voluntary madness lost and found in the mental healthcare system

While recognising the social need for incarceration as safety net, she provides potent criticisms of entrenched medical habits - the grim realities of bureaucratic inertia and lazy diagnosis in which the sickness of patients is reflected in, and reinforced by, the nature of the institution. 'Good intentions,' she writes, are 'the casualty of contact.'

Nor does she shy away from the paradox that lies behind the stigma - that to care for the mentally ill means confronting a potential abhorrence of the sufferer. She begins her journey in a New York public hospital where the reality of diseased minds presses upon her with irrefutable force. The shallow, anti-psychiatric conclusions that might be drawn from this - that mental illnesses do not really exist or that diagnostic classifications are meaningless - are not, however, ones that Vincent indulges (though she certainly questions the categories). Vincent is not exactly faking it, but she plays up to what she knows her doctors need to hear to achieve the level of admission appropriate to her task.

The fact that all of them were admitted with formal diagnoses exposed the central difficulty of the profession (one that remains as real today as it was then): that the only test for even the most extreme psychiatric illnesses is a patient's own report of his or her state of mind. The precedent is the famous 1972 experiment by American psychologist David Rosenhan, who sent researchers into a dozen psychiatric institutions with instructions to report phony hallucinations. It is a problematic balancing act, but one that captures the fundamental dilemma of psychiatry - how to reduce subjective experience to the objective classifications of medical science. She must, to tell a sane story, maintain perspective on other patients whose experiences of the world are defined by far more profound distortions and psychoses. To give the reader a feeling of what happens to disordered minds in an institution, she has to be mad enough herself to render the experience, but not so mad as to lose the plot. Vincent attempts to speak both with the authority of a commentator who has researched the American psychiatric system from the outside, and with the psychic vulnerability of someone experiencing it from within. This blurring of roles creates an interesting ambiguity.

Voluntary madness lost and found in the mental healthcare system