Read These Books If You Want To Understand Mental Illness

Everybody knows what severe mental illness looks like in the homeless and knows someone who says they have depression and anxiety, but what does recovery from severe mental illness look like?

This is my first post on Substack - I found I liked writing long comments on TracingWoodgrains, Freddie DeBoer, and Astral Codex Ten a bit too much and I decided to try my hand at writing something longer. Other than technical reports, I haven’t written anything this long since college and I hope it’s readable enough.

This is a combo review of 4 mental illness memoirs I’ve read over the last few years that make a fascinating collection. I would recommend these to anybody else who is frequenting the comments on mental illness + culture or mental illness + youth or mental illness + overmedication/overdiagnosis Substack posts. These books provide insight and context for what serious mental illness, of the sort that a few percent of the population has, looks like, especially in people who are otherwise functional.

There’s a habit I’ve seen in many Substack comments where people seem to assume that everybody is either Severely Mentally Ill in the way Kanye or the homeless guy on your bus are, or has garden variety depression/anxiety and could really just use some stoicism. These books show the middle ground between those that 5-10% of the population is in. We definitely have mental illness that can use clinical treatment, but you wouldn’t be able to tell for 90% of our adult lives.

I’ve been fascinated with our cultural relationship with mental illness and the mentally ill ever since I had a psychotic manic episode when I was 18. That experience was extremely different from how my friends were experiencing the ups and downs and stresses of emerging adulthood, and I felt very alone because of it. Depression, self harm, anxiety, suicidal ideation, and the occasional 72 hour hold in the local ward were common enough reference points for my Tumblr-influenced friends and acquaintances, and a few had picked up Borderline Personality Disorder, or Bipolar 2 diagnoses somewhere along the line. There seemed to be little reference point for anything else. Supposed mental illness highly correlated with certain social circles and aesthetic choices and it seemed to be the new Goth. I didn’t want to be in that subculture, and I thought that that subculture was what mental illness was.

I didn’t really buy the whole mental illness thing, and as my life disintegrated and spun out of control into grandiose paranoid delusions over a 6 month period, I didn’t recognize or have a language for it. Eventually things came to a head and I was coerced into moving home and taking antipsychotics under strict parental supervision. I recovered nearly entirely in a few months and returned to college the next fall. At some point I was gently informed that I met the criteria for Bipolar 1 disorder, and that an untold number of older relatives also had it and the family never spoke of it. I didn’t know how to combine what I’d experienced with what my friends said mental illness was, and I went looking for answers.

The summer between my episode and going back to school, I read every book about bipolar disorder I could get my hands on, and one of the memoirs I read then really stuck with me. I would later read several other memoirs about different mental illnesses, and this piece is a quick review of the 4 best.

An Unquiet Mind - Bipolar 1

An Unquiet Mind is a memoir of Bipolar 1 disorder of the sort that I have. It has the best description of what it feels like to be manic that I have ever read. It shows a wonderful example of someone who is simultaneously prone to moods and madness and is a successful professional, like many of my relatives.

The author, Kay Redfield Jamison, is a prominent psychology professor who has literally written the standard textbook on bipolar disorder. She also has bipolar herself, with a classic presentation of bipolar 1. She is prone to black moods and energized positive moods, on the order of months, starting in her teens. Her depression and mania became unignorable during her early 20s. She tried multiple medications, and recovered well on lithium. She struggled to take her medication due to side effects, missing the euphoria from her manic phases, and not really recognizing that she was ill.

College and graduate school were flexible enough as long as she passed her exams, so she was able to make it through. She eventually recovered nearly entirely once she was on the proper dose of lithium and took it consistently. She bounces between elite universities throughout the memoir, and is given grace by multiple advisors and faculty throughout her struggles.

My favorite aspect of this memoir is how rich and detailed her descriptions of her moods are. Her depiction of the internal logic of her manic delusions and how they are connected in her mind, but also how a lot of odd logical jumps are occurring was amazing and I have frequently suggested this book to friends and relatives who want to understand bipolar disorder better.

Building a Life Worth Living - Borderline Personality Disorder

Building a Life Worth Living is a memoir by Marsha Linehan, a psychologist best known for developing Dialectical Behavior Therapy (the first successful treatment for Borderline Personality Disorder) discussing how she dealt with her own BPD and used that process to inform her therapeutic manual. This book does not have the rich descriptions of madness that An Unquiet Mind does. In fact, the author seems to have little understanding of why, exactly, she was so prone to suicidal ideation and self harm in her teens and 20s.

She gets shipped off to a fancy psychiatric hospital at a young age for no real clear reason, develops a self harm habit there, and continues to struggle with self harm and intense relationships for quite some time afterwards. My impression is that part of the escalation in her symptoms is a response to the treatment environment and is an attempt to get attention and reassurance in an institutionalized setting.

Therapy and medication don’t help her much, but she finds safety and peace in her Catholic faith and in developing an intense Zen practice. Eventually between those coping skills and other practices, she stops experiencing the intensity of symptoms she had at a young age. She becomes a psychologist and her life’s work is to codify a treatment program for BPD, chronic suicidality, and self harm, called DBT. Before she developed it, BPD was widely considered untreatable, but now it is considered highly treatable.

I found this book fascinating because I have been in therapy programs that draw from DBT, and have found aspects of it helpful and aspects of it unhelpful. I’ve heard certain aspects of DBT described as “Weaponized Buddhism,” and I can really see that influence in Linehan’s story. A lot of DBT is accepting situations and thoughts and grounding yourself to get through them. DBT involves learning a lot of specific skills to deal with life from a workbook and explicitly does not involve ruminating about your childhood. I frequently wonder if our society would be healthier if we replaced a large portion of talk therapy with something more practical and concrete.

One ongoing theme of this book and of quality DBT treatment is that hospitalization and institutionalization make BPD worse, and that recovery is best supported in the community. Traditional DBT is a one year program with two sessions of therapy a week (one group class and one individual) while the patient goes on with a normal life.

I had a friend in college who’d had BPD symptoms (the full thing isn’t diagnosed until 18) in high school, and did a year of quality outpatient DBT. She entirely recovered and by the age of 18 did not meet criteria for a BPD diagnosis. I’m not sure whether the DBT was the cure, or whether it was growing out of it, or simply that they made her shut down her self harm Instagram and get off Tumblr, but either way she grew up to be a completely normal adult.

The Center Cannot Hold - Schizophrenia

The Center Cannot Hold is a memoir by Elyn Saks, a schizophrenic law professor. This one of course must have the caveat that the author is an extreme outlier and there are very few successful professionals with schizophrenia. Like Jamison’s memoir, her twenties involve bouncing between the campuses of several elite universities and enjoying the flexibility of 20th century academia. As far as I can tell from these memoirs, if you passed all of your exams at the end of the semester or year, nobody much cared what exactly you were doing in the middle of the semester.

Saks’ psychotic breaks are terrifying and bizarre and she doesn’t happily consent to treatment, but in between she is surprisingly functional. Despite experiencing the so called positive symptoms of schizophrenia (delusions, hallucinations, word salad), she does not have the crippling negative symptoms (flatness, low motivation, cognitive decline). This allows her to be much more functional than the typical schizophrenic when her positive symptoms are managed.

Saks is in and out of hospitals for quite some time, but eventually does very well with treatment. She does a long course of old school psychoanalysis of the sort where you see an analyst for many hours a week and free associate much of the time, and finds it to be extremely helpful. She somehow avoids being kicked out of any program, keeps her grades up, graduates from Oxford and Yale Law, and goes onto a successful career as a law professor.

She focuses her research on mental health law and advocates for the ability of patients to decline unwanted treatment. I find this to be impressively naive, considering that the alternative to involuntary commitment for many schizophrenics is not student housing at Oxford and 10 hours a week of psychoanalysis, but is instead rotting on the street or jail.

I found it extremely interesting to compare her bizarre schizophrenic psychosis to the manic psychosis I have experienced and witnessed. Manic psychosis in my experience generally has some kind of through-line. There’s a logic there, but the jumps being made are a bit too much. It makes me think of the meme of the guy with the strings and the board. It ends up at a bizarre place, but each step in the middle could be explained, if the manic person slowed down enough to say it. In contrast, Elyn Saks’ psychosis is bizarre. There is no internal logic. Entirely unrelated words and concepts are right next to each other over and over again.

Good Girls - Anorexia

Good Girls by Hadley Freeman is a memoir with some nonfiction elements. It is about the author’s struggle with Anorexia Nervosa decades’ previously. She has some obsessive compulsive tendencies and rapidly stops eating in her early teens, leading to dramatic hospital stays and a years’ long struggle with her parents over food. She is in and out of hospitals, and describes the milieu of eating disorder units extensively. The hospitals themselves become an escape from life, and in the end her parents get her to fully recover by threatening that the next time she becomes underweight she would have to recover at home instead. She also is increasingly disturbed by the patients who are over 30, have spent their whole lives since their teens in hospitals, and are still getting into screaming matches about how much butter is on their toast.

Freeman credits her long term recovery to the fact that she was never fully pulled out of school, with her parents delivering her homework to each hospital weekly. She discussed how for the girls who were pulled out of school, they had nothing to go back to when they were discharged and had no future besides going back to the unit.

The preferred treatment for teenage and young adult anorexics these days is a program called Maudsley Family Therapy, where families do the refeeding process at home under professional psychological and medical guidance. This is preferred to pulling the child out of the home and out of school to send them off to a residential facility. I can see in Freeman’s story why home treatment is increasingly preferred.

As seen in both Linehan’s and Freeman’s stories, that urge to ship off or institutionalize behaviorally disturbed teens seems to worsen the situation for many. Treatment environments are artificial and a lot of teens will adapt to whatever gets them attention in that setting, which is not what will help them live stable adult lives.

Why these books?

I found these memoirs to be fascinating reads, and great reminders that there is a very real phenomenon of mental illness that is distinct from the mercurial ups and downs of everyone’s teens and twenties. There’s been an increasing overmedicalization of young adulthood, and people my age love to view our lives and experiences through the lens of mental health and the lens of trauma. I don’t know that those lenses are particularly helpful for ennui and existential questions, but mental illness is an extremely helpful explanation for events such as Jamison’s mania or Saks’ psychotic breaks. Anorexia and BPD are a bit different, but the extreme variants are so out of the norm that it is clear that they need structured therapeutic treatment.

Part of why I find these particular books so insightful is that the authors are all multiple decades past the period discussed in their books, and have the distance to give a thoughtful perspective. I’ve read a few other mental health memoirs by women in their 20s, and those all fall flat. There’s a certain kind of navel gazing and romanticization that young people are very prone to, and nobody should be allowed to write a memoir before 40.

Thanks for finishing this piece and I’d love to see you in the comments!