Mental Illness Memoirs

There is now a whole category of memoir and autobiography genre that is called mental illness memoir or psychological memoir for lack of a better term. As I am interested in the memoir genre anyway, I have over the years read many fascinating memoirs and even graphic novels on these topics, first hand reports in the trenches of psychosis, mania, depression, borderline personality disorder, even one by a self proclaimed pathological liar!

At times they all seem to blend together: first there is childhood and background history and setting, then description of first “breakdown” or psychosis, subsequent hospitalization and/or treatment and recovery program, the transformation undergone by the author in recognizing, coping with, accepting her mental illness and/or addiction, the return to normal life that will never be the same, and how one deals with reentry into society or staying an outsider on the margins of society. There is also often discussion of the effect of mental illness on family relationships, where the author found support and acceptance and where not. In addition, there is often guilt about being mentally ill and draining family and friends- another common topic.

I would add here that in identifying the typical formulas of such memoirs, I do not mean to devalue them; in fact despite such repetition, I find it fascinating how each person has her own unique experience despite the similarities evident in these books and the movies made from them as well.

Obviously as a therapist I am fascinated with the unique and individual journey of a person over time and how the healing process can occur in so many different ways. Society’s constantly shifting attitudes towards mental illness also fascinate me. The courage involved in bearing your soul and describing intimate personal moments, even those you are ashamed of, is extremely admirable. And of course, when a large part of the book is taken up with the relationship between author and therapist, those are the most interesting memoirs. Case in point: one of my favorites called, “Get Me Out of Here: My Recovery from Borderline Personality Disorder”, by Rachel Reiland (a pseudonym), all about her struggles with anorexia and BPD. This book was great, as there is a lot of detail about BPD, especially the author’s awareness that identifying it and knowing she suffered from it actually helped her, and her courage and honesty do a great deal to erase the special stigma of this controversial diagnosis. As a therapist, what I liked most about this memoir was her focus on the long ongoing relationship with her therapist because she had great memories of sessions and was able to convey with great writing how reparative that therapy was for her.

So I find that Rachel’s book sets the bar high for this type of memoir. That is why I hate to say it, but I was not impressed by Mark Vonnegut’s memoir, entitled, “Just Like Someone Without Mental illness Only More So”. To be quite honest, I don’t even like or really understand the title. Is it meant to express just how good he was at going to Harvard med school and becoming a pediatrician despite his struggles with bipolar disorder and hospitalizations and this it makes him even more like ” normal” people? I just don’t get it. Having read really a lot of these memoirs, in comparison with a lot of ones that I liked or loved, this one did not impress me.

Before I continue to criticize this book, here’s a list of just a few of these books I found compelling and moving: “Drinking: A Love Story”, by Caroline Knapp- the title says it all!, any of Kay Jamison’s books but especially her personal struggles with bipolar disorder in “An Unquiet Mind” is a classic… Another classic psychological memoir also written by a therapist is Carl Jung’s “Memories, Dreams, Reflections”. Any of Lauren Slater’s many memoirs of her trips through depression and crazy land make for great reads, including “Lying” whose first words are “I exaggerate.” I also enjoyed “The Quiet Room: A Journey Out of The Torment Of Madness”, the only book I’ve read about schizoaffective disorder, by Lori Schiller and Amanda Bennett. Brooke Shields’ “Down Came the Rain” is brave, moving, personal, quite beautifully written and a pioneering book in this genre, the first of its kind about a “normal” person developing Post Partem Depression. The graphic novel I don’t remember but have on my bookshelf is “I’m Crazy”, by Adam Bourret, but obviously I don’t find it particularly memorable! These are just a few of a host of others. I should leave the movies on this topic for another post.

Getting back to Vonnegut’s book, the most recent one which I finished last week, I was very disappointed and I guess had an uncommon reaction to it, as it received a lot of great reviews. Someone called it the most insightful and enjoyable memoir he’s read in some time. Well not for me. Yes it was candid; all of these memoirs are. However, something was missing for me. I did not feel like I got a really good peak into his personal life or psyche. I got a good impression of his desire to be a doctor and brave foray into medicine, despite bouts with mental illness, but he seemed still almost shocked that he got into Harvard Medical School and got to be a pediatrician. I got no sense of his relationship with his psychiatrist or his feelings about medications or experience with them. This book just did not go that deep. I did not get that wonderful feeling of intimacy that I’ve gotten repeatedly from others of its kind. I was not moved and did not experience any profound feelings while reading it…

Stay tuned for a discussion of films of this type…

Mindfulness and Art Therapy

I started writing this post a while ago and somehow two paragraphs got erased so I’m starting over again. Maybe it makes sense due to the topic. Computers can really test how mindful you are. Especially to be mindful about saving and backing up stuff but even more so to be able to let go of your attachment to your stuff when you lose data…

Anyway I randomly picked up a book about meditation by a Yoga/Buddhist meditation teacher and therapist. Michael Stone’s “Awake in the World: Teachings from Yoga and Buddhism for Living an Engaged Life.” He talks about replacing the word enlightenment with intimacy and realization with relationship. “Little by little, we step into our real life, the one that’s always been here, because the present always finds us in our bodies, even when we are lost.” (page 24) I pick this sentence because I can easily connect this idea to the art therapy process itself as a way to get back into our real lives and be in the here and now in our bodies. I think that is one of the connections between mindfulness and art therapy. The here and now of the therapy session is all about intimacy and relationship as well as connecting to our bodies.

Of course there are many moments in any kind of therapy where we disengage from our true self in the moment and fly off somewhere into stories about the past or predictions about the future. However, the process of art making in art therapy keeps us back in the here and now through the use of the art materials no matter what one chooses to make. There are those special moments in the session when a quietness settles into the room as I sit with a patient who is intently working on their art project. I have had a few rare patients who are mostly quiet throughout the session, for many different reasons. For some, this is their first experience of being at peace with themselves, of allowing for a calm being in the here and now, and slowing down to just be with the materials, me and the art making process. True healing can take place in these quiet moments of therapy. For people who have survived a lot of early childhood trauma of one kind or another, feeling safe enough to be in the room in the here and now and to be able to focus on something tangible and concrete like the art materials helps a lot with the process of letting go as well as being able to be in one’s body and not dissociate. The dissociation is a learned behavior that has worked for the person in the past as a way to get through times when they feel themselves shutting down due to overstimulation of some kind and overwhelming feelings as well. Slowly the act of making art in a safe space with a therapist as witness and collaborator of “the moment” can take the place of dissociation. Finding new methods to soothe oneself is a key part of the healing process for all of us.

However, the majority of the people I work with tend to talk during the art making process, and some choose just to talk with me and find the art making to be too scary or associate it with their insecurities and perfectionism and shame. So no matter how the session proceeds, there will still be these moments of real intimacy in the here and now, which is the stuff of mindfulness. With a few people I have been able to meditate with them for part of the session and then discuss what came up while they were attending to the breath and the body. Some take up my invitation to engage in making a mandala after meditation with me and then see what their energy looks like and what was going on for them during the meditation.

This author, Michael Stone, and others for that matter, like to refer to “failing” at meditation, the idea that you will of course fail at it and go off into your head and then witness that you “failed” and bring yourself back to the breath, the body, the moment. Especially people unfamiliar with the meditating process can be easily put off by the fact that they “can’t” do it because as soon as they start to focus on the breath they go off into their head and it’s too frustrating to constantly notice and bring oneself back to the breath. Many people mistakenly think that the object of meditation is to achieve some kind of special state of mind that they could never get to. A lot of meditation involves feeling uncomfortable and fidgety or spaced out and then having to bring oneself back into the room. I have done some walking meditation groups and have found the walking meditation to be very helpful with this. Just being able to stand up and focus on each step and be moving the body very slowly helps with awareness and being in the moment.

We are always waking up to ourselves and our bodies. Even powerful emotions can bring one into the here and now which explains why some people report that they cry at the end of a yoga class or some other meditative practice. Being in touch with the real feeling of love for those you are most intimate with only happens from time to time for most of us as we are mostly preoccupied with what we are doing, what we are going to do next or what already happened.

The art therapy process can involve many fluctuations between moments of awakening and then sort of going back to sleep and just talking around oneself. This can be more noticeable for people during the art making process that they “went off somewhere” and then became aware of coming back into the room. As therapists we are also mindful of when we tend to disappear or get into our heads or leave the room when with different people. And the moments when we awaken together with our patient are the most treasured moments that are usually what keeps us going in this very challenging kind of intimate relationship work…

Separation Anxiety

Separation anxiety is normal in extremely young children up to around 14 months old. As the child gets older s/he can tolerate periods of separation from caregivers. Obvious signals that your child is too anxious about separation includes crying and inability to be soothed after separation, nightmares about separation, excessive obsessive “checking” that parent is there and clinging, constant temper tantrums at separation and reuniting, even bed wetting.

Often a child will pick up on an adult’s anxiety, and sometimes changes in the caregiver’s behaviors can go a long way towards easing the anxiety of the child.

What happens when these issues don’t get addressed? What behaviors linger on into adulthood?

“I notice that I get very anxious when I know the time I’m spending with a friend or on a date is running out and we are about to say goodbye. I know it’s an overreaction but I still feel this anticipatory anxiety and after we part ways I feel immediately a lot of sadness, loneliness and fears of being alone.” At other times this person is fine with being alone.

Another interesting scenario: “I seem to keep getting into long distance romantic relationships. Reuniting is always so dramatic and intense but then when one of us has to leave, it feels almost as bad as if we’re breaking up, and the depression lingers for a few days. During that time I’m excessively calling, texting, chatting online with him/her. Then for a while I feel fine and then it’s time for another visit and the whole pattern starts all over again”

“I hate the beginning of the therapy session. I always feel really uncomfortable. And at the end of the session it’s hard to leave. The worst is when you announce a vacation…”

Some people express their anxiety through needing to control the session, wanting to be the one who alerts their therapist that the session is over every time.

Of course as therapists we constantly see different styles of attachment. Aloof and avoidant: this may be the patient who can only tolerate bi-weekly sessions and/or “misses” sessions often through forgetfulness. It can be very challenging to work with a patient with this attachment style as they have a hard time staying in therapy. They may need to control things so much that they become the patient who suddenly leaves therapy when the therapist is noticing that s/he is finally starting to open up and trust. Next minute the patient leaves with no warning or notice. S/he may be able to send an abrupt text or email saying s/he needs a break from therapy, but in some cases this is the elusive patient who just stops coming to sessions and avoids any contact with the therapist. In these cases I have found it is still a good idea to contact the patient and leave a message voicing concern about this behavior, demonstrating to your patient that you have noticed their disappearance and are concerned about it. Often the “parentified adult”, used to the role of caretaker of absent, unstable or anxious even alcoholic parent is very accustomed to their role and has a hard time being in therapy and admitting they need care and attention.

The “ambivalent” attachment style can be expressed quite differently. This may be the patient who opens up very quickly in therapy, demonstrates many shifts in and dramatic affect states, even starts a fight with the therapist. This person needs a lot of contact but feels conflicted about needing it and how to express that need. The consistency and firm boundaries of the therapist with this type of person can be very effective.

The very neglected child can be very consistent as a patient and respond well to individual psychotherapy. S/he is often punctual and gets a lot out of the consistency and holding support of the therapeutic relationship. While this person may take a long time to trust the therapist, I have found patients like these to be very self aware even if their awareness includes a lack of connection to their feeling states and a lot of intellectualization. The goals of therapy are as clear as the patient is eager to work on his/her self…

Many people oscillate between different attachment styles and feeling states about separation depending on the stressors in their lives.

Personally I have oscillated a lot in my life between feeling overly needy and clingy to feeling overly detached, uninterested in connection with others and when under too much emotional stress, reacting very differently as a teenager versus young adult versus older adult. Most of us have a variety of experiences with separation.

I also find it interesting that having a pet dog or cat can help a person heal from whatever childhood separation anxiety they may have experienced. The unconditional consistency of a dog cannot be matched by a human. While this leads probably to a big topic for another post, I find it fascinating how our relationships with our pets can help repair early anxiety and trauma. Of course there is the other side to this, when people get overly attached to their pets and it affects their relationships with people…

Mandala Journalling

The mandala was first mentioned in the context of therapy, as far as I know, by Carl Jung. He did his own mandalas and talked about them in his memoir and in The Red Book. He worked with his patients using the mandala. The word mandala means sacred circle. The mandala is thought to be a symbol of the self.

I have often invited new patients in the first session to create a mandala. I find it best done on dark or black paper for the mandala to emerge out of the “shadow”. Also of course many people, even artists and art therapists, feel frozen in the therapy session when presented with a blank piece of white paper, so the circle makes a big difference between anxiety and feeling grounded…

The mandala makes a wonderful holding environment and it can feel very soothing to draw one. I usually have my patient trace the circle themselves, using a paper plate about the size of a face on big enough paper to provide room for extending the mandala outwards and for drawing outside the circle. The boundary of the circle will be emphasized and not crossed when a person has a great need for boundaries in his/her life or if one is by nature very conscious of boundaries. Some have rigid boundaries, some fluid…

This first session mandala is not only useful as an “ice breaker”. I find mandala making most helpful when I make them over time and can compare them with each other. I often suggest to patients that they keep a small sketchbook and try to make one mandala per day as a form of journalling with images. I myself have done this form of Journalling from time to time. For me it is a great thing to do to make sure I am making time daily for art making which I need to do most of the time to ensure good self care. If I happen to be at a crossroads in my artwork or a bit stuck, the mandala is always there for me. The following are images from different journals: the ones on the black background are from June 2005 and the others are from 2010.





I just now remembered that my patients actually sit facing a wall with a huge mandala collage on it (7 foot diameter) in my studio that I made many years ago when I was only making a series of mixed media mandala collages of different sizes. It is very abstract and chaotic looking. Over the years various patients have commented on the piece as a whole or noticed small parts of it where they see and recognize some image that I did not consciously try to make in this piece.
I hope this post inspires you to make your own mandalas or do them in a group or with individual patients. I have also led several workshops incorporating art and meditation in which the art making part involved making mandalas on black or brown paper with the non dominant hand to help facilitate a level of comfort with image making, ie. this is my other hand so I don’t have to worry about making a “good drawing”…