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Book Review: Reclaiming Oneself From the Symptoms of Mental Illness   |    
First Person Plural: My Life As a Multiple • Win the Battle: The 3-Step Lifesaving Formula to Conquer Depression and Bipolar Disorder • Prozac Diary • Holy Hunger: A Memoir of Desire • Inner Hunger: A Young Woman's Struggle Through Anorexia and Bulimia
Jeffrey L. Geller, M.D., M.P.H.
Psychiatric Services 1999; doi:
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by Cameron West, Ph.D.; New York City, Hyperion, 1999, 319 pages, $23.95 • by Bob Olson with Melissa Olson; Worcester, Massachusetts, Chandler House Press, 1999, 140 pages, $15 • by Lauren Slater; New York City, Random House, 1998, 203 pages, $21 • by Margaret Bullitt-Jonas; New York City, Alfred A. Knopf, 1999, 253 pages, $23 • by Marianne Apostolides; New York City, W. W. Norton, 1998, 171 pages, $22

The five books reviewed here offer first-hand experiences of psychiatric disorders and of the authors' evolution from largely victims of their symptoms to mostly master over them. The accounts cover dissociative identity disorder, bipolar affective disorder, major depressive disorder, and eating disorders. Several of the books will prove more useful for clinicians to use as adjuncts to therapy then to simply read for their own edification.

Written by Cameron West, First Person Plural is an outgrowth of the author's doctoral dissertation in psychology on the experiential aspects of dissociative identity disorder, more commonly referred to as multiple personality disorder. This autobiography, like some of the others reviewed here, is aimed both at professionals and at persons who suffer from the disorder. West says in his epilogue that "having DID is, for many people, a very lonely thing. If this book reaches some people whose experiences resonate with mine and gives them a sense that they aren't alone, that there is hope, then I will have achieved one of my goals."

West's story, starting with a description of his life with multiple medical disorders and moving through his discovery that he has multiple personalities and his account of his successful treatment, is a heartwarming, although somewhat perplexing, tale. In reading West's description of the sequential emergences of his personalities, their interactions, and the integration of these personalities, I kept wondering how someone can write a book about his alters if he has only vague consciousness and cannot remember experiences during most of the period he writes about.

Stylistically, the book has many problems. West seems unable to resist intermittent eruptions into glib statements. For example, "We had serious trouble right here in River City. And that ends with why and that rhymes with die and that stands for dead." For those not familiar with the lyrics from The Music Man, this statement has little meaning. The use of metaphors is equally burdened by the need for specialized knowledge to comprehend them. For example, "Battling the infection was like trying to hold back tsunami with a parasol." For virtually everyone in the book, West includes a description of what he or she was wearing, and most times the reader is left confused by the relevancy of these descriptions.

The author struggles admirably to describe the experiential nature of multiple personality disorder, but fails when he tries to make symbolic representations of his experience. For example, "I'm aware that the voices belong to others who live in the lazy Susan of my mind."

West describes various treatments he underwent. He talks about his relationships with several psychotherapists, and one gets a good sense of how a therapist and a patient are a team in pursuit of the patient's goals. First Person Plural also provides a good description of what life is like on a contemporary psychiatric inpatient unit.

The "healed" West describes himself as follows: "I've got 24 alter personalities. I call them my guys even though some of them are females, and we all live together in this body. We try to communicate with each other, try to get along and be concerned about each other's problems, but sometimes it takes so much energy that somebody who may be in real pain gets left out to fend for himself. And if we let that happen … if we don't tend right to it and stick together, we eventually end up having serious problems."

First Person Plural is more useful for patients who have been diagnosed with dissociative identity disorder than for professionals. The book portrays an individual who struggles mightily and a spouse who does the same. And in these portrayals, patients and families may find hope. Similar to the theme of Win the Battle, reviewed below, the message here is that a psychiatric disorder—in this case dissociative identity disorder—can go, through proper treatment and hard work by the patient, from a debilitating force to identifiable pathology to a building block in a constructive life.

With the help of his wife, Melissa, Bob Olson in Win the Battle has mainly written a testimonial talk presented in the form of a book. The first part of the book is the testimonial, while part 2 fills out the book with a series of shorter speeches and some other bits of advice. Win the Battle is about the author's five-year debilitation by bipolar affective disorder, his intense work with three psychiatrists through both psychopharmacologic and psychotherapeutic interventions, and his remission now lasting five years. The book is aimed entirely at individuals with bipolar affective disorder, with the exception of one short chapter directed to physicians, therapists, and nurses.

Olson's message resonates with that of Cameron West's in First Person Plural: work hard in treatment, don't give up no matter what, and you will find successful treatment. Olson's model for this treatment is a three-step process: belief, action, and persistence. Belief is simply believing that an individual can and will find successful treatment. Action is the pursuit of finding it, and persistence means never giving up because "you are sure to find the right treatment for you."

As with any proselytization, the reader encounters repetition after repetition after repetition of the message. Win the Battle is certainly a book delivered from a pulpit.

Each chapter starts with a quotation. The one that best captures the essence of the book comes from Thomas Edison: "Many of life's failures are people who did not realize how close they were to success when they gave up."

By Olson's own description, this book is a "treasure map for achieving … winning your battle with depression (unipolar disorder) or manic-depression (bipolar disorder)." The book is written by an individual who says of himself, "I am your proof that depression and manic-depression are treatable."

Olson makes very cogent points about working with physicians, following through with treatments, learning about one's disorder, and learning how to cope with it. An interesting interaction that Olson experienced with his treaters is that "they respected me for trying, and their respect influenced me to try more."

Is Win the Battle helpful for patients? That's not entirely clear. For patients who are ambivalent about treatment or who have not been in treatment long and feel overwhelmed by their disorder, the book may in fact be inspirational. For individuals who have long-standing struggles with affective disorder and whose outcomes to date have been poor or marginal, this book may be something they can use to castigate themselves, to feel more demoralized by their failures, and perhaps even to worsen their affective states. Both of these possibilities are hypotheses. Take a quick look at Win the Battle and see whether you would consider it useful for your patients.

Lauren Slater's second foray into describing her psychiatric history and its treatment, in Prozac Diary, is more successful than her first effort, Welcome to My Country (1). Prozac Diary is the musings of a woman with a long psychiatric history; she has had five psychiatric admissions, the first when she was 14 years old. The central theme of Prozac Diary is Slater's treatment as an outpatient at McLean Hospital in Belmont, Massachusetts. Fluoxetine was prescribed for her, and she had a stunningly good response to it.

Slater describes her quest to learn how to live as a woman in her thirties who has experienced depression since she was six or seven years old; who had psychiatric hospitalizations in 1977, 1979, 1983, 1984, and 1985; and who knows very little about life without significant psychiatric symptoms. The Prozac pill becomes like magic in her hands. As Slater describes it, "There it lay, cream and green. Tiny black letters were stamped downside—DISTA—which sounds to me like an astronomy term, the name of a planet in another galaxy."

She articulates a myriad of questions such as "Doctors assure the public that psychotropic drugs don't get a patient high; rather, supposedly, they return the patient to a normal state of functioning. But what happens when such a patient, say, myself, for instance, has rarely if ever experienced a normal state of functioning?" Or, "What happens if 'regular life' to such a person has always meant cutting one's arms, or gagging?" She says that "if this is the case, then the 'normal state' that Prozac ushers in is an experience in the surreal, Dali's dripping clock, a disorientation so deep and sweet you spin." In essence, Slater asks, "When you're sick, there are plenty of places (insurance willing) where you can go to get healed, but when you are healed, are there any places you can go to learn not to be sick?"

The author's description of the struggle to find herself, with Prozac in her bloodstream, is poignant and powerful. For example, "Now I am a woman with an apple in my hand. I am a woman who stepped from the opera into silence, a quiet and calm difficult to decode. In making such a move, I am having to learn many new skills, but most of all, it occurs to me, I'm having to learn to leave her [her former self]. This is maybe the hardest part of the pill, the hardest part of health. It is the deepest departure I have ever known."

Slater's autobiography has somewhat of a chronology, but the major trip it takes the reader on is the exploration of an individual's feelings about a medication. Because those feelings are not a diatribe against psychotropic medication delivered by an angry "psychiatric survivor," as has most often been the case in first-person accounts by patients, the expressions are of great value. While reams of material on the psychopharmacology of fluoxetine are available, there is very little on the existentialism of taking Prozac. Read this book—it's a very quick read—and learn what an individual experiences in responding to an antidepressant after years of active symptoms.

Written by Margaret Bullitt-Jonas, Holy Hunger is the story of a 48-year-old woman who grew up on the campus of Harvard University, starving for parental love and attention and self-medicating with food. She writes, "I'm here to get the goods. I don't have to use a weapon or threaten anyone. I don't have to hold anyone up: I have the money for my drug of choice, which is food. But I'm as hard-core as the guy on the street corner who stops passersby to demand money for his fix."

The book follows Bullitt-Jonas' life, touching on points along the way. At age 11 she was in a boarding school in Switzerland, where she was sucking peanut butter off her fingers, wishing "this food would fill the hole in my heart." During tenth grade at a boarding school in Maryland, her bingeing began after years of knowing what she could and could not say in her family. "Every family has its mother tongue; it's a way of shaping the boundary between what can be spoken and what can never be named."

Then she finally realizes how all these things fit together and accepts the dynamics. "I am a compulsive overeater. I grew up with a father who was alcoholic, a mother who was emotionally reclusive. These are facts, yet the recognition of these facts was hard-won, indeed. It came at a price. It took years of inner work before I could perceive the truth, years before anyone could break through my denial about my addiction to food, my father's drinking, my mother's depression."

Along the way the reader is exposed to many of the details of Ms. Bullitt-Jonas' life. We see her go through years of outpatient, insight-oriented psychotherapy and her attempts at treatment through Overeaters Anonymous and Adult Children of Alcoholics. Unfortunately, the author's story is considerably weakened by her tendency to clichés and melodrama.

Bullitt-Jonas seems intent on having everything work out. She measures her success as being neither disappointed nor angry at anyone in her life. She says, "What kind of story heals? A story that is both loving and true, but that nothing essential is left out, neither the pain nor the joy. Loving, because everyone in the story—narrator protagonist and characters alike—is seen with compassionate eyes." The reader is left with an autobiography written by a woman who becomes an Episcopal priest and leads spiritual retreats throughout North America. In the end, Bullit-Jonas' Holy Hunger is heavy on the holy and light on the hunger, leaving this reader not fully satisfied.

As its subtitle indicates, Inner Hunger, by Marianne Apostolides, describes a young woman's struggle through anorexia and bulimia. The author, who grew up in Garden City, New York, a New York City suburb, was president of the student council in high school and a graduate of Princeton University. She describes ten years of anorexia and bulimia. The book is a combination of her own story interspersed with educational chapters on anorexia and bulimia, focusing exclusively on females with these disorders.

Apostolides, whose weight ranged from 80 pounds to 160 pounds, describes anorexia as a means of asserting herself. "Since I didn't feel capable of asserting myself in a positive way, I subconsciously 'asserted' myself by becoming an emaciated, unhealthy, fragile girl. I got sick as a means of making people recognize that I had value."

Apostolides does a good job of describing the shifts between anorexic and bulimic phases. She poignantly details how one phase would invariably and repeatedly drive her to the other. This pattern indicated to Apostolides and to everyone she came in contact with that she was out of control—or, even worse, "My body became a billboard announcing to everyone that I was a pathetic, deviant failure."

Inner Hunger has some useful messages and some dangerous ones. In the first instance, Apostolides describes binges of sex as if somehow they would become substitutes for binges of food. Her failure to reject substance abuse—in fact, her endorsement of experimentation—is worrisome. Her mischaracterization of psychiatrists as not physicians certainly doesn't help the field: "Most people get an antidepressant prescription from a psychiatrist in consultation with their primary therapist, rather than from a doctor in consultation with their primary therapist."

Overall, Inner Hunger can be a valuable resource for young women struggling with problems of self-worth and eating disorders. However, it contains enough misinformation that it should be read in conjunction with an informed parent or therapist and be used as the basis for discussion.

Dr. Geller is professor of psychiatry and director of public-sector psychiatry at the University of Massachusetts School of Medicine in Worcester.

Geller JL: Book review of Welcome to My Country. Psychiatric Services 47:658-659,  1996
 
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References

Geller JL: Book review of Welcome to My Country. Psychiatric Services 47:658-659,  1996
 
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