The New Yorker ‘s Psychiatric Evaluation

In the Jan. 8 issue of The

New Yorker, Daphne Merkin describes her multiple stays on the psychiatric

wards of several institutions. She tells us of her desire to die, her fierce

and unremitting attraction to death, describing the boredom, the flatness, the

grayness of her hospitalized days. The piece is written with exquisite control,

perfectly chosen details, a bare whisper of the acute, lobe-penetrating pain

hissing beneath. She writes coolly about the furies that have attacked her

periodically since she was 8 years old. She has stared at them-is staring at

them still-and knows that staring doesn’t scare them away. She knows she may

not emerge from the darker cycles ahead.t

This is not a piece filled with confessional details. It is

far more of a hardened journalist’s report from the battlefield than a gory,

four-hour war movie. But it has a shocking effect. Because despite our

enlightened pose, mental illness frightens us in a special way, still carries

an aura of shame and failure that renders it different from artery leaks or

brain tumors-even in the age of Oprah. We fight to keep our medical records

private. We fight to keep our darkest dreams private. Each morning we make

ourselves up to present our prettiest, cleanest selves to the world, our

tremors hidden, our dental records filed away, our closeness to death our own business,

not for publication.

As a result, stories by Sylvia Plath, Robert Lowell, A.

Alvarez, William Styron and Kay Redfield Jamison seem to vibrate with

transgression: The curtain has been pulled back, and we are allowed to visit

places where we do not belong. It is this transgression that makes for such

good reading, grabs our attention and emboldens our not entirely nice,

rubbernecking curiosity-pulling us in, moths to the flame that is consuming

someone else.

It is the writer’s prerogative to rummage in exactly those

attics that have been marked “off limits.” It is the writer’s responsibility to

go right to the edge of human experience and explore the very place where the

dragons are licking their chops. Since the age of Columbus ended, the mind has

been the writer’s richest terrain, and one’s own mind is without doubt the

fertile crescent of the writer’s project. But Daphne Merkin has done a brave

and wondrous thing (even if it is in the job description): She has made clear

that what we can offer now-even to the best, the richest and the most educated

of the dangerously depressed-is not much more than a cupping of the soul, a

bleeding that leaves the patient to fight another day.

Think if Daphne Merkin had been poor, how quickly she might

have joined the homeless. Think if years of therapy hadn’t steadied her shaky

step, how many more times she would have fallen and how much shorter and less

fruitful this brilliantly productive life would have been. Think if there

weren’t family to take in her young daughter, to accompany Ms. Merkin to and

from the hospital. Think if there had been no great talent, just raw, boring,

incapacitating illness-what would have happened?

Money and mental illness, insurance and deep pockets should

have nothing to do with one another. But they do, oh they do, and that fact is

just one more nail in the coffin of our democratic responsibility to the

weakest among us . We are very far

from living in a just society. While mental illness blasts apart life on Park

Avenue as equally as it does in Bed-Stuy, the chances of surviving to write

about it are not equal. That is our shame. In the old days of lengthy stays at

expensive places like McLean and Austen Riggs, the patients at least received

the focused tenderness of a staff that knew them, that was trying as hard as

possible. But now the H.M.O.’s have spoken, and the patients are hustled

through. Medicine doses are adjusted, but no one has the time, the months it

takes to know anyone. The expensive way probably didn’t cure large numbers, but

it might have better preserved the civilities of care, the amenities of a

helping hand and a listening ear. Now we are on a shuttle that stops for no


I am not dewy-eyed about

the holiness of writers. The story I am discussing would never have appeared on

Ms. Merkin’s computer screen had the writer not possessed a more than

considerable need for attention. Some writers have an exhibitionism that the

Puritans would despise, that would make any psychoanalyst a little nervous. But

it is nevertheless a prerequisite

for some kinds of writing. Writers of a certain sort do tend toward an almost

perverse form of lifting the window shade at all the wrong moments. I admit to

being a part of that sisterhood myself. From time to time, wrapped in my holy

writer’s mission, I may have seriously harmed myself or others. Writers are

prodded toward what they say out of complicated, self-serving need. But the

public, those who watch when the shade is up-they, too, have odd motives. In

the end, writing well is still the best defense against the monsters within,

the good citizens without. Writing well is not only a revenge against those who

have rendered one powerless, but also a beribboned gift, an offering to the

rest of us, a way of expanding our ability to use the whole ball of wax rather

than just our little God-given piece.

The truth that Ms. Merkin brings us is that psychiatric

institutions are holding pens, vastly expensive timeouts, not particularly

humane or caring places. They are mostly helpless before the roaring of the

illness they contain, but necessary because there is nothing else, because

there is no cure. Nevertheless, these hospitals provide the only hope, even if

this hope is not first-rate, not genuine. As Daphne Merkin describes it, as we

have heard it from others, these hospitals do not grant renewal; rather they

provide-with the best of intentions-a dreary half-time show.

I wonder why it is that we can see the protein combos of the

tiniest microbes and all the moons that circle Mars, but we cannot assure that

every little girl will hopscotch right into a calm and rewarding adulthood-one

that banishes the nightmares, defeats the dark voices within. Reading Ms.

Merkin’s story, I thought of the hundreds of thousands of minds pulled down

toward death, of the voices sending out a siren song of hopelessness across the

land, a deathly loon call echoing lake to lake.

Daphne Merkin bravely gives words to the silent scream and

deserves not our pity, not our voyeurism, but-better than our sympathy-our envy

and admiration of her sharp eye and sharper tongue. We need her to stay with us

for a very long time. The New Yorker ‘s Psychiatric Evaluation