Falling Into the Fire: A Psychiatrist's Encounters with the Mind in Crisis

I have found that one of the gifts of medicine is that it allows those who practice it to participate in the purest and most vulnerable moments of human life.

Woolf, they said, Dante, Sexton, Lowell. With each pronouncement the group seemed to gain confidence and momentum: Shelley, Plath, van Gogh. It struck me as a marching song. A cadence by which the Mad Pride parade could rally and process: Handel, Hemingway, Munch!

Mental illness pierces the veil, and those who suffer from it dwell with their fragility in plain view. My role as a psychiatrist is not to try to repair the veil but to strengthen my patients so that they can live, so that they can suffer less, so that they can hope.

Even if madness is at the root of some of the world’s great creations, it is hard to imagine that if someone asked each of us to live an entire life of suffering in the service of the arts, we would agree to do so. Even if we might choose such altruism, it’s unlikely we would allow anyone else to make that decision for us.

At what point can we know that ecstasy, or singular purpose, or religious fervor has become pathological, if we don’t wish to wait until obvious and irreversible damage has been done?

That too much elation is a chimera.

The brilliant psychologist and author Kay Redfield Jamison has said that bipolar disorder—an illness from which she herself suffers—“benefits mankind at the expense of the individual.”

The body mystifies. The mind more so. Witnessing their complex intersections—and the unbidden ways in which the two can catastrophically fray—can unmoor us.

I believe that healing is a kind of holiness. But like any good religion, it leaves me with a fair number of huge and unanswerable questions.