Summary: New Frontiers in Dental Health

As her time at the hospital approaches its end, Kaysen begins to plan her next steps. She thinks back to the job she held before hospitalization—typing student bills at Harvard. Kaysen was surprised by the sexism she encountered there. The typing and supervisory staff was strictly segregated by gender, and the male and female staff was subject to different rules. Women obeyed a conservative dress code and were not allowed to smoke except in the bathroom, while men enjoyed much more freedom. Eventually, Kaysen simply stopped going to work. She notes that she was the only woman on the job who objected to the rules and wonders whether this was a mark of illness or a just reaction to sexism. Finally, the job search is put to rest by her boyfriend’s proposition of marriage.

Summary: Topography of the Future

Kaysen describes meeting her husband before she entered the hospital. A friend’s brother introduced her to him. They watched a French film and spent the night together. After her future husband returned to Reed College, Kaysen began the mental decline that led her to McLean. He insisted on visiting her in the hospital, despite her worsening situation and occasional refusal to see him. Over time, Kaysen’s mental health improved, and she was able to visit him outside the grounds of the hospital. Eventually, he proposed marriage. Kaysen admits that she had given the realities of marriage very little thought before accepting his proposal. To her, marriage was escape and freedom. The marriage eventually ended in divorce.

Summary: Mind vs. Brain

Kaysen considers the relative importance of the “brain,” composed of a series of complex neurochemical processes, and the “mind,” the invisible mechanism that creates consciousness. She isn’t sure whether the two can be divided. Perhaps there are two levels of interpretation occurring in our heads, she theorizes, one that processes basic data, and another that considers it. She imagines that mental illness appears when the two interpreters can’t communicate. Sometimes, however, confusion exists that doesn’t indicate mental illness. People might sense that a train in which they’re sitting, although stopped in a station, is moving, simply because the train next to them is moving. Kaysen describes this gray area as the edge of psychiatric disturbance. She points out that treatable mental illness is always signaled by a patient’s doubts about what she is seeing or imagining. Those who do not doubt are most likely untreatable. Kaysen draws a distinction between therapists, who treat the mind, and physicians, who prescribe psychoactive medications. She considers the long-term effects on patient treatment caused by neurochemists.


With her twentieth birthday approaching, Kaysen prepares to leave McLean. The employment opportunities available to her are undesirable and remind Kaysen of her brief employment as a typist in a Harvard office. There, she noticed that typists (all women) and supervisors (all men) obeyed entirely different sets of rules. The experience was a crystal-clear example to Kaysen of the overt sexism still in practice in the American workplace. Kaysen wonders why she was the only employee to object to the rules. Was this a sign of her illness? This episode illustrates one of the book’s major themes—that of society’s insistence on classifying those who reject conventional behavioral norms as odd or crazy. She encounters a similar response from her social worker at the hospital. The adults around her have a difficult time understanding why Kaysen rebuffs the job opportunities typically available to a woman of her age at that time. Even Valerie, now a confidante of sorts, tries to steer her toward a career as a dental technician. The world in Kaysen’s eyes operates similarly to the typing office: women should expect to take up an undemanding service job and to live within a set of boundaries set by men. Only a marriage proposal, the most traditional role for women, releases Kaysen from the hospital and earns the approval of everyone around her.

Kaysen decides to marry with little thought of consequences. Marriage is socially palatable to her parents and doctors. Once married, questions about Kaysen’s life choices and future will subside; traditional society will consider her life’s path settled. More importantly, the marriage proposal is Kaysen’s instant ticket out of psychiatric care. “I guess my life will just stop when I get married,” she says. Certainly Kaysen’s life will continue, but probing questions about her prospects will indeed cease.

The psychiatric establishment’s growing reliance on neurochemical solutions to mental illness interests Kaysen. Pharmaceutical remedies have replaced entire classes of mental illness that once required lengthy therapy. Most forms of depression and manic depression no longer require long periods of hospitalization; the nearly two years that Kaysen spent in a residential program would be unheard of today, except in the most dire cases of illness. Kaysen believes that the mind interprets chemical processes that occur in the brain. This interpreter gives us a rough report of the brain’s actions and reactions to stimuli. Kaysen thinks that there are countless interpreters checking the work of the one that came before, thereby refining our conclusions about what we see. Mental illness occurs when there is a break in the interpretive chain, resulting in “false impressions have all the hallmarks of reality.” She notes that Freud believed that patients who had no doubts about their own delusions were untreatable. Ultimately, Kaysen looks at the gap between the therapeutic and neurochemical schools of thought with some alarm. More cooperation between the two would, in her opinion, be better for patients.