Customer Reviews

Voluntary Madness: Lost and Found in the Mental Healthcare System

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I was really dismayed by Vincent's depiction of psychiatric drugs in Voluntary Madness, particularly antipsychotic drugs like Seroquel.

As someone whose mental illness (schizoaffective disorder) is and was NOT voluntary, I could tell Vincent that, for me, Seroquel made and continues to make the difference between life and a living death.

The onset of my illness brought loud and threatening hallucinations (voices that threatened to kill me and worse). I was treated with a variety of drugs, the first of which were not very helpful for me.

When my doctor tried giving me Seroquel, however, my life returned to normal as the drug built up in my system. The delusions stopped almost completely, and what voices I heard from then on were and are few and far between. They were also easy to distinguish from real sounds and ceased to be frightening--they became merely annoying and easy to ignore.

While the drug was sedating at first, my body adjusted to it very quickly (it is usually taken at bedtime for this reason). I could also tell Vincent that I certainly DO NOT twitch, drool, or fall asleep during daily activities!

If and when people experience these side effects from drugs, their doctors should withdraw them slowly and gradually while starting them (also slowly and gradually) on new ones. Unless I missed it, Vincent failed to mention that this simple solution to these problems is even possible.

Stopping any psychiatric drug slowly and gradually, under a doctor's supervision, is also an easy way to avoid a painful withdrawal. Vincent demonizes Effexor, for example, as causing withdrawal, but she never mentions that this withdrawal is avoidable.

She also observed that antidepressants and antipsychotics did not seem to work on the real patients on her ward. Well, unlike aspirin, these drugs usually take weeks and even months to build up to a theraputic level in the body. This is something Vincent would have known had she done a bit of research.

Vincent seems intent on making a career of posing as things that she is not. Still, she should have educated herself MUCH better on the subject of severe mental illness and the drugs used to treat it before filling Voluntary Madness with her baseless opinions.

Instead of writing a book about mental illness and its treatments (especially psychopharmacology), Vincent should have read one!

I would like to recommend three books to her or anyone else who wants to read a good first-hand account of mental illness and its treatment:

The Center Cannot Hold by Elyn R. Saks

The Quiet Room by Lori Schiller

An Unquiet Mind by Kay Redfield Jamison

Clarification:

I believe that many psychiatric patients are normal, healthy people who are unhappy for external reasons or going through temporary crises. Vincent, by her own account, seems to fall into this category.

Others, however, have real, biologically based illnesses that (so far) cannot be cured. They can only be treated and the most effective treatment is usually medication, often used with conjunction with therapy. I fall into this category, and I am frustrated that Vincent seems to deny its existence.

Vincent should be glad that she is lucky enough not to need medication. Instead of insisting that since she doesn't need it, no one does, she should have enough humility to refrain from judging what she doesn't understand.

In Norah Vincent's last book she describes disguising herself and living as a man in every way imaginable for six months. She concludes that book by committing herself to a mental institution. Tough to top? Not for Vincent who turned that experience into the idea for this memoir. She would commit herself into three mental health facilities, and dish out all the dirty details of mental health facilities from the patient perspective.

She easily gets herself committed into her first public health facility and begins to recount colorful stories about her fellow mental patients and scathing criticisms about the hypocrisy of the system. Only Vincent is no stranger to mental demons. She is currently taking Prozac for a history of depression and medication to aide sleep. When she stops taking her medication, she falls into a depression. So before she can commit herself into her next facility, the book then takes a turn. While it still punches at mental health procedure, it mostly becomes the author's personal internal struggle to heal herself. Although the author does make progress and delivers some jewels about modern treatment methods worth considering, the book falls short of the salacious premise originally embarked upon.

I bought this book because I spent three months on "Meriwether Ward 20" as a psychiatry resident, and I thought it would be fun to read something a patient on the unit wrote about it. However, the book turned out to be an poorly-researched anti-psychopharmacology diatribe full of rather egregious, ideologically-driven factual inaccuracies. For example, the author states that the role of excess dopamine in psychosis is entirely unproven, and that the safety and efficacy of D2 receptor antagonists in treating hallucinations and delusions is the subject of "great debate in the scientific community." That's like saying that the role of treponema pallidum in syphilis is entirely unproven, and the safety and efficacy of penicillin in treating syphilis is the subject of great scientific debate. She makes similarly inaccurate statements about the role of serotonin in depression, and perhaps more humorously, attributes the symptoms of other patients' illnesses to the medications used to treat them! Of course, that's what happens when you spend ten days as a tourist on a unit where the average length of stay is almost a month; you're not there long enough to see how well the meds can work and how much better people can get. None of that would even bother me that much if she didn't go around on the unit, encouraging other patients to cheek their meds. Because in a way, that's what her book does--tell the millions of Americans who actually have serious mental illness to stop taking their meds.

While her ignorance of the topic may be her greatest sin as a journalist, her greatest sin as a writer is mainly that the book is not more interesting to read. By focusing so exclusively on herself, she fails to spend enough time describing the fascinating, colorful characters that one encounters on a unit like "Meriwether Ward 20," which would have made the book a lot more entertaining.

Whats the point? & who's it meant for? I'm not sure who would be the target audience for a book that has really no point or purpose. The author appears to be making a half-hearted attempt to get some mileage out of a literary degree by sharing her sophomoric ideas about a subject she has obviously not studied or fully experienced. It's not about her own 'illness' (although that is what she implies in the title) as she doesn't ever really commit to exposing her own struggles but rather gives a preachy and perfunctory speck here and there. At one point she describes her reaction to another person prefacing it with "me being me," and it hit me that I have no idea what that means. She doesn't share enough for the reader to join her in her concept of "me" so it just emphasizes the fact that she has not really developed her 'character' at all for the reader. It's unfortunate too, because there's probably a story here if the author was willing to really commit to telling it instead of hiding under pretense. The writing winds back & forth between vague descriptions of her being a "depressive" and her treatment in the mental health establishments. If you want to write a book exposing the latter- there is alot more to say than is portrayed here! If you're looking for a book that will help you to empathize with those who struggle with mental illness and the institutions/ treatment woes that are a part of that, you're better off elsewhere (Saks or Redfield Jamison). This author appears not to really have much passion and therefore much focus with regard to whatever subject she's calling this & it just comes off as trite as the word "bin" she continually uses. She extracted her 'words to live by' off of the patch on someone's jacket- need I say more? It seems her purpose was simply to write a book. It's practically an insult to people who actually have a diagnosed mental illness, and full of opinions disguised as information. Don't waste your time-

The primary flaw with the book, in my opinion, is that Vincent offers many generalized critiques (often centering around the concept that all psychotic people need is a little human interaction) without offering any alternatives. Many of the people she so pitied for being stuck in the hospital would otherwise have been in prison or on the streets. If Vincent has a solution in mind for this problem, she sure doesn't present it here.

Throughout, Vincent struck me as a sort of know-it-all teen. She would simply lie to rest age-old psychological and social debates (we are a product of our environment, without question, and thus ends the 'nature vs. nurture debate). She also claims, basically, that most everyone is misdiagnosed (she seems to believe there is no such thing as ADHD or Bi-polar disorder -- or at least the diagnosis is usually incorrect). Maybe more than a hubris-filled teen, Vincent reminds me more of that friend many of us have who is an 'expert' at anything they've gone through. So, if they've had knee surgery, they are suddenly a surgeon; in Vincent's case, since she's seen a shrink, she's suddenly a neurologist.

I almost never give up on books without finishing, but after suffering through a little over sixty pages of this garbage, I tossed it aside. The basic idea of the book is intriguing - a journalist checks herself into three psychiatric facilities in an effort to get a close look at mental health treatment in the United States today. I bought my bargain-priced copy of this book because my brother is a psychiatrist, because I am a public defender who has many clients who spend significant periods of time in hospitals, and because I love investigative journalism works by talented authors like Barbara Ehrenreich (Nickel and Dimed: On (Not) Getting By in America), Ted Conover (Newjack: Guarding Sing Sing), Piper Kerman (Orange Is the New Black: My Year in a Women's Prison), and A.J. Jacobs (The Year of Living Biblically: One Man's Humble Quest to Follow the Bible as Literally as Possible).

This book, though, is just vile. Vincent starts out with a clear "smarter than the doctors and everyone else" agenda, which is grating to me on a personal level and makes all of her observations suspect from a purely journalistic standpoint. She has valid concerns about whether or not doctors know all of the side effects of the drugs they prescribe, but when she vents in such a snotty way, I have no interest in listening. She also details a history of psychiatric medications and inpatient treatments that make her "ha ha, these stupid doctors don't even know that I'm not crazy" attitude that much more repulsive (and when she rants about the chemical processes used to create a dinner roll provided for patients at a meal, she sounds pretty mentally ill to me - her point is a fair one, that good nutrition could have a valuable impact on a patient's physical and mental health, but when she makes the point in such a shrill and out-of-nowhere way, she loses credibility).

Also, even if I weren't thoroughly repulsed by her character as presented in the first few dozen pages, I would still have abandoned the book because it is written so poorly. Immersive journalism works because a journalist gathers first-hand observations, laying out for the reader a number of facts and conclusions. Then the writer has earned the right to expand his/her analysis to question the systemic implications of these observations. Vincent just throws everything into a jumble. She'll begin to describe some narrative event, and she will suddenly veer off into a philosophical discussion of how and why we give doctors power, and what our system is like, and the nature of healing as she sees it, then she'll return to the narrative. It is poor writing that would be savagely edited in a college class, and it is insulting to pay money for a book and find such a low level of professionalism.

I respect Vincent's goals, to an extent. She clearly believes that the mental health care system in the United States is broken, and I applaud her efforts to personalize the problem and present it to a wider audience. Her lack of self-awareness, her refusal to set aside her personal agenda, and her failure to abide by a simple "facts first, then discussion of implications" structure, though, make this an unreadable mess, and I wish that I had never wasted time or money on it.

This book confounded me if for no other reason than Norah Vincent can write, and well, yet I kept feeling like I was being talked at by a news station. She tries to straddle the line between the personal and journalistic and the combination does not work. I have a hard time working up any kind of empathy or seriousness for someone who purports to write an exposé of sorts about psych wards. Is she a reporter? A patient? And whatever depression she supposedly suffers from is at best a bad mood. The way she left Meriweather, embracing the outside world like the joy she believes it is, with its wonderful people and steaks and fresh air, was too phony for words. There is a huge difference between psych wards and prisons and I'm not sure she knows this. Leaving a psych ward is often more terrifying than entering one.

Speaking of prisons, that's how this book read; like a crime free citizen going into Attica under false pretenses not to write about prison life per se but the emotions and realities of being an inmate. She's not qualified.

Does she know how it feels to have your mind betray you? No. Is she qualified to only point out the negative side effects of medications that can and do save lives? No. (For this to be better, she should have taken the meds) I never once got the feeling like she was really there. At best, she was engaging in an experiment while her bills and nice apartment in the city were taken care of and she never forgot she'd get back home. To write about hopelessness, it's best to understand its bleak landscape.

It's not that she lacks insight into the system of psych wards, the burnt out nurses and doctors but, like I said, I felt like she was trying to teach me a lesson from which I was supposed to form new opinions. She really can write but her detached, disingenuous "I'm gonna show you something" sensibility ruined this book to the point I could not finish it. Plus, she mentioned that she was on The View. That pretty much did it for me.

Vincent, who is actually a genuine former involuntary patient in a mental institution, decides to return to three different institutions to study, experience, and analyze how the systems work (or don't work), and what happens to the people inside-- both patients and employees.

This fact that she was a former patient gives her book an edge upon which she has had to tread lightly: If she hadn't formerly been committed, it would be easy to suggest that she didn't truly understand, because she had gone there by choice as someone who wasn't really sick. Yet, the fact that she has been formerly committed will likely give many people pause, as they consider her analysis and conclusions, and wonder if her judgment can be trusted as a coming from a reliable narrator.

This dilemma, although not specifically addressed in the book, is really at the heart of what Vincent seems to be suggesting overall about mental health, however. Most of the time throughout the book (there are exceptions) Vincent is fairly even-handed in her analysis of her experiences. She is almost always quick to offer oppositional arguments for why many of her questions are unwarranted. Yet it is the fact that there are so many unanswered questions that makes Vincent's book an indictment against the mental health industry. Anyone employed in the mental health field or training for such, or anyone who accepts the identity of their psychological diagnosis will probably hate this book.

For the rest of us, what her book does is raise the issue of how little we actually know about mental illness, while pretending, labeling, and treating people as if all causes and outcomes are well-documented. Some of the great questions to come out of this book include, why are psychological professionals unable to reliably diagnose mental illness? (That is, why are diagnoses inconsistently applied based on who is doing the diagnosing?) Why is 'taking the patient's word for it" good enough for a diagnosis, but then if the patient states that s/he no longer feels ill, their words cannot be trusted? Why are medications that are so poorly understood administered to patients so carelessly and frequently?

Although I would certainly hesitate to suggest that any policy decisions should be made based on her anecdotal experiences and conclusions, it is difficult to argue that many of the questions she raises deserve serious, evidence-based answers from the psychological community, which-- and she is right about this-- has not yet been forthcoming with them. This is probably not due to any sinister reason, but more because at this point, we simply as a people do not yet fully understand how our brains work.

Although some people will not like it that the mental health industry is being criticized, the reason why we need more work like this is because it would be foolish to pretend that only good comes out of the industry. Although certainly some people are helped by some procedures and medications, some people are also harmed and the more we know, the more we can reduce the latter.

I thought this book would be an enlightening tome on mental care in the US. Even though I had never heard of this author I thought she must have had some very educational and/or harrowing things to say. Nope. By her own admission at the beginning, she was bored with her job and was looking for a way to make some money. I mean serious money. So, much like the author of Julie & Julia, she decides to go through something just to write a book about for the money (probably with an eye to a movie deal or at least a Lifetime TV movie). This is not a memoir, it is not even good investigative reporting. She has no skill at reporting unless you call "I did this, then this, then this happened to me, etc" reporting. I don't. It was a calculated way to write a sequel to another contrived book where she supposedly lived as a man for a year. Even if this book was fiction, it is so poorly thought out and written and edited it is a bore! How can you have yourself committed to 3 mental hospitals and make it seem like a dry text book? First she claims she is not an investigative reporter then a few pages later claims she is investigating as a writer. Big difference, huh? I agree she is no reporter. I came away knowing little about her life, her experience, the workings of the hospitals or much of anything. She goes on and on about girls she meets and her subjective observations of patients and nurses and doctors. Boring, boring, boring. This book should have never seen the light of day. It is insincere since the motivation was not to write about an experience she had but to make cash off a thought-out subject that book buyers would be most likely to find interesting. She fails miserably even in that deceit. She needs to go back to being a secretary and leave the poor readers of the world alone.
P.S. One point I agree with her on is that drug companies like to buy doctors to push their particular drug and how the companies run ads to make patients think they need the drugs. However, this is hardly a revelation or news. An amateurish time-wasting mess of a "book".

The author's rudimentary understanding of the subject matter becomes glaringly obvious not two pages into this book. She does not seem to understand the most basic principles of psychopharmacology, as seen when she warns a patient with insomnia not to take her Seroquel, because she knows it to be a drug used to treat schizophrenia. Had she done her homework at all, she would have known the HUGE differences in dose. The dose given to someone who cannot sleep is as low as 25 mg, and can be lower. When given to a schizophrenic, the dose of Seroquel is over the 300 mg mark. In the beginning, she set out to describe the horrors of the institution, and quickly turns to whining about her own insignificant issues that millions of other people without an expense account for voluntary commitment possess. If she meant to describe institutions in terms of her own illness and issues, she does a lackluster job, obscuring her own story with a slew of over-elaborate pop culture references and a style of description that makes use of an uncommon vocabulary that uses overflowery speech to describe irrelevant topics. The overall effect is that a relatively simple point is again obscured and difficult to understand. She makes an attempt at a stream of conciousness style of writing and ends up sounding as though she has a Kindergartner's understanding of the world. Her view of the mental patient is unclear, as is her viewpoint on many other subjects. Her simultaneous love and hate for the psychotics she shares a ward with is hypocritical. She is delving into the topic to improve the institutions for them, is she not? Then why does she portray them as inferior human beings instead of people with tragic circumstances? On top of it, she finds their medication routine to be dangerous and not helpful. I challenge the author to spend time on a locked ward with un-medicated psychotics. All of these errors in writing aside, at the end of the book the reader cannot be sure what the book was about, what the author "discovered", what her viewpoint on anything REALLY is and whether or not he should set the book on fire or use it to line a birdcage.