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.