Lucky Man: A Memoir • The Day I Went Missing

Two recent ventures in the genre in which people in the entertainment industry write autobiographical accounts of their psychiatric or neurological disorders (1,2,3) are reviewed here. The first, Lucky Man, is by the well-known television and film actor Michael J. Fox; the second is by the television and screenplay writer Jennifer Miller, whose pen name is Jennifer Heath.

The focal point of Michael J. Fox's autobiography is his early-onset Parkinson's disease. Readers who are not particularly interested in celebrity biography can skip the first half of the book. Unfortunately, for those interested in more than a superficial understanding of Fox's responses to Parkinson's disease, the second half of the book falls short. And readers interested in Fox's psychological responses, including a detailed description of his depression in the face of a debilitating neurological disorder at an early age, will find no more than a gloss treatment of this subject.

Lucky Man, which covers the period between November 1990 and December 1998, chronicles the progressive development of Fox's symptoms from early-onset Parkinson's disease. Fox makes some interesting observations about his celebrity status and his disease. For example: "Odd as this might sound, becoming famous is something that happened to me in the same way that Parkinson's disease is something that happened to me. I'm not saying celebrity is a disease, but it can trigger an abnormal psychological condition not unlike mania or amnesia. I became so intoxicated on the nectar of money and the ambrosia of unlimited possibility that I fell completely under its influence, forgetting for a time that it wasn't real." The abnormality of fame is underscored when Fox talks about interacting with others who are similarly situated, which he compares to a support group whose motto would be "I'm famous, you're famous."

However, unlike celebrity status, to which the actor contributes, a disease and its diagnosis places one, as Fox observes, "in an identity I had no part in creating." His concern and his struggle is to avoid being cast as others "just like me." Will he simply be written off?

Lucky Man covers various coping mechanisms, both constructive and destructive. It provides a good portrayal of the use of alcohol as a destructive strategy. Abstinence brought its own cost: "Although living without the filter of alcohol provided an opportunity to examine every part of my life, it did not immediately equip me with the ability to understand what I was seeing, or to make reasoned decisions about how to react."

A substantial part of the book describes Fox's efforts to remain "closeted," that is, to hide from others the fact that he had a neurological disorder. He would time his medication to be able to "perform," be it in front of an audience or with peers. Fox refers to the distinction between being able to function asymptomatically and being overwhelmed by symptoms as his "on" and "off" periods, referring to the scenario as a "Jekyll and Hyde melodrama."

Through the course of the book, Fox does come to terms with his disorder. He also undergoes a series of interventions, the most dramatic of which is a thalamotomy. His plight sparked a national conversation about Parkinson's disease as he and the other famous sufferer of Parkinson's disease, Muhammad Ali, launched a campaign to improve funding for research on the disorder.

An important message of Lucky Man, and one that is useful for persons who suffer from chronic mental illnesses, is that the expectation of being marginalized and misunderstood, or of being stigmatized, can be held by anyone and need not come to fruition. For patients for whom this is an important lesson to learn, Lucky Man is an easy, pleasant read that may help instill that message.

Jennifer Miller, in her autobiographical account The Day I Went Missing, is moved to subtitle the book "A True Story," perhaps because the account is so outrageous that the reader needs regular reminders that it is not fiction. Miller, who in addition to her writing credentials has worked as an actress and as a stand-up comedian, is the daughter of a psychiatrist. She had gone through five therapies already before she began therapy with psychologist David Cohen, which is the subject of this book.

Dr. Cohen violates every boundary, with the exception of sex with a patient, that any therapist or any patient could imagine, and many that seem unimaginable. Imagine, for example, a therapist asking a patient to pay for 20 sessions in advance but telling the patient that if she changes her mind at any time during the 20 sessions he will give her a full refund. Or better still, imagine a therapist who suggests that a patient pay in advance for a lifetime of therapy!

Miller is perhaps vulnerable to Dr. Cohen's attentiveness because of the emptiness in her own family. Throughout the text, in poignant fashion, Miller points out what she lacked in her family of origin. "That our family was a shell, a beautifully decorated piñata, hollow inside, and in our case, if you broke it open, it would fall empty to the ground." Or "David [Cohen] believed that even as a tiny baby I took care of my mother—cheered her up, entertained her, eased her depression, distracted her, kept her company, helped her avoid the fact that my father was never there and rarely spoke." While Miller points her guns somewhat ambivalently at her former therapist, she hesitates less at highlighting the deficits of a psychiatrist father who was there for his patients but absent from his daughter's life.

Miller, by her own portrayal, suffers from depression and anxiety, but her psychopathology is not the subject of this book. Rather, the subject is how enmeshed a patient can become in the course of treatment with a therapist who knows no bounds in his efforts to meet his needs rather than his patient's. One wonders, for example, how either patient or therapist could think that therapy five times a week at two or more hours per session is a good idea.

In the end, Miller can intellectually acknowledge and affectively experience that what Dr. Cohen did was "immoral and unethical and cruel, and it was criminal." In fact, she wanted to title her book "TheRapist."

The Day I Went Missing reads like a novel or a mystery; it's an easy, quick read. One keeps questioning, at each more outlandish violation on the part of the therapist, could this really have happened? Because this is "a true story," the Cohen-Miller dyad can only be described as the nadir of the therapist-patient relationship.

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