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.
