Narrating Madness: The Challenge of First-Person Accounts

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Length: 30 minutes


Gail Hornstein, PhD

For more than 200 years, psychiatrists have claimed authority over mental life.  They have drawn and redrawn the lines between "normal" and "abnormal" thoughts, feelings, and perceptions, and fought to legitimate their views within medicine and society.  But at every point in psychiatry's history, patients have fought back with their own ideas about madness and treatment.  The closing of public mental institutions across the US, UK, and Europe over the past 25 years has made it possible for current and former psychiatric patients to join together in an international political movement whose approaches now rival those of psychiatrists.  Assumptions about diagnostic frameworks, a "biological basis" for mental illness, and the effectiveness of drug treatment are increasingly under attack as people with first-hand experience of madness develop their own strikingly effective theories and methods.  In no other field of medicine could such a challenge from patients even be possible, so this phenomenon offers provocative insights into the history of science and the sociology of knowledge. 

Relationships between psychiatrists and their patients have always been complex. The insularity of asylums and a shared interest in the enigma of madness led both groups to write about the causes and treatment of psychological problems.  Since the origins of madness remain elusive, and patients have always had their own distinct viewpoints, psychiatrists have never succeeded to the same extent as other physicians in establishing their claims as authoritative. 

More than 700 patient narratives have been published, providing a rich source of data about the mind and its workings.  (I have compiled a bibliography listing all the accounts published in English.)  People with AIDS or cancer or heart disease also sometimes write about their experiences, but they don't do so primarily to critique their treatments or challenge their doctors' expertise.  But a surprising number of mental patients write for just these reasons. Their treatment hasn’t worked or it has made them worse. Or their doctors have ignored information they consider crucial. Or they’ve figured out a better method of treatment and want others to benefit from it. 

Patient accounts of madness are a kind of protest literature, like slave narratives or witness testimonies, offering insights into the mind otherwise unavailable to us.  Biological psychiatrists claim that these accounts are gibberish, the product of disordered brain functioning.  Is that because so many patients contradict doctors’ triumphant stories of “conquering" mental illness, choosing to write instead of trauma, insight, recovery, and resilience?

In my new book, Agnes's Jacket: A Psychologist's Search for the Meanings of Madness (published March 2009 by Rodale Books), first-person accounts of madness in every form are considered -- published memoirs, oral histories, and visual narratives like the jacket on which Agnes Richter, my title character, stitched an autobiographical text while incarcerated in a German asylum in the 1890s.  I want to offer ISPS members an opportunity to learn from the extraordinary works that patients -- past and present -- have created, so as to broaden our understanding of the mind and its workings.

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