Voluntary Madness

I am putting this post down as a marker. Most of my readers will likely not guess quite what I am driving at, though I think they might find it interesting anyway. More information is going to come out over time on this book, and I just want my initial impression to be recorded.

Norah Vincent’s new book, Voluntary Madness: My Year Lost And Found In The Looney Bin recounts her experience being treated at three psychiatric hospitals. There is an excellent review in the NYTimes which also gives a decent summary of the book.

Norah is first treated at “Meriwhether” Hospital, likely a stand-in for Bellevue, for depression. I am already suspicious, in a way that only people who work in psychiatric emergency settings can be. The next two hospitals she signs herself into, and her experience of them, reinforce the suspicion.

I don’t doubt that she does indeed encounter “Teflon-slick professionals and brutish aides” at Meriwhether. I have seen both – heck, I have been both - and acknowledge that the failings of public psychiatric hospitals most commonly lie in these directions. It is hard to deal with violent people without looking – or becoming – brutish, and similarly difficult to deal with manipulative people without looking – or becoming – evasive. That certainly makes life harder for those remaining patients who are neither violent nor manipulative. They need to trust someone on the staff, but much of the staff looks untrustworthy. Meriwhether may be particularly bad as well. But Norah hasn’t walked a mile in those shoes. She can tell her side; her caregivers are prevented from responding because they keep her information confidential.

Tangent on medications. There are good reasons to attempt treatment for depression without resorting to medication, but these are more often an excuse. Because withdrawal from some medications is unpleasant is not sufficient logical reason to refuse all medications. Because medications can have side effects is only a legitimate reason to refuse them if you actually have those side effects. The fact that other people have them is irrelevant. Complaints about pharmaceutical companies and beliefs that doctors prescribe medications only because it is part of their blinkered world-view or that they’re getting a cut are likewise evasions. Doctors prescribe psychoactive medications because they often work, and work quickly. At $1000/day, quickly is important. When symptoms are severe, the efficacy of nuts and berries on mild-to-moderate symptoms does not factor into the immediate situation.

Second tangent on costs: Norah Vincent’s hospitalizations cost someone tens of thousands of dollars. If she was insured, then the cost was borne by ratepayers and the reduced care for others served by her insurer. That these considerations do not enter into Ms. Vincent’s planning her adventure is mildly diagnostic.

Back on track, or something like it: She insists on treatment without medication, then is resentful when she later becomes severely depressed. She wants certain types of therapy she thinks she will like better. These all involve paying attention to her. Is that harsh? Yes, and possibly unfair.

But I doubt it.

I would like to see the discharge diagnoses from those hospitals, especially the first one. I would like to see what her scores on the MMPI-2, or even better, the PAI, were. I am less enamored of projective tests, but the results of those would be interesting as well.

I am interested in this data because I suspect that a diagnosis of depression for this patient is uh, incomplete. Much of this pattern is familiar. Additionally, Norah Vincent’s previous book was Self-Made Man, an account of her 18 months posing as a man. While that would not ordinarily be pathological, in combination with the other information it is suggestive.

Update: I should ask Dr. Sanity for her opinion.