DEPERSONALIZATION

The term “mental illness” is of recent origin.It was coined by people who were humane in their inclinationsand who wanted very much to raise the station of (and the public’s sympathies toward) the psychologicallydisturbed from that of witches and “crazies” to one that was akin to the physically ill.And they were at leastpartially successful, for the treatment of the mentally ill has improved considerably over the years.Butwhile treatment has improved, it is doubtful that people really regard the mentally ill in the same way thatthey view the physically ill.A broken leg is something one recovers from, but mental illness allegedlyendures forever.A broken leg does not threaten the observer, but a crazy schizophrenic?There is by now ahost of evidence that attitudes toward the mentally ill are characterized by fear, hostility, aloofness, suspicion,and dread.The mentally ill are society’s lepers.That such attitudes infect the general population is perhaps not surprising, only upsetting.But thatthey affect the professionals – attendants, nurses, physicians, psychologists and social workers – who treatand deal with the mentally ill is more disconcerting, both because such attitudes are self-evidently perniciousand because they are unwitting.Most mental health professionals would insist that they are sympathetictoward the mentally ill, that they are neither avoidant nor hostile.But it is more likely that an exquisiteambivalence characterizes their relations with psychiatric patients, such that their avowed impulses are onlypart of their entire attitude.Negative attitudes are there too and can easily be detected.Such attitudes shouldnot surprise us.They are the natural offspring of the labels patients wear and the places in which they arefound.Consider the structure of the typical psychiatric hospital. Staff and patients are strictly segregated.Staff have their own living space, including their dining facilities, bathrooms, and assembly places.Theglassed quarters that contain the professional staff, which the pseudopatients came to call “the cage,” sit outon every dayroom.The staff emerge primarily for care-takingpurposes – to give medication, to conducttherapy or group meeting, to instruct or reprimand a patient.Otherwise, staff keep to themselves, almost as ifthe disorder that afflicts their charges is somehow catching.So much is patient-staff segregation the rule that, for four public hospitals in which an attempt wasmade to measure the degree to which staff and patients mingle, it was necessary to use “time out of the staffcage” as the operational measure.While it was not the case that all time spent out of the cage was spentmingling with patients (attendants, for example, would occasionally emerge to watch television in thedayroom), it was the only way in which one could gather reliable data on time for measuring.The average amount of time spent by attendants outside of the cage was 11.3 percent (range, 3 to 52percent).This figure does not represent only time spent mingling with patients, but also includes time spenton such chores as folding laundry, supervising patients while they shave, directing ward cleanup, and sendingpatients to off-ward activities.It was the relatively rare attendant who spent time talking with patients orplaying games with them.It proved impossible to obtain a “percentmingling time” for nurses, since theamount of time they spent out of the cage was too brief.Rather, we counted instances of emergence from thecage.On the average, daytime nurses emerged from the cage 11.5 times per shift, including instances whenthey left the ward entirely (range, 4 to 39 times).Later afternoon and night nurses were even less available,emerging on the average 9.4 times per shift (range, 4 to 41 times).Data on early morning nurses, whoarrived usually after midnight and departed at 8 a.m., are not available because patients were asleep duringmost of this period.Physicians, especially psychiatrists, were even less available.They were rarely seen on the wards.

offspring

PSEUDOPATIENTS

detect

(thatis, people who do not have, and have never suffered, symptoms of serious psychiatric disorders)

tag

7 to 52 days, with an average of 19 days

show”

(which was not swallowed)

feign respect for a doctor’s supposed expertise while silently

knowing that there are many other doctor and patient testimonies that contradict or complicate his or her opinions.

Though I know better, I still go to doctors desperately believing in their authority and wanting a recognized name for my illness; I want the uncer-tainty corralled and explained, I want my future narrative to be pre-dictable based on a time-tested treat-ment for my recognized problem and to require no agency on my part.

It also re-quires that she relinquish the need for the kind of clear answer she’s come to expect when she goes to a doctor’s appointment

You stop obsess-ing over a diagnosis—none really seem to t perfectly, after all—and instead start focusing on symptom relief.

He doesn’t do this. He waits until she’s finished talking. Then he thinks.

A skeptical part of me wondered: Might reading certain kinds of novels actually reinforce doctors’ tendency toward overconfidence? Might it re-inforce the belief that a patient is, like a character in some mainstream lit-erature, a collection of traits that add up and “make sense”—the sort of sense that doesn’t require a second or third or fourth opinion? Might reading such novels make a person danger-ously convinced (as I was, when I di-agnosed Lady Sybil) that she is an unusually perceptive diagnostician and, moreover, that she is correct? How does reading this kind of novel not emphasize (rather than program against) pathway thinking?

tended to believe in his innocence while at the same time writing a book portraying him as an inscrutable de-mon. These were just a few of the fac-tors, according to Morris, that led to MacDonald’s conviction, and radically diminished his chances of a fair trial. He was, claims Morris, “condemnedto the story that had been created around him.”

In medical terms, they might be seen as victims of premature-closure errors, defined as a doctor’s (or, in this case, a writer’s) early dismissal of still viable narrative possibilities

She does not disagree with the implication: stories in the head, she’s learned, can be expressed by the body. It’s a form of literary interpretation.

Her Midwestern cousin suggests that her crystals have been knocked out of place

The detec-tive expends all his resources and en-ergy on proving the innocence of the suspect. Meanwhile, the real murderer is still running around, caus-ing more harm

Doctors, they conclude, are listen-ing, but not to your entire story. They are listening for a “chief complaint” in order to activate a diagnostic protocol.

“This is Dr. Owens,” Putnam says. “She will answer any and all questions you have.” To Owens he whispers, “Bo-nus points if you can get the mom on meds.” Back in the hallway Putnam soapboxes to Owens, “The Internet has ruined medicine.. . . Medicine should remain inaccessible.. . . You know, we should invent a private lan-guage for doctors.”

Emily Owens, M.D. is a medical drama that premiered on the CW

She might have believed the doctor.

one of the aimsof Sick Woman Theory is to resist the notion that one needs tobe legitimated by an institution, so that they can try to fix you.You don’t need to be fixed, my queens – it’s the world thatneeds the fixing.

These visitors havealso brought their friends: nervous breakdowns, mentalcollapses, or whatever you want to call them, three times in mylife. I’m certain they will be guests in my house again

they are mycanaries in the coalmine, the harbingers of at least three weeksto be spent in bed.My acupuncturist described it as a little demon steaming blacksmoke, frothing around, nestling into my bones.

Perhaps it can all be explained

to the sensation that I have becomenothingness

“disorders,”

“sick woman”

emotional,” and involuntarilyhospitalized in the Harlem Hospital psych ward. (As someonewho has also been involuntarily hospitalized for behaving “too”emotionally, this story feels like a rip of recognition through mybrain.)

the trauma of not being seen

limited funds

For those without chronic illness,you can spend and spend without consequence

the weight of time

being present inpublic

invisible bodies

sick woman fist