By Nicolás Medina Mora

I first met Sandy Allen four years ago, when I was a reporter and they were an editor at BuzzFeed Dot Com, the online Internet Web-Page. I have always been an impertinent fool and at the time I was considering graduate school, so when someone told me that Allen had an MFA in Nonfiction Writing from the University of Iowa I didn’t think twice before walking to their desk and interrupting their work to ask whether they thought I should apply.

“First, nice to meet you,” Allen replied. “Second, why in the world would you do that?”

Instead of getting the message, I proceeded to bombard Allen with a litany of questions about the relative merits of journalism and academia; then, as if that wasn’t enough, I had the gall to ask them whether they wouldn’t mind taking time away from their own deadlines to take look at a story that I was scheduled to publish later that afternoon.

The fact that Allen not only acquiesced to edit my story but also wound up becoming one of my close friend is a testament to their particular species of patience, which I would describe as a willingness to stick around people for long enough to take them on their own terms. Such generosity is rare enough in everyday life, but it’s even harder to find in what us Liberal Arts kids like to call The Discourse, where impatience seems to have become the norm.

This same generosity of spirit animates Allen’s debut book, A Kind of Mirraculas Paradise. AKOMP, as the author refers to it online, is a narrative essay on the life and times of Allen’s late Uncle Bob, who was diagnosed with schizophrenia as a teenager and then spent several decades negotiating the violence of the American psychiatric system — and also playing music, converting to Christianity, working as a welder, and getting abducted by aliens. The book braids what Allen calls a “cover version” of Bob’s typewritten autobiography with a sprawling literary investigation into the history of mental health-care, the current state of psychiatric science, and the efforts of people who’ve been labeled as mentally ill to convince society to take them on their own terms. Anne Fadiman called it “an act of radical empathy,” and I couldn’t agree more.

Earlier this year I had the pleasure of sitting down with Allen in Iowa City, where they wrote the first draft of AKOMP as their MFA thesis in the Nonfiction Writing Program, where I am currently a student. They were in town for the Mission Creek Festival in April 2018, which had arranged for them to have an informal discussion with the clinicians and students of the Carver College of Medicine. The conversation was for the most part productive and pleasant, but there were moments of tension — particularly after a psychiatric clinician in attendance became openly hostile not just toward Allen, but also toward some of the medical students in attendance. Allen handled the interaction with their usual poise, but when we met for lunch the next day it became clear that the experience — and a number of similar scenes over the course of their book tour — had taken a toll on them. I asked them if they wanted to talk about it and they said yes. Below is a transcript of our conversation, which I’ve edited for clarity.

The Essay Review: Yesterday, at your talk at the medical school, there was a member of the audience who seemed bent in presenting, in very ungenerous terms, the view that clinicians and scientists shouldn’t take into consideration the opinions and preferences of people who’ve been labeled as mentally ill when they are making determinations about their treatment, because such people simply don’t have a grasp of reality. I thought his objection was very interesting, but probably not for the reasons that he thought it was interesting. It seems to me that his question is, in a sense, one of the main concerns of the book. AKOMP has always seemed to me to be an exploration of the questions of epistemology just as much as it is a story about mental health and California in the sixties. You seem to be asking questions like: What can we know? How do we access reality? And, ultimately, what is the meaning of “truth?” Or — to put it in more MFA-y terms — whether the claims that people who’ve been labeled as delusional make about their own experience can ever be considered ‘nonfictional’ So maybe that’s a good place to start. How did you approach, in the book and in your thinking, the question of the facticity of stories like the one where Uncle Bob says he was abducted by aliens?

Allen: I worked on this project for many years before I had answers for the question you’re asking. I was engaged with it as a writer who’d been given this really compelling document, Bob’s autobiography, and my desire was to render that document in a form with which more people might be willing to engage. It wasn’t until many years into that process that I felt compelled to answer questions like: What am I up to? What am I asserting? Am I asserting that my uncle — someone who’s been diagnosed as schizophrenic and who’s had experiences that others might find unbelievable — should be taken at his word? Is that valuable? Does it add to the conversation?

The clinician on Friday seemed to be saying that if a particular physician can work to understand the humanity of someone who’s been diagnosed, then physicians in general already understand their patients’ humanity. And what I tried to say to him was that I think it’s important to think on the level of the system. The same way that an individual white person can feel that they aren’t racist and yet benefit from white privilege and therefore be racist, or that a given man can think that he is an ally to women and queer people and nonetheless benefit from the patriarchy and therefore be sexist, I think we all benefit from acknowledging that those of us who haven’t been psychiatrically diagnosed benefit from a system of oppression even when individually we strive to see the humanity of those who’ve been labeled as disordered.

I agree with Bob that it’s important that we listen to those who have been in the position of that subordinate caste, especially on the topic of their own lives, their own minds, their own bodies. I made that leap when I realized that, as long as we stay within the realm of medicine and science, as long as doctor are presumed to be correct and patients are presumed to be disordered and therefore wrong, we’ll end up repeating what that man was saying, which boils down to: ‘I don’t know how I could improve the clinical experience of people who have been psychiatrically diagnosed, so therefore it cannot be improved.’

I think the point of Bob’s book, and the point of my project of carrying it into a broader discourse, is to move this conversation into the realm of civil rights. Because what we really are talking about here is whether my uncle is a full person, whether people who hear voices or see visions, people who’ve had experiences that others deem unbelievable, people who’ve survived trauma — whether such people deserve to be represented in the conversation. When I think about that disgruntled doctor, I remind myself that my qualification to be talking about this stuff is that I’m Uncle’s Bob biographer, that I listened to his story and took his point of view seriously and then did the due diligence to try to understand people who are currently living something like what he went through — people who’ve been diagnosed with schizophrenia and are working to assert a civil rights movement for the psychiatrically diagnosed, people who are involved in demonstrating that we can create solutions that actually help folks like my uncle in moments of crisis.

I think the clinician wanted me to say something like, ‘Oh, in a moment when someone is in a mental or emotional state that others are finding concerning, we shouldn’t do anything about it!’ But of course I’m not saying that. What I am saying is that we, as a society, should listen to folks who’ve been there about what we should strive to provide. What the clinician was unable to see, maybe because of his position within the system, is that the very fact that he’s in an exam room with that patient who has been diagnosed with schizophrenia is underwritten by a set of assumptions, because that diagnosis has not been biologically confirmed. It’s a hypothetical description.

That doctor, like a lot of the medial system right now, wants it both ways. We want to softly acknowledge that these diagnoses are hypothetical, but we also want to treat them as biological realities. We communicate a diagnosis of schizophrenia as a damnation, as a reason to be fundamentally pessimistic about the future course of a person’s life, and also as an excuse to put them on chemicals that are going to change their brains and bodies and probably kill them young. And I think that we need to pause and examine that premise.

The Essay Review: One of the most fascinating aspects of the book, for me at least, is that one of the methods that you use to put forth this argument is to fact-check Bob’s account of his life. In my experience, the relationship between writer and fact-checker is, if not necessarily antagonistic, often quite tense. And so it’s interesting to me that the mechanism by which you seek to legitimize Bob’s story — so that it can be taken as ‘nonfiction’ and therefore have enough authority to enter into this political conversation — is to ask questions that could potentially disqualify somebody who has been labeled as disordered: But is it actually true? Did it really happen? And so I’m curious — how did you think about using the tools of objectivity and verifiability in the service of a project that implies questioning the way in which those tools are used to exert power on people like Bob?

Allen: As I describe at the end of the book, there was a phase of the project, pretty far in, when I began building a timeline across my wall to check Bob’s chronology against verifiable facts and world events. And as I began that task I remember feeling that maybe it was a mistake, that maybe I would discover that Bob’s story didn’t line up with anything. And, of course, if that had happened, I don’t think that would have invalidated the project, because Bob was a very meticulous craftsman and storyteller, and in the end the book is about him as an individual and about the stories he told about himself, regardless of everything else. But in terms of the stereotype of the psychotic paranoid-schizophrenic, to use Bob’s phrase, one of the presumptions that people make about folks who’ve been psychiatrically diagnosed its that they are untrustworthy, that their accounts of things aren’t accurate, that they live in fictional worlds. And, honestly, that’s where my initial interest in the project came from, because on a very simple level I just didn’t understand how I could create ‘nonfiction’ about my uncle that excluded the fact that he was abducted by aliens, because in his reality that is a fact. And so what I tried to do was to make that feel as real on the page as it was for him.

Ultimately, this is a work of literature. It is not a how-to or a polemic. But it does seek to quietly highlight the architecture of a system that is based on power and allow us to think more freely, not just about Bob’s life, but also about the truths that his experiences can reveal about our society. I want us to think more deeply about what we would want for ourselves in the event that we found ourselves in the need of help, because for a long time there’ been this false binary between psychiatry and anti-psychiatry, but as long as this conversation is only about the profession of shrinks, we’ll continue to miss the point.

This is not about taking someone who’s in the middle of a crisis and saying, ‘Ok, let’s dismantle this hospital and now you can run it.’ What I’m saying is that one of the things that you feel as you read Bob’s life is that it happened day by day. There are days in his life when things are really tough and then there are others when it’s clear that he’s absolutely capable to deal with the world, and this really makes me wonder about the inherent pessimism of a lot of DSM diagnoses. It’s shitty that someone’s entire being can be defined by the worst day of their life; that just because you had some sort of incident you can become The Schizophrenic. The idea that reducing people to labels could help them or help society as a whole — that’s the myth that I’m looking to shake up.

But to return to your question about how truth is functioning in the book, schizophrenia is a great example of just how messy these things are. The book is an attempt to contend with the fact that facts don’t always square; that there isn’t an ultimate answer to many of the big questions; that a work of nonfiction can’t make good on its promises unless it acknowledges that the record might not add up, or that there might be radically incompatible versions of the truth. On the one hand, you’ve got a professional body — and a society as a whole, generally speaking — that believes in the objective reality of the category ‘schizophrenia.’ On the other hand, you’ve got someone like my uncle, who has been diagnosed with schizophrenia but simply doesn’t believe that the concept is real, and who then goes ahead and writes his life story, I believe, in order to to critique this label that he has been given.

And then, when I set out to investigate this as a fact-checker or a reporter, what do I find? I find that people have spent billion dollars researching the status of this category but haven’t figured it out yet. They’ve figured out enough to know that it’s not simple; that it’s not like Huntington’s disease; that there doesn’t seem to be a gene or genes that causes schizophrenia — but at this point these questions have been investigated so exhaustively and for so much money that there are a lot of people who wonder, I think validly, about the utility of this category.

When I approached the question of what I wanted my reader to know — because I think educating the reader is part of my job — I decided that I wanted to present the science, but also complicate the ways in which we think of science as being ‘true.’ Bob was labeled as a schizophrenic, and this meant, among other things, that schizophrenia was real to him, insofar as it was a social designation that changed his life in ways big and small. In that sense, schizophrenia is absolutely biologically real. It’s something we make, something that we created, in the same way that we invented gender, race, and other similar constructs. As long as there are power structures that enforce the existence of a caste of people, the caste is real.

So that’s why I think it’s important that a writer like me, who isn’t in Bob’s position, should be honest with the reader and say, ‘Yeah, science has checked it out, but they haven’t been able to validate this yet.’ And, to be clear, I don’t think that this means that someone who believes that science will someday find biological evidence for what they believe is an awful disease is necessarily wrong. There are people who vehemently believe that this thing is real, and there are people who vehemently believe that this thing is not real, and my book is trying to create a nonfiction that includes both of those points of view.

The Essay Review: What you are describing sounds a lot like the classic definition of the ‘essayistic impulse,’ which I like to think of as a refusal to resolve things, an insistence on holding multiple possibilities at once. Something like Montaigne’s question: ‘What do I know?’ But what’s fascinating is that you end up finding out that Bob’s story for the most part squares up, that even some of the more surprising details turn out to be true.

Allen: I mean, there’s almost nothing in his story that I was able to prove was wrong. For example, I wasn’t able to determine whether or not Bob was abducted by aliens for three days. The one thing that is absolutely and unquestionably false is something that I actually discovered only after the book was published, and it’s that he had Elvis’ death date wrong by a decade.

The Essay Review: And it’s not just the details of the story that turn out to be true; the argument that Bob seems to be trying to make also hold water. From what I heard on your talk on Friday, the science kind of backs him up. If I understand you correctly, the question of whether what we call ‘schizophrenia’ has any objective reality beyond the heuristic categories of the DSM is far from resolved. The entity ‘schizophrenia’ has a similar ontological status to aliens.

Allen: Yes, and I’m glad that you get that. I had as much trouble verifying the existence of schizophrenia as I did with aliens. And in both cases, the end result is that I don’t know enough to make a call, so it’s up to my reader to decide. That said, am I someone who tends to be skeptical of powerful groups and who tends to want to listen to less powerful groups? Yes. If there’s a bias to my book, that’s it.

The Essay Review: I mean, if you had just interviewed the luminaries of psychiatry and asked them ‘Schizophrenia, what’s up with that?’

Allen: I did do that!

The Essay Review: Right, but if you had stopped there . . .

Allen: The tendency of the mainstream press has been to end exactly there, which is why people do things like publish articles about how to ethically write about behavioral disorders that quote a psychologist, a psychiatrist, and some journalists who write about mental health — and that’s it. There are people writing about this who don’t seem to see the need to talk to people with lived experience, because we are conditioned to presume that such people have nothing valid to say.

And the thing is, these errors really get to the folks who are involved in movements for social justice for people who’ve been psychiatrically diagnosed — and I understand why. In this culture, in 2018, it’s preposterous that, instead of asking the members of a particular minority group what they think, you would default to a class of professionals who claim to know what’s going on. As a trans person, I’m aware of the fraught relationship between the psychiatric profession and LGTBQ people, and I can’t help but see a lot of these issues under that light.

We have to create a space for people to self-define, and we need to talk back to powerful systems and to the rest of society, because folks who aren’t already aware of these conversations probably have no idea that there’s even a debate — and that’s the fault of the mainstream press, of folks’ privilege making them unaware of the need to pick up the phone and talk to someone who represents the point of view of people who’ve been psychiatrically diagnosed but are now skeptical of the label they’ve been given.

I think people are afraid that even listening to that point of view could be construed as anti-medicine or anti-science, but my experience is that, if you spend time talking to self-defined psychiatric survivors, it quickly becomes apparent that such people tend to have a very good sense of the current state of science and medicine. This is not to say that you shouldn’t also talk to a psychiatrist or a pharmaceutical rep, but I think that a truly nonfictional discourse about mental health must include the perspectives of people who’ve been told that they are deficient and broken and beg to differ.

The Essay Review: One issue that this raises for me is the question of climate change. That’s a situation where I feel strongly that I want to trust the scientific consensus and that any dissent view is actually quite harmful. I don’t think these are necessarily analogous situations; if for no other reason, because the people behind most climate change denialism tend to be members of powerful groups, such as fossil fuel companies, while the people who question the psychiatric consensus tend to be disempowered in one way or another. If anything the analogy works backwards: Having a billion dollar corporation fund research to show that climate change isn’t real is analogous to having a billion dollar corporation fund research to show that schizophrenia is real. But still, the comparison seems gnarly and potentially dangerous. What’s the criteria that you, as a writer of nonfiction, use to differentiate between those critiques of scientific orthodoxy that are worth considering and those that are not?

Allen: What’s peculiar about psychiatry — and this is something of an open secret — is that the DSM has not been borne out in a lab. In 2011, the director of the National Institute of Mental Health, the federal body that oversees mental healthcare in this country, wrote a blog post where he said that the DSM diagnoses are not valid, but these diagnoses continue to have profound consequences in our healthcare system, in our criminal justice system, and in our society at large.

When you try to understand the people who strongly believe that these things are real, it’s fascinating to see how many generations of psychiatrists have been detractors within their own profession — for example, how we came to have this split between psychiatrists who dispense drugs and psychologists who for the most part don’t. From a consumer standpoint, it’s really confusing that some people become the purvey of psychiatry while others talk to psychologists, I guess because our problems aren’t as severe . . .

The Essay Review: And then there’s a whole class of people who talk to social workers or case workers because their problem is . . .

Allen: That they don’t have money!

The Essay Review: Right, it’s fascinating to see how different problems, or similar problems in different people, get allocated to different kinds of professionals.

Allen: Yes, and that would be my first response to your question about climate change. The scientific status of the DSM is not like what you find in global warming. For example, there was this famous hunger strike organized by a group of activists involved with a website called Mind Freedom, which is one of the earliest digital homes of the psychiatric-survivor movement. These hunger strikers wrote to the American Psychiatric Association, the Surgeon General, and the National Alliance on mental illness, which is a support group for family members of people who have been diagnosed with mental illness that’s in large part funded by pharmaceutical companies — the strikers wrote to these groups and said, ‘Hey, send biological proof of mental illness and we’ll eat again.’ And then what happened? No proof was sent. At first the APA sent one of their own textbooks, which kind of cited itself, and then there was a bit of a dismissive back and forth, and that was it. And this is concerning to me as a member of the public who, like everyone else, could become a schizophrenic tomorrow and find myself in a system that might cause me to lose my civil rights.

Because that’s what happens when you receive a serious psychiatric diagnosis:Your rights, your ability to make decisions about where you are, what you do, what you imbibe — they can all be radically reduced. You can lose your job, your kids, your status among your peers, etcetera. I think this is what the Mind Freedom hunger strikers were seeking to demonstrate, that the implications of a diagnosis like this can be pretty severe. I don’t think they succeeded in getting through to the general public — which is another difference between this debate and climate change denialism, in that it’s not something that we are talking about as a society as whole.

The Essay Review: The example of the hunger strike is poignant because, if a bunch of climate change denialists went on a hunger strike and said, ‘Submit proof that the earth is warming . . .’

Allen: There’d be so much fucking proof!

The Essay Review: Not to sound like a college sophomore, but this really highlights how the whole ‘knowledge is power’ equation is actually upside down — it isn’t that knowledge empowers people, but that power allows people to determine what constitutes knowledge. You seem to be saying that what gives the diagnosis of schizophrenia its solidity isn’t a mountain of scientific evidence, but the fact that powerful people say it’s so. And when these people are confronted with a group of hunger strikers, they send a textbook.

Allen: And that’s because the presumption is that, since people who’ve been diagnosed aren’t trustworthy, there’s no reason to engage with them as having a valid position. There’s a Catch-22 here, which is that folks who end up inside the psychiatric system see — or at least I think Bob saw — the naked flaws of our society, but the very fact that they’ve been in a position to see these flaws means that they can’t be taken seriously.

So yes, my book does critiques psychiatry, because I think that the difference between what Bob’s life was allowed to become and what your life or my life are allowed to be is on a very basic level unfair. We like to pretend that there is only one reality that we are all experiencing together, but there are so many different undercurrents that remain unseen and unthought even though they are omnipresent. What I seek to do in my nonfiction is to highlight those undercurrents and make the chords that are already there resonate louder, so that more of us can say, ‘Well, wait a minute, what is going on here?’

The Essay Review: You’ve told me in the past that one of the main sources of inspiration for your book was Anne Fadiman’s The Spirit Catches You And You Fall Down. One of the things that I really like about Anne’s book is that it also presents an essayistic critique of Western epistemology, but unlike your book it does so not from the perspective of a Western person, but by exploring the story of a Hmong family. This comes to my mind because one of the facts that you mentioned at the medical school was that recovery rates for people who are diagnosed with a severe mental illness are higher in developing countries than they are in developed countries. Can you say more about that?

Allen: Right, that’s from a study that the World Health Organization did from the 70s onward. And again, this makes me wonder whether our system here is actually accomplishing what it says it’s set out to accomplish. Because the fact is, though this is a different point than the one raised by the study, that life expectancy for American people diagnosed with schizophrenia has been falling for some time. Many people feel that, on a public health level, things have gotten worse rather than better since the advent of psychiatric medications, which should probably make us pause for a moment, because typically what we would hope for with medical advances is that they increase life spans and rates of recovery rather than reducing them.

The Essay Review: Right, so perhaps this is yet another area where Western societies could really learn from non-Western ones, or at least where America could learn from other countries. In the book, you write about some of the things that people are doing in Europe in terms of alternative treatments, many of which seem to be predicated on the idea that a person who has a different relationship with reality can and should be valued for their particularities rather than in spite of them. And, like, this isn’t exactly new, there have historically been societies in which people who see visions or hear voices have been deeply valued as having contact with the divine or else having access to aspects of reality that the rest of us don’t. And so I wonder: Is that the direction in which you’d like American mental healthcare to move? I’m not saying that we should reopen the Oracle of Delphi and that, instead of having a psychiatric hospital, we have, like, soothsayers, but it seems . . .

Allen: Seems fine, TBH. Which isn’t to say that a 16-year-old kid like my uncle should literally be given an oracle seat, but that the course of action that the adults around him felt was necessary — psychiatric hospitalization — was necessarily what should have happen. What we need is a system of care that takes seriously the humanity of the person who needs care, a system that doesn’t profit from reducing people to a label or seek to force them back into a fake standard of what it means to be ‘normal.’ Those of us who don’t hear voices or see visions have a problem: We need to decide whether or not we believe people who do experience those things. But beyond that problem, what we’ve got is a difference, the same kind of difference between folks who have different levels of melanin or folks who have different genitals.

The fact is that we’ve got differences amongst people. So the question is: What do we do with that fact? What do we do with genetic variation? One mistaken answer that 19th century white men really loved to enforce is that difference amounts to hierarchy — to observe a difference and then go, ‘OK, so we’ve got this color and that color, so clearly this one must be better than that one; OK, so we’ve got these genitals and these genitals, so we are going to make two castes, and one of them is better than the other.’ We need to ask ourselves: How can we do a better job respecting the fact of difference? What allowances can we make if, for example, someone is hearing all day long a voice that is screaming at them to kill themselves?

If I were some sort of wizard and I could snap my fingers and create a better mental health care system in America, I would step away from the metaphor of health and wellness and I would focus on the creation of spaces where people who are seeking this kind of help, for whatever reason, can be appreciated for their full humanity and given a chance to go through what they are going through. Because, again, science hasn’t found a genetic marker or a pathogen or a brain deficiency that causes schizophrenia, but it has found is a higher correlation between early childhood trauma, especially sexual abuse, and traumatic voice-hearing. So, in a hearing voices meeting, are people sitting around and talking about their voices? Sure. But what they are really talking about is their lives and their experiences and their traumas.

For someone who hears voices, voice-hearing is not necessarily something extraneous. If everyone had four fingers and you had five fivers, I’d be like, ‘You have an extra finger!,’ and you’d be like ‘But these are all my fingers!’ It’s an indelible part of yourself. And, like, you might have a voice that is distressing, of course, but we need to consider the reasons why a voice hearer might benefit from having a space where they aren’t presumed to be deficient or abnormal or in need of antipsychotic medication, but where they are instead met with understanding and with practical strategies for how to convince an awful voice to leave you alone, in the same the way that you might work to negotiate the fact that you have a rude colleague or a partner who’s a dick to you.

What this kind of approach does is empower people to define themselves and also help liberate our society from a liberalized metaphor of wellness. Which is not to say that thinking of these things in terms of health might be beneficial for some people. I take no issue with people who understand themselves as dealing with mental illness. But I also think that we don’t need to infantilize people and distribute these metaphors as if they were literal truth, and that we need to be skeptical as fuck of knowledge that has been created by a profession that is in cahoots with an industry that stands to make a lot of money off of vulnerable people, often in the most vulnerable moments of their lives.

The Essay Review: What you are saying makes me think of the opioid crisis, which is obviously not perfectly analogous but . . .

Allen: It’s the same system, yo! Everyone is like, ‘Oh, the pharmaceutical manufacturers don’t seem to have our best interests at heart, huh?’ Yeah, no fucking shit. I’ve been to the APA pharmaceutical fair; I’ve seen what we’re selling and what we’re buying and who’s selling it and who’s buying it — but again, the problem is with capitalism in general. It’s not like there’s one evil capitalist in his tower counting his coins. It’s that there’s a system that incentivizes an approach that divides the world into people who are normal and people who are not. But I think that this is actually — and this is such a buzzword — a spectrum. Some people certainly hear one or several distinct voices that don’t appear to exist in the world, but others hear birds, choirs, music — in fact, I’ve actually been grappling with whether I myself identify as a voice hearer, because I have other channels that run in my head.

When it comes down to it, it just isn’t clear what constitutes this ‘normal’ that psychiatry is so invested in maintaining. There’s people like Charles Fernyhough, who wrote this book called The Voices Within, who have really looked into the fact that studying interior experience is actually very difficult. The second you start asking questions like ‘What is a thought?’ or ‘What is the self?,’ the assumption that everyone has nothing in their head except their one stream of thought start to fall apart. Someone who hears voices or sees visions might seem to the rest of us to be super fantastic or out there, but we all know that we live inside minds that are complicated and full of imagination and fancy.

The Essay Review: The question of whether the human mind can understand itself is a huge and very old philosophical problem. It takes a lot of epistemological naivety to hold onto the kind of positivism that supposes a unified consciousness. All of this makes me think of one of the last times when psychiatry and the humanities — or methodological and essayistic thinking, if you want to use the terms that I like these days — were in conversation with each other, which was during the heyday of psychoanalysis. And, of course, psychoanalysis has all kinds of limitations, but one of its fundamental ideas is that we are all are a little psychotic . . .

Allen: I have a few thoughts. First, psychoanalysis is still a system that seeks to parse ordered from disordered. Second, it’s not like psychoanalysis is or was the only alternative to the kind of psychiatry we have today. There’s always been bio-psychiatrists who’ve taken a different view on these things. There’s been a power struggle within different strains of the profession ever since psychiatry rose to challenge the Church as the source of soul-healing. So are Freudian psychoanalysis and its progeny, talk therapy, more humane than some of the approaches that we see today? Sure. But again, I just want to remind us that they are still inscribing this entire conversation into the valence of medicine and science, and part of the point here is that someone who is struggling in this way might also benefit from the help of a spiritual advisor, or from being in a peer support group or in a choir, or from going on a hiking trip.

Mental health professionals are this caste that is almost like a secular priesthood, because part of the function of science in our culture, especially for folks who aren’t religious, is to fill in the vacuum left by spirituality. Before the rise of professionalized psychiatry, it was priests who were tasked with helping people who were struggling in this way. Psychiatry is young in the scheme of human history, but madness, to use that word, is old.

The interpretation of these things as a medical disease is a recent phenomenon, and even today it’s by no means universal on this planet. I hope it’s just a late-capitalist blip. Because it’s not just that society shapes treatment; it’s also that people need treatment in the first place because of how society treats them. One point that people who know more about this than me tend to make is that there’s no way to separate the institution of a better mental healthcare system from the institution of a less violent society. Ultimately, the reason why people end up suffering mentally and emotionally comes down to interactions they have with others, which is why we can’t think about mental health without thinking about oppression. Again, one of the things that was really profound for me as I learned more about the hearing voices movement was that people in those groups end up talking about things like that — the trauma of racism, the trauma of sexism, the trauma of bigotry.

The Essay Review: So perhaps the difference between sanity and insanity is simply a question of how much violence you are able to tolerate and of how much violence you’ve experienced.

Allen: Yes, but part of the question is whether those words even help us. Because it seems to me that the binary between sanity and insanity is actually a smoke screen for the violence of hierarchy. It doesn’t matter how together you’ve got it today, this afternoon you could experience a trauma and there goes your next decade. As long as that is the case — as long as you can lose a loved one, or get hit by a car, or experience humiliation, or be reminded of the rape you experienced in childhood — we will remain these little sacks of jelly wandering through a violent world, and we need to think about how we would like to be treated if we suddenly needed help.

The Essay Review: Well, yet another reason to look forward to the revolution. After it comes, we’ll all have good mental healthcare!

Allen: Ishmall had won!

“Picaresque” by Annie Fletcher

Annie Fletcher received her BFA in drawing from the University of Tennessee. She is an award-winning illustrator and currently works as a freelance artist in Memphis and Knoxville. Some of her accolades include Outstanding Graduate in Studio Art, Drawing, and the Mary Lynn Glustoff Scholarship for watercolor.