Medical science versus personal experience, wellness versus illness, genetics versus environment, free will versus determinism—these are a few of the binaries Sarah Fawn Montgomery dismantles in her nonfiction debut, Quite Mad: An American Pharma Memoir. But she does so without dismissing or diminishing any of those concepts. Instead, Montgomery’s stunning attempt to map out her mind embraces seeming-opposites as inseparable pieces.
Montgomery interweaves her own story of diagnosis and illness into research that details, among other things, the misogynistic underpinnings of past and current psychological frameworks, the horrific experiments and treatments mentally ill people have been subjected to in the not-distant-enough-past, and the folly in our contemporary worship of medication. While she writes about historic cruelty and inequity with fitting disdain, her examination of psychotropic medicine is endlessly ambivalent. American doctors might be in the concerning habit of hastily prescribing medications with unpredictable side effects, but Montgomery maintains that medication has helped her and countless others. Quite Mad continuously locates gray area and strives to inhabit it.
Continuing in the vein of Lauren Slater’s work—Prozac Diary to Lying, which both pointed to the narrative foundation of psychological diagnosis—and the hubris in seeing those narratives as concrete, fundamental truth, Quite Mad branches from there to highlight the potential for patients to find agency in diagnosis. To Montgomery, the narrative quality of psychological diagnosis can be burdensome and empowering, oftentimes simultaneously.
I recently had the pleasure of speaking with Sarah Fawn about Quite Mad and the daunting task of writing about mental illness with nuance and grace.
***
The Rumpus: You highlight many aspects of America’s historic and contemporary mistreatment of mentally ill patients, from trans-orbital lobotomies to our current obsession with medication. Can you describe the research process for Quite Mad?
Sarah Fawn Montgomery: The research process began—as it does for so many patients—with my desire to understand what was going on with my brain and body. There are so many unanswered questions left after the brief doctor’s visit folks encounter (if they are privileged enough to go to physicians at all), and my interest in contemporary mental healthcare was fueled by what I felt was insufficient information and unsatisfactory quality of care. Medical staff are overburdened and work within medical institutions often ruled by profit and bureaucracy, so I was desperate for more information about my diagnosis, but also about the medications I was prescribed, many of which had detrimental side effects. The research was also driven by the general feeling that I was being dismissed, that my pain wasn’t believed, and that gender was influencing my treatment. As I began researching, I found that my experience continued a centuries-old narrative about mental illness, particularly for women; so, the research in the book covers everything from the history of asylums to pharmaceutical marketing, lobotomies to talk therapy, the literature of mad women to diagnostic patterns for women over the last century.
Rumpus: The two main facets of the book—the history of treating mental illness and your own experiences—have enough energy to conceivably become books of their own. What made you decide to combine them?
Montgomery: Mental illness is incredibly isolating and the burden is increased when the public doubts or suspects you because of your diagnosis. It was important to situate my story within the stories of others, to remind those of us with mental illnesses that we aren’t alone but also to speak out against the collective silencing that happens to patients and the dehumanizing treatment many suffer. It’s not uncommon to feel as though your pain is being invalidated or ignored, that you have little autonomy over your medical treatment. And America’s cruel history of treatment is a reminder that patients have been part of this narrative of silence and erasure for centuries, and that our contemporary healthcare practices, particularly for marginalized communities, need reevaluating. It was crucial to combine my story with an interrogation of America’s treatment of the mentally ill because I am one of millions in a nation whose medical practices and very attitudes towards mental health are also mad.
Rumpus: As you also discuss in Quite Mad, depictions of people with mental illnesses in books, movies, and TV shows have so often been oversimplified in damaging ways. How did you avoid the oversimplification our culture seems to crave?
Montgomery: Our culture gravitates towards oversimplification because it makes the abstract, frightening concept of mental illness something seemingly within our power to control—we value the inspirational recovery narrative because it is reassuring. But it is also inaccurate. Mental illness operates on a spectrum, and those with mental illnesses often negotiate symptoms over the courses of their lives. In order to avoid an oversimplified narrative that suggests we have easy “cures” for mental illness, which blames and shames patients who do not “try hard enough” to recover, we need to accept and appreciate narratives that resist the inspirational recovery narratives we find so reassuring. My goal with writing Quite Mad was to share a complicated, painful, honest narrative about mental illness, one that resisted inspiration, the promise of recovery, the very notion that those with mental illnesses are faulty, wrong, broken. These are the narratives we need, and we need them from writers, actors, and advocates who are actually mentally ill—we need to let folks with illnesses speak for themselves. We need to examine ableist language and consider how appropriating depression, anxiety, OCD, and bipolar disorders as metaphors, as punchlines, as plot lines, takes power away from patients. We mustn’t sanitize our stories of mental illness or apologize for our experiences. We mustn’t use our struggles to make others feel better.
Rumpus: Quite Mad reveals the patriarchal scaffolding of psychological treatment in crushing ways. Can you say more about that?
Montgomery: Women have long had their gender medicalized, “deviant” or “undesirable” behavior labeled madness, and they continue to be diagnosed and treated for mental illness at much higher rates compared to men. The history of mental illness treatment in the United States is one that both blames the female body and injures it further. Things like imprisonment for early women in power, accusations of witchcraft, the Rest Cure’s forced submission, lobotomies and sterilization without consent, and the mass prescribing of tranquilizers at a time when women were seeking equality are echoed in our current narratives about “angry,” “emotional,” and “unstable” women during a social and political moment when women are coming forward with their stories and systemically being shamed and silenced by those who regulate and abuse their bodies.
As I discuss in Quite Mad, perhaps it is not women’s bodies and brains that are to blame, but a world that would rather believe women broken than abused. It is no wonder women suffer from mental illness at higher rates when so many women experience sexual assault and domestic abuse—victims are told that their bodies and brains and bruises, even their true stories, don’t matter—and when this country is quick to pathologize women’s attempts to access agency and power.
Rumpus: Considering that you write poetry in addition to nonfiction, do you typically start out by wanting to write in a particular form, or does content and subject matter lead the way?
Montgomery: It depends on the project—sometimes I want to employ a particular form, like the hermit crab essay or a villanelle, but often the subject matter determines the form. That was certainly the case for Quite Mad. It seemed impossible, and more importantly, inaccurate, to write a linear narrative. Mental illness and the illness experience do not move linearly. They are often full of darts in time, compressions in time, missing time, leaps forward and steps back; so, my memoir does not move entirely linearly. While the book contains a somewhat linear narrative about my various diagnoses and treatments, the form is also reminiscent of madness, incorporating fragmented time, the frenzied and illogical experience of anxiety, the circular compulsion of OCD, the flashbacks of PTSD. To tell the story of mental illness accurately, the writing had to embody madness, lyric and strange, real and unreal, terrifying and tender. I wanted the experience of reading the book to be immersive, readers making their way through the pages like one makes their way through the world with mental illness.
Rumpus: How would you describe the differences in approach when you’re thinking of writing a poem versus a piece (or book) of nonfiction?
Montgomery: I don’t think of genres as separate, as I find this limits the ways readers and writers believe “nonfiction” or “poetry” can exist, regulating and restricting performance, and often favoring privileged voices and forms. My task as a writer is to construct a world and experience for readers, and the mutability of genre becomes a way to challenge expectations about subjects and storytelling. Nonfiction is a genre regulated by beliefs about “truth” and “fact,” the pressure to know what is certain and what is fabricated in overly simplistic black and white terms intensified in our social and political climate. But mental illness often resists standard definitions of “truth,” darting or dancing around “fact” and offering up sometimes painful, other times delightful, gray areas. It would be dishonest—perhaps impossible—to write truthfully about mental illness without addressing this framework, the ways mental illness differs from patient to patient, one person’s “fact” another’s “fault.” Although Quite Mad is classified as “memoir,” it is very much a hybrid text, a work of nonfiction that operates, like I described earlier, with the poetics of madness.
Rumpus: Along those lines, how do you see Quite Mad in relation to your most recent poetry collection, Regenerate: Poems of Mad Women?
Montgomery: In Quite Mad, I wanted to tell my story alongside America’s story of mental treatment, which included a cultural critique of the ways medical sexism and bureaucracy have shamed and silenced so many patients over the years. In Regenerate, however, I wanted to fill that cultural silence with the rich stories of the mentally ill, stories where illness was not suspect or dangerous, but subversive and domestic. I juxtapose poems about unhappy young girls, unsettled new wives, and dissatisfied mothers with poems about (in)famous historical and literary madwomen to de-romanticize madness and bring it closer to home. As with Quite Mad, I wanted to explore how the social and domestic spaces women inhabit lead to legacies of insanity, but I also wanted to reclaim madness and explore the fierce ways women react, resist, and regenerate.
And unlike my memoir, much of Regenerate is persona, written from the perspectives of real and imagined madwomen—patients, writers, literary characters, characters I dreamed up—the collection a way to give voice to those silenced, to let patients become people with full and rich interior lives, and with the autonomy to exist beyond symptom and diagnosis. Many of these women only “exist” in their medical records, so by layering the voices I imagined for them with the medically sexist, cruel language I found from their families and physicians in medical textbooks and records, I hoped to create a space for these women and their stories. The responsibility I felt to “get it right” when assuming the voice of others—for persona is fraught with issues of power and privilege—was perhaps even greater than my desire to get the facts right in my memoir.
Rumpus: Quite Mad depicts a lot of difficult familial times but manages to avoid the common pitfall of blame. Was that a tough place to reach?
Montgomery: Despite writing about my messy, imperfect family, I’m fiercely protective of them. One of my main focuses while writing the book was to explore the ways our complicated family dynamics—I’m one of eight siblings, many adopted, ranging in age from fifty to fifteen—impacted our various mental health struggles while also acknowledging the range of circumstances, genetics, and experiences that have been contributing factors. Much of my experience with mental illness has been about accepting contradiction and resisting the blame and shame that so often accompany illness, so writing about my family required I give them the same care and respect that all patients deserve. It wasn’t tough—it was honest, and it was right.
Rumpus: I know a lot of people think of academia as progressive and enlightened, but has that been your experience with regards to colleagues’ perceptions and reactions to mental illness?
Montgomery: For the most part, folks are supportive and forthcoming with stories of their own, but I also encounter ableist language regarding mental illness and who is “fit” to engage in academic culture. I’ve heard folks imply that the mentally ill are not capable of working in academia, armchair diagnose colleagues or students, or suggest that disclosing disability might be detrimental to future employment. I’m increasingly concerned by discussions that mitigate the ways students’ mental health impacts their academic performance. Providing accommodations is not a burden, but our job as instructors—we have the responsibility but also the power to create accessible, safe spaces for learning that allow for experimentation, risk, and joy. It pains and angers me to see so many within academic institutions resist more inclusive learning opportunities.
This rhetorical framing ignores an important relationship between mental health and the academy—mental illness is deeply ingrained in academic culture, yet rarely supported by it. Folks are overworked and underpaid, navigating full teaching loads while far from family and friends, doing so despite a dwindling job market and challenges to the American education system. Yet while academia claims much from its participants, it provides little support for mental health: students must advocate for themselves, faculty must risk their health or their tenure, and as the shift from tenured to non-tenured positions increases, so too does the number of folks without benefits and access to health care. It is deeply troubling that colleagues and students are expected to work themselves beyond the brink without support from the very institutions to which they devote themselves. So, too, that the time and space needed for wellness—and, quite frankly, for productive scholarly and creative work—has somehow been reframed as indulgent, wasteful, unproductive.
Rumpus: How do you address ableism in the creative writing courses you teach?
Montgomery: We’ve long known that the creative writing workshop often privileges certain voices at the expense of others, silencing and thereby erasing marginalized identities. This is why it’s so important to frame the workshop as a space designed to help authors locate the best way to tell their particular stories as opposed to one that facilitates a collective “correcting.” I work with students to locate the author’s intent and to resist the inclination to read our own experiences or expectations onto the page. We address ableist metaphors like blindness, dumbness, lameness, or madness, those tired clichés that appropriate disability, and we contend with common cultural misconceptions that disabled folks are “broken” or “weak.” We also work to resist characters and plot lines that suggest disability is a burden we must “battle.” These ableist tropes reinforce the inspirational narrative we encounter so often in popular culture. It’s easy to identify the impulse—things like mental illness can be frightening, and focusing narratives on hope or recovery is a way of feigning control—but these narratives are dangerous because they imply disability is something we can or should control, that those who don’t “fight” are somehow to blame. Narratives that focus on “overcoming” are particularly harmful, for they imply that illness and disability are only of interest when we rid ourselves of them. Often, these narratives are written by folks without the applicable lived experience. The workshop offers important opportunity to talk about ableism and authorial responsibility when writing from another’s perspective.
Rumpus: If you could go back and talk to your teenage self about anxiety, what would you say?
Montgomery: Oh, goodness! A lot. First, that mental health struggles are normal—there is such pressure, at any age, to be focused, professional, logical. American culture values independence, perseverance, an up-by-the-bootstraps mentality that leaves little room for emotion, for struggle, for what we often label “weakness” but is really just everyday human suffering. If folks acknowledged how common mental illness is, those experiencing physical and emotional symptoms wouldn’t also have to shoulder the burden of shame. Along those lines, I’d challenge the popular misconception of “mind over matter” and the ways we blame folks for their mental illnesses. Implying that folks are in control of their illnesses allows us to remove ourselves from the conversation, from the shared responsibility we have to care for our citizens. We need look no further than our current healthcare system to see this in action. Folks need support from friends, family, education systems, employers, and most of all our healthcare systems and government. And finally, I’d tell myself that our psychiatric experiences are okay. That we are not broken. The world is cruel enough; we must be kind to ourselves.
***
Read an exclusive excerpt from Quite Mad: An American Pharma Memoir, here, and an earlier essay on mental health by Sarah Fawn here.
