We're All Mad Here: A Discussion of Mental Illness in Literature

Hyvää päivää from Finland!

I hope the summer is being kind to everyone, with plenty of sunshine, minimal contact with wasps and time off for some travel and/or relaxation. Right now I’m on a working holiday, teaching English in a charming lakeside summer camp in Kiljava, and have just about recovered from my overnight trip to Tallinn, Estonia (Travel tip: try the honey beer and the spiced claret in the Olde Hansa, if you ever happen to visit Tallinn’s Old Town. You won’t regret it, at least not until you wake up the next day! There’s also a Depeche Mode bar worth checking out.)

Those of you who I manage to pester into reading my posts will likely recall that my last offering was a (hopefully) light-hearted introduction to a subject that I find to be of great interest: mental illness. For centuries, mental health has been something of a taboo, which naturally accounts for the social and media stigmas that are often still attached to conditions such as depression, anxiety, PTSD, OCD, autism or eating disorders nowadays. In all fairness, however, there have been highly significant advances in the way mental illnesses are researched, treated and talked about over the past few decades, and one particularly effective medium that has facilitated the improvements in how we perceive those affected has been the medium of art. Illustrated books such as Hyperbole and a Half by Allie Brosh show how mental health issues can powerfully impact a person’s ability to think, speak and act, and in the world of popular culture, we are now seeing more and more icons of music, television, film and literature opening up about their own struggles with depression, anorexia, anxiety, and numerous other conditions in interviews and biographies.

Thanks to the recent and increasing rise of diverse depictions of mental health problems and treatments in film, television and literature, we are now gradually breaking down stereotypes that are commonly associated with these illnesses, allowing us to better understand and support those affected, and for those affected to better understand and accept themselves, and help to overcome discrimination in academic, professional, and social life. As always, I’ll be focusing on the literary side of mental illness portrayals, beginning with a look at how such portrayals have evolved over the past two centuries, the varying illnesses depicted in famous literary works, moving on to compare mental illness depictions based upon character gender, and delving finally into the role that the young adult (YA) genre is now playing in raising awareness of mental health among teenage readers.

To start, we will need to go back to the early nineteenth century, the era of the Romantic poets. The likes of Shelley, Coleridge, Keats, Byron and Baudelaire are commonly associated with laying the foundations for literary discourse on mental illness, not just by their creative accomplishments, which often treat such themes as melancholia, lovesickness and intense emotions too powerful to be expressed in any other way but in metaphor and verse, but by their own states of mind; Lord Byron, in fact, has often been described in modern media as “mad, bad and dangerous to know”, and was known to suffer from bulimia. During this time, awareness and understanding of the vast spectrum of mental illness was severely limited, as is eloquently explained in Chloë Filson’s Talonbooks article, “Portrayals of Mental Illness in Literature: From Tennyson to Today”:

“In the early nineteenth century, popular understandings of madness permitted two categories… mania, or delirium in which a patient showed ‘violence, tempestuous passion, and fury’; and melancholia, or what would today be called depressive disorders.”

Filson goes on to highlight how, as the nineteenth century progressed into the Victorian era, members of both the artistic and medical professions began to explore the complexities of mental health, and so to separate the facts from the fictions, although one could surely be forgiven for believing otherwise, given the popularity of female characters being locked up in towers, attics or asylums. To give just one particularly iconic example of this, we need only look to the beloved Charlotte Brontë classic, Jane Eyre. On her very wedding day, Jane learns that she cannot marry Mr Rochester because he already has a wife, who was diagnosed with congenital madness after the marriage and locked away under the watch of nurse Grace Poole, but manages to escape and set a train of mysterious events in motion at Thornfield, including sneaking into Jane’s room and tearing her wedding veil in two. Interestingly, Jane Eyre was published around the same time that the term “psychiatry” was first coming into use, in the mid-1800’s, and was typically associated with what were considered as "hereditary" forms of madness; a small start by today’s standards, but undoubtedly a considerable step up from the attitudes to mental illness of the sixteenth and seventeenth centuries. During these earlier times, madness was a much broader term attributed to most forms of “unconventional behaviour”, and sufferers were regarded in the same bleak light as criminals and those in extreme poverty. As a result, this Unholy Trinity was viewed to be the by-product of an immoral lifestyle, and religious remedies were often prescribed.

Staying in the vein of early treatments for mental illness, let’s now turn to another nineteenth-century icon, Edgar Allan Poe. It goes without saying that madness is something of a recurring theme in Poe’s many works, but for this article I will focus on two in particular: The System of Dr. Tarr and Prof. Fether, and The Tell-Tale Heart. Starting with the former, I can highly recommend a read of Marianne Sagen Larsen’s thesis, which discusses the fine line between sanity and insanity, and how certain literary works succeed in blurring these lines through the author’s use of language, characters and narrative perspective. In Poe’s short, darkly comic story, a nameless protagonist seeks to satisfy a point of medical curiosity by visiting a lunatic asylum known as the Maison de Santé, or House of Health as a literal translation, while travelling through France. Upon his arrival at this institution, which has been renowned for its use of a treatment called “the soothing system”, the protagonist is met by a superintendent named Maillard, who invites him to dine with what can only be described as an eccentric gathering of people. Over a sumptuous feast and excellent wine, Maillard tells the protagonist of a system of psychiatric treatment of a “famous” Dr. Tarr and Prof. Fether. As the evening wears on, he behaviour of the other diners becomes ever more erratic and unusual, but the protagonist appears to be none the wiser, so taken in is he by Maillard’s account of the doctor and the professor. Due to the narrow perspective offered by our main character, the reader is left with a strong sense of uncertainty throughout the tale, and is led to wonder about this strict new treatment system that has replaced Maillard’s original soothing system. It is only as we near the end of this dark comedy that we get any hint of confirmation that the asylum has, in reality, been taken over by its patients, who have incarcerated their doctors and guards, and subjected them to tarring and feathering. While this plot twist may be evident to a keen-eyed reader with a love of mystery fiction, the protagonist’s enduring ignorance and the character of Maillard lends a thin veil to the boundary between reason and lunacy, and so can successfully disorient the audience.

In contrast, the narrator of our second Poe offering, The Tell Tale Heart, makes an immediate introduction to the notion of madness in the very first line of the story:

“True, nervous, very very nervous I had been, and am. But why will you say that I am mad? The disease had sharpened my senses, not destroyed, not dulled them.”

From the very outset, the protagonist is aware of a “disease” which he refers to as an over-acuteness of the senses, with hearing being the most acute sense of all, but believes himself, despite his actions and the motives behind them in the story, to be perfectly reasonable – even going as far as to boast of “how healthily and how calmly I can tell you the whole story”. This story, it transpires, is of how the narrator tasks himself with murdering the old man with whom he lives, purely because of the old man’s eye. This eye, we learn, is of a pale blue shade, and is covered with a film, and is often referred to by our madman as a “vulture eye”. And so, after eight nights of creeping up to the old man’s room and watching him silently through a small opening in his chamber door, the narrator murders the old man in his bed, dismembers him, and buries the corpse under the floorboards of the same room. In the early hours of the morning, just as the killing has been concealed, and the narrator is satisfied with his work and subsequent liberation from the dreaded eye, he is visited by a group of police officers responding to reports of a scream. The protagonist, unaffected, proceeds to calmly show the gentlemen the whole house, even daring in his high confidence to invite them into the dead man’s room and sit in conversation. As if this were not sufficient evidence of the character’s insanity, he brings about his own downfall when his over-acute hearing leads him to believe that he can hear the beating of the old man’s heart beneath the floor, sending him into a tormented rage and confessing his deeds. By looking at these two particular Poe texts, we are given vastly different perspectives of mental illness; the first is subtly revealed after remaining barely concealed below the surface throughout the narrative, while the second casts the character’s madness in the clearest possible light, thus blinding the madman himself, but not his audience, from his condition.

I just about resisted the temptation to include our friend the Mad Hatter from Alice's Adventures in Wonderland in the article, so I'm rewarding myself with a picture. Credit: John Tenniel.

Venturing now into the twentieth century, we find ourselves in an era that has explored the variations and complexities of mental health in greater depth, with advances starting to be made in finding treatments that go beyond the simplistic “out of sight, out of mind” remedy favoured by the Victorians. First, let’s consider one of Virginia Woolf’s most well-known novels, Mrs Dalloway. Focusing on the life of a high-society woman, Clarissa Dalloway, in post-First World War England, we are given an insight into how far the medical profession may have come but still had to go in those days, by their failure to treat and in turn save Septimus, a veteran of the Great War afflicted by shell-chock, or post-traumatic stress disorder as it’s more commonly known today. In this novel, Woolf, who was herself a victim of mental health problems, criticises the insufficiency of mental health treatment during her time, and it may not be unreasonable to say that those sentiments are still echoed today, during an age where funding and research for mental health treatment so often lags behind that of treatment for physical ailments. Moreover, the inclusion of the mental illness theme in Mrs Dalloway provides us with a fine example of how literature can be used as a means of hiding personal experiences in the shroud of fiction, serving to both allow the author to use their writing as an outlet for their personal suffering, and to protect them from too close a public and familial scrutiny at the same time.

To give a further example of the autobiographical nature of novels depicting mental health, we can turn to an American classic, Tender is the Night, written by F. Scott Fitzgerald while his wife Zelda was undergoing treatment for schizophrenia, and while he himself was afflicted by alcoholism. This 1934 novel, also discussed in-depth in Sagen Larsen’s thesis on seeing and recognising mental illness, paints a picture of a rather unusual doctor-patient relationship; that is to say, that the doctor and his patient go on to become husband and wife. After exchanging letters with Nicole Warren, a patient suffering from severe mental distress, psychiatrist Dick Diver is invited to the institution she is staying at by a friend and colleague, and develops a closer relationship with her. The couple marry and settle into a lavish villa in the South of France, where they meet and befriend Rosemary Hoyt, a young actress. Through a series of flashbacks and narrative shift, it is revealed that Dick married Nicole in the hopes of helping to provide her with stronger emotional stability, and that her breakdowns are the result of childhood trauma, namely abuse inflicted on Nicole by her father. Until Rosemary’s arrival in the Riviera, the Divers’ marriage has been to all intents and purposes a success, but Dick finds himself yearning for an affair with the young star of the ironically named Daddy’s Girl, and sinks into alcoholism as his marriage begins to fall apart. As with Mrs Dalloway, Fitzgerald projects elements of his personal struggle into a work of fiction, and breaks away from the trends of Victorian literature by depicting a mental health patient as an individual who is able to re-integrate, albeit temporarily, into society after treatment.

Tom Hiddleston and Alison Pill as Scott and Zelda Fitzgerald in Woody Allen's Midnight in Paris, alongside a photo of the real Fitzgeralds.

While we are on the subject of twentieth-century portrayals of mental illness, there is of course a temptation to touch on Sylvia Plath’s semi-autobiographical novel The Bell Jar, and Ken Kesey’s One Flew Over the Cuckoo’s Nest, a novel known for its harrowing descriptions of the effects of such treatments as electroconvulsive therapy and the lobotomy. As these two great works have surely been done to death by writers who have a far better grasp of what they’re talking about than I do, I shall not be dwelling on them too heavily, but they do hold a point of interest in how mental illnesses differ by character gender. Returning for a moment to the texts of the nineteenth century, a popular figure for projecting mental illness was often that of a female; a hysterical young woman prone to violent fits, erratic behaviour, and so must be hidden away as a grim family secret. As time went on and ideas and understanding of mental health issues evolved, a more diverse collection of mental health patients would start to appear, including our shell-shocked soldier in Mrs Dalloway and our alcoholic psychiatrist. However, in my own readings I have noticed a distinct difference in how the sufferings of male and female characters are described. In Tender is the Night, Nicole has breakdowns, but no such term is affixed to Dick’s deteriorating mental state. Now, you may argue that this could be due to the difference in the two characters’ conditions, and that may well be the case, but I have more. In The Bell Jar, the reader is given a clear outline of the onset of protagonist Esther’s depression following her rejection from a writing course and her fears that she lacks sufficient life experience to write a novel, and of how she is forced by her mother to visit a psychiatrist, and how she feels trapped under a bell jar – all of which is rendered more solemnly poignant by Plath’s own severe depression and eventual suicide. In this text, the lack of control that Esther, and so most likely by Plath herself, is painfully evident, which can be contrasted by the portrayals of the Chief and of McMurphy in One Flew over the Cuckoo’s Nest. “Chief” Bromden, a Native American, narrates the novel’s events, contrasting with his absolute silence as a character for most of the story, presenting himself to his fellow inmates and the medical staff as a deaf-mute, but in reality he can hear and speak perfectly well, choosing instead not to as a means of being left in relative peace by Nurse Ratched and her colleagues. The newcomer in the story, Randle Patrick McMurphy, is sent to the institution after pleading insanity to escape a prison sentence, and immediately sets about disrupting the established order over which Miss Ratched proudly rules.

What strikes me about the difference between the portrayals of mental illness in these two novels is the internalised and isolated feeling that emanates from The Bell Jar, and how much more haunting a feeling is created within the mind of the reader in comparison to the sense of aggressive, boyish rebellion that rises up among the male residents from McMurphy’s arrival in One Flew Over the Cuckoo’s Nest. Indeed, even McMurphy’s reduction to a vegetative state following a lobotomy offers a thin glimmer of hope in the scene of the Chief’s recovery of his forgotten strength, which allows him to break out of the hospital.

The setting of the mental institution is also a point of interest in itself, as in the context of Kesey’s novel it brings together a range of mental conditions in one space, each categorised into what the Chief terms “Acutes” and “Chronics”. It also allows the author to set the scene for an insight into what we can call in this article a more “modern” approach to treating mental illness. For example, during her regular meetings with the patients, Ratched draws an inmate’s insecurities out into the open for scrutiny, apparently more for her own enjoyment than as a form of therapy, and treats electroconvulsive therapy almost as a form of punishment for McMurphy and the Chief’s rebellious behaviour and as an example to the others, when it is widely considered as a last-resort form of treatment for depressive disorders, and has been shown to provide a typically temporary relief for patients who have been subjected to it. In a chillingly interesting way, the strong sense of intimidation and inability to function within the rest of society that is imposed upon the patients in the novel is apparently not as fictitious as one would wish. For instance, O. Somasundaram writes in the Indian Journal of Psychiatry of a visit paid to a mental hospital by the Tamil author Jayakanthan, and his emphasis on the fact that these patients, although they are human beings like everyone else, are treated as something less than human because of the state of their mind, and that even in cases where treatment is successful, the patients are often at risk of returning to institutions because of ingrained social fears that they may suffer a violent relapse.

This call for destigmatisation of the mentally ill leads us, finally, to the role of the YA genre in raising awareness of mental health issues among younger readers. One recent example of how this is being fulfilled is Jennifer Niven’s 2015 novel All the Bright Places, which sees an unlikely relationship develop between Violet, who has been traumatised by the death of her sister, and Finch, a mentally ill classmate. While working on a school project together, Violet begins to focus less on escaping her hometown and learns how to start living without her sister, and the two teenagers find they have finally encountered someone with whom they can be themselves. Although the novel’s ending isn’t quite as full of hope as you might expect, it gives a voice to young readers who feel that they have no-one to whom they can relate or open up.

Jennifer Niven's All the Bright Places. Credit: Knopf Publishing Group.

Another, perhaps more famous example, is Stephen Chbosky’s coming-of-age tale, The Perks of Being a Wallflower. Writing to an unknown confidant, young and sensitive protagonist Charlie talks openly and without fear of judgement about life as a middle-school wallflower, his various friendships and troubled past, building up to reveal that he has repressed memories of sexual abuse by a favourite relative. As with All the Bright Places, a key message to be taken away from Chbosky’s novel is the immense importance of a young individual with a mental illness having someone there, whoever they may be, who will listen without judgement, without offering empty words of comfort that are all too easy a trap to fall into.

The final book that I would recommend for a vivid, modern depiction of mental illness, is Mark Haddon’s mystery masterpiece, The Curious Incident of the Dog in the Night-Time. While it is not classed as young adult fiction, the young protagonist’s venture into writing a detective story about the murder of his neighbour’s dog is a thoughtful, thought-provoking and potentially beneficial insight into the behaviour and mindset of someone with Asperger’s syndrome, both for those who have the condition and those who wish to better understand it and provide support for a friend or family member with autism spectrum disorder. Throughout the novel, fifteen-year-old Christopher shows us how he uses certain behaviours, such as groaning or screaming, as a coping mechanism in stressful and unfamiliar situations, as well as how he is often told that he cannot say certain things to people that would be taken as rude, even though to Christopher it is simple honesty. At the same time, Christopher describes the reactions of others around him as they struggle to understand what is going on in his mind. What is striking about The Curious Incident of the Dog in the Night-Time, for me at least, is the portrayal of Christopher’s father, who raises the boy as a single parent. Despite his best efforts, the father is seen to lose his temper when Christopher’s behaviour becomes too much for him to handle alone, as it deepens the realistic tone of the book with regard to family members caring for someone with a mental illness, showing that often it is not just the mentally ill themselves who feel the strain. Moreover, the father’s loss of temper can almost be overlooked by his efforts to protect Christopher from things that may trouble him, misguided though certain actions may be, highlighting that none of us, even those lucky enough not to have their minds as their own worst enemy, are perfect.

And so, dear readers, we come to the end of what has been a far longer article than I intended. I hope it’s been worth the read, and that you can take something away from having read it, be it a few additions to your reading list, or an assurance that if you are affected by a mental illness, or know someone who is affected, we are making progress, and there is help at hand. Personally, I’m fortunate enough that I can manage my anxiety and depression more or less on my own, but there have been times when I have had to ask for help, and I would encourage anyone who needs it to do the same, no matter how small or insignificant you feel that you and your problems are. Remember, as a wise man (aka Matt Smith as the Eleventh Doctor) once said: “In 900 years of time and space, I’ve never met anyone who wasn’t important.” If that quote doesn’t quite do the trick, try this one from the Seventh Doctor for size: “Anybody remotely interesting is mad in some way or another.”

References and Further Reading:

Brontë, Jane Eyre (Smith, Elder & Co., 1847).
Chbosky, The Perks of Being a Wallflower (Pocket Books, 1999).
Filson, Chloë, “Portrayals of Mental Illness in Literature: From Tennyson to Today”.
Fitzgerald, Tender is the Night (Scribner’s, 1934).
Haddon, The Curious Incident of the Dog in the Night-Time (Jonathan Cape, 2003).
Kesey, One Flew Over the Cuckoo’s Nest (Viking Press, 1962).
Niven, All the Bright Places (Knopf Publishing Group, 2015).
Plath, The Bell Jar (Heinemann, 1963).
Poe, The System of Dr. Tarr and Prof. Fether (Graham’s Magazine, 1845).
Poe, The Tell Tale Heart (The Pioneer, 1843).
Sagen Larsen, Marianne, “Mental Illness in Literature – Seeing and recognizing mental illness in Conrad’s ‘The Idiots’, Poe’s ‘The System of Dr. Tarr and Prof. Fether’ and Scott Fitzgerald’s Tender is the Night”.
Somasundaram, “Literary Destigmatisation of mental illness: a study of the writings of Jayakanthan”.
Woolf, Mrs Dalloway (Hogarth Press, 1925).

Emma McMullan's Picture

Emma McMullan

Writer, blogger, book hoarder, mug collector and language enthusiast.