Abstract

Narrative is increasingly recognized as a vital method of developing care. It is a means for an ill person to be better understood cognitively and empathetically by professionals, those close to them, to themselves, and a wider readership; it is an exhibit of symptoms and the patient’s treatment, a rich resource available to be studied to evaluate and improve practice. This essay focuses on the mental health facet of illness narratives. The author examines a selection of recent works through the lens of his own condition as a life-long sufferer of anxiety, obsessive compulsive disorder and depression; he asks what stylistic approaches to mental health narratives connect to one reading from the “inside”, and offers a guide of where to begin reading as one looking to embark upon one’s own self-reflective writing.

 

Keywords: Mental health, mental illness, anxiety, obsessive compulsive disorder, OCD, depression, Stossel, Haig, Adam, illness narrative

 

“You are as distressed by these measures you take to combat being anxious as you are by the actual feeling of panic,” said the Acceptance Commitment therapist, as though I was being delightfully silly. We sat in a magnolia consultation room. Through a privacy film on the window, which backed directly onto the high street, a couple of ghosts passed by. “Your anxiety is a part of you. It’s just there, and you’re banging your head against a brick wall to fight it, and getting nothing but a headache in return, so to speak.”

“I just don’t feel like I should give up trying to get better –”

“‘Should?’ ” She smiled: I’d fallen into her favourite trap. “‘Should?’ What is this ‘should’ you keep saying? Who wrote the rulebook on what ‘better’ is?”

“‘Better’ means an improvement over this. This can’t be it. How it will be, now. You know. I can’t leave my house anymore without taking hours to prepare and load up on tablets. As soon as there’s somewhere to be, someone to see, it’s this.” I rapped my temples with my knuckles, eyes scrunched. “It’s like: imagine a train is hurtling past you, so startlingly loud, and dotted all over the carriages are TV screens showing you your worst nightmares, and you’re horrified and transfixed, and it just goes on and on behind your eyes, too loud and real to ignore. It’s like –”

“Chris,” she said to halt me. “You could tell me every detail of every thought you have in these panicked states. You could write me a whole library of books about it – and it would be beautiful – but I hear the same thing each time: symptoms. The same symptoms.”

Oh, I thought.

Are symptoms the truffles professionals are taught to sieve through the muck of a patient’s ramblings to find?

An empathetic understanding is grounded in context and detail – in the story. Not least finding meaning in, and respecting, that the teller of this story is clearly looking for a cathartic outlet, a way to perhaps organize thoughts and feelings by externalizing them through writing or spoken word. This wasn’t in the repertoire of Acceptance Commitment Therapy, nor the other schools of modern therapies I’ve been through; quick evaluations confirm what it is you have and an action plan is drawn to address it. However, I believe in the emotionally engaging and informative connection that narratives alone manage. They deserve to be heard, and we deserve to learn from them.

A rising wave of literature aspires to improve public understanding of mental health issues. This analysis of an emerging canon of literature is a guide for those who, like me, are reading from the inside of a condition.

In what way do, or might, such books offer insight, confidence or camaraderie on the subject of mental health? What lessons can an aspiring writer of illness narrative take away from them?

An ideal entry point is Our Encounters with Madness (2011), an edited collection of mental illness experiences as written by the service users themselves, and towards the book’s end, carers and family members of service users. Spanning many points of view, in varied voices, across many forms of neurotic and psychotic disorders, Our Encounters has scope in mind. In its epilogue, editors Fran Biley and Hannah Walker state, “We have attempted to include voices, words, that represent as wide a range of experience and situations as possible. However… There always will be gaps, however all-encompassing we try to be” (Biley & Walker 2011: 236). Our Encounters boasts nearly forty accounts within a relatively modest book length. As such, most chapters are only snapshots of a life, however rich with intense content. It leaves a frustration that each couldn’t expand on their experience; some tales were clearly brushing up against a tight word limit.

“An intense, incredibly brave narrative,” with the potential to “enlighten untold fellow sufferers,” say the reviews on the back of Scott Stossel’s My Age of Anxiety (2014); this book seemed so in line with – and indeed had seemingly already achieved – what I wished to write, part of me was afraid to read it. “Tender, candid, inspiring,” say the reviews and tweets enveloping Matt Haig’s Reasons to Stay Alive (2015). An “unflinchingly honest attempt to understand the condition and his experiences,” says the blurb of David Adam’s The Man Who Couldn’t Stop (2014). Three popular books on mental health released within a year or so of each other, covering anxiety, depression and OCD, respectively[i]; penned by hosts of the disorders, each is marketed with the promise of being informative and deeply personal at once. This is true, but the balance of all three veer towards information over narrative. The firsthand accounts are intermittent, and ultimately add flesh to an assemblage of the science, history and statistics of mental health. This causes the personal mental health narratives to feel tailored to their chapter’s point, used as an example when applicable, which belittles how vital they are in their own right as a resource to improve readers’ understanding of a condition. Much like the powerful anecdotes in Our Encounters with Madness, they can be more tantalizing than satisfying.

One of our most powerful forms for expressing suffering and experiences related to suffering is the narrative. Patients’ narratives give voice to suffering in a way that lies outside the domain of the biomedical voice. (Hydén 1997: 49)

Stossel’s footnotes in My Age of Anxiety are a breath of fresh air amongst the medical history. For example:

My first glimpse of clinical depression came as I was sitting in class one Friday afternoon that year. I was experiencing my characteristic relief at the prospect of being sprung for the weekend when I had the thought But on Sunday night this starts all over again, and I was chilled by the infiniteness of my plight, by the notion that Sunday nights – and Monday mornings – eternally return, and that only death would put a stop to them, and that therefore there was nothing, ultimately, to look forward to that might help me transcend my dread about bad things to come. (Stossel 2014: 167)

or

I’d sit there in history class, my mouth full of spit, terrified that if I were called upon to speak, I would choke on my mouthful of saliva or spew it all over my desk – or both. I took to carrying wads of Kleenex around with me everywhere I went, discreetly drooling into them so that I wouldn’t have to swallow. By lunchtime each day, my pockets would be full of drenched tissues, which would leach into my pants and make them smell like saliva. (Stossel 2014: 169)

These footnotes are often short stories of their own; one details an “incestuous” “web of psychopathology”, as his family crumbles and each member has a different relationship with the same therapist, and the treatments bleed together (Stossel 2014: 316). The little asterisk indicating a footnote can rouse more of an interest than the section of the main text it resides in.

It remains commendable how personal Stossel keeps even the most research-thick sections of My Age, and the book perhaps works best – if its goals are to educate both on an informative and empathetic level – when a balance is struck. For example, his misadventure with Effexor: “my anxiety levels shot through the roof… Glimmerings of suicide began twinkling at the edge of my consciousness” (Stossel 2014: 206). Quantitative findings are successfully humanized, too, such as the section detailing how ‘Freedom of choice generates great anxiety’ (Stossel 2014: 302); after wading through his extensive reading list corroborating the same point, Stossel caps the section off with the realistic correlation between media vernacular and public anxiety: “Between 2007 and 2010, there was a 31 percent increase in the number of news articles employing the word ‘uncertainty’” (Stossel 2014: 306).

In The Man Who Couldn’t Stop, David Adam’s research more often comes in the form of stories – of himself and the countless cases of obsessives throughout our time of recording OCD (and before). From the stunning opener of a schoolgirl who ate the mud brick wall of her house, to the “Rat Man” who envisions the torture of his loved ones, to psychologist Richard Solomon’s cruel tests on dogs to develop what is now a common treatment for OCD (Adam 2014: 1, 46, 205). Though scattered across the book – as this is the condition’s story as well as Adam’s – we piece together a relatively full picture of his own illness.

Explaining something as messy as the interlacing, overlapping tangle of intrusive thoughts is hard. David Adam strives to give thoughts a physicality, like they have a shape and mass, their interactions and collisions tangible: ‘intrusive thoughts are the raw materials for obsessions… The mind is a thought factory… The conveyor belt always rolls and new thoughts arrive in a constant stream’ (Adam 2014: 113). Reading through The Man Who, I found myself evaluating each of Adam’s metaphors and similes, on both how close they aligned with my own obsessions, and how successfully they made me picture his torment. “It is hard to communicate obsession,” (Adam 2014: 8) he says in the introduction, an almost audible sigh before the ensuing book’s-worth of attempts he’s about to make to do just that. Tangibility was the common denominator in writing a good metaphor. For example, in the same introduction is a more abstract comparison of obsession being a window on one’s computer that won’t close and “acts as a constant drag on the battery and degrades the performance of other tasks,” (Adam 2014: 9) which captures the concept – very reductively, perhaps as this is the book’s opening – but little of the distress; compare that to, “I wanted to tear my skull to reach inside and rip the thoughts from my brain. I was desperate to find the cells that held the intrusive thoughts and to squeeze them between my fingers until they burst” (Adam 2014: 221). The artistic-but-formal nature of Adam’s writing, akin to William Styron’s classic Darkness Visible (1990) in its quite archaic tone, make this violent impulse all the more startling.

Quick-fire facts and quotes rarely fail to entertain, particularly in relative isolation, and presented creatively. Scott Stossel digs up quotes from sport stars, members of the military and actors that outline some degree of neurosis, and finds evidence that icons of culture and science, dating back millennia, shared my plight.

Matt Haig makes a list of celebrities with depression.

David Adam’s facts can drip with a kind of weary voice, unlike the gallows humour Haig, and to a lesser extent Stossel, employ:

Children with OCD are more likely to want friends, but less likely to make them. Adults with OCD are more likely to be unemployed and unmarried. They drag down their families. They are more likely to live with their parents. They are more likely to be celibate. If they do marry, they are less likely to have children. They are more likely to divorce. (Adam 2014: 10)

This passage reduces to a despondently slow tempo, broken by full-stops. It makes manifest a cynicism in the narrator without one word of added opinion. Rhythm, and order – from childhood to adulthood, mapping a miserable story – do the work. Cold, hard facts, indeed.

In My Age of Anxiety, Stossel paints himself as the direct subject of a lineage of failed treatments:

Here’s what I’ve tried: individual psychotherapy (three decades of it), family therapy, group therapy, cognitive-behavioural therapy (CBT), rational emotive therapy (RET), acceptance and commitment therapy (ACT), hypnosis, meditation, role-playing, interoceptive exposure therapy, in vivo exposure therapy, supportive-expressive therapy, eye movement desensitization and reprocessing (EMDR), self-help work books, massage therapy, prayer, acupuncture, yoga, Stoic philosophy, and audiotapes I ordered off a late-night TV infomercial.

And medication. Lots of medication. Thorazine. Imipramine. Desipramine. Chlorpheniramine. Nardil. BuSpar. Prozac. Zoloft. Paxil. Wellbutrin. Effexor. Celexa. Lexapro. Cymbalta. Luvox. Trazodone. Levoxyl. Propranolol. Tranxene. Serax. Centrax. St. John’s wort. Zolpidem. Valium. Librium. Ativan. Xanax. Klonopin.

Also: beer, wine, gin, bourbon, vodka, scotch.

Here’s what’s worked: nothing. (Stossel 2014: 7)

Stossel shows his penchant for a humour that doesn’t expect laughter. He slows the reader not only with shorter sentences, but a bunch of words the common reader will at best limp through, at worse gloss over, and makes sure we see the punch-line coming from a mile off. It works very well.

Matt Haig dives into a two paragraph chapter outlining depression’s link to suicide, and suicide’s massive death toll (Haig 2015: 25). It’s haunting stuff, but the material is undermined by the dramatic title “Killer” dangling over this one-page chapter[ii], and the awkward injection of humour into the succeeding chapter, titled “Things people say to depressives that they don’t say in other life-threatening situations” (Haig 2015: 26).

Reasons quickly exhausts any enjoyment of facts in “relative isolation”, because here, everything is in isolation. While small chapters can be effective when threaded together (Nick Johnstone’s A Head Full Of Blue, 2002, mentioned later), or strong in their own right (try Lydia Davis’s Varieties of Disturbance, 2007), Reasons is a scattering of disparate sketches that forgo linearity for the sake of being quirky. Tales of depression are cut woefully short to make way for ridiculous ideas like “A conversation across time” (Haig 2015: 20, 109, 176), “Things depression says to you” (51), a crowbarred-in Haruki Murakami quote floating on its own page (70), some books he read in his twenties[iii] (136), a “Depression is…” (173) list, followed by the gushy pick-me-up “Depression is also…” (175), a collection of tweets (202), a list of “Things that make me worse” (211) followed swiftly by “Things that make me better” (213).

Worse still is the opaque structure of each not-a-list chapter: a headline first sentence – “A human body is bigger than it looks” (Haig 2015: 39), “I want to talk about being a man” (65) – and cliffhanger closing sentence – “Just ask Abraham Lincoln” (165), “I’ve just seen tomorrow. It’s even worse” (52) – occur so often, the pattern quickly becomes hard to ignore. It reads like a plea to keep the reader engaged. And as the template is used again and again, this scattershot book somehow feels looping and repetitive. Sandwiches with different fillings. Occasionally arresting anecdotes (the sleepwalking incident in Derbyshire, 79, his father discovering him in tears, 56) exist beneath subject headings (“My Symptoms”, 46, “Love”, 114, for example.) as though short essays.

My frustration towards this format has led me to value a linear narrative. Within the subject of mental health, it’s important to let the reader observe the peaks and troughs, or even an arc if there is one, as it happens. Mental health seems to carve narrative arcs (if only the tale of becoming ill and subsequently getting better) into sufferers’ lives. Establishing a start, and working forwards from there primes the reader about a potentially obscure, esoteric subject; relationships, thought processes and symptoms can slowly collect and be elaborated.

Reasons to Stay Alive is considerably shorter than My Age of Anxiety and The Man Who Couldn’t Stop, and is perhaps the most author-focused, which could have its merits, but it is the tone that ultimately ruins the book. Haig frequently addresses the reader, no doubt to strike a conversational angle (he lists “Talking to you” as a source of joy, 246), but this can result in feeling talked down to. “Depression makes you feel alone. That’s one of its main symptoms. So it helps to know you are not alone” (Haig 2015: 159) is oversimplified and blunt. Does the narrator know how depression makes the reader feel? Does he assume what helps the reader? His language implies he is the authority on depression: “Now, listen. If you have ever believed a depressive wants to be happy, you are wrong”, he writes (Haig 2015: 18). “When you are at the lowest ebb, you imagine – wrongly – that no one else in the world has felt so bad” (Haig 2015: 56).

I take exception with someone telling me, let alone a massive readership, how neurosis works, in these concrete terms. Wouldn’t any individual within a culture outside of a mental health condition resent the assumption of all being the same? Why write the satirical “Things people say to depressives that they don’t say in other life-threatening situations” (Haig 2015: 26), highlighting how people outside of mental health spheres fail to empathize with its magnitude, whilst simultaneously writing as though all depression, and depressives, are the same?

And whilst Haig’s melodrama attempts to accentuate the pain of depression and anxiety – and it sometimes works – the cutesy humour seems intent on undoing this. For example, “On the days when I was feeling very brave, I would say something – ahem – impossibly heroic like ‘I am going to go to the shop to get some milk. And Marmite’”, he writes (Haig 2015: 100), before calling what was clearly a massive feat against anxiety “Indiana Jones and the Temple of Marmite” (Haig 2015: 105), likening an internal struggle in a seemingly innocuous context to an action film showing “real” bravery and “real” danger, to highlight the ridiculousness of the former. Yes, you’ve got to laugh sometimes, at how these conditions can make their hosts behave and think, but Haig’s humour misses the mark. And despite on the surface being a cringingly safe joke, the price it pays is the mockery of his younger self’s bravery.

The melodrama and humour antagonize each other to the tone’s detriment, rather than strike the dichotomy Stossel and Adam manage, to an extent that it’s hard to take either side of the voice seriously.

When not telling us we “depressives” are “wrong” about depression, he offers patronizing balms of encouragements, such as the condition being “Smaller than you. Always, it is smaller than you” (Haig 2015: 175). He adopts a benevolent survivor’s wisdom in the “conversation across time” chapters:

THEN ME: I am starting to believe in you.

NOW ME: Thank you.

THEN ME: I mean, the possibility of you. The possibility that I exist more than a decade in the future. And that I feel a lot better.

NOW ME: It’s true. You do. And you have a family of your own. You have a life. It is not perfect. No human life is. But it is yours.

THEN ME: I want proof.

NOW ME: I can’t prove it. There is no time machine.

THEN ME: No. I suppose I’ll just have to hope.

NOW ME: Yes. Have faith. (Haig 2015: 178)

It raises the question of where these authors are at the time of writing, in respect to their condition, and what relationship the author’s present has with the text. Because, despite the aforementioned arcs mental health can present in our lives, it is rare that the issue ever leaves. Stossel writes from within the condition; Adam has gained something of a grip on his but remains in an ongoing struggle; and Haig has long-since overcome his, but is still aware of its threat[iv]. Stossel brings his arc to a relatively positive close with “Part V: Redemption and Resilience”, though what felt like a tragic ending for me was the unwilling pass of the anxiety baton to his children (Stossel 2014: 262, 282); Adam spends a final chapter aware that he “should reach a triumphant and emotional conclusion” (Adam 2014: 279), whilst knowing he won’t; Haig spends the latter quarter of Reasons offering advice on getting better and staying better (Haig 2015: 197).

Within the genre of illness narrative, the branches keep parting: there are many (often conflicting) views on how stories can be categorized[v].

Arthur Frank’s The Wounded Storyteller (1995) proposes three types[vi]. “The Restitution Narrative” is the most common illness narrative, and the one that yields reader satisfaction: “Yesterday I was healthy, today I’m sick, but tomorrow I’ll be healthy again” (Frank 1995: 77). A story about becoming fixed[vii]. It might make observations on tests, interpretations, doctors, outcomes, treatments, etc. Restitution stories are even used in the adverts we see for non-prescription dugs (Frank 1995: 79). “The Chaos Narrative” is “the opposite of restitution: its plot imagines life never getting better” (Frank 1995: 97). Readers find them harder to read, as they are a reminder of how futile remedy, help and positive thought can be. “Stories are chaotic in their absence of narrative order… without sequence or discernable causality” (Frank 1995: 97). In “The Quest Narrative”, an ill person will “meet suffering head on; they accept illness and seek to use it. Illness is the occasion of a journey that becomes a quest… defined by the ill person’s belief that something is to be gained through the experience” (Frank 1995: 115). Frank aligns the quest narrative with Joseph Campbell’s oft-referred to The Hero With a Thousand Faces (1949) framework (Frank 1995: 117).

Lars-Christer Hydén sorts stories depending on how the narrator, illness and narrative interrelate, in his essay “Illness and narrative” (1997). “Illness as narrative”: where the “narrator, illness and narrative can be combined in one and the same person” (Hydén 1997: 54). “Narrative about illness”: a narrative which “conveys knowledge and ideas about illness. Examples are situations in which doctors and other professional care staff talk about the patient’s illness” (Hydén 1997: 54). “Narrative as illness”: “situations in which a narrative, or an insufficient narrative, generates the illness” (Hydén 1997: 55); an example of this is taken from Oliver Sack’s The Man Who Mistook his Wife for a Hat (1985) – where a patient’s Korsakoff syndrome prevents him from retaining new memories, and as a result he unwittingly creates stories to fill the gulfs of amnesia (Hydén 1997: 55; Sacks 1985: 25).

In “Narrative and Sociology” (1990), Laurel Richardson arranges different forms of narrative from both the sociological standpoint, and according to their relationship with the “uniquely human experience of time” (Richardson 1990: 125). The “everyday” story: how we report to each other on our daily experience of life, our anecdotes organized ‘with temporal markers, such as “first,” “then,” and “after.” ’ (Richardson 1990: 125) The “autobiographical” and “biographical” story give “meaning to the past from the point of view of the present and future” (Richardson 1990: 126). The “cultural story” is concerned with the prescribed norms, understandings and behaviours of a culture, how these affect the narrative’s focal individual, and vice versa (Richardson 1990: 127).  The “collective story” gives voice to those “silenced or marginalized in the cultural narrative” (Richardson 1990: 128): rather, “it displays an individual’s story by narrativizing the experiences of the social category to which the individual belongs” (Richardson 1990: 128). So, “the depressive” or “the obsessive” being a main character of sorts, for example.

There must certainly be an itch to round things off in illness narratives. Perhaps it is knowing the often chronic nature of mental health (or having enjoyed the many no-beginning, no-end narratives in Our Encounters with Madness) that makes me resistant to this.

Nathan Filer’s The Shock of the Fall (2013) distills the author’s experience of mental health nursing into a novel about the narrator Matthew’s descent into schizophrenia; it has a gripping voice, powerful illustrations of psychosis, and a plot which revolves around a recurring partial memory that isn’t fully realized until the book’s climax. However, even with Matthew’s explanation that “This story doesn’t have an end” and “We move in circles, this illness and me” (Filer 2013: 306), enough narrative threads are neatly tied to slightly undermine both the gravity of this promise of recurring symptoms and the heavy content that preceded it.

Jennifer Traig’s Devil in the Details (2006) vividly recalls obsessive “scrupulosity”[viii], often coming closer to my experience of OCD than anything else I’ve read. It’s told with a keen balance of sincerity and wit, successfully mocking the lunacy of obsession without trivializing it. “OCD is a disease of pathways,” she writes (Traig 2006: 203) – a summary so short and perfect I snapped my fingers to it. A trip Traig’s family take to France “plucked me out of the grooves I’d worn smooth with repeated rituals” (Traig 2006: 204), which seems to inspire a pivotal moment back at home, beginning her road to recovery. In a manic phase of being awake for days, Traig is “in my bathroom, holding my nightgown by the hem to form an apron filled with water. I think I was worried an insect had touched it” (Traig 2006: 204), when she experiences an epiphany:

This wasn’t going to get me anywhere. But it had simply never occurred to me that I could do anything else.

Having an obsessive-compulsive impulse is like standing on red-hot coals. Every cell in your body is screaming for you to jump off. To keep standing there is so hard. It’s just so hard. Leaning over the sink that night, I suddenly understood that that’s what I had to do. I had to stand on the coals and take a tiny step forward. I had to feel the impulse and move past it. I got it, all of a sudden, just like that. (Traig 2006: 204)

“Just like that?” is exactly what I snarl under my breath when reading or hearing a self-congratulatory, humble-brag tale of how an author conquered mental illness, yet it makes sense here. As her story concludes, it’s hard to be unconvinced by a fairly clean restitution arc when the reasons are logical and telegraphed with heartfelt dramatization[ix]. Traig generalizes OCD in the above quotes, which I resent in works like Matt Haig’s, but find successful here largely due to a tone that softens the presumed authority of “you” and “is”. The tone only lost me in the final pages:

I could do anything. I could join a cult. I could follow the Dead. I could grow out my bangs. I could take up drumming. I could learn Chinese. I could become an anarchist or a vegan. I could stop wearing socks. I could run down the hallway and touch every doorknob. I could stay out, sleep late, run away, run back. I could do anything. Shalom. (Traig 2006: 242)

It’s not quite a pat on the back; it’s a gratefulness and wide-armed welcome to all the possibilities before her that her obsessions have denied until now. The sugary-sweet sentimentality, the romanticized optimism, form quite a hard stop to the OCD, as though she won’t relapse, unless one reads it as Traig denoting a time she felt this buoyant, and knew it would serve as a rounded ending, even though the feeling and state of control over her mental health were ephemeral.

Touch and Go Joe by Joe Wells (2006) has near-identical aspirations of mental health awareness through an account of personal experience as my work, in this case presented in the format of an OCD handbook. Like Haig, he writes from beyond the happy ending of his story. Wells’ chirpy voice wonders what passed him by in the five years of suffering his condition. An annotation of mine scribbled down the margin reads, “seems like he got away very lightly”. It’s certainly a sour attitude from a reader still lost in what Wells charmingly calls the “OCD woods” (Wells 2006: 103), but I was beginning to want my position better represented.

In “Illness and narrative”,  Lars-Christer Hydén contemplates how narrators organize an illness “to configure his or her life and illness in culturally recognisable and acceptable patterns”, and that some find an illness narrative’s lack of ‘a clear and foreseeable end’ to be problematic (Hydén 1997: 60). “The lack of an ‘ending’ gives rise to a central problem with respect to illness narratives: they are narratives forever in search of meaning” (Hydén 1997: 61). An ending closes the arc and therefore puts the narrator’s symptoms into perspective because we can see the illness as a whole, from start to recovery. Without an ending, the reader is less enlightened on what future the narrator has, or indeed if they have seen the worst yet. But a rounded ending to an illness narrative needn’t involve escaping from, or even gaining control of, one’s illness. A quest resolution can regard other respects of one’s life – strengthening family bonds, a relationship breakthrough, a career move – perhaps in spite of illness.

Arthur Frank’s “chaos narrative” is valuable as an option of storytelling that too few are aware of. Narratives needn’t necessarily reach any form of epiphany or closure. The sum of its parts need not add up to something if the parts are important as they stand. “Quest stories”, cautions Frank, “risk romanticizing illness… they can present the burning process as too clean and the transformation as too complete, and they can implicitly deprecate those who fail to rise out of their own ashes” (Frank 1995: 135).

In Good Prose (2013), authors Tracy Kidder and Richard Todd show an example of memoir’s transformative effect over traumatic memory. Their friend Pacifique, initially only to improve his English, would hesitantly write about the violent horrors he had experienced during his childhood in Africa. Through writing, he “discovered a partial defense” against “the dreadful things he could not banish from his mind” (Kidder & Todd 2013: 64).

I wrote a story and felt relieved. I could control it. In the head, I could not. It’s as if you had your hands on it and you could control it and make it beautiful… I would remember what happened, but it was never as before. I would think of making some modification in the story, to make the story better. (Kidder & Todd 2013: 64)

Though I’m troubled by predictions, rather than traumatic memories, Pacifique’s discovery is very relatable. As Kidder and Todd observe, rather than using memoir to find peace with the past and put it to rest, “One can also use memoir to get closer to the past” (Kidder & Todd 2013: 65). Even today, I think in terms of narrative; when I struggle through a “bad” day, I make notes on my phone and wonder how I might write about it, as a way to cope. As though all hardships must amount to something. Ten years ago, a Creative Writing tutor spoke to our undergrad class about turning life experience into writing. He summarized the distressing familial conflicts he suffered during his childhood, then raised his voice to say, “What do you do with all that?” Pain, anger, loss, regret, fear, thoughts that to the bearer are monolithic and life-defining. It has to go somewhere, form something, mean something. Our tutor’s arms were outstretched. “All that”: like matter in his hands only he could see.

But as healthy as this existential growth through writing is, it seems best left to rest outside of the text itself. David Adam, Matt Haig and Scott Stossel trip into the pitfall of the memoir that opens with the process of writing a memoir. “Why am I writing this book?” Adam asks (2014: 13); “This book is impossible”, laments Haig (2015: 1); “It has occurred to me that writing this book might be a terrible idea”, Stossel deliberates (2014: 23). When each author explains the reasons and motives for their work, it feels like a pitch to a book I’ve already begun reading, and attention is drawn to the book’s sense of importance. A quest the author is about to embark upon. Any author writing any book asks themselves these questions; it isn’t necessary to make their own hard work a metanarrative. The writing of the very book you’re reading becomes a framing device, and that’s boring.

Hilary Mantel’s Giving Up The Ghost (2003), after a fine introduction establishing themes of superstition, moving on in life, migraines, etc., stumbles at the gates to the story proper, with an almost absent-minded search for its own meaning:

I hardly know how to write about myself. Any style you pick seems to unpick itself before a paragraph is done. I will just go for it, I think to myself, I’ll hold out my hands and say, c’est moi, get used to it. I’ll trust the reader. This is what I recommend to people who ask me how to get published. (Mantel 2003: 4)

Two pages of eye-roll-inducing high-brow wit explaining her anxieties about writing quality, writing about herself, doing her story justice, an Orwell and Atwood reference, and we’re nearly ready to begin. My plummeting interest warned me (eliciting some anxieties about writing) how quickly a clichéd or self-indulgent opening can throw a reader off. The massive comedic preamble of A Heartbreaking Work of Staggering Genius (2000) by Dave Eggers mocks the self-indulgent author of memoir, who deliberates how to format their life into writing; but it does so with a tone, and magnitude, that becomes the very content he mocks. Mantel and Eggers’ two and forty-five-page parodies, and the aforementioned author’s hesitations to begin, might be read as defence mechanisms, playfully condemning the reputed memoirist’s vanity whilst being aware of, and apologizing for, the introspection they are about to exhibit.

Shielding oneself from potential scorn, even of less personal work, is natural. “You’re not allowed to apologize,” I often say when another Creative Writing student hands their work around the group with a verbal disclaimer: “I just scribbled it down last night, really.” “It’s really shit.” “Don’t judge me for this.” Nearly every section of work I send to my supervisor is prefaced with “it might be a bit rough, still,” like a renunciation. But these comfort blankets at least remain outside of the writing itself, or they are a process towards the finished work that are eventually dropped.

Writers know that a novel nearly always follows one of the cookie-cut arcs famously categorized by Joseph Campbell, Christopher Vogler and Christopher Booker, but they strive to surround these familiar structures with interesting characters and a fresh voice to distinguish their text and mask the inner workings. In the sense of a mould to work out from, the same applies to memoir: its narrative nearly always gravitates around the author, but tone, voice, setting, what it focuses on outside of the self, and which part of the self it focuses on, gives it an identity. Avoidance, or an ironic approach to memoir’s innate self-centredness, doesn’t negate or forgive the author’s self-centredness. Nor should the memoirist’s “vanity” be feared, like an obstacle to write around and shroud, rather than an inherent trait of memoir one might as well embrace. You’re writing about yourself, and we’ve bought the book to read about you.

“Exulansis” is a made-up word by John Koenig; it means, “the tendency to give up trying to talk about an experience because people are unable to relate to it” (Koenig 2015)[x]. One of my initial difficulties in writing (and talking) about my condition is that no amount of explaining could make the reader understand. Once I begin a description of obsession, it snowballs, and I can’t keep up with the amount of information I’m trying to convey at once; I can’t write, or even speak, fast enough; each point branches into different points, and I can only tell so much at a time; I try to remember the points that were relevant a minute ago but I forget it. I often wondered whether the enormity of these authors’ experiences (whether relating to illness or otherwise) felt like too much to begin chipping away at, which leads to these hesitant openings.

Nick Johnstone’s A Head Full of Blue (2002) is titled A Memoir; its blue-tinted cover shows rows of top-shelf liquors. It’s the story of a man growing into young adulthood, but its focus is the battle with alcoholism (and depression, self-harm, panic attacks) that gripped Johnstone from an astonishingly young age.

Though it is a restitution narrative, in that Johnstone gets progressively worse then progressively better, he makes the admirable choice to keep the inherent repetitions and relapses that occur in illness, rather than mould his life to better fit a streamlined arc. And such repetition is deftly controlled: A Head Full is not only selective (I can only imagine how many variants of “‘Don’t you ever stop?’”, 45, “‘You’ve had enough’”, 114, and “‘I think you’re an alcoholic’”, 80, are omitted), but strives to keep its recurring themes fresh, told through thoughts he had in the past, thoughts from the present, reported speech, different locations, relationships and states of lucidity.

Johnstone relishes implementing long sections of tiny, often single-word sentences. He uses fragments until they feel as commonplace as full sentences: “All that hard work, crushed and flattened beneath the enormity. Of my need. Of my hunger. Of my thirst. I had to have it…” (Johnstone 2002: 121). Throughout the book, I was struck by the resonant depictions of alcoholism: “I ordered a double Scotch. I downed it in one go and ordered another before the change from the first had even stopped rattling on the counter” (Johnstone 2002: 16); “The giggle of ice cubes” (208); “I called back in a voice shot to pieces from all the vomiting” (126). And though it can spill into sentimentality – “All sweet emotion. And bitter loss. Feelings. Beautiful blue birds. Wings beating. Skies forgiving” (210) – the writing earns it; it’s clear to the reader that Johnstone has dwelt on, and perhaps rehearsed the writing of this section of his life for so long, it has grown vignettes of poetry like ivy on a monument.

The narrative is told in tiny chapters, typically ranging from only a short paragraph to a page in length, and numbered rather than named. Though it’s not entirely clear what this was intended to achieve for the book – possibly symbolic of the staccato memories of an alcoholic – it gives pace and adds literal breaks to what could have been a slog to read, and often gives resonance, like a free-verse poem, to each chapter. This means that, like Matt Haig, Johnstone often bookends these short chapters with a strong entrance[xi] and exit[xii].

A structure that occasionally alleviates the intensity of heavy-going content is important to keep the interest of any non-masochist reader. I’m familiar with the fatigue one feels after a relentlessly bleak read. A tutor once leant me Charlotte Perkins Gilman’s The Yellow Wallpaper (1892), a short story which after only a dozen pages I found intolerable. The narrator’s physician husband treats her with gentle oppression: “There comes John, and I must put this away, – he hates to have me write a word” (Gilman 1892: 3). She lives in a time where her mental health is woefully misunderstood. It was, I think, the descriptions of depression’s lethargy, fixating on the mundane details of one’s surroundings until they grow a significance, and being more anxious in the presence of your partner, that felt too familiar to bear:

John does not know how much I really suffer. He knows there is no reason to suffer, and that satisfies him. Of course it is only nervousness… and here I am a comparative burden already! Nobody would believe what an effort it is to do what little I am able… I cannot be with him, it makes me so nervous. (Gilman 1892: 3)

The opening chapters of Johnstone’s A Head Full of Blue are a bit of a chronological jumble, perhaps to make way for the stunning opening passage: “When I was fourteen, I got drunk for the first time. Champagne drunk. My mouth was stretched in a smile so wide that my jaw hurt” (Johnstone 2002: 3). We instantly learn what this book is about: alcoholism. And only two paragraphs (and simultaneously, two chapters) later, we know the book is also concerned with mental torment; his wide drunken smile wasn’t crass teenage fun that one might’ve presupposed, but the joy of alleviation from “the humming in my head. The nameless, shapeless humming” (Johnstone 2002: 4). This isn’t just Johnstone sifting through his younger years to see if there’s something, maybe, worth telling. It is focused, to an almost bullet-pointed extent.

I have built a knowledge base for ten years on anxiety and its comorbid conditions, but I certainly have less objective information to offer than Adam, Haig and Stossel. And what exactly would another informative text add to the culture of mental health awareness?

My experience is the unique input I can contribute, and the experience of others is what I found the most illuminating within these authors’ books. But even so, I shouldn’t assume my experience and research puts me on a higher footing than the reader. The gap that none of these authors assume is a place of ignorance, an extended narrative reconnection with the time they didn’t know what they do now; their forays into the past are told from the vantage of the author’s present self, who has the gift of hindsight and a better knowledge of their condition. With enough faux-psychologist’s books on the market, I should let the reader do their own analysis for a change. This motivates me to strip away the research that birthed my PhD and remove my present self from the narrative. What remains is an unaware, frightened voice, with no experience to draw from: “in the lived chaos, there is no mediation, only immediacy. The body is imprisoned in the frustrated needs of the moment. The person living the chaos story has no distance from her life and no reflective grasp on it” (Frank 1995: 98).

 

[i] The comorbid trio of conditions I have.

[ii] Which must be understandable, as according to Haig, “depression and panic only give you melodramatic thoughts to play with” (Haig 2015: 11).

[iii] The irony of my complaint about which isn’t lost on me.

[iv] A member of what Arthur Frank calls “the remission society”: “These people accept some level of illness as the permanent background and intermittent foreground of their lives” (Frank 1995: 82).

[v] Emphases added in the following Frank (1995), Hydén (1997) and Richardson (1990) quotes.

[vi] As a means of ‘listening devices’ (Frank 1995: 76); he accepts that there are other types, and that one’s story can move between any combination of these three.

[vii] ‘Contemporary culture treats health as the normal condition that people aught to have restored’ (Frank 1995: 77).

[viii] “The doubting disease, because it forces you to question everything. Anything you do or say or wear or hear or eat or think, you examine in excruciatingly minute detail… Foundation garments, beverages, reading material: for the scrupulous, no matter is too mundane for a dissertation-length theological interrogation.” (Traig 2006: 5)

[ix] Her mother’s presence and gentle interaction in the nightgown and sink scene. (Traig 2006: 204)

[x] Koenig’s fascinating The Dictionary of Obscure Sorrows website (soon to be a published work) is dedicated to the invention of words describing specific emotions that we don’t yet have a descriptive term for.

[xi] “‘What are we doing up here?’

Dennis, like me, was soaked to the bone.

‘I have no idea.’” (Johnstone 2002: 115)

[xii] “‘Oh yes,’ she says. ‘We’ve been expecting you.’” (Johnstone 2002: 113)

“I wondered if I heard what I was trying to say.” (Johnstone 2002: 59)

 

References

Adam, D. (2014) The Man Who Couldn’t Stop. London: Picador.

Campbell, J. (1949) The Hero With a Thousand Faces. London: Fontana Press.

Davis, L. (2007) Varieties of Disturbance. New York: Farrar, Straus and Giroux.

Eggers, D. (2000) A Heartbreaking Work of Staggering Genius. London: Picador.

Filer, N. (2013) The Shock of the Fall. London: The Borough Press.

Frank, W. (1995) The Wounded Storyteller: Body, Illness, and Ethics. London: The University of Chicago Press.

Gilman, C. (1892) “The Yellow Wallpaper” and Other Stories. New York, NY: Dover Publications.

Grant, A., Biley, F. & Walker, H. (2011) Our Encounters with Madness. Ross-on-Wye: PCCS Books.

Haig, M. (2015) Reasons to Stay Alive. Edinburgh: Canongate.

Hydén, L.C. (1997) Illness and narrative. Sociology of Health & Illness, 19 (1), 48-69.

Johnstone, N. (2002) A Head Full Of Blue, London: Bloomsbury.

Koenig, J. (2015) The Dictionary of Obscure Sorrows [Online]. Available from: http://www.dictionaryofobscuresorrows.com/post/96261999250/exulansis [Accessed 2 March 2018].

Mantel, H. (2003) Giving Up the Ghost. London: Fourth Estate.

Richardson, L. (1990) Narrative and Sociology. Journal of Contemporary Ethnography. 19 (1), 116-135.

Sacks, O. (1985) The Man Who Mistook His Wife for a Hat. London: Picador.

Stossel, S. (2014) My Age of Anxiety: Fear, Hope, Dread and the Search for Peace of Mind. London: William Heinemann.

Styron, W. (1990) Darkness Visible. London: Vintage.

Traig, J. (2006) Devil in the Details: Scenes from an Obsessive Girlhood. New York, NY: Back Bay Books.

Wells, J. (2006) Touch and Go Joe: An Adolescent’s Experience of OCD. London: Jessica Kingsley Publishers.

 

Bibliography

Apter, T.  (1996) ‘Expert Witness: Who Controls the Psychologists’s Narrative’ in Josselson, R, (ed.) Ethics and Process in The Narrative Study of Lives, Volume 4. London: Sage.

Bakan, D. (1996) ‘Some Reflections About Narrative Research and Hurt and Harm’ in: Josselson, R. (ed.) Ethics and Process in The Narrative Study of Lives, Volume 4. London: Sage.

Baranay, I. (2004) It’s the other who makes my portrait: Writing self, character and other. TEXT Journal, 8 (2) [online]. Available from: http://www.textjournal.com.au/oct04/baranay.htm [Accessed 6 January 2017].

Crossley, M, (2000) Introducing Narrative Psychology: Self, trauma and the construction of meaning. Buckingham: Open University Press.

Frank, W. (2000) The Standpoint of the Storyteller. Qualitative Health Research. 10 (3), 354-365.

Kidder, T. & Todd, R. (2013) Good Prose: The Art of Nonfiction. New York, NY: Random House.

Morse, J. & Johnson, J. (1991) ‘Toward a Theory of Illness: The Illness Constellation Model’ in: Morse, J. & Johnson, J. (ed.) The Illness Experience: Dimensions of Suffering. London: Sage.

Morse, J. & Johnson, J. (1991) ‘Understanding the Illness Experience’ in: Morse, J. & Johnson, J. (ed.) The Illness Experience: Dimensions of Suffering. London: Sage.

Lisa, O. (2014) Scott Stossel: ‘I’m pretty successful at hiding my anxiety’ The author of My Age of Anxiety discusses his condition, his family and Big Pharma [online]. The Observer. Available from: http://www.theguardian.com/books/2014/jan/05/scott-stossel-anxiety-interview [Accessed 6 March 2014].

Ritter, H. (1990) Anxiety. Journal of Religion and Health, 29 (1), 49-53.

Shapiro, J. (2011) Illness Narratives: reliability, authenticity and the empathic witness. Medical Humanities, 37, 68-72. 

Smith, B. & Sparkes, A. (2006) Narrative inquiry in psychology: exploring the tensions within. Qualitative Research in Psychology, 3 (3), 169-192.

 

Chris Westoby is a Creative Writing PhD research student at the University of Hull. His interdisciplinary project “The Fear Talking” bridges arts and social sciences; it promotes writing as a means to improve quality of life and display the intricacies of mental health in an accessible format. His non-fiction work “The Base of Death Hill” is published in Writing Hull, edited by Martin Goodman (Barbican Press, 2013).