Kaysen begins her account of mental illness and hospitalization with a question often posed to her: how did she end up there? Kaysen believes that people are curious about the circumstances of her hospital stay primarily to discover whether they might find themselves in the same situation. “It’s easy,” she says, to find oneself in a “parallel universe” of mental illness. Georgina, Kaysen’s roommate at the hospital, was stricken with severe depression during her junior year at Vassar. While watching a movie, Georgina realized that she was undergoing some kind of mental breakdown. Most people suffering from mental illness do not enter the parallel universe immediately, Kaysen says. Instead, they catch brief glimpses of this other world where everything is different, including time, the laws of physics, and even the way everyday things appear to the eye. Eventually, the temptation to cross over is irresistible, and the alternate reality replaces the familiar. Once in the parallel universe, one is perfectly aware of the world left behind.
Kaysen travels to the suburbs of Boston to see a psychiatrist. He notices that she has a pimple, and that she has been picking at it. Kaysen describes the sense of achievement she felt that morning, popping the pimple. The doctor believes that the pimple is a symptom of a self-destructive disposition. He suggests to Kaysen that she take a rest. Kaysen agrees under his repeated questioning. She is tired and distracted by thoughts of the effort it will take to travel from the doctor’s office to her job. While the doctor calls to reserve her a bed at a mental hospital, Kaysen considers escaping, but she is too exhausted. Kaysen notices that the doctor seems pleased, even proud, of his decision. She weakly attempts to postpone admission to the hospital, but the doctor is firm: she will leave immediately. He puts Kaysen in a taxi and instructs the driver to be sure that she makes it there. Kaysen, having submitted to the plan with little argument, thinks about how much more pleasant it is to be driven in a taxi than to wait for a train.
Etiology is a branch of medicine that deals with the causes of diseases. This chapter is a one-page, multiple-choice questionnaire, asking us to identify which of the answers best describe an imaginary patient. Several of the questions are absurd, asking whether the person is possessed by the supernatural. Others present historical treatments of the mentally ill, from removal of the uterus (hysterectomy) to leeches and electric shock. The final questions are the most relevant to Kaysen’s story: is she in fact in full possession of her mental faculties while the world has gone mad? Is she embarking on a dangerous voyage that will take her life?
Polly is a fellow patient of Kaysen’s on the hospital ward. Prior to entering the hospital, Polly poured gasoline over herself and lit a match, badly scarring her face and upper body. Kaysen notices that scar tissue does not age or change as skin does, but remains the same throughout a burn victim’s life. She imagines that the ruined tissue is a protective shell disguising the person underneath. Despite her horrific injuries, Polly is always kind to the others and never complains. Kaysen thinks that the fire must have burned any negativity out of Polly forever. Kaysen concludes that anyone who would choose to end her life so painfully must have tremendous courage. Kaysen tried to kill herself once by swallowing fifty aspirin, but she thinks that her half-hearted effort means little in the face of Polly’s dramatic choice. One day, the girls on the ward hear crying and screaming. They discover Polly overcome with emotion, as though she has seen her damaged face for the first time. Kaysen realizes that though she might one day emerge from her difficulties, Polly is trapped forever in her damaged body.
The metaphoric “parallel universe” of mental illness that Kaysen describes gives us insight into the all-consuming nature of diseases of the mind. Afflictions of this sort are, in the author’s view, as encompassing as a physical disability, a life of crime, or even death. Georgina’s life enters the parallel universe without any warning when a “tidal wave of blackness” sweeps over her. This frightening description of the sudden and inescapable onset of profound depression sets the stage for the memoir’s exploration of Kaysen’s own struggles. She notes that even from within the parallel universe of illness, one is aware of the reality left behind. Kaysen and the other patients are trapped in more than one kind of parallel universe. Behind the barred windows of the hospital ward, the girls are conscious of the events taking place in the world around them but are unable to participate.
Kaysen’s interaction with the doctor sheds light on both the reality of Kaysen’s illness and the chilling consequences of a medical establishment too quick to pronounce someone ill. Kaysen puts up little resistance to the doctor’s hurried diagnosis, even when he draws conclusions from an offhand observation about a pimple. She considers escaping, but pleads exhaustion. In truth, Kaysen doesn’t need to “escape”: she is eighteen and can leave any time she chooses. Too exhausted by depression, however, Kaysen relents. Her fear in this scene is justifiable and foreshadows the bleak months of hospital confinement ahead. At this crossroads, both the doctor and Kaysen make choices that will have grave consequences for Kaysen in the two years to come.
The mock questionnaire of the “Etiology” chapter provides a darkly humorous look into the history of treatment for mental illness and foreshadows the direction of the story to come. For hundreds of years, the mentally ill were often assumed to be the victims of supernatural possession. By presenting options, each more absurd than the last, Kaysen asks us to consider the nature of psychiatric medicine. Should we accept today’s mental illness diagnoses without question, just as the people of other eras accepted the notion of demonic possession? Kaysen is purposefully vague on this subject, insisting that we draw our own conclusions. The questionnaire goes on to pose a choice of treatments: medieval-era leeching, in which a patient’s blood or other fluids is drained in the belief that too much of one or the other has built up in the body, or electric shock therapy and Thorazine. Shock therapy became common in the 1930s, and Thorazine, a powerful sedative, in the 1950s. Both treatments were popular during Kaysen’s time at McLean; doctors continue to prescribe them today. Kaysen challenges the dogma of the psychiatric medical establishment in order to demonstrate that there is no simple explanation for mental illness.
Polly’s horrific story of self-immolation puts Kaysen’s illness in perspective and reveals the grave nature of certain mental disturbances. Kaysen initially envies Polly’s scar tissue because she feels that her own suicide attempt was timid in comparison. She imagines a sliding scale of suicides, from the violent to the relatively peaceful, that ranges from the ingestion of pills to more violent options. The method of suicide indicates the courage a person brings to the task. With Polly’s shrieking realization of the extent of her injuries, however, Kaysen realizes that she herself is fortunate. Kaysen might one day escape her own affliction, but Polly’s ruined face will forever be a reminder of her troubled past and will trap her, at least outwardly, in the parallel universe of mental illness.