A nonfiction story by Rachel Aviv ran in the May 30th issue of the New Yorker about a 51-year-old woman who was discharged from a mental hospital in New Hampshire, in October 2007 with no plan in place, who wandered about and then holed up in an abandoned house, eating nothing but apples from the adjoining orchard, and shunning any public appearance, until her death from hypothermia and starvation sometime around January 2008.
Although she had been hospitalized on many occasions, she consistently denied that she was mentally ill and refused medication or any form of treatment. During her months in isolation, she wrote journal notes indicating that she gave a great deal of thought to her situation, and that, despite her awareness of the hardships, she found a great deal of pleasure in her independence. Her notes indicated that she understood that she would die if she didn’t leave the house to seek warmth and food, but she preferred to live this way rather than risk having her sanity challenged and being labeled mentally ill, only to be hospitalized again.
One interesting tidbit from the article was the description of an assessment tool (The Scale to Assess Unawareness of Mental Disorder) that psychiatry uses to measure insight (defined vaguely as the ability to recognize one’s own mental disorders). Some psychiatric experts use the term anosognosia to describe the phenomenon; this term is more commonly used to describe brain damage that inhibits the ability to recognize loss of function, for example, the loss of a limb. (Another astonishing tidbit from the article: about 25% of jail inmates meet criteria for a psychotic disorder.)
The article was fascinating because the story is so compelling, but particularly because of the enormous questions raised by it about how mental illness is understood, diagnosed, treated, and portrayed. The idea that we are ill if we don’t admit to illness is to readily used against people with mental illness, but in people who think they are going to “beat cancer”, we call it hope. The story reinforces my notion that mental illness is as real as physical illness, and often just as deadly. And our Western paradigm for describing and codifying mental illness is just as primitive as that for physical illness. As a society, we have no idea what we are doing, in my opinion.
Fast forward a few weeks to the most recent New Yorker (June 13-20) containing a fiction story by Lauren Groff, entitled Above and Below—a story in which a young college student, abandoned by her boyfriend, drifts into homelessness in Florida, unable or unwilling to find an anchor of help among family or friends, losing more and more of her sense of self until one night, “She was frozen. There was nobody who could save her, nobody who could deliver her gently back to the solace of people.”
The two stories offer a stark parallel. There is no indication in the fiction that the protagonist is diagnosed with a mental illness, yet, like the real woman in the first story, she sinks below survivability. In the fiction, however, she doesn’t die. The story skips ahead to her during a difficult labor, as she recalled the “panic, the darkness, the sense of being lost … before she stumbled back to the light …”. I felt somewhat cheated by the easy out the story offered. And yet, I’ve also been there, at the brink of survival, and have somehow survived. Maybe that is the part of the story that cannot be explained.