More, Now, Again: A Memoir of Addiction • The Camera My Mother Gave Me • Lying: A Metaphorical Memoir

Three first-person accounts are reviewed here each written by a woman who has previously published work about her mental illness: Elizabeth Wurtzel (1), Susanna Kaysen (2), and Lauren Slater (3,4). In each book, the author speaks about her experiences with pathology other than psychopathology.

In More, Now, Again: A Memoir of Addiction, Elizabeth Wurtzel, a 30-year-old single, Jewish author from New York, portrays her trials and tribulations, including popping Ritalin, snorting cocaine and heroin, and pulling out her leg hairs. Her psychiatric labels are depression, polysubstance dependence, and trichotillomania. In this personal account, Wurtzel recounts her journey from lower Manhattan through the tedium of southern Florida to months of inpatient rehabilitation in Connecticut. The book is an account of a substance abuser who tracks through rehabilitation, restabilization, relapse, rehabilitation, and finally drug-free recovery. The book loses what might have been a powerful antidrug saga, because Wurtzel makes it very difficult for the reader to care about her.

Wurtzel characterizes herself as follows: "I love to talk"; "I'm cursed with a personality that feels too much or too little"; "I'm so fucking empty"; "ridiculous … neurotic … undependable"; "I've been looking for salvation my whole life"; "I'm a wuss"; "always seeking approval"; "a drug addict"; "aloof… uncaring … vain … selfish"; "I never learn"; "I'm an awful person"; "terminally unique"; "a pain in the ass"; and a "fucked-up failure." The reader might think that much of this self-characterization is due to Wurtzel's depression—particularly readers who are familiar with Wurtzel's autobiographical account of her depression, Prozac Nation (5). However, in More, Now, Again, Wurtzel tells us that Prozac Nation "was, after all, just me prattling on and on about my problems." Terminology that Wurtzel does not use that describes her self-portrayal include entitled, narcissistic, self-centered, self-destructive, and a user, more of people than of drugs.

More, Now, Again is simply too long, leaving the reader feeling that the book might better have been titled "Now, More, Again?" Wurtzel could have written the entire book in three sentences that she includes in the over 300-page account: "For all my life I've needed more." "I don't want to wait for the answer." "I've already used everyone up."

The Camera My Mother Gave Me, by Susanna Kaysen, is a large, small book. The book measures less than six inches by eight inches, has fewer than 160 pages, and is printed in a font size that will challenge very few readers, even without their reading glasses. Kaysen's account, however, is powerful in its ability to capture how a single symptom can override virtually all aspects of an individual's life, to wreak havoc with her very being.

Kaysen's symptom is vaginal pain. She is quick to point out that one thing that vaginal pain does is remind the person who has it that she has a vagina. Kaysen reminds the reader that without the pain, one doesn't feel the presence of her vagina most of the time. Because Kaysen becomes constantly aware of her vagina, she seeks relief.

Among the practitioners Kaysen visits after getting no relief from her gynecologist are an internist, an alternative medicine nurse, a "biofeedbackologist," and a "vulvologist." This cohort prescribes various remedies for Kaysen, including vaginally inserted antifungal cream, vinegar rinses, an unnamed pill, salt water soaks, estrogen creams, a jelly formulated with the proper vaginal pH, baking soda, lubricants, tea, novocaine, and cortisone. In addition, amitriptyline, fluoxetine (which Kaysen never took), and biofeedback were prescribed.

Kaysen received no shortage of advice. She learned such things as "the more you use the vagina, the better its health." When told to keep a pain diary, Kaysen's retort was "my whole life is a pain diary."

Kaysen adroitly describes not only how a symptom can be destructive to an individual's sense of self and sense of well-being but also how that symptom can be destructive to relationships. The sequela of vaginal pain is a painful life.

Even though The Camera My Mother Gave Me is a short book, Kaysen goes off on an unfortunate sidetrack in references to her psychiatric history. At one point, when she goes to St. Mary's hospital for her first biofeedback appointment, she indicates that the long-term care hospital "had much in common with the psychiatric hospital where I'd spent two years of my youth." The reference to Kaysen's autobiographical Girl, Interrupted is unnecessary. Kaysen goes further, however. Because antidepressants were prescribed to address the dysphoria she experienced as a result of the vaginal pain, Kaysen uses the opportunity to provide a one-half page chapter entitled "Why I Am Opposed to Antidepressants." Although I think this digression derails the progress of this autobiographical account, Kaysen's opinions are worth repeating for the readers of Psychiatric Services. Kaysen opposes antidepressants because she thinks "depression has something to tell me; because often depression is an appropriate reaction; because I am terrified of changing the function of my brain in any way; because I believe that depression is 'me,' and that without it I would not be 'me'; because I can't imagine my life without the time off I get from periodic depression."

All health care practitioners should read this book, and many will read it in one sitting. At the end of the account, Kaysen says, "My vagina keeps trying to get my attention. It has something important to say to me. I'm listening." We should listen too.

Lying, by Lauren Slater, is her best outing to date. It is an autobiographical account—or maybe not—that Slater characterize as follows: "When all is said and done, there's only one kind of memoir I can see to write, and that's a slippery, playful, impish, exasperating text, shaped, if it could be, like a question mark." Slater writes about her life with epilepsy, a disease that she may or may not have had. The thesis of this book can be summarized in the question, "What aspects of an autobiographical account are actually accurate?"

Slater's first chapter is two words: "I exaggerate." In chapter 2 Slater informs the reader: "I have epilepsy. Or I feel I have epilepsy. Or I wish I had epilepsy, so I could find a way of explaining the dirty, spastic glittering place I had in my mother's heart." Slater learned about epilepsy at school and saw movies portraying individuals with epilepsy, so, she says, "I know what it is." Slater informs the reader that "epilepsy shoots your memory to hell, so take what I say, or don't."

Throughout her book, Slater points out both the difficulty that authors face in providing a realistic autobiographical account and the difficulty that readers have in evaluating an autobiographical account. For example: "That was the night I started to steal. Maybe I'm wrong. Maybe I really started to steal a few days after that, or a few weeks before. Maybe it's just certain narrative demands, a need for neatness compelling me to say that was the night or, and this led surely to this, my life a long link of daisies, a bolt of cloth unbroken, I wish it were." Slater highlights the difference between "emotional memory" and "factual memory," and she leaves the reader wondering on almost every page whether what they are reading is fact, or even if there is fact.

But lying, if that's what it is, has costs. "Lying is lonely." The reason: "No one knows you." Slater informs us that "just because something has the feel of truth doesn't mean it fits the facts." She muses, "I don't even know why the facts should matter." This is a particularly interesting observation, because many facts about geography, architecture, and services in the greater Boston area that are mentioned in the book are in fact incorrect. Errors on Slater's part? Intentionally misleading the reader? Or not bothering to check out details because they simply don't matter? Slater elaborates: "Why is what we feel less than what is? Supposing I simply feel like an epileptic, a spastic person, one with a shivering brain; supposing I have chosen epilepsy because it is the most accurate conduit to convey my psyche to you? Would this not still be a memoir, my memoir? After all, if I were making the whole thing up—and I'm not saying I'm making the whole thing up—but if I were, I would be doing it not to create a character as a novelist does, but, instead, to create a metaphor that conveys the real person I am."

Stylistically, Lying has some interesting features. Slater makes good use of analogies. For example: "When my period came, you could barely even tell. I had imagined blood spooling generously from inside. Instead, there was just a brownish little flow, like rusty trickles from an old tap." Slater frequently speaks directly to the reader, on some occasions addressing the reader as "dear reader." One unfortunate stylistic device is referring to persons with epilepsy as "epileptics." Slater makes the point that a person is not her disease and then translates the disease into a noun form referring to a person. In the book, Slater talks a great deal about the book itself. Sometimes this becomes a bit too much, making the reader wonder whether Slater doesn't trust her readers to ascertain what she's done or how clever she's been, and hence needs to point it out.

Slater's coup de grace may be the "scientific" sidetracks she takes, such as her discussion of Munchausen's syndrome. She includes "excerpts from journal articles" and provides citations for the quotations. However, the citations are bogus, but not so off the mark that the casual reader might not believe them. Slater subtly changes journal names, or provides volume numbers that don't exist, or provides content that uses language not known at the time of the particular volume number. No dates are given for any of the citations.

Lying can be highly recommended for a general readership. It should prove particularly interesting to therapists of all disciplines whose treatment is based on oral autobiographical material, notably psychoanalysis, psychodynamic psychotherapy, and narrative therapy. For those interested in the concept of lying, a recently published book by Jeremy Campbell entitled The Liar's Tale: A History of Falsehood (6) will be of interest.

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