This book is one of my favorites.  Written by Susanna Kaysen, it is an autobiographical narrative of her time spent in famed McLean psychiatric hospital.  Whether she should have been there in the first place is debatable but that is in essence the thing that makes her story so great. For anyone who is interested in mental illness, psychiatry, the history of psychiatric treatment and evaluation or just basically anything to do with the entire subject, this book is a treasure trove of thought. Likewise, for anyone who personally struggles with, or has a loved one who struggles with mental illness, this book can be a thoughtful illumination on such issues.

I posit that autobiographical narratives require more of the artistic suspension of disbelief than even fantasy or science fiction.  Fantasy and science fiction are rooted in their own realities.  And so long as things make sense within that reality then they can be trusted and believed by the reader.  That is why world building is so important.  Don’t get me wrong.  Good fantasy and science fiction parallel our reality and are based on our reality in such a way as to convey serious, thought provoking questions about it but our fundamental basis for suspending that disbelief is based on that narrative’s world.

Autobiography requires even further suspension of disbelief with almost no reason to suspend it.  I should explain.  People tell lies.  You know that.  I know that.  Honesty is at a premium in this life.  And to believe that someone would tell the truth about their own life requires you to trust in their honesty.  And to expect them to tell the truth about something as serious and stigmatized as mental illness requires quiet a great deal of trust.  I have read a number of biographies and autobiographies that immediately reeked of BULLSHIT.  I would keep reading the book just to see how I could get before the book became so slippery from the bullshit that the it dropped out of my hand.  However, with Susanna Kaysen, I immediately believed her.  I felt she was honest damn near to a fault.  She tells you those thoughts that people are afraid to write in their diaries or say in their prayers for fear of admitting irreconcilable truths.  I never thought to question her honesty at any point.  That is because she questions her own honesty for the reader.  She ponders her own thoughts in such a way that the experience created feels unbelievably trustworthy.

The characters were real people in real pain so I find it difficult to say I had a favorite character or say I hated this or that character but I will say that a number of the people will stay with me forever.  Although many of the other characters had these incredible and terrifying journeys with mental illness, the people whose stories touched me the most were Susanna and her roommate Georgina Tuskin.  The reason being their relatability. How could anyone not relate.  Kaysen ended up in the institution after making a mistake.  It was a dire mistake that could have cost her life but it was mainly just a moment of weakness and a poor decision.  She thought of it similarly herself.  She made a bad decision and was generally a non-conformist or contrarian as many adolescents can be.  But did that make her insane?  By that definition we could say that for mass swathes of people.  Georgina’s situation was touching and simultaneously frightening.  If the sincerest form of flattery is imitation then the sincerest form of empathy must be fear or relief.  Relief that it didn’t happen to you.  Of fear that you will not be the next to which it happens.   Georgina’s story hit me like that.  She felt completely fine and normal until one day when she sits down in a movie theater and feels an all encompassing darkness begin to close in around her and that was it.  She feared for her sanity and then sought treatment.

Kaysen also has a lot to say about the state of mental illness diagnosis and treatment.  Here she is brutally honest and explains the situation as she experiences it.  Kaysen was basically duped into signing herself into the hospital which therefore meant that she could not sign herself out.  Her psychiatrist who was also a family friend told her that she would be there for just a few weeks but instead she was forced to remain there for nearly two years. She laments often in the book about the dramatic disparity in time between how long it took her doctor to diagnose her and how long she was forcibly treated.  I think the original counseling session that she received before being admitted into the hospital was something like twenty or thirty minutes.  Her views on the families of the patients are interesting as well. I thought about this quite a bit.  She saw them as casting the sick one away as an attempt to maintain there own sanity and draw a clear distinction between there mental state and those of their insane family member by sequestering them from that family which would keep them from being forced to play the natural comparison game. Kaysen’s work touches on other important ideas as well such as freedom and conformity and how they play into the concept of sanity.

I rate this book as an honest account of a genuine experience in mental illness and if nothing else, just a thought provoking narrative with intrepid storytelling and lively characters.