Joanne Greenberg wrote I Never Promised You a Rose Garden to refute the simultaneously romanticized and stigmatized status of mental illness. In the late 1960s, reactions to mental illness generally fell between two polarized attitudes. One, popular with the counterculture generation, romanticized mental illness as an altered state of consciousness that was rich in artistic, creative inspiration. The protagonist of this myth was the tortured artist who poured out his or her soul in writing or art between periods of mental breakdown; Sylvia Plath, Vincent Van Gogh, and Virginia Woolf are only a few such individuals whose artistry is practically inseparable from the idealized myths of their mental instability. Often their periods of mental breakdown were a source of inspiration, but before one romanticizes their mental illnesses, it necessary to remember that all three committed suicide.

On the other end of the spectrum, mental illness was stigmatized as a weakness or fatal flaw on the part of the sufferer. Even today, many uninformed people regard mental illness as a stigmatized condition, shrouded in shameful secrecy and negative stereotypes, to be described with frightening or belittling euphemisms. In the late 1960s, when Greenberg's novel was published, mental illness was even more misunderstood and feared. The reading public had absorbed centuries of inaccurate information about mental illness, all based on prejudice, ignorance, and fear.

Greenberg portrays the problem of mental illness from different perspectives. She details Jacob and Esther Blau's struggle with self-doubt, blame, and the stigma of their daughter's sickness. The novel also portrays the difficult, stressful work required of the medical professionals and the staff who work with mentally ill patients. However, most importantly, Greenberg portrays the experience of mental illness from the patient's point of view. Struggling with mental illness is not glamorous or easy. The road to recovery is lined with setbacks, doubt, and fear. It takes a great deal of courage and perseverance on Deborah's part to face her illness and fight it through treatment.

The doctor's most important tool is empathy, as Clara Fried demonstrates. Treating the mentally ill requires a combination of emotional sensitivity, strength, and intuition in addition to good clinical training. The relationship between the patient and doctor is a key part of treating mental illness, but a good relationship depends on illusory qualities than cannot be defined or acquired in advance. Dr. Fried acknowledges the value of Deborah's imaginary kingdom as a kind of map to Deborah's illness. Over the course of three years, she guides Deborah through a re-interpretation of Yr and its logic. In this way, she helps Deborah cope with the often confusing, often irrational laws of the real world. When Dr. Royson takes over Deborah's case, his approach is to prove to Deborah that Yr is her own creation. His approach does not work with Deborah, although it might with a different patient.

Some of the information in I Never Promised You a Rose Garden is outdated. In recent years, schizophrenia has come to be regarded as a problem in brain development, a physiological condition. Although no one knows exactly what "causes" it, studies indicate that a complex combination of genetics and environmental factors contribute to the development of the condition. The novel implies that Deborah's treatment is composed mostly of therapy. It is unlikely that therapy without the use of psychiatric drugs is sufficient to treat schizophrenia. Still, these new findings certainly do not invalidate the importance of empathy and understanding in the treatment of schizophrenia. Greenberg's desire to garner sympathy, respect, and understanding for sufferers of mental illness is still a valid concern, and her novel remains valuable as a sympathetic portrayal of mental illness.

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