." Despite the differences between the two, Lewis says, "the boundaries separating us are thin."

The adolescents' pervasive fear was that prolonged stays would lead to deterioration. In one of her more interesting analogies, Lewis suggests that the "looney bin is like the bins in my mother's refrigerator—one for fruits, another for vegetables. The vegetables are pathetic. I'd rather be a fruit than a vegetable. Fruits are juicier, more interesting. Right now I'm a fruit, but maybe after I've been here a while, rotting away in this bin, I'll become a vegetable."

Lewis did get out of the New York State Psychiatric Institute, albeit via a discharge to Manhattan State Hospital on April 9, 1970, two years and four months after she was admitted. Her discharge diagnosis was chronic and undifferentiated schizophrenia, her condition improved. Manhattan State Hospital, says Lewis, was "a warehouse for lost souls located on an island in the middle of the East River...the other structures on Ward's Island house prison wards for the criminally insane. Criminals on one side; long-term, hopeless cases on the other." The ironic thing about being shipped, however, was that these state hospitals didn't keep any patients for very long if they didn't have to; hence, within a month, Lewis was discharged.

In the second half of the book, Lewis talks about her life after being discharged from Manhattan State Hospital. She became involved with the Mental Patients Liberation Project, struggled with the ways she was "not like other people," sorted out what it meant to be "crazy" or to have a "mental illness," and moved on with her life. A particularly interesting aspect of Lewis' account is her return years after her hospitalization to visit the places and meet the people that provided her care, treatment, and confinement years earlier. She also reports on her psychiatric record. The nature and quality of the interactions between Lewis and her past teachers and treaters is touching. Lewis portrays something not often encountered in the practice of psychiatry—the opportunity to revisit the experience shared by patient and treater decades after that experience ended.

Life Inside is an engaging memoir that for a few will recall their professional lives of the 1960s, for others will recall their own adolescence, and for others will feel like an account of some historical period. Life Inside is valuable for each of these cohorts of readers. Like other contemporary memoirs portraying psychiatric care and treatment from decades earlier, it is important, particularly for the naive reader, to be conscious of the distinctions between then and now and to be cognizant of those aspects of care and treatment that have changed very little despite all the reported advances that have occurred over the past four decades.

It is a sad irony that Chip F. Correll, the author of Overcoming OCD and Schizophrenia With God in My Life, died at home at the age of 30 from natural causes. In his book, he informs the reader from a fundamentalist born-again Christian perspective that God has important plans for him. The book, a memoir published during Correll's lifetime, says nothing about his death. His mother sent me a note along with his obituary.

Like many patients in today's world of only the briefest inpatient hospitalization, Correll spent four days in a public psychiatric hospital, treated early in his career as a psychiatric patient with thioridazine and perphenazine. In the last years of his life, Correll took in various combinations of clozapine, thiothixene, fluvoxamine, and clomipramine.

Correll writes in a style that is naive—sometimes almost childlike—repetitious, and meandering. Paragraphs are often so loosely constructed that it is hard to understand how the sentences relate to any theme. The book has almost as many quotes from scripture as it does pages. Some chapters seem totally unrelated to Correll's major messages. Nonetheless, this short book of 85 pages is worth a quick read, because one rarely encounters men from the central part of the United States, rooted in a fundamentalist Christian perspective, who are willing to step forward and tell the story of their mental illness.

Correll, who had a diagnosis of schizophrenia, graduated from a junior college and then from the University of South Florida with a bachelor of arts degree in English. His goals were to be a writer and to work for a television talk show. His life was simple and his social circle small. He was active in the National Alliance for the Mentally Ill.

Correll's story tells us how his faith in God sustained him through his chronic mental illness and its associated burdens and setbacks. "Even with my faith in God, I've always idealized what could be rather than settling for what is. I've always liked to stretch myself spiritually, academically, and socially, knowing that God has always been there for me to catch me when I fall." Correll was not without his share of burdens before his first psychiatric hospitalization. He was taunted and bullied in school, his parents divorced when he was ten years old, he was confused about his heterosexuality, and he was physically degraded by classmates. Correll never really dealt with these issues but rather turned them into challenges from God and believed that if he wanted something badly enough "and prayed, it will happen."

The degree to which these developmental issues relate to Correll's career as a psychiatric patient are questions the reader might ask but are certainly not queries that Correll considered. He was involved in a car accident in the spring of 1995, which led to "a nervous breakdown." He subsequently received diagnoses of schizophrenia, depression, and behaviors or traits associated with obsessive-compulsive disorder. Correll even turns his car accident into a religious experience, noting that when the bulldozer plowed into his car a Christian radio station was playing "Angels Are Watching Over You...God Is With You."

Correll's memoir may well be useful to practitioners who confront individuals who believe that their entire care and treatment can be rooted in religion. Although no reader will doubt Correll's sincere embrace of fundamentalist Christian ideology, Correll does state in his book that he also needed medication and psychotherapy to provide vocational opportunities and support.

Fundamentally, Overcoming OCD and Schizophrenia With God in My Life is about hope. Hope is an all too scarce commodity in the lives of persons with serious and persistent mental illness. Some might say that Correll's hope was misplaced. Correll says, not always directly, that he has hope in science and in religion, hope in people and in God, hope in himself and in others, and hope that no matter what the adversity, he can sustain himself through it. For any person with a lifelong disability, who can fault a multidimensional, eclectic, ever-present basis for hope?

Carol Hebald's The Heart Too Long Suppressed: A Chronicle of Mental Illness marches the reader virtually chronologically through Hebald's life. Before the trip begins, however, the reader is treated to a foreword by Thomas Szasz, who quotes the poet W. H. Auden: "Writers can be guilty of every kind of human conceit but one, the conceit of the social worker: 'We are here on earth to help others; what on earth the others are here for, I don't know.'" Szasz opines, "Many are here to recover from such 'help.' Carol Hebald gives Voice to them and shows them the Way." I'm not sure I can agree.

In the book's prologue, Hebald recalls the summer of 1978, when she was on a cruise: "I threw overboard the following medications: the psychotropic tranquilizers Haldol and Thorazine and the antidepressants Imipramine Daytime and Tofranil P.M. A psychiatric patient in and out of hospitals for thirty years, I'd been on massive doses of medication for twenty. I was forty-four." Hebald sometimes does and sometimes does not make the argument that for most of her life psychiatry was a burden and that she succeeded only when she escaped from it. One way of reading her book is to see the journey as useless and her "transformation" as resulting from a release from the power of psychiatry, hospitalizations, and medications. Another interpretation is that this transformation resulted from what she had gained along the way through her experiences with psychiatric treatment. Hebald has trouble making up her mind. Others, including some who are quoted on the book's dust jacket, would like to spin this as an antipsychiatry book.

Hebald was born in 1934, and her father died in 1938. Her own history included incest, promiscuity, suicide attempts, and an abortion. Her psychiatric history included two admissions to Gracie Square Hospital in New York City, the first from December 3, 1959, through February 27, 1960, and the second from November 2, 1962, through April 30, 1963. The second of these hospitalizations ended when Hebald was transferred to the Payne Whitney Clinic in New York City, where she spent almost a year—from April 30, 1963, to April 1, 1964. Her other psychiatric admissions in New York City were to Bellevue. Hebald's last psychiatric admission was to the Allen Memorial Hospital in Waterloo, Iowa, during the winter of 1972.

In addition to a wide range of psychiatric medications, sometimes at quite high dosages—not uncharacteristic of the 1960s—Hebald was treated with electroconvulsive therapy (ECT). Between December 9, 1959, and January 8, 1960, she received 15 ECT treatments. Hebald reports that on the days between treatments she was given between 100 and 200 milligrams of thorazine every four hours. Even ECT elicits a mixed response from Hebald. She recognizes that for much of her life she was trying to escape from what haunted her, and she cutely says of ECT, "Shock was a blessing, not a punishment! Why did the others make such a fuss about losing their memories? When they found their memories, they lost their minds."

Hebald, who spent part of her life as an actress, recognized her own acting abilities during her early adolescence. Even then, she reports, "The harder my life seemed, the more easily I slipped into another's."

An individual who saw herself as tortured, she sought relief in "lust." In a description filled with pathos, Hebald talks about her attempts to get men to wait before having sex with her to allow her to believe the man cared or to pretend that she was in love. "But no man would," she indicated—they quickly proceeded to screw her, both literally and figuratively. Even this "mortification felt sweet," says Hebald, because "it kept me close to my father."

When Hebald "breaks free" she struggles to understand some of her life history as a psychiatric patient. She wonders, "Weren't my failed efforts to grow abetted by well-meaning doctors who cultivated my dependence, reinforced the lie that I couldn't thrive without them or their pills, which muffled the needs they urged me to express. And by so activating my feelings, only to shut them off, didn't they render me unable to connect my distress to the circumstances that caused it? This they called 'dissociation,' that 'classic symptom' of schizophrenia, and grew fat on the profits."

As the book moves quickly forward to the present time, Hebald deals with being "outed" for her medical history and struggling with the resultant stigma. In 1984, after 13 years of full-time college-level teaching, Hebald gave it up to become a full-time writer. In the end, Hebald says, she needed to get rid of the psychiatric drugs to be "able to come fully alive." She provides considerable evidence in her book that if she had not taken the medications up to that point, she might never have lived to have this epiphany.

The Heart Too Long Suppressed is not an antipsychiatry tome. It is a fairly mixed-up book about a person who was fairly mixed up for a good part of her life. That Hebald now has clarity and ease is to her credit. The fact that she doesn't know how to fit in the piece that psychiatry played in achieving peace is all too common. If The Heart Too Long Suppressed educates the reader about anything, it informs psychiatrists, in particular, that we need to do a better job of assisting patients in their journey while simultaneously explaining what we are doing, what the patient is doing, and what we and the patient are doing together at each turn in the road.

Footnotes

Dr. Geller is professor of psychiatry and director of public-sector psychiatry at the University of Massachusetts Medical School in Worcester.

Reference

1. Kaysen S: Girl, Interrupted. New York, Turtle Bay Books, 1993