Illness as Narrative: On Sarah Fawn Montgomery’s ‘Quite Mad’

Montgomery’s memoir is an inquiry into what it is like to struggle and thrive with mental illness in modern America.

Sarah Fawn Montgomery
Memoir| 296 Pages | 5.5” x 8.5” | Reviewed: Electronic ARC
978–0–8142–5486–8 | First Edition | $23.95
Mad Creek Books| Columbus, OH | BUY HERE

Image: The Ohio State University Press.

I rarely tell people, even friends, about my bipolar disorder. I mask my depressive episodes by saying I’m just feeling a little down and blame it on the weather, stress, or poor eating. When I am feeling the exhilarating highs of a manic episode, it’s harder to hide, but I do what I can to minimize the expression of my grand statements, delusions, irritability, and incessant chatter. Revealing my bipolar disorder risks irrevocably linking my identity to my condition, muddying the narrative of who I am.

In her debut full-length memoir, Quite Mad, Sarah Fawn Montgomery details the many struggles and blessings of living with a mental disorder. Since being diagnosed with anxiety, PTSD, and OCD as a young woman, Montgomery has undertaken a journey to live more comfortably with those aspects of herself, pursuing different avenues of healing, many of them pharmaceutical in nature. In the process, she deconstructs the factors of her condition, examining her family history, stressors in her unorthodox childhood, and traumas in her adulthood. In conjunction with exploring her own illness narrative, she examines the often neglected challenges of mental disorders from a broader perspective, addressing stigma, lack of medical help, representation in the media, and the difficulty of remembering after trauma. In speaking outside herself, Montgomery brings in outside sources, statistics, and the history of the psychiatric field, creating a sweeping view of mental illness. It is an ambitious work that extends outside the speaker to address the state of the mental healthcare system in America as a whole.

“The separation between patient and illness, the moment where a person ceases to be and where the illness takes over, captures our cultural imagination. For physical illnesses, the line is clear — he has high blood pressure, he has diabetes. But when discussing mental illness, the line shifts — a patient is his diagnosis, we insist. He is bipolar. He is anxious.”

The book is comprehensive and covers not only the speaker’s history but the history of the psychiatric field including the Diagnostic and Statistical Manual of Mental Disorders (DSM), the invention and marketing of various medications, famous trials involving mentally ill persons, and treatments that have come and gone out of style. Because I have lived with a mental illness much of my life and hold a bachelor’s degree in psychology, the extensiveness of these particular sections felt redundant to me specifically, but a reader who is newer to the subject will appreciate the painstaking research that Montgomery has included in order to present the most thorough picture of the mental health industry possible.

The portions that I was most drawn to in the memoir dealt with the unique situation of Montgomery’s upbringing. Her working-class parents fostered and adopted several at-risk children over the course of her childhood, a stressful and isolating experience for her. To accommodate the constant influx of new children, Montgomery had to care for herself and her siblings when needed, settling for lack of stability, privacy, and support from her parents. When looking at her anxieties, compulsions, and tendencies, Montgomery finds parallels in the ways she coped as a child and as an adult. She oscillates between holding her parents accountable and absolving them from blame entirely, a pattern that is in line with making statements saddled with guilt, and she acknowledges limiting her emotional expression based upon what she thinks she should feel (she should feel grateful to have such selfless parents, for instance). Montgomery is aware of the differences in her trauma versus those of her adopted siblings, and she raises interesting questions about who may lay claim to suffering, sickness, and sympathy. Although doctors are quick to prescribe Montgomery with drug after drug, even when those substances cause more harm than good, they fail to turn to her past for insight into her body’s maladaptive responses to the environment.

“I do not recall if I had panic attacks as a child, but when I think back to this time I am overwhelmed by the adoptions, Candy and Casey, Cameron and Bailey, Victoria, foster children whose names and faces I cannot recall, though I can feel the weight of their bodies as my parents place them in my lap, can hear my mother on repeat, clicking, clicking like a metronome, “No time, no time,” a phrase that lines up with my blinking and breathing and makes me twitch and choke, suffocating, too many bodies taking up air in the house, none left for me.”

Perhaps because of her background in writing, Montgomery discusses at length the narratives we construct and the rhetoric we use to describe madness. Reminiscent of Susan Sontag’s Illness as Metaphor, Montgomery critiques such seemingly harmless colloquialisms as calling something “crazy” or claiming one has OCD when one is particular about order or cleanliness. This language serves to both stigmatize and minimize the reality of mental illness, generating stock images of what each condition looks like based entirely on public expectation. Montgomery is a writer and academic who is analytical in her approach to her own history, and she writes with an appreciation of nuance, exploring the gray areas and contradictions of mental illness.

“Before bed I swallow Celexa like I’m supposed to — it’s been six, seven, eight months now. I’ve come to view medication as the hall monitor for my out-of-control fear — a fear I still don’t understand because no one, myself included, has thought to question what makes me so afraid. The drug is guardian, authority, savior, but if I feel more in control than before — I can leave the house, after all — it’s mostly because I’ve had so much practice. I’ve learned how to live when you’re convinced you’re dying.”

Although I am greatly interested in the analysis Montgomery provides regarding the intersections between illness, narrative, and identity, the contradictions in her memoir occasionally raise more questions for me. While I recognize the nuances and understand that few things in life are black and white, I struggled at times to find and follow her argument. For instance, Montgomery condemns the Western tendency to pathologize and medicate away qualities we don’t find culturally valuable (shyness, gloominess, etc.), insisting that the current climate does not allow for enough variance in people’s personalities; however, Montgomery also denounces the usage of the term “anxiety” by people who do not have diagnosed mental disorders, coloring it as appropriation of her condition. (I admit it’s a different argument if someone is laying claim to possessing a specific disorder, like OCD or bipolar disorder, but I question this attitude when the word is such a broad one as “anxiety.”) At once, Montgomery calls for less pathologizing and a loosening of labels while also acting as a gatekeeper to certain terms. She does this despite admitting that we often mask our illnesses, citing scenarios in her own life where acquaintances expressed surprise when they learned of her disorder. For me, it is problematic to assume that those in her life who seem like they are doing all right have no diagnosed illnesses when Montgomery herself expresses exasperation when acquaintances who have learned of her disorder tell her that they never would have guessed.

Additionally, as a reader, I had difficulties with an attitude of one-upmanship that occasionally surfaced in the memoir. In one chapter, Montgomery, who is silently coping with psychosomatic symptoms, is frustrated by her colleague venting about dissertations and class workload, implying that her colleague’s stressors and anxieties are empirically less important than her own. In another chapter, in which she’s filling out paperwork in preparation for her first session of talk therapy, she writes,

“When asked to rate my symptoms on a range of scales, I want to point out how severe my suffering is — I’m not here for couple’s counseling after all, or grief, which is real and awful, but which is nothing like my delusions of ghosts and God. I want to be crazy enough to warrant serious attention.”

This is a position that I find troublesome, one that suggests there is a hierarchy of suffering and that, if you’re able to get through the day, you are somehow less entitled to seek mental health assistance. Finally, Montgomery straddles the line between insisting her symptoms are indicative of a severe problem and, paradoxically, are simply parts of her personality, likening her anxiety and compulsions to her mother’s dislike of avocados or her husband’s fondness of pepper. I struggle to be convinced by this contradiction in particular, because it employs statements that are so opposite of each other.

“There is nothing inherently wrong with me. What is wrong is how frequently people feel the compulsion to correct my behavior. Here’s what I want to say to anyone who implies there is something wrong with my brain: the only one who has a problem with it is you.”

Because so much of Montgomery’s memoir explores illness narrative, it is important to mention the way her own language reflects her anxiety. Her style fluctuates to echo her state of mind, going from paragraph-long lists to lyrical passages to short, fragmented sentences. The words on the page mirror her bodily experience in the physical world. Additionally, like her compulsions and intrusive thoughts, the text loops back around on itself, and Montgomery addresses the same points multiple times, mimicking the pervasive nature of her anxiety. I naturally lean more toward shorter works, and, because of this preference, I found the memoir a bit too long, many chapters continuing on longer than was necessary for the reader to get the point. Despite my penchant for shorter works, however, I understand and appreciate the author’s purposeful artistic choice for writing the way she did.

“Madness makes me see things — spiders, shattered sky, sometimes ghosts standing in the cemetery — but I am grateful for this moment. Many cultures experience collective visions of deceased family members, natural and spiritual phenomenon, but Americans label this delusion. Ours is a nation intent on medicating madness away; I feel sorry for those who haven’t experienced the mystical.”

Montgomery’s memoir is one that explores multiple facets of madness, both private and public. Quite Mad is an extensive inquiry into what it is like to struggle, live, and thrive with mental illness in modern America. It is a work that pays special attention to illness narrative and the limitations of language when describing symptoms, seeking professional help, and securing a correct diagnosis. Although the memoir included sections that did not completely convince me, I admire the comprehensive approach Montgomery pursued in exploring her own illness narrative. It is an ambitious work that many readers, particularly those with an interest in mental health and trauma, will find valuable.

JEN CORRIGAN is a Prose Editor for Alternating Current Press and a Staff Book Reviewer for The Coil. A nominee for the 2017 Pushcart Prize, her prose has appeared or is forthcoming in The Rumpus, Pithead Chapel, The Tishman Review, Hypertext Magazine, and elsewhere. Visit her at her website.