Mental Illness as Plot Twist – Ethics in Fiction

Y’all… I have a love-hate relationship with the thriller genre. Soooo many of these books seem to fall under the cookie cutter “white woman with a dark past, a drinking problem, and a terrible husband who turns out not to be what he seems” plot without much new to offer. But once in a blue moon, I’ll find a book like The Silent Patient that kind of blows me away and keeps me coming back to the genre. (This is only marginally related to the topic at hand, but if you haven’t read The Silent Patient, please do. It has a major character in a mental hospital and managed to do so without feeling exploitative towards those with mental illness.)

This post was prompted by a thriller I recently read which will remain unnamed, because it’s impossible to discuss the issue at hand without delving into huge spoiler territory. The book was an advance reader copy, and I’d hate to throw the whole plot out into the world before the book is even released, but if the subject matter is something you know you want to avoid, I’ll happily email you the title. (Send me a message at JennaBookish@gmail.com.)

But really, I could be talking about any number of books or movies and the point would remain the same; writers seem to really love using dissociative identity disorder for cheap thrills.

Definition via https://www.psychiatry.org/

The trope of the evil alter-ego in someone with DID is heavily used in horror/thrillers, seemingly without any regard for the fact that real people suffer from these disorders and the associations formed through fiction carry through to the public’s view of them in real life. We see this trope popping up in movies like Split, Psycho, and in countless books, like Before She Knew Him (Peter Swanson) and (albeit with a sci-fi twist) The Strange Case of Dr. Jekyll and Mr. Hyde. It’s easy to see where the trope comes from; there is an intrinsic horror in the thought of large gaps in memory where we aren’t fully in control of our own actions. But fiction delving into DID routinely focuses on the prospect of harm to others as opposed to the ways the person with the disorder suffers. This, despite the fact that the evidence shows that people with DID are no more likely than the general population to be violent. In fact, those who suffer from mental illnesses are more likely to be the victims of violent crime than the general population.

The book that prompted this post made an effort to turn this trope on its head. The main character suffers from DID and is unaware of it. Her husband has been manipulating her for his own purposes, using one of her alters to get rid of inconvenient mistresses. While he is portrayed as the true villain and puppet-master, the book still hinges on the assumption that DID is linked to a proclivity for violence. The first murder was not committed at the husband’s request, and this was what made him realize he could use her disorder to his own advantage. The book ends with an afterward about mental health awareness and a desire for writers to do better by those who suffer from things like DID. It’s a nice sentiment, but it seems the author herself missed the mark in this case.

Thanks for reading, friends! Please feel free to share your thoughts on this topic in the comments, or tell me about one trope you want to see die in 2020!

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Review – No One Cares About Crazy People, by Ron Powers

No One Cares About Crazy People: The Chaos and Heartbreak of Mental Health in America
by Ron Powers

Genre: Nonfiction, Psychology

Length: 360 Pages

Release date: March 21, 2017

Publisher: Hachette Books

Synopsis: 

New York Times-bestselling author Ron Powers offers a searching, richly researched narrative of the social history of mental illness in America paired with the deeply personal story of his two sons’ battles with schizophrenia.

From the centuries of torture of “lunatiks” at Bedlam Asylum to the infamous eugenics era to the follies of the anti-psychiatry movement to the current landscape in which too many families struggle alone to manage afflicted love ones, Powers limns our fears and myths about mental illness and the fractured public policies that have resulted.

Braided with that history is the moving story of Powers’s beloved son Kevin–spirited, endearing, and gifted–who triumphed even while suffering from schizophrenia until finally he did not, and the story of his courageous surviving son Dean, who is also schizophrenic.

A blend of history, biography, memoir, and current affairs ending with a consideration of where we might go from here, this is a thought-provoking look at a dreaded illness that has long been misunderstood.

I should have liked this book. I wanted to like this book. I was a psych major in college and I’m very passionate about mental health. This book also delves into the history of mental health, including treatment and abuse in various contexts. That being said, I had a lot of issues with No One Cares About Crazy People. 

First and foremost, the structure felt a bit meandering and messy. Powers goes off on tangents that aren’t really relevant to the subject matter and add nothing of value to the book. For example, at one point he pauses in telling a story about taking his sons to an amusement park to give the reader a little aside about the history of that park. What he was attempting to accomplish with this bit was beyond me.

But it also just feels like Powers is trying to do too much with this book. He delves into some of the medical knowledge about schizophrenia. He recounts anecdote after anecdote about mentally ill people being mistreated by medical professionals and law enforcement. He details the descent of both of his sons into madness as they developed schizophrenia, alongside chapters and chapters about their passion for music. (Including speculation as to how their creativity could have been linked to their illness, which felt like the same tired “tortured artist” spiel we’ve all heard too many times before. No, madness is not the cost of great art, and implying that it might be is harmful, because it discourages suffering artists from reaching out for help for fear they’ll “lose their creative spark.”) He gives a very detailed history lesson on psychology as a whole and the varying treatments (and mistreatment) to which the mentally ill have been subjected over the years.

All of the things mentioned in the prior paragraph are surely worthy subjects (with the exception of the whole tortured artist bit, of course), but they don’t feel tied together in any cohesive manner. The end result simply feels like… rambling.

Powers is also critical of the some of the modern day laws regarding the rights of mentally ill patients. Specifically, he seems to take great issue with the requirement that mentally ill patients show signs of being a danger to themselves or others before they can be involuntarily committed and medicated. He argues that at that point, for many patients, it is too late and the harm has already been done. Tragically, this often means suicide. Given the family history, this is an understandable sore spot, but Powers notably does not offer a better solution. The alternative is taking away the rights and bodily autonomy of anyone with a diagnosis, regardless of whether or not they show signs of being at risk. In his desire to protect the mentally ill from themselves, he seems alarmingly content to strip them of rights.

That being said, there were some strong points. Powers has clearly researched this topic exhaustively, and his attempt to impress upon the public the extent of the problem we are still facing is admirable. After deinstitutionalization, America’s jails became the de facto insane asylums, an issue which has never been resolved. Powers’ coverage of this topic is nuanced and well-researched. The most severely mentally ill are unable to advocate for themselves and thus most dependent on the public at large to do so for them. This book was, however flawed, an attempt at that advocacy.

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ARC Review – When Elephants Fly, by Nancy Richardson Fischer

When Elephants Fly
by Nancy Richardson Fischer

Genre: YA, Coming of Age

Length: 400 Pages

Coming: September 4, 2018

Blurb via GoodReads: 

T. Lily Decker is a high school senior with a twelve-year plan: avoid stress, drugs, alcohol and boyfriends, and take regular psych quizzes administered by her best friend, Sawyer, to make sure she’s not developing schizophrenia. Genetics are not on Lily’s side.

When she was seven, her mother, who had paranoid schizophrenia, tried to kill her. And a secret has revealed that Lily’s odds are even worse than she thought. Still, there’s a chance to avoid triggering the mental health condition, if Lily can live a careful life from ages eighteen to thirty, when schizophrenia most commonly manifests.

But when a newspaper internship results in Lily witnessing a mother elephant try to kill her three-week-old calf, Swifty, Lily can’t abandon the story or the calf. With Swifty in danger of dying from grief, Lily must choose whether to risk everything, including her sanity and a first love, on a desperate road trip to save the calf’s life, perhaps finding her own version of freedom along the way.

I received an early release copy of this book in exchange for an honest review, courtesy of NetGalley and the publisher. 

As a person with an education background in psychology, I had some misgivings about the subject matter of this novel going into it. Lily’s schizophrenic mother tried to kill her when she was a young girl. Lily struggles to deal with that trauma and also the looming threat of developing the disorder herself, given the genetic component. Schizophrenia is a such a highly stigmatized illness, and a novel with a schizophrenic character committing such a dramatic act of violence at the center of the story is concerning. While delusions in thought can cause a person with schizophrenia to become violent, most people living with this disorder are not violent and are at far greater risk of harming themselves than they are anyone else. So while Lily’s story is certainly not out of the realm of possibility in the real world, these are important things to keep in mind when reading a story like this.

Photo by Kat Jayne on Pexels.com

That being said, I do think that Fischer made efforts to treat the subject matter with sensitivity. She has used Lily’s concerns about developing the disorder as a means to relay information to the reader; Lily has researched this topic tirelessly as a means of maintaining a sense of control over her life and mental health, and is aware, for example, of the risk of suicide for patients dealing with this disorder. Lily is a very sympathetic protagonist who is acutely aware of her risk of developing this disorder; she also gives the reader a window into what it feels like to be unfairly dismissed based on their mental health status.

Certain characters look down on Lily based on the mere possibility that she may have inherited her mother’s illness; should this possibility prove to be true, the contempt would be that much worse. Any and all of Lily’s opinions can be dismissed based on the speculated status of her mental health. For an insecure and yet passionate young woman just emerging into adulthood, this is excruciating.

Photo by Casey Allen on Pexels.com

And then there’s Swifty. I got so emotionally invested in this baby elephant; Lily’s connection with Swifty is palpable, and my heart broke for both of them as Swifty struggled after being rejected by her mother. Many of the passages about Swifty are very well written, but some of them showcase the novel’s main weakness, in my opinion. It’s very clear that Fischer wanted this novel to educate, and that’s admirable.

However, with a 400 page book dealing with intricate subjects such as mental health, adolescence, parenting, and animal rights, the information may not always be woven seamlessly into the story. Certain passages felt forced and awkward. It sometimes felt like the author’s own research was pasted into the story without regard to the overall flow of the novel; it had the effect of pulling the reader momentarily out of the story.

Overall, this was a strong novel. It was well-paced with a well-developed and sympathetic protagonist. The story was interesting and multi-faceted. It brought us a character who, despite her overwhelming anxiety about her mental health, is more than her mental health status. Lily has people who love her deeply and a cause she’s willing to fight for.

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Have you read When Elephants Fly? Please share your thoughts in the comments below.
What are your favorite novels about mental health?