Both real and fictional psychiatric institutions are often described in books as places filled with fear, manipulation and danger. Authors frequently take creative liberties to up the intrigue, and frighten their readers with tales of abuse, hauntings and corruption. Although these themes may have been closer to reality in generations past, one hopes that as a society we are progressing toward better treatment and better facilities.
I have worked in many mental health and addiction treatment facilities in my career as a psychotherapist, and my experiences in these places helped inform my first novel, The Blind. Its protagonist, Dr Samantha James, works at Typhlos, a fictional psychiatric institution in Manhattan that is suffering from overcrowding and underfunding. Despite feeling caught up in red tape, Sam is an intrepid clinician, doing everything in her power to reach and help her patients – something that is, happily, also a common reality. Typhlos acts as the backdrop for her journey, teetering on the edge of mental illness, and her experience is mirrored in the chaos of the institution itself.
The following books are diverse representations of institutions (for both mental health and drug and alcohol treatment) as they once existed, and as they exist today, as well as the humanity and compassion that flourishes within the walls of these facilities.
1. One Flew Over the Cuckoo’s Nest by Ken Kesey
In this masterful representation of the relationships that develop between patients and staff in an Oregon institution, Kesey explores the all-important questions of who is mentally well, who is unwell, and who makes that distinction. Narrated by “Chief” Bromden, Randle MacMurphy’s relationship with Big Nurse Ratched is a brilliant example of the frightening power struggle that can exist inside treatment facilities, and the terrifying abuses of authority that can take place there.
2. I Never Promised You a Rose Garden by Hannah Green
I read this book for the first time as a teenager, and was struck by the imaginary world of Yr that the author frequently visited, and discussed with her psychiatrists. The doctors, based on the author’s real-life psychiatrist, are not convinced that the world of Yr is a true delusion, and base their diagnosis on the idea that she is making up her delusions to impress her doctors. While this may seem a step in the wrong direction, the doctors are impressed with her ability to create such a magical and detailed kingdom, and believe this is an indication that she will be capable of making a successful recovery. A story of hope and understanding, I Never Promised You a Rose Garden shows what can occur when a patient is empowered to help in her own treatment.
3. Gracefully Insane: The Rise and Fall of America’s Premier Mental Hospital by Alex Beam
A fictionalised setting for both The Bell Jar and Girl, Interrupted, McLean Hospital is the main character in Beam’s non-fiction work. He describes the hospital at administrative, clinical and patient levels, and explores the history of the physical plant itself, the society surrounding it, and its ultimate fate. Through the decades that McLean served as the backdrop for myriad stories of tragedy and recovery, Beam takes a critical, often aloof and sometimes comical approach to describing and dismantling the mysteries and nuances of a famed institution.
4. Girl, Interrupted by Susanna Kaysen
Kaysen’s memoir explores her experiences in McLean Hospital, where she was institutionalised after an overdose, and eventually diagnosed with borderline personality disorder. Kaysen describes the oscillation between feelings of madness and sanity, and struggles to determine how she can be placed squarely in one category or the other. This book has detailed portraits of fellow patients, as well as comprehensive accounts of her experiences with staff. The richness of her narrative, combined with the almost panicked storytelling make for a compelling look into life in a 1960s mental hospital.
5. A Million Little Pieces by James Frey
Frey’s representation of the cold, sterile world inside a drug and alcohol treatment facility, structured with schedules and rules that are inevitably broken, echoes the real hallways where I have worked as a psychotherapist and addictions counsellor. Despite the controversy surrounding the veracity of the stories in this work, Frey illustrates an authentic journey into and eventually out of inpatient treatment. A Million Little Pieces also deftly explores the complicated role that family plays in treatment.
6. It’s Kind of a Funny Story by Ned Vizzini
Vizinni’s beautifully narrated tale of institutionalisation after a suicide attempt is made all the more powerful and relevant in the wake of the author’s suicide. Having grown up in New York City, Vizzini created a semi-autobiographical young adult story of a privileged New York City teenager trudging through the depths of depression, who learns in treatment that he has talents that he can use to aid in his recovery. It’s a hopeful story, highlighting the often overlooked hopeful possibilities of psychiatric treatment.
7. I Know This Much Is True by Wally Lamb
There is so much going on in this book – the experience of being a twin, survivor’s guilt, sexual abuse and self-injury – that the reader is left frightened and breathless. The institution is one of those dangerous and corrupt fictional places that have haunted and fascinated readers for generations. Throughout the twists and turns, cringes and tears one experiences, in the end it’s a powerful story of family support and loyalty in the face of severe illness and tragic circumstance.
8. Great Apes by Will Self
The worlds of mental health treatment and addiction counselling are often despondent and difficult. In fictional and historical portrayals, catastrophic ends and dreadful environments are ubiquitous. Call in Will Self and his superbly satirical and thought-provoking novel, where humans and chimpanzees have switched places in the pecking order, for the comic relief we have been craving.
9. Go Ask Alice by Anonymous
Although there is controversy surrounding the presentation of this book as an actual journal when it is a work of fiction, I find it an excellent representation of the fears and anxieties of adolescence that, in the case of the protagonist, lead to experimenting and self-medicating with drugs, which eventually result in her hospitalisation. The vulnerability the author expresses feels at times almost too much to bear.
10. The Bell Jar by Sylvia Plath
Perhaps the best-known representation of an individual experience of insanity, The Bell Jar became even more poignant in the wake of Plath’s eventual suicide, in 1963. A work of somewhat autobiographical fiction, the story takes readers on an extraordinary journey into the mind of Esther Greenwood as she descends into madness. The book is based on Plath’s experience at McLean Hospital, and it elucidates the experience of losing one’s self with such realism and clarity that one can’t help but question one’s own fragile psyche.
Link to Guardian article here
- The Blind by AF Brady is published by Harlequin, priced £12.99. It is available from the Guardian Bookshop for £11.04 including free UK p&p.