Nation Topics - Mental Health | The Nation

The desire to impose a narrative on chaotic events leaves the meaning of
the Virginia Tech shootings up for grabs.

In his memoir Wish I Could Be There, Allen Shawn movingly details a life crippled by phobias.

Some people are scaring themselves about the wrong
things in ways that are doing terrorists' work for them. Here's one
physician's prescription for bringing irrational fears under control.

Jeff Weise, teen slayer of ten, including himself, at the Red Lake
Indian reservation in northern Minnesota, was on Prozac, prescribed by
some doc.

Six years after Kip Kinkel, dosed up with Prozac, killed his parents and two students at Thurston High, in Oregon; five years after Eric Harris, dosed with Luvox, embarked on his day of slaughter

Correction:
Editorial tightening created the impression that two drug studies, by Pfizer and GlaxoSmithKline, were one study by Pfizer. We regret the error.

Forty-four states in the United States today bar people with mental illnesses from voting.

The billboard at the east entrance to the remote rural village of Tamms,
Illinois, reads "Tamms: The First Super Max," and below, in lowercase
letters, "a good place to live." Inmates at Tamms,

A recent front-page story in the Boston Globe proclaimed that New
England leads the nation in Ritalin prescription levels. Somewhat to my
surprise, the prevalence of Ritalin ingestion was generally hailed as a
good thing--as indeed it may be in cases of children with ADHD. But to
me the most startling aspect of the Globe's analysis was the
seeming embrace in many places of Ritalin as a "performance enhancer."
Prescription rates are highest in wealthy suburbs.

While the reasons for such a statistical skewing need more exploration
than this article revealed, what I found particularly interesting was
the speculation that New Englanders have a greater investment in
academic achievement: "'Our income is higher than in other states, and
we value education,' said Gene E. Harkless, director of the family
nurse-practitioner program at the University of New Hampshire. 'We have
families that are seeking above-average children.'"

Aren't we all. (And by "all," I mean all--wouldn't it be nice if
everyone understood that those decades of lawsuits over affirmative
action and school integration meant that poor and inner-city families
also "value education" and are "seeking above- average children"?) But
Ritalin, after all, works on the body as the pharmacological equivalent
of cocaine or amphetamines. It does seem a little ironic that poor
inner-city African-Americans, who from time to time do tend to get a
little down about the mouth despite the joys of welfare reform, are so
much more likely than richer suburban whites to be incarcerated for
self-medicating with home-brewed, nonprescription cocaine derivatives.
If in white neighborhoods Ritalin is being prescribed as a psychological
"fix" no different from reading glasses or hearing aids, it's no wonder
the property values are higher. Clearly the way up for ghettos is to
sweep those drugs off the street and into the hands of drug companies
that can scientifically ladle the stuff into underprivileged young black
children. I'll bet that within a single generation, the number of
African-Americans taking Ritalin--to say nothing of Prozac and
Viagra--will equal rates among whites. Income and property values will
rise accordingly. Dopamine for the masses!

Another potential reason for the disparity is, of course, the matter of
access to medical care. Prescriptions for just about anything are likely
to be higher where people can afford to see doctors on a regular
basis--or where access to doctors is relatively greater: New England has
one of the highest concentrations of doctors in the country. But access
isn't everything. Dr. Sally Satel, a fellow at the American Enterprise
Institute, says that when she prescribes Prozac to her lucky
African-American patients, "I start at a lower dose, 5 or 10 milligrams
instead of the usual 10-to-20-milligram dose" because "blacks metabolize
antidepressants more slowly than Caucasians and Asians." Her bottom line
is that the practice of medicine should not be "colorblind" and that
race is a rough guide to "the reality" of biological differences.
Indeed, her book, PC, M.D.: How Political Correctness Is Corrupting
Medicine, is filled with broad assertions like "Asians tend to have
a greater sensitivity to narcotics" and "Caucasians are far more likely
to carry the gene mutations that cause multiple sclerosis and cystic
fibrosis." Unfortunately for her patients, Dr. Satel confuses a shifting
political designation with a biological one. Take, for example, her
statement that "many human genetic variations tend to cluster by racial
groups--that is, by people whose ancestors came from a particular
geographic region." But what we call race does not reflect geographic
ancestry with any kind of medical accuracy. While "black" or "white" may
have sociological, economic and political consequence as reflected in
how someone "looks" in the job market or "appears" while driving or
"seems" when trying to rent an apartment, race is not a biological
category. Color may have very real social significance, in other words,
but it is not the same as demographic epidemiology.

It is one thing to acknowledge that people from certain regions of
Central Europe may have a predisposition to Tay-Sachs, particularly
Ashkenazi (but not Sephardic or Middle Eastern) Jews. This is a reality
that reflects extended kinship resulting from geographic or social
isolation, not racial difference. It reflects a difference at the
mitochondrial level, yes, but certainly not a difference that can be
detected by looking at someone when they come into the examining room.
For that matter, the very term "Caucasian"--at least as Americans use
it, i.e., to mean "white"--is ridiculously unscientific. Any given one
of Dr. Satel's "Asian" patients could probably more reliably claim
affinity with the peoples of the Caucasus mountains than the English-,
Irish- and Scandinavian-descended population of which the gene pool of
"white" Americans is largely composed. In any event, a group's
predisposition to a given disease or lack of it can mislead in making
individual diagnoses--as a black friend of mine found out to his
detriment when his doctor put off doing a biopsy on a mole because
"blacks aren't prone to skin cancer."

To be fair, Dr. Satel admits that "a black American may have dark
skin--but her genes may well be a complex mix of ancestors from West
Africa, Europe and Asia." Still, she insists that racial profiling is of
use because "an imprecise clue is better than no clue at all." But let
us consider a parallel truth: A white American may have light skin, but
her genes may well be a complex mix of ancestors from West Africa,
Europe and Asia. Given the complexly libidinous history of the United
States of America, I worry that unless doctors take the time to talk to
their patients, to ask, to develop nuanced family histories or, if
circumstances warrant, to perform detailed genomic analyses, it would be
safer if they assumed that, as a matter of fact, they haven't a clue.

We live in a world where race is so buried in our language and habits of
thought that unconscious prejudgments too easily channel us into
empirical inconsistency; it is time we ceased allowing anyone, even
scientists, to rationalize that consistent inconsistency as
"difference."

Eileen Myles's new novel, Cool for You, is much more a writing-out of female madness than a book about it. Framed around the author's search for the medical records of her grandmother, who spent the last years of her life in a state mental institution, Cool for You is about the institutionalized life in general. Though she begins with a description of the sanctioned squalor of the state asylum, really Myles is looking at the big picture: the processing of people into grades and schools and genders, cliques and classes. Like the writing of the late Kathy Acker, Cool for You is a kind of fragmented autobiography. Both Acker and Myles write adventure books in which their lived experience becomes the engine, not the object, of a narrative. Both present an "I" as large as the narrators of Heart of Darkness or Tropic of Cancer, although in female hands, the use of "I" is often misconstrued as memoir. Like Acker, Myles values the most intimate and "shameful" details of her life not for what they tell her about herself but for what they tell us about the culture. In this sense, Cool for You makes the classic Female Madness Tale, from Sylvia Plath's The Bell Jar through Susanna Kaysen's Girl, Interrupted, look like a kind of psychic liberalism.

Unlike Plath and Kaysen, and dozens of practitioners in between, Myles has no particular belief in the possibility of a fully integrated female self. She doesn't think her experience will be redeemed. The circumstances of Myles's life--she is the daughter of a Polish secretary and an alcoholic Irish mail carrier in class-riddled Boston--are no more dire than those of millions who daily feel the disparity between their own lives and the surfaces of upper-middle-class life that are projected blandly on TV and intricately probed in most contemporary literary fiction. What's harrowing is the detail in which this disparity is experienced and recorded.

Nellie Reardon Myles entered the Westborough State Hospital at the age of 60. Her complaint: "I don't feel well." She was a refugee of the Irish potato famine who'd cleaned houses all her life in Boston and given birth to seven children. Appetite: normal. Sleep: normal. Speech: normal. Nellie was stricken with grief over the death of her daughter, Helen. The color of her urine is fully documented over the fifteen years she spent before her death at Westborough. Teeth missing: thirty-two. Economic condition upon her entry: marginal. Her mental state: sometimes resentful. What Myles remembers most are the Sunday outings of her family to the asylum: "Dad went inside. My mother stayed out with us and the camera. Nellie is led out with great aplomb. The queen mother. The camera clicks.... It was our Buckingham Palace."

It's fitting that Cool for You begins with a quote from the Modernist hero Antonin Artaud. Just as Artaud's experience as a wartime inmate of the Rodez asylum became a launching pad and paradigm for his rage against the military-corporate forces that were then gathering toward a new postwar order, Myles reads the cursory entries on her grandmother's life at Westborough State Hospital, where she waswarehoused by the State of Massachusetts, as proof of something she already knew: The Poor Don't Matter.

The writing of both Myles and Acker is dependent on a great belief in myth, the conduit through which we may experience the Modernist passion to be larger than oneself. To use a very public "I" to speak, as Myles has put it, "to her time..." But mythification doesn't happen much to female writing. We have great hagiographies through which to read the works of Jack Kerouac, Neal Cassady, Allen Ginsberg and William Burroughs, but in the case of their contemporary, Diane di Prima, the twenty books she's published must suffice. Criticism also helps create a myth around the lives of certain male contemporary fiction writers. Girls in my writing class refer to the author of A Heartbreaking Work of Staggering Genius as "Dave," as if they knew Eggers, and memorize his interview remarks as if they were late-night phone confessions. Female myth, it seems, is something much more self-created.

Myles and Acker have both succeeded in bringing difficult work that goes against the grain of contemporary commercial narrative to wider audiences through the sheer willingness to cultivate and engage with myth. Acker hit large in the United States and England following Grove's rapid publication of her books in the mid-1980s. She knew the game and cultivated straight-girl celebrity with a vengeance: sex and motorbikes, tattoos, black leather. Acker Junkie, screamed the headline of her review in The Independent. She could be seen at 10 am hailing taxis on Third Avenue in full Punk Priestess regalia whenever heading uptown to meet her agent. By 1995, she knew myth inside out. "The kathy acker that you want...," she wrote to a friend in Australia, "another mickey mouse, you probably know her better than I do. It's media, it's not me. Like almost all the people I know, and certainly all the people I'm closest to, all of whom are 'culture-makers' and so-called successful ones...our only survival card is fame.... We're rats walking tightropes we thought never existed. Oh sure, we all look good while traveling. We're good at media images."

Myles, who isn't straight and is best known as a poet, approaches myth from a different angle. Since the publication of her first book, The Irony of the Leash, in 1982, she's been offering audiences fleshy, candid slices of her consciousness and life. A friend and apprentice of the late James Schuyler, Myles writes in a style that is deceptively immediate and conversational, giddily expressing a huge range of speculative thought. She arrived in New York City in 1974, a working-class butch lesbian from Boston, and adapted the literate candor of New York School Poetry to her needs. Her very presence at that time and place was perceived as confrontational, and it was a challenge she accepted. In 1992 Myles ran as a write-in candidate for President in eleven states, memorizing her poems and delivering them like stump speeches. In "An American Poem," she poses as a Kennedy and implores her listeners:

Shouldn't we all be Kennedys?
This nation's greatest city's
home of the business-
man and home of the
rich artist. People with
beautiful teeth who are not
on the streets. What shall
we do about this dilemma?...

Like Acker, Myles uses "autobiographical" material, but her deployment of it is more revelatory, less strategically conceptual. In Cool for You, Myles's first published novel, she sees much of her own life in tandem with her grandmother's madness. "It seems people go nuts," she writes, "from a number of things," and then proceeds to tell us what. The trajectory of a lost, dissatisfied working-class girl who wants to be a boy is necessarily less insulated, more wide open to a scary form of chance than that of the Harvard Blessed, whose lives she naïvely tries to emulate. She takes a job at Harvard Coop and gains twenty pounds stealing expensive candy bars while marveling at her co-worker, a girl who'd come from Beaver Country Day School who took time off from school to work a little job. "All these people had a certain colored skin, kind of golden peachy and expensive. It was leisure skin." Meanwhile, she was getting pimples. She attends the University of Massachusetts, Boston, imagining "images of the past--college, some bunch of bright young people in sweaters dashing up the steps to their astronomy class," only to find that "it was not school. There was no campus." She commutes on a string of suburban trains and buses to her classes and sits with her fellow students at a seedy coffee shop called Patsio's, as close as U Mass got to an off-campus hangout:

We would sit...and drink our bleary morning coffee and see the first street people we had ever laid eyes on. An old woman pulled up her skirt for us and showed us her bald old pussy. We were going to school. There was an Irish bar around the corner where we'd go after jazz class and smell stale beer and a trio would play there on Friday afternoons, a really old man and a really old woman and some third thing, I can't remember, but I know it was a trio. They were so drunk the music was incredibly bad...and one afternoon they weren't there because one of them had died.... This could not be college.

She knows she's lost. She feels the future opening up into the present and looping back again; she sees a girl dancing to the Doors and it is Jim Morrison's voice that keeps repeating in her head as if the voice were hers, and she wants to be the one to take the dancing girl on a ride into a parallel universe. Like Sade's Justine, Myles has many picaresque adventures. She quits her taxi-driving job and starts working as a nurse-assistant at The Fernald School after a chance conversation with a fare. The Fernald School is an institution for retarded men, and there she finds three classes: the institutionalized men; the staff, consisting of "the slightly educated well-meaning down and out confused," like her; and the Harvard-trained behavior-modification therapists, who rarely venture out into the wards but devise a program in which the staff pass out handfuls of M&Ms to reward appropriate behavior. The Fernald School is as dead-end an institution as any Myles encounters. She recalls: "All around us was the subtle feeling of a campaign for self-improvement. If we were daily...improving these men's capacity to live 'normally' then what could the therapy do for paragons of intelligence like ourselves. When the buzzer went off we would hug each other for not smoking."

She saves up; she travels to the West. She remembers blueness and the perfection of the air and mountains and working lots of different jobs. She wants to be James Joyce, get rid of everything and write, but then there's nothing to hold on to. She starts a book but can't get past line one, about gerbils running around a cage. At night she hears a million voices. The only thing that held her still was taste, and she kept thinking if she could taste the right thing then she would have something to hold on to. "The day was some runs that I knew with my mouth." One time in the park she floats, and realizes she's not anyone or thing. "I was not connected...not in at all. Not outside either. It wasn't like a movie."

For Myles, madness is not exactly something to be overcome. It is a permanent state, because it is a correlate of the female struggle against poverty. Madness isn't ever isolated from the dead-end jobs, the crummy schools, the institutionalized future that awaits the unconnected. Therefore, madness is something richer, darker, more inevitable than a way station on an affluent, rebellious girl's journey to success. In one of the book's most terrifying scenes, 14-year-old Eileen is working part time in her neighborhood at a nursing home. Delivering trays one night, she gets a glimpse of a familiar body, a woman she'd known as Mrs. Beatty. Seven-year-old Eileen had known the same Mrs. Beatty as the most elegant lodger at her friend Lorraine's mother's boardinghouse. She was a large woman with chestnut hair, joyful, with an air of sophistication, who wore hats with veils. But now she's naked, no longer wrapped in an elaborate fox-fur coat, and she's being lifted off the potty by a nurse and she's not a person anymore, she is a smelly shapeless thing. "She turned or a I saw her face and there was nothing in it. She was gone.... I wanted it to be someone else so I wouldn't have to have seen what I saw. This is Mrs. Beatty, said the nurse, disgusted."

Cool for You is a difficult, painful book to read. It is a construction of identity that's truly public, absorbent of the lives of others. With the audacity of Henry Miller, without the protection of his bravado, Myles lets the voice of poverty-madness-shame speak through her and proves the past is never operable.