May 18

“Imagine Me Gone”: Mental Illness In the Family

Adam Haslett‘s new novel Imagine Me Gone echoes a main theme from his highly acclaimed 2002 debut, You Are Not a Stranger Here: mental illness and its effects on loved ones.

As Haslett tells Scott Simon, NPR, there’s personal background to go with this: “…I’m no stranger to mental illness. You know, my father committed suicide when I was 14. My brother indeed suffered from anxiety. And I’ve been no stranger to those states myself, luckily, for some unknown reason, not in the same severity of my father or brother.”

Kirkus Reviews introduces Imagine Me Gone: “This touching chronicle of love and pain traces half a century in a family of five, from the parents’ engagement in 1963 through a father’s and son’s psychological torments and a final crisis…Each chapter is told by one of the family’s five voices, shifting the point of view on shared troubles, showing how they grow away from one another without losing touch.”

More info from Heller McAlpin, NPR, about the five family members:

…a British-American couple, John and Margaret, and their three grown children. We learn early that Margaret chose to proceed with her marriage to John even after unexpectedly learning about his history of severe depression during their engagement. We also learn that their eldest son, Michael, manifested a ‘ceaseless brain’ and obsession with the plight of slaves even as a child, while their daughter Celia began showing mature coping skills at an early age. Celia recalls the time her father cut the engine and played dead on a small boat in Maine, testing her and her younger brother Alec with the challenge, ‘Imagine me gone, imagine it’s just the two of you. What do you do?’ Celia kept her cool and reassured her panicked brother to regard it ‘like a safety drill at school.’

Celia becomes a social worker, Alec “a bossily opinionated gay man” (WSJ), but in the center of family turmoil is Michael. The following is an oft-cited quote from the book about Michael’s high anxiety, for which many different medications are tried:

What do you fear when you fear everything? Time passing and not passing. Death and life. I could say my lungs never filled with enough air no matter how many puffs of my inhaler I took or that my thoughts moved too quickly to complete, severed by perpetual vigilance. But even to say this would abet the lie that terror can be described when anyone who’s ever known it knows that it has no components but is instead everywhere inside you all the time until you can recognize yourself only by the tensions that string one minute to the next. And yet I keep lying by describing because how else can I avoid this second and the one after it? This being in the condition itself, the relentless need to escape a moment that never ends.

Jessica Winter, BookForum: “…Michael is…a figure at once half-deranged and brilliant, stymied and restless, utterly self-absorbed and yet pseudo-empathetic to the point of pathology…Imagine Me Gone confronts the moment when the motion finally stops, when the mind’s wheels spin and squeal against the skull until a person breaks apart, his family looking on helplessly, haunting him and haunted by him.”

Despite the seriousness of Haslett’s material, apparently there’s also no shortage of humor.

Alexis Burling, San Francisco Chronicle: “Haslett hits the nail on the head when it comes to describing just how anguishing and time-consuming psychiatric disorders can be, not only for the afflicted but also for the flailing loved ones trying their damnedest-and failing-to find a suitable fix…”

Mar 13

“Side Effects” Spoiler: Shrink Boundaries and Ethics

Previously I posted a preview of Side Effects, a new film directed by Steven Soderbergh. That, of course, was before I’d seen it; now I want to say more. Major Side Effects spoiler ahead: Read this post only if you’ve already seen the movie and/or want to know how psychiatrists are portrayed in it.

First, The Not-So-Big Revelations

It’s actually no revelation at all that medication “side effects” that may have led to a murder are a significant factor in this film.

On the other hand, it may be a revelation to some viewers just how enmeshed the relationship between psychiatrists and the pharmaceutical industry can be. It’s a common viewpoint and one that’s succinctly put by psychologist Tyger Latham in his post “In Bed with Big Pharma“: “…(T)he psychiatric field has allowed itself to be co-opted by the industry and failed to fully question the scientific merits of those psychoactive drugs which they prescribe.”

A related issue presented in Side Effects is the ease and quickness with which some shrinks make psychiatric diagnoses. Kelly Patricia O’Meara, author of Psyched Out: How Psychiatry Sells Mental Illness and Pushes Pills that Kill, points out in her movie-related post that “the psychiatrist merely has to briefly listen to the patient’s life complaints and, voila, the psychiatrist is able to determine the exact alleged mental disorder.”

Bigger Revelations

Read reviewer Rex Reed‘s strongly negative critique and without warning, he spills a huge Side Effects spoiler: “What started as a cautionary thriller about drug abuse…now turns into a battle between two psychiatrists for the soul of their patient—one who keeps her medicated, the other who turns out to be her lesbian lover.”

Well. As we know that Jude Laws character, Dr. Banks, isn’t the lesbian lover, hmmm…who could it be? The one well-known star that every critic mentions is another psychiatrist but then barely says a word about? The former shrink of Emily, the homicidal patient of Dr. Banks?

Anil Vora at Bi Magazine describes this Side Effects spoiler thusly:

The ‘surprise’ plot twist in the final act is that Victoria Siebert (Catherine Zeta-Jones) is bisexual. By this point in the film we have also learned that Siebert is self-serving, a corporate sellout, and a hypocrite. But she has also done something completely unethical. To get her to confess to this crime, Emily Taylor (Rooney Mara) seduces her. We learn that Taylor had previously seduced Siebert when she was Siebert’s client in therapy. Siebert had allowed herself to be seduced and had sex with Taylor.

What many viewers may not realize is that it’s the shrink who is always responsible for setting the boundaries. It doesn’t matter who seduces whom. Crossing this line is considered exploitative and highly unethical.

Siebert also plots to commit murder—an infraction so obvious it doesn’t need to be spelled out in ethics manuals. In the mind of internist Dr. Frank Spinelli, as expressed in his post titled “Harmful Side Effects,” another aspect to this situation that sucks is that “(i)n perpetuating the stereotype of the crazed gay killer, Soderbergh marginalizes gay people.”

Fellow member of the psychiatry specialty Helen M. Farrell writes in a Psychology Today post regarding some other ethics violations in Side Effects. For one, shock treatment is used as a threat against the patient, Emily; another is that, in an entirely vengeful act by Dr. Banks, Emily is eventually committed against her will to a mental institution .

Dr. Sasha Bardey, the specialist in forensic psychiatry who served as the movie consultant, has apparently indicated that the film’s plot is largely based on real cases or incidents. Therefore, Psyched Out author O’Meara asks: “…(O)ne has to wonder who is the real-life patient that has been committed to a mental institution because the psychiatrist wanted revenge?” In other words, does this actually happen? Do all the other things? How often?

And how about other actions of Siebert such as blackmailing another psychiatrist (Banks) and committing securities fraud?

In Conclusion

Don’t get me wrong. When I saw Side Effects, I was interested in the plot and didn’t always mind that psychiatry was being lampooned and criticized. I’m also okay with some Hollywood-type stretching of reality, whatever the topic.

But will the movie makers out there ever give shrinks a break? Present a more balanced picture? Can’t they lay off the tired ethics breaches, particularly that of becoming sexually involved with a client—especially when little is done to point out how wrong this is?

In the finale, after all, what are the actions that get Siebert into trouble? The securities fraud and conspiracy to commit murder, not having sex with a client. Because the latter is only an issue when the patient complains—and this never happens in popular movies.