Working the Trap: On Suzanne Scanlon’s “Committed”

AT 20, WRITER Suzanne Scanlon checked herself into the New York State Psychiatric Institute. The ward, her home for the next three years, was a living relic of the midcentury golden age of long-term inpatient psychiatric care. Dorms and common spaces radiated outward from a panopticon-like nurses’ station, presided over by a framed photograph of […]

The post Working the Trap: On Suzanne Scanlon’s “Committed” appeared first on Los Angeles Review of Books.

AT 20, WRITER Suzanne Scanlon checked herself into the New York State Psychiatric Institute. The ward, her home for the next three years, was a living relic of the midcentury golden age of long-term inpatient psychiatric care. Dorms and common spaces radiated outward from a panopticon-like nurses’ station, presided over by a framed photograph of Sigmund Freud. An outpatient psychoanalyst had diagnosed her with hysteria, that tired, sexist catch-all for female emotional pain; on the ward, Scanlon rehashed her childhood wounds ad nauseam with a rotating group of doctors looking for the magic trauma plot point to explain her suicide attempt months before. The patients—mostly women—spent their sedentary days smoking and watching television, their hands shaking from tardive dyskinesia, the uncontrollable muscle tremors induced by antipsychotics and tricyclic antidepressants.

These scenes of daily life in the psych ward, which Scanlon depicts in her new memoir Committed: On Meaning and Madwomen, bring to mind the standard of care familiar from classic asylum narratives like One Flew Over the Cuckoo’s Nest (1962), The Bell Jar (1963), and Howl (1955), which Allen Ginsberg wrote following his own 1949–50 stint in the same hospital. But Scanlon arrived at the Institute in 1992, at the dawn of the Clinton era, years into the sea change in the conceptualization of mental illness that began with the systematic defunding and closure of long-term psychiatric facilities in the 1960s and accelerated in the late 1980s with the arrival of Prozac, the first SSRI antidepressant.

This shifting landscape, and Scanlon’s struggle to carve out an identity for herself as a young woman within it, animates Committed, a personal history of mental illness as well as a study of the long lineage of writing about madness and medicine. The Institute’s doctors, she writes, “needed me to get better and instead I got better at being sick”—a function of the treatment modalities, already outmoded by the early ’90s, that taught patients to perform illness in exchange for care. Scanlon’s literary heroes, from Virginia Woolf to Audre Lorde, Shulamith Firestone, and many others, offer an antidote to the self-destructive behaviors Scanlon learns on the ward, giving her a more expansive framework for understanding her pain. Though 1992 feels a world away from what psychiatric treatment looks like for patients today, Scanlon’s search for meaning outside the predominant medical model of her youth remains as relevant as ever. Long-term institutionalization may no longer be a common practice, but the approach to mental illness espoused by Big Pharma—“curing” it with profitable pills and mostly ignoring its social, political, and psychological causes—is no nearer to what Scanlon believes ultimately allowed her to heal: the practice of voracious reading and deep thinking that helped her assemble a more resilient sense of self.

Like many accounts of chronic illness, Committed resists traditional narrative structure, a neat story of incitement, conflict, and resolution. Scanlon tries repeatedly to locate the beginning of her pathology, finding traces of it everywhere: in her mother’s death, in her move to New York,  in her decision to stop eating, in her first suicide attempt. She balks at the official narrative brought to life in the medical files she receives from the archives, which offers a neat redemptive arc: a depressed young woman enters the institution, stays for three years, and gets better, thanks to the doctors’ interventions. Though she has since checked the boxes that indicate recovery—marriage, baby, career—the core of her identity was forged in the asylum, and in resistance to it. “I want the details,” she writes. “I don’t want the official language, the axis 1 or axis 2, the list of medications and symptoms. What I want is the story of our long, dull days and years in that hospital. […] It is the quotidian I want to recover.”

As such, Committed flows like a psychotherapy session, with rich, entertaining digressions that culminate in unexpected insights. Midway through the book, Scanlon wonders, “Have I become a writer so that I could do something with those days, weeks, months? This book, too, a way to shape the chaos, the formlessness of grief into something else.” The nature of that “something else” shifts when I try to put my finger on it, as restless and shifting as Scanlon’s young mind. Committed is a difficult book to summarize, rich with the texture of a life, of the passionate and varied intellectual pursuits of its author. Its existence serves as an addendum to Scanlon’s case file, a correction to the record, illustrating how drastically medical narratives can reduce the scope of a life.

Scanlon arrived at the New York State Psychiatric Institute acutely troubled, following a period of self-harm, uncontrollable crying, isolation, and severely restricting her food intake. She describes her affliction as a quality of excessive porousness: “That gauzy feeling, a trap: everything could get in, no boundary between my body and the rest.” Twenty years old, without a fully formed sense of self, Scanlon felt highly susceptible to suggestions from her peers—she attempted suicide after a male friend suggested it—and later from her doctors. In talk therapy, the doctors traced the origins of Scanlon’s pain to her mother’s death from breast cancer when she was eight. The loss was so monumental that the surviving family members were unable to speak of it, leaving her to grow up without language to express the magnitude of her grief. Under the surveilling gaze of the panopticon, Scanlon, a budding actress, learned to perform her pain. “It was a way to please your doctor, and by extension, to receive care,” she writes. She describes reciting the story of her original wound again and again: “I thought back then that the content of the story mattered above all—that I needed to get it right.” Though these treatments provided Scanlon with a measure of insight into what caused her initial descent, they also engendered a learned sense of helplessness: “It is the perfect escape, isn’t it? To lose your mind. To go mad. To fall apart, go crazy, all of it.” But “[t]he perfect escape becomes a trap. […] And there you are, trapped. It might become your life.”

Yet change was underway at the institute, though the extent of it wasn’t visible to Scanlon as she was living it. Perusing the journals she kept as a patient, Scanlon discovers an insight she copied down from a visiting medical resident: “Being sick is a cure for how bad you feel.” The speaker is Dr. Tomlinson, a psychoanalyst Scanlon doesn’t remember, but whose words now strike her as an accurate summation of how and why she fell apart. Looking Tomlinson up online, Scanlon finds him quoted in a 1992 New York Times article about the ward, where a new class of psychiatrists had begun espousing the (still unproven and hotly contested) chemical imbalance theory of depression popularized by Eli Lilly and other pharmaceutical companies. The Times journalist describes a luncheon, sponsored by the pharmaceutical company Upjohn, taking place a few floors below Scanlon’s quarters. Upjohn’s sales representatives are at the hospital to persuade staff psychiatrists that their controversial, habit-forming sleep aid, Halcion, is safe. “The faculty and medical doctors in the ward are split, some favoring Freudian talk therapy, while others were excited by the new pharmaceutical options. The hospital was mired in this split, these opposing factions,” Scanlon writes. “Reading this article so many years later validates my confusion over the nature of treatment all those years.” Dr. Tomlinson is “the voice of reason—the resistance to market forces.” Yet by the end of the article, he appears to have capitulated to Upjohn’s powers of persuasion. Scanlon notes that the reporter “doesn’t speak to a single patient.” Reading the article in the present day, Scanlon is discomfited by this revelation, by the intrusion of marketing and capital into the practices of the ward. “I should not be reading this,” she says. “The details in the article were not meant for me.” Her angst is affecting—in 2024, years into the opioid crisis, we know much more about pharmaceutical companies’ aggressive, sometimes unethical sales tactics, but the magnitude of its influence on the medical care we receive still stuns.

In 1996, a year after Scanlon left the Institute, it closed permanently, a casualty of the new era of psychiatric care. Unlike many of her peers on the ward, Scanlon finished college and built a career as a writer, but even today, she feels altered. “I’d never really become a normal person again,” she writes. “Never really get that feeling of illness out of my system.” Scanlon describes the era that follows as a time when “mental patients became consumers. That neoliberal move—you, too, can buy your mental health care.” In 1997, the FDA reversed restrictions on marketing prescription drugs directly to patients, flooding the airwaves with ads for the latest SSRIs and encouraging patients to ask their doctors if Zoloft was right for them. This Big Pharma era is the one we’re still living in, where online drug retailers like hims & hers position doctor visits as a box to check on the way to accessing your drug brand of choice, purchased through slick websites offering a frictionless user experience. The chemical imbalance theory put forth by Eli Lilly and other pharmaceutical companies has been repeatedly discredited—if SSRIs work, it may be due to the placebo effect, or the palliative benefits of boosting serotonin, but to quote sociologist and psychiatric historian Andrew Scull, “the roots of most serious forms of mental disorder remain as enigmatic as ever.” Or, as Scanlon writes, “drugs can lift your mood, but that doesn’t mean an imbalance caused your depression. This does not mean that the drugs are not helpful; it does mean that the narrative (likely pushed by pharmaceutical companies, and especially so when I was in the hospital) is reductive.”

One of the benefits of growing up in the age of SSRIs is that depression and other mental illnesses don’t carry the same stigma they once did. Recasting depression as a biological illness caused by a chemical imbalance, or by genetics, handily refutes previous conceptions of it as a character flaw or weakness, making asking for and receiving psychiatric care less shameful. I’ve felt the effects of this shift in my own life—when I was first prescribed antidepressants in 2004, at the age of 19, I wasn’t aware of anyone outside of my own family who had taken them. Today, I hardly know anyone who hasn’t. I feel fortunate to have received access to outpatient care that allowed me to continue to develop a sense of self out in the world, even if taking antidepressants every day for the following 17 years also made depression an irrevocable part of my identity.

One problem, though, is that the drugs don’t seem to be working, or to the extent that they are, they operate as a palliative treatment for illnesses whose root causes may be as much social and political as they are biological, and whose nonbiological causes we ignore when we treat SSRIs as a cure. Antidepressant use is on the rise: according to data from the CDC, between 2015 and 2018, 13.2 percent of American adults took antidepressants in a given month. And yet, we’re also more depressed than ever—a 2023 Gallup poll recorded record highs, with 29 percent of Americans having received a depression diagnosis in their lifetime—and not much closer to understanding mental illness than we were when Scanlon entered New York State Psychiatric Institute. We’ve left the solutions to profit-driven pharmaceutical companies and largely ignored the social structures that helped Scanlon most: the world of literature and learning, of humanities-based approaches to care.

¤

If Scanlon’s affliction is a result, at least partially, of unprocessed grief at the loss of her mother, part of the work of Committed is processing the grief of the lost years Scanlon gave up to at best ineffective and at worst actively harmful medical interventions: “I woke up one day and realized that all the drugs I’d been taking, the long and expensive and unresolved conversations I’d been having with doctors—was a waste of time. I no longer believed in it.” What saved her—what saved some, though not all, of the writers who came before her (e.g., Charlotte Perkins Gilman, Janet Frame)—was the work of reading and writing, the way art-making created a space where Scanlon’s porousness was an asset: “I was oversensitive. I’d been told this my entire life. It was a liability […] but it was also a power when it came to reading, a hyperacuity.” Marguerite Duras’s The Lover (1984) teaches Scanlon about longing and desire. Sylvia Plath creates a language of female rage. Audre Lorde’s The Cancer Journals (1980) gives Scanlon “an example of how to tell your own story in the face of a dominant medical model story of illness and recovery. To live outside of normalcy was possible—in this way, the grief […] is a part of you, not an obstacle to life, but rather something that made you who you are.” In the asylum, watching Anita Hill testify against Clarence Thomas during his Supreme Court confirmation, Scanlon realized “[t]here were two worlds” she could live in: “There was a world in which men like Joe Biden and Clarence Thomas held authority; and there was the world of literature.”

In his 1961 book Madness and Civilization, Michel Foucault wrote about the social practice of separating the sane from the insane, first in the medieval era’s ships of fools, then with the asylum. Categorizing a social group as insane reaffirms the sanity, the validity, of those outside of it—a practice that reifies our social order. But these boundaries are less rigid than those of us who think of ourselves as sane would like to believe; those who have slipped to the other side of the divide can tell you as much. “I am writing for the ones who read this and think: This could be me,” Scanlon says. “I don’t believe […] in the sick and the post-sick […] We are all mortal, and we are all fragile. We are all one moment away from disintegration.” Writing about the popularity of multiple personality disorder as a diagnosis in the 1990s, Scanlon notes that “for patients with MPD, one alter was always a slut. This says at least as much about what it is to be as a woman as it does about pathology or madness.” In this framework, the suicides of writers like Virginia Woolf and Sylvia Plath remain a tragedy, but they also represent a mode of escaping social and political structures that confine them, as women and as thinkers: “An immature if necessary attempt to avoid committing to life. Suicide is one way of working the trap, after all.” This is an uncomfortable idea, but it also suggests something we lost when we shifted to a pharmaceutical model that treats mental illness as an individual affliction rather than a sociopolitical one—its capacity to highlight what is sick in the world outside of us.

In the chilling final scene of Committed, present-day Scanlon visits a new doctor at the clinic where she receives prescriptions for her medications. Unfamiliar with her history, the doctor is startled by Scanlon’s file, the three years she spent in the institution. “This is very unusual,” she remarks. “They don’t keep patients in hospitals that long. It makes things worse.” Scanlon tells her she knows this—she’s lived it. “I wanted to tell her to read the books,” she says, wondering if a more robust education in the humanities, in medical history, might have trained the doctor to treat Scanlon as something more than a curiosity. When the 15-minute appointment is up, the doctor, dismissing the three years that still loom large over Scanlon’s life, says, “I really can’t imagine why you were institutionalized for so long.” The treatment of mental illness has changed since 1992, but whether this change represents true progress remains an open question. Even now, it is still the work of writers and readers to fill in the gaps where medicine fails us, to teach us more thoughtful and expansive ways to learn how to live with the grief at the heart of the human experience.

The post Working the Trap: On Suzanne Scanlon’s “Committed” appeared first on Los Angeles Review of Books.