January 23, 2021

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What a Lost Psych-Ward Memoir Teaches Us About Madness

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Bette Howland holds her life at arm’s length in “W-3.”Photograph courtesy Saul Bellow Papers, Special Collections Research Center, University of Chicago Library

Society loves “rediscovering” authors; the act suggests something alluring about both our taste and the arc of justice. Recently, writers such as Lucia Berlin and Eve Babitz have been exhumed to fanfare, proving that the elevation of unsung talent can be thrilling—and even a little lucrative. (Extra points if the talent is female.) But some rescues are especially spectacular. Take the author Bette Howland. A protégé of Saul Bellow, Howland won a MacArthur Fellowship, in 1984, for her pure, inward fiction, and then faded from view—only to reëmerge, in 2015, when a copy of her memoir, “W-3,” caught the eye of Brigid Hughes, a New York editor browsing a bookstore’s dollar cart. “W-3” refers to a Chicago psychiatric ward; the work describes Howland’s stay, in 1968, after she swallowed a bottle of sleeping pills. Now reissued by Hughes’s nonprofit, A Public Space, the book feels at once crafted, its prose full of calibrated grace, and startlingly unmediated. No brush (with obscurity) is necessary to buff its surface.

Tales of institutionalization tend to clump into subgenres: anti-authority parable, à la “One Flew Over the Cuckoo’s Nest”; drama of damage, à la “Girl, Interrupted.” Generally, they critique the medical system, which is shown to turn complex people into patients. This isn’t Howland’s way, though she doesn’t dispute what hospitals do. Rather, her account of their homogenizing procedures can’t quite be called a critique. When “W-3” ’s narrator makes up her mind to die, it is because she is overtaken by a kind of fatal boredom with the facts of her life: “I wanted to abandon all this personal history—its darkness and secrecy, its private grievances, its well-licked sorrows and prides—to thrust it from me like a manhole cover.” Howland is desperately sick of herself; she’d try anything new. And the ward, at least, has newness going for it, with its “brash strangeness . . . perhaps in the mind, a bright, stunned state.” Howland, an expert defamiliarizer, depicts doctors and nurses not as characters but as a motif, a hydra of pea-brained condescension. Here are the physicians, their “mustaches and beards” conveying “such dark, silky intensity, that it startled me to see how bored were the faces behind them.” And here are their methods: “Inmates were drugged to the point of stupidity, then patted on the shoulder and urged to get it all out.”

Could such a treatment plan possibly help anyone? In “One Flew Over the Cuckoo’s Nest,” the notion that some people do, in fact, belong in a mental hospital is the normative ostinato under McMurphy’s song of self. But Howland seems reluctant to reinscribe the cruelties of these categories: sick and well, normal and abnormal. Suspicious of the ways in which they are delineated, she proceeds according to a simpler binary. Those who suffer are patients. Those who don’t are not.

The choice for Howland thus becomes one between the vulnerability of the inmate and the brusque, fatuous bullying of the keeper. Early on, she describes a squad of patients and nurses pressuring a woman named Flora to go on a group outing. The woman resists. Howland reflects: “If I felt swayed by Flora, moved by her tears, wanted impulsively to leave her alone—then I was identifying with her helplessness, weakness, panic—I was sick. But if I went along with the group, enforcing its collective pressure, bearing down on Flora . . . what was I?” Eventually, Flora joins the others, and they squeeze into the elevator, at which point the patients remember, en masse, that, actually, “nobody really wants to go.” Howland paints the scene:

We forgot all about that—too busy coaxing poor Flora. We’re being
forced, that’s what it is! Packed into a boxcar like cattle! In a
panic, we break for the doors. But it’s too late—the doors are sliding
shut. The nurses shove against us. The doors close. Down we drop.

There is something both transfixing and slippery about the tone of this passage. Often, books set in mental institutions are at their dullest when they are presumed to be at their most fascinating: when the inmates are depicted “acting crazy.” These scenes, relayed faithfully by the narrator, are supposed to build atmosphere (or comedy), but they often just beat a dead horse—if one can’t access the logic behind a flight of illogic, one’s attention wanders, sated of novelty. Howland’s “we,” though, is a passport into meaning. The patients’ consensus gives them grace, solidarity: the “community” that the staff pretends to encourage. And yet Howland also stands apart. Her tone, recounting the stampede toward the doors, feels slightly mocking. She’s no longer present in the anguish of the moment, but she isn’t explaining it to us from without, either. Instead, she seems to be ironically reconstructing a flood of feelings that has already subsided, serving them up as a wry, self-conscious simulation: “We’re being forced, that’s what it is!” There’s the nauseating sense that Howland is veering ever closer to a real, claustrophobic horror—one that even now lunges toward her, out of the past—but, thank God, the doors are sliding shut.

Much of the power in “W-3” can be chalked up to this dance of distance and nearness. Howland holds her life at arm’s length; recounting a nurse’s rudeness or a fellow-inmate’s aggression, she sounds grateful for the good material. The prose, too, is pointedly unstraitjacketed. (A patient “perambulated down the corridors lashed to her intravenous stand . . . looking like a sort of injured parade float.”) Howland only glancingly mentions her two sons, who move in temporarily with her parents, and she achieves a pinnacle of remove in her evocations of her mother, whom she compares to a charismatic weasel: “Her handsome, conspicuous white head—sleek, striking, like an ermine.” The sketches are all so pleasurable that one almost misses the intimations of a deeper pain. (After likening her mom to a seal, Howland adds, “I think she has had a difficult life; I’ve done my bit.”)

It all feels like an attempt to overwrite, or perhaps just write away from, the present tense of suffering—which, for Howland, is akin to madness. Similes, any device that transforms a thing into what it is not, become helpmeets: if Howland’s mother suggests a glamorous animal, then the patients appear as beautiful aliens, with eyes like “cosmic dust” and faces possessing “a frozen radiance, a space look.” What is Howland escaping? Pain, yes, but also cliché. “Nothing was original on W-3,” she writes. “There was no novelty. One gesture was stale, powerless, and unoriginal as the next.” This may be due to the totalizing force of the psych ward, a place that takes over one’s identity so completely that it can seem to predict one’s every move. (Do anything at all, no matter how odd, and the system responds: of course you did.) But this is also how trauma behaves. Whoever you are, pain feels like pain, too clunkily obvious to narrativize. When Trudy, one of Howland’s friends in the ward, opens up about her problems, her “self-revelations were so predictable as to leave you speechless.”

When people write about their rendezvous with mental illness, there are often a few false notes scattered among the true ones, places where the meaning of the thing feels not fully absorbed. Howland’s book struck me as remarkably perceptive and wise, but there was one passage, toward the end, that protruded as an exception. Howland’s friend has sprung her from the ward for an afternoon. He takes her out for steak and tells her that she doesn’t belong in a mental hospital. But Howland realizes that she disagrees. “I’m afraid I won’t be able to help myself,” she replies, and continues, in her head, “I had only just now grasped my true situation. You can’t take up arms against the outer darkness. You can’t rely on self, on argument, on rational persuasion. There is only one thing you really need to know. That it isn’t yourself. That the force is the enemy’s. That you are alone, helpless, hiding your head—but that you don’t want to die.”

This analysis isn’t wrong, exactly—the terror of suicide’s lure deserves an airing—but it does not feel like the neat summation, the moral of the story that Howland wishes it to be. She seems, here, to want to frame her time in the ward as a necessary, if ego-destroying, obeisance to health: I did not have the power to resist my sickness, so I surrendered to those who could assist me. The seductiveness of such an account is obvious, but, if I were to pull, from between the lines of Howland’s own memoir, a more honest narrative, it might go like this: I was broken, and I went to the place where people go to be broken. It was a dysfunctional unit that undid my identity in a way that felt both familiar (from my illness) and new. Howland stays in the ward until she is no longer sick of the person that she was; then, she leaves. “I had had what is called a breakdown,” she writes, at the end of the book. “I had . . . got myself . . . free of my own personality, my particular history. . . . Now I was ready to reclaim it.” This may not be the smug sentimentality of the memoir’s psychiatrists, who are eager to congratulate Howland for submitting to their expert care. But it does seem to contain the felt truth of someone who parted from her life and then returned. No one is going to rediscover you. You have to rediscover yourself.

Katy Waldman


2021-01-05 15:23:25


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