First-Person Accounts: The Importance of Being Honest

First-person accounts, or memoirs, have held an important role in the development of American psychiatry. Early editions of the American Journal of Insanity published letters from patients to asylum superintendents, although Isaac Ray warned Dorothea Dix in 1864 to be cautious about the reliability of such letters. Nineteenth-century accounts, such as those by Elizabeth Packard, highlighted perceived abuses of psychiatry and contributed to commitment law revisions. Clifford Beers' 1908 account, A Mind That Found Itself, incited the founding of the mental hygiene movement.

Over the past half-century, persons in the public eye have published accounts of their psychiatric disorders. Recent examples include Jane Pauley's account of her bipolar disorder and Brooke Shield's account of her postpartum depression. Authors who wished to take liberties with factual accounting of their illness and treatment have chosen in the past to provide their account as fiction. Thus, we have such classics as Mary Jane Ward's Snake Pit and Joanne Greenberg's I Never Promised You a Rose Garden .

Some first-person accounts became known more through what happened to them after publication than through the book itself. The film version of Susanna Kaysen's Girl, Interrupted made it widely known, while a pharmaceutical company did the same for Lori Schiller's The Quiet Room: A Journey Out of the Torment of Madness.

First-person accounts have provided information to the public about psychiatric disorders and their treatments, decreased stigma, and spurred many to press for reforms. There is a basic, implicit contract between author and reader: what is portrayed in any nonfiction account is, to the best of the author's ability, true.

Recently, the value of first-person accounts has been called into question by the breaking of the covenant between author and reader. The driving force for this deviation may be authors' interest in achieving fame (and perhaps fortune) in an environment where exaggeration or misrepresentation may be seen as necessary to rise above the general din of scandal. Thus James Frey has been severely criticized for distortions of the facts in A Million Little Pieces ; the family of "Dr. Finch," the central figure in Augusten Burroughs' Running With Scissors, has indicated that this account is rife with events that simply never happened.

Psychiatric Services values first-person accounts, through both a column devoted to these accounts and occasional book reviews of them. This month's book review section is entirely devoted to first-person accounts. We cannot afford to lose the valuable perspectives of those who are willing and able to share the nuances and consequences of their mental illnesses and their treatments.