Voluntary Madness: Lost and Found in the Mental Healthcare System

  • ISBN13: 9780143116851
  • Condition: NEW
  • Notes: Brand New from Publisher. No Remainder Mark.

Product Description
From the author of The New York Times bestseller Self- Made Man, a captivating expose of depression and mental illness in America

Revelatory, deeply personal, and utterly relevant, Voluntary Madness is a controversial work that unveils the state of mental healthcare in the United States from the inside out. At the conclusion of her celebrated first book–Self-Made Man, in which she soent eighteen months disguised as a man-Norah Vincent found herself emotionally drained and severely depressed.

Determined but uncertain about maintaining her own equilibrium, she boldly committed herself to three different facilities-a big-city hospital, a private clinic in the Midwest, and finally an upscale retreat in the South. Voluntary Madness is the chronicle of Vincent’s journey through the world of the mentally ill as she struggles to find her own health and happiness.

Voluntary Madness: Lost and Found in the Mental Healthcare System

5 Comments so far »

  1. Booker said,

    Wrote on May 1, 2010 @ 12:18 am

    In Norah Vincent’s last book she describes disguising herself and living as a man in every way imaginable for six months. She concludes that book by committing herself to a mental institution. Tough to top? Not for Vincent who turned that experience into the idea for this memoir. She would commit herself into three mental health facilities, and dish out all the dirty details of mental health facilities from the patient perspective.

    She easily gets herself committed into her first public health facility and begins to recount colorful stories about her fellow mental patients and scathing criticisms about the hypocrisy of the system. Only Vincent is no stranger to mental demons. She is currently taking Prozac for a history of depression and medication to aide sleep. When she stops taking her medication, she falls into a depression. So before she can commit herself into her next facility, the book then takes a turn. While it still punches at mental health procedure, it mostly becomes the author’s personal internal struggle to heal herself. Although the author does make progress and delivers some jewels about modern treatment methods worth considering, the book falls short of the salacious premise originally embarked upon.

    Rating: 2 / 5

  2. W.H. said,

    Wrote on May 1, 2010 @ 2:28 am

    I was really dismayed by Vincent’s depiction of psychiatric drugs in Voluntary Madness, particularly antipsychotic drugs like Seroquel.

    As someone whose mental illness (schizoaffective disorder) is and was NOT voluntary, I could tell Vincent that, for me, Seroquel made and continues to make the difference between life and a living death.

    The onset of my illness brought loud and threatening hallucinations (voices that threatened to kill me and worse). I was treated with a variety of drugs, the first of which were not very helpful for me.

    When my doctor tried giving me Seroquel, however, my life returned to normal as the drug built up in my system. The delusions stopped almost completely, and what voices I heard from then on were and are few and far between. They were also easy to distinguish from real sounds and ceased to be frightening–they became merely annoying and easy to ignore.

    While the drug was sedating at first, my body adjusted to it very quickly (it is usually taken at bedtime for this reason). I could also tell Vincent that I certainly DO NOT twitch, drool, or fall asleep during daily activities!

    If and when people experience these side effects from drugs, their doctors should withdraw them slowly and gradually while starting them (also slowly and gradually) on new ones. Unless I missed it, Vincent failed to mention that this simple solution to these problems is even possible.

    Stopping any psychiatric drug slowly and gradually, under a doctor’s supervision, is also an easy way to avoid a painful withdrawal. Vincent demonizes Effexor, for example, as causing withdrawal, but she never mentions that this withdrawal is avoidable.

    She also observed that antidepressants and antipsychotics did not seem to work on the real patients on her ward. Well, unlike aspirin, these drugs usually take weeks and even months to build up to a theraputic level in the body. This is something Vincent would have known had she done a bit of research.

    Vincent seems intent on making a career of posing as things that she is not. Still, she should have educated herself MUCH better on the subject of severe mental illness and the drugs used to treat it before filling Voluntary Madness with her baseless opinions.

    Instead of writing a book about mental illness and its treatments (especially psychopharmacology), Vincent should have read one!

    I would like to recommend three books to her or anyone else who wants to read a good first-hand account of mental illness and its treatment:

    The Center Cannot Hold by Elyn R. Saks

    The Quiet Room by Lori Schiller

    An Unquiet Mind by Kay Redfield Jamison


    I believe that many psychiatric patients are normal, healthy people who are unhappy for external reasons or going through temporary crises. Vincent, by her own account, seems to fall into this category.

    Others, however, have real, biologically based illnesses that (so far) cannot be cured. They can only be treated and the most effective treatment is usually medication, often used with conjunction with therapy. I fall into this category, and I am frustrated that Vincent seems to deny its existence.

    Vincent should be glad that she is lucky enough not to need medication. Instead of insisting that since she doesn’t need it, no one does, she should have enough humility to refrain from judging what she doesn’t understand.

    Rating: 1 / 5

  3. Jacinda said,

    Wrote on May 1, 2010 @ 3:50 am

    Whats the point? & who’s it meant for? I’m not sure who would be the target audience for a book that has really no point or purpose. The author appears to be making a half-hearted attempt to get some mileage out of a literary degree by sharing her sophomoric ideas about a subject she has obviously not studied or fully experienced. It’s not about her own ‘illness’ (although that is what she implies in the title) as she doesn’t ever really commit to exposing her own struggles but rather gives a preachy and perfunctory speck here and there. At one point she describes her reaction to another person prefacing it with “me being me,” and it hit me that I have no idea what that means. She doesn’t share enough for the reader to join her in her concept of “me” so it just emphasizes the fact that she has not really developed her ‘character’ at all for the reader. It’s unfortunate too, because there’s probably a story here if the author was willing to really commit to telling it instead of hiding under pretense. The writing winds back & forth between vague descriptions of her being a “depressive” and her treatment in the mental health establishments. If you want to write a book exposing the latter- there is alot more to say than is portrayed here! If you’re looking for a book that will help you to empathize with those who struggle with mental illness and the institutions/ treatment woes that are a part of that, you’re better off elsewhere (Saks or Redfield Jamison). This author appears not to really have much passion and therefore much focus with regard to whatever subject she’s calling this & it just comes off as trite as the word “bin” she continually uses. She extracted her ‘words to live by’ off of the patch on someone’s jacket- need I say more? It seems her purpose was simply to write a book. It’s practically an insult to people who actually have a diagnosed mental illness, and full of opinions disguised as information. Don’t waste your time-
    Rating: 1 / 5

  4. D. R. Carroll said,

    Wrote on May 1, 2010 @ 4:16 am

    The primary flaw with the book, in my opinion, is that Vincent offers many generalized critiques (often centering around the concept that all psychotic people need is a little human interaction) without offering any alternatives. Many of the people she so pitied for being stuck in the hospital would otherwise have been in prison or on the streets. If Vincent has a solution in mind for this problem, she sure doesn’t present it here.

    Throughout, Vincent struck me as a sort of know-it-all teen. She would simply lie to rest age-old psychological and social debates (we are a product of our environment, without question, and thus ends the ‘nature vs. nurture debate). She also claims, basically, that most everyone is misdiagnosed (she seems to believe there is no such thing as ADHD or Bi-polar disorder — or at least the diagnosis is usually incorrect). Maybe more than a hubris-filled teen, Vincent reminds me more of that friend many of us have who is an ‘expert’ at anything they’ve gone through. So, if they’ve had knee surgery, they are suddenly a surgeon; in Vincent’s case, since she’s seen a shrink, she’s suddenly a neurologist.

    Rating: 2 / 5

  5. Katie said,

    Wrote on May 1, 2010 @ 6:48 am

    There are a lot of 5-star and 1-star reviews of this book. I thought it was good but average; hence the three stars.

    Between October 2008 and April 2009, I had 6 psychiatric hospitalizations. Five of them were inpatient and the other one was an outpatient day program.

    I have bipolar disorder with psychotic features and I was in a depression which had followed a manic episode where I was delusional about a number of things. I ended up leaving my job and going on disability.

    I needed the hospitalizations b/c in the depressive phase, my mind got “stuck” on suicide; I was getting closer to making attempts, including stockpiling medication, and I could not stop thinking about suicide.

    I was on medication the entire time, ironically that did include Seroquel. It also included mood stabilizers and anti-anxiety medication. I was compliant with meds the whole time, and also attended psychotherapy sessions regularly. However, I continued to have significant mood instability.

    That having been said, here is what I agree with Vincent about:

    1) Hospitals/treatment programs can be anything from a depressing dumping ground for the severely ill to an almost country-club atmosphere that accepts only fairly well patients (or at least excludes the floridly psychotic ones).

    2) The nicer the hospital, the more likely it is that personal development will be stressed and management of feelings will be taught.

    3) When patients lack the skills to manage feelings, it is very possible to get into a ‘revolving door’ situation with repeated admissions, as I did. Four of my inpatient hospitalizations were at rapid stabilization programs, where the emphasis is on calming patients in the short-term followed by a quick release.

    4) Like the author, my last hospitalization was in a much nicer place than the previous ones. There seemed to be much more money devoted to the program, and patients came from all over the United States and even Canada to stay inpatient there. That was the place I had wanted to go all along, but there was a several-month waiting time, hence the other hospitalizations.

    5) Also like the author, my last hospital stay seemed to do the trick and I don’t anticipate future inpatient stays.

    6) it is very possible to overpraise medicine, and overestimate its power to help all mental health issues. While I believe medication is helpful to a lot of people, and essential for many, I also think it is not a cure-all and psychotherapy is often beneficial as well.

    That having been said, here is where I disagree with Vincent, and this is why she loses two stars:

    Throughout the book, but especially at the end, she attempts to speak for people who are far more ill than she has ever been or will be. (in my opinion).

    Severe mental illness, which cannot be easily overcome, is reality for too many people, including me. Anyone who denies that is not seeing issues of mental health and illness clearly, in my opinion.

    Techniques and treatments that work for mild to moderate mental health issues may be very inadequate for people with severe mental illness. There is also a level of suffering and loss of function that increases dramatically with severity of illness.

    Appropriate treatment and medication can help a great deal, but the author, as I read her ending, wound up telling patients everywhere that “your attitude is up to you. You have the power to improve your own life.”

    I read that statement, which is paraphrased instead of quoted, as saying that the author believes that even very ill people with schizophrenia, bipolar, or severe depression need to take responsibility for themselves.

    In my opinion, this statement denies the reality that many people live in. Ill people often lack insight, so they may not be in touch with reality enough to know they are ill. Or insight can be partial at best. During breakdowns, they may not be able to accurately describe their lives, much less take responsibility for changing them.

    As I said above, I have struggled with severe illness. That is why it continues to cause me a lot of trouble despite medication, psychotherapy, and other work on symptom management.

    I had a breakdown with extensive psychotic symptoms last year and the insight I had went out the window. :(

    I still take medication, which was changed in my last hospitalization and is working better. I think I needed both the time in the program and the new medicine. I still take seroquel but am now on depakote (instead of lithium) and wellbutrin.

    I am 40 and I entered the mental health system in 1988, when I was 20 and extremely depressed. My dx changed to bipolar about 7 or 8 years ago. I have PTSD as well. I have been on medication and in psychotherapy for a long time. Medication-wise, this has included trying a number of drugs to see what would work the best. I have also had electro-convulsive therapy (ECT), which helped on a temporary basis, but the benefits did not last.

    (I have some abilities also. I try to see the positive as well as the negative.)

    I have enough money to pursue the best treatments I can find.

    I have a husband who is extremely supportive. My parents try to be supportive to some degree, as does my husband’s family. I live in a nice townhouse, not on the street. I was approved for disability and now I have some time away from the workplace to learn better skills and coping techniques so I can avoid future manic and depressive episodes, or at least do what I can so they will be milder.

    That is a lot more than a LOT of people with severe mental illness have.

    The author has similar good fortune to mine. She is not going to find herself in jail or on the street due to mental illness. However from her conclusion, I am not sure that she fully realizes that access to resources, including good doctors and good insurance policies, depends in large part on luck.

    When I told my husband about this book, he made an analogy to kidney disease. If you are on dialysis, it is important to maintain a good attitude. But if you are not fortunate enough to have dialysis as a treatment option, having a good attitude won’t save you.

    Vincent is right that there is still a lot of uncertainty in psychiatric care. for example, here are two books I have read. They are from complete opposite ends of the nature-vs-nurture argument. They both claim to provide the best description of care for people with schizophrenia.

    nature: E. Fuller Torrey, The Insanity Offense. Heavy coverage of the disaster that is mental health treatment, in too many states. A strong, some might say extreme, focus on taking medication.

    nurture: Bertram Karon, Psychotherapy of Schizophrenia: the treatment of choice. Very strong emphasis on childhood experiences and psychotherapy, and an extreme non-medication focus. Although I think medication is often needed, I find this to be an excellent book in an era where many professionals don’t listen to psychotic patients.

    as for the suffering of people with bipolar and schizophrenia:

    for bipolar, Madness by Marya Hornbacher. warning: this book is very triggering to people who are not doing well.

    schizophrenia: Welcome Silence by Carol North. Chilling description of psychotic symptoms and the author’s determination to function in spite of them. Claims a cure through dialysis.

    Voluntary Madness was an OK book. With better editing it would have been a 4 or 5 star from me.

    I agree with Vincent that there are at least as many questions as answers at this point, given the wide variety of people who may be described as mentally ill, or having mental health issues. I do appreciate that she focused more on her own experience as the book went along. But I thought that, at the very end, when she looked back and tried to draw conclusions from the treatment programs as a whole, that she overgeneralized based on her own observations.

    I have included a lot of autobiographical detail. That is to show that these problems have been quite serious for me, for a long time.

    I am also being pretty hard on Vincent based on just a few pages, basically. And that is b/c mental illness causes so much suffering for so many people that the “change your attitude; it worked for me” argument really bothers me.

    I believe treatment success depends on luck, rather than it being impossible to find good treatment. even for people in poverty, there are dedicated doctors. The problem is that this is a complex system to navigate when you are ill or caring for an ill loved one.

    Improving care for the poor and those with little insight would help a lot.

    7/5 – edited to add, I am glad that Vincent is feeling and doing better. It is rewarding to read about someone who gets good help, even if it takes a while. It’s great that she had such a good experience in the last treatment center.
    Rating: 3 / 5

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