Tennessee Williams said a writer should never be embarrassed. That great playwright’s nakedly honest writing is filled with painful truths about human nature, drawn from his own experiences, observations, and relentless self-scrutiny. I took his words as inspiration during the many difficult times in writing my recently published memoir The Broken Places. Once I made the decision to be open about my physical and mental breakdown as a teenager in the 1960s, and the abuse that preceded it, I had taken the first step toward healing those wounds. But it was hard to keep confronting them and to overcome the social stigma that surrounds mental illness. Although we have made considerable progress in diminishing that stigma, it still exists and remains a barrier for many people who need help and are afraid to be open about their problems.
A stigma is defined as “a set of negative and often unfair beliefs that a society or group of people have about something.” We’ve made some progress from the days when it was considered socially acceptable to publicly label people as “nuts” or “crazy” and to view mental illness as a moral failing, much as alcoholism and drug addiction usually were regarded. But we haven’t come far enough. In many ways, such language has simply been massaged to make it sound less harsh. Society often views psychologically troubled people as objects to be shunned, mocked, or treated with condescension. We are much more aware of and empathetic toward people who suffer from development disabilities — such as autism, dyslexia, and ADHD — and we have learned not to blame abused people for the abuse they suffer. When I realized in 2000 that many of my early troubles probably had stemmed from a borderline case of Asperger’s syndrome, I was relieved and somewhat delighted; it’s almost become fashionable today to have that condition, and it made me feel less alone. But the primitive fear of “losing one’s mind” still leads us to stereotype people with various degrees of psychological disturbance.
My institutionalization in a mental hospital for four months during my senior year at Milwaukee’s Marquette University High School in 1965 followed years of family dysfunction, physical and psychological abuse in schools, and damaging sexual repression. My sexual guilt was tearing me apart as my adolescent body grew toward manhood in that puritanical period just before the Sexual Revolution. Having a breakdown was the best thing that ever happened to me: It enabled me to get out of the house, school, and the Catholic Church, and it was the only way I could meet a girl. In the hospital I met a teenager named Kathy Wolf, who was half Native American and half Irish. She was brilliant but even more troubled than I was. She saved me by opening me up to a freer, more relaxed way of looking at life. The sad part was that while I was getting better, she was getting worse. Kathy, who had family problems and conflicts over her cultural identity, as well as undiagnosed physiological problems with her brain, had been vaguely stigmatized for years as “schizophrenic”; she was overmedicated and subjected to shock treatment. She was sexually abused by her psychiatrist (unfortunately not an uncommon occurrence in those days) and fired by an employer who learned of her psychological problems. That sent her into a downward spiral that ended in suicide.
When I was in the hospital, I received a letter from a friend of my mother’s I barely knew. I didn’t fully understand the wisdom of his advice then, but it has meant a lot to me over the years. Marty Parnelli wrote me about my incarceration, “Perhaps strangely to you, I think it is a great grace. There are two immediate benefits: (1) Until one is isolated from the nuts who roam the streets he tends to look upon these nuts as being perfectly sane. When you leave the hospital you will have the advantage of being able to recognize which of your fellow men have been so unlucky as not to have experienced what you are now going through. (2) The fact of psychotherapy is a fantastic stroke of good fortune. The ultimate good of this present situation is that, like a man who knows he has a heart condition and who is not likely to drop dead of a heart attack because he knows how to take care of himself, so do you have a greater chance of living a more happy life than would otherwise be likely.”
Without the good fortune of cracking up, I would have spent many years, perhaps my whole life, repeating the self-destructive patterns of my youth. But as I went back out into the world after my release from the hospital and naturally tried to share my experiences with friends and family, I found that people didn’t want to hear about it. It made them uncomfortable, and when I expressed unorthodox viewpoints, as I am prone to do, I often felt myself being treated as a “nut” to be avoided. Marty had already warned me of this: “But before we get to the issue of ‘What do I do when I get out of here?,’ there is a more insidious and subtle question, namely, ‘What do people think who know about this now, and what will people think when they do find out about this?’ I don’t give a damn what they think. And neither should you. This is your life, and nobody else’s; and yet, the recognition that it is your life is one that you must come to yourself.”
Freud said the first step to mental health is realizing you have a problem. Many people never come to that realization, and so they are unable to get treatment and keep repeating their neurotic behavior. Even as I gradually came to recognize that I was largely responsible for my own wellbeing, some of the old patterns of behavior persisted. I had such anger over what I had been through with my parents, teachers, and classmates that I finally realized I had to perform a sustained form of self-psychoanalysis by writing about it. Doing so forced me to confront hard truths and dig deeply into my memories as well as challenging my parents and doing other research to piece the story together in a way that made it more understandable. I thought the process would be cathartic and therapeutic, and to some extent it has been, though I found that there is no such thing as “closure.” Now when I look back at those days, I see that troubled boy as someone I can look at from the outside, with dispassion and sympathy (if not “objectivity,” another chimerical word). That kind of dual perspective is what we gain from writing a memoir, or from undergoing psychotherapy with the right doctor.
I hoped my story would find an audience and, by sharing my experiences, strike a chord in others who have suffered. I have had many positive reactions from people who share similar experiences and express gratitude for being given a candid window onto psychological problems. That reward has been a long time coming — the writing process took decades, off and on, as I wrestled the manuscript into the form it needed — and there has been some negative feedback along the way. A few people have found such self-scrutiny a form of self-indulgence or self-pity and have expressed other ignorant reactions, mocking my sexual repression, making harsh judgments toward Kathy, or simply indicating they don’t want to hear such stories.
Most damaging over the years, perhaps, has been my own internalizing of such attitudes, which still persists to some extent. I have long felt a hypersensitivity to anyone applying such words as “crazy,” “nuts,” “paranoid,” etc., to something I say or do. Our society often puts such simplistic labels on things it doesn’t understand. And we all worry about how our friends, family, colleagues, and employers will react to us. I didn’t know how people would respond to my process of self-revelation in The Broken Places. Over the years I couldn’t help taking readers’ reactions to this project especially personally. Most of the early readers found the story gripping, but I had to draw another deep breath as publication approached. I am gratified that the response has been so positive, but that’s not the primary reason I write. As Marty Parnelli wisely put it, “I don’t give a damn what they think.”
Since 2000, I have been fortunate to live in the San Francisco Bay Area, which, as the world knows, is sort of the Ground Zero of liberalism. Much more so than in the previous places where I lived, Wisconsin and Southern California, people here tend to be tolerant and accepting. Oddity and nonconformity are seen as virtues rather than frightening aberrations. But nowhere is utopia; our supposed liberal attitudes have their limitations. We can see that in the disparities of wealth and the mistreatment of the often psychologically disturbed homeless people, classism and stigmatization are as present here as anywhere else. I wanted to get more of a sense of how well we manage to overcome stigmatization of the mentally ill and how much progress our culture in general has made in solving that problem. Since I don’t consider myself any kind of expert on that general topic, I asked a psychologist and a psychiatrist who work near me about how they view the subject.
Dr. Ruth O’Hara, a psychologist and associate professor in the Department of Psychiatry and Behavioral Sciences at Stanford University in Palo Alto, told me, “We are still educating the general public about the extent to which mental health reflects real brain changes. In the last twenty years there have been tremendous technological advances which have increased our understanding of mental health. Most mental health disorders are the result of brain dysfunction. For example, impairments to those parts of the brain that control decision-making and/or risk-taking are now believed to contribute to addictions and other behavioral health problems. Yet, as with asthma in decades past, there is a tendency for people to perceive mental health problems as simply emotional control problems rather than recognizing them as having a physiological basis. Mental health professionals and the field of psychiatry are trying to increase education so it’s better understood that mental health disorders are not always under people’s control. That doesn’t mean we should hold people less responsible for seeking treatment. But the ability to seek treatment is to some extent may be tied in with destigmatization. The current research on the brain may well ameliorate the kinds of stigmas and perceptions people have around mental health problems.”
Dr. Michelle Primeau is a psychiatrist who specializes in sleep medicine at the Sutter Health Palo Alto Medical Foundation and a consulting assistant professor at Stanford. She told me that despite the wealth of resources in the Bay Area, people often are still limited in finding treatment because some health insurance plans are inadequate for psychiatric treatment. Many doctors don’t accept certain health insurance plans, which causes some patients to be unable to find treatment or to have to pay themselves for private doctors. This results in what she calls a “tiered” approach to mental health care, favoring more affluent people (the same kind of problem that often causes less affluent people to receive a lesser quality of education). One way Dr. Primeau has found around this Catch-22, she said, is to provide psychiatric care under the umbrella of sleep medicine, because sleep and psychological problems often are interrelated, and insurance companies can be more willing to pay for treatment on that basis.
As for stigmatization hampering people’s ability to find treatment, Dr. Primeau said, “I definitely think stigma still persists. There still is a large amount of secrecy that persists in this area.” She noted that some students at Stanford ask her to refer them to doctors off-campus so no one will know they are being treated. Many people operate under a code of silence, not knowing how to talk about their or their families’ problems or fearing to do so. Some people worry that psychological treatment will go on their record, affecting their employment, even if that’s usually “a bit of irrational anxiety” because of privacy laws. Problems she sees that are particularly acute include the increased prevalence of post-traumatic stress disorder in our society, the pressures for high achievement in college and elsewhere, and an ongoing problem with a high rate of suicides among young people and veterans. Stigmas and silence only exacerbate these problems. Dr. Primeau agreed that education is needed so that people will break through the roadblocks surrounding mental health treatment, including overcoming the remaining social stigmas. As she puts it, “Maybe if you actually talk to someone else,” the fear surrounding such problems can be ameliorated.
Joseph McBride lives in Berkeley and is a professor in the Cinema Department at San Francisco State University. He has published eighteen books, including biographies of Frank Capra, John Ford, and Steven Spielberg; and three books on Orson Welles. His website for his 2015 memoir The Broken Places is thebrokenplaces.info.
Joseph can be found on his website.
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