Sarah Fawn Montgomery talks about mental illness, its history and treatment in the United States, and her new memoir.
Elizabeth Schulte Martin: I’m delighted to get to chat with Sarah Fawn Montgomery about her writing life, her human life, and her new book, Quite Mad: An American Pharma Memoir (Ohio State University Press, September 2018). Sarah Fawn is also the author of the poetry chapbooks, Regenerate: Poems from Mad Women, Leaving Tracks: A Prairie Guide, and The Astronaut Checks His Watch. She has been Prairie Schooner’s Nonfiction Editor since 2011 and is Assistant Professor at Bridgewater State University. I’ve been a devout fangirl of her beautiful language acrobatics for many years now, and I found myself completely fascinated while reading Quite Mad, which explores Sarah Fawn’s personal experience with anxiety disorders, while also examining the history of the way we think about and treat those who live with mental illness. The book feels keenly like an important part of a public discourse we should be having about mental health, and yet it also invites the reader into a more intimate conversation, which is the natural result of Sarah Fawn’s careful and humane way of thinking about the world.
So, having said this is an important book (which is not a thing I’d say lightly, by the way), I want to start out by asking why it was important to you to write? Books are daunting tasks, so what was the moment, the thought, revelation, or feeling that made you think it was a topic you could commit to for a book-length work?
Sarah Fawn Montgomery: Ultimately, I set out to write the kind of book that I needed as a patient. When I began to experience severe changes in my mental health, I turned to literature to try and makes sense of the experience. But I found a real divide in the texts — either the texts were medical texts or they were patient narratives, but rarely did the two overlap. As a patient desperate to understand my diagnoses, but also to connect with the larger mentally ill community, I wanted a text that shared information about mental illness and its treatments, but that also shared the stories of patients like me, which were so important as I was coming to understand and accept my brain and body.
I also wanted to reflect on the misinformation and stigma in conversations surrounding mental health. As a patient I frequently encountered disbelief from physicians, family, and friends, and found myself having to defend my pain or prove my trustworthiness. That so many patients are met with suspicion was something I wanted to address. I also wanted to reflect on the ways diagnosis impacts patient autonomy and the silencing that happens to so many patients. Quite Mad is a book about erasure in many ways — my attempt to rewrite my story and the stories of many others who have been told they are exaggerating, making it up, not to be trusted.
I found some of the information in Quite Mad regarding the history of mental illness and the methods for treating it surprising. Was there anything that surprised you in the course of your research? Anything that challenged your own assumptions or steered the course of the book in a direction you weren’t expecting?
America’s cruel history of treatment toward the mentally ill is always a shock — this nation has locked up large numbers of folks deemed “deviant,” treated them with inhumane drug therapies, and advocated for eugenics — but what was the most surprising for me while researching and writing was how familiar seemingly outdated attitudes toward mental illness remained. Things said 50 or even 100 years ago about the “danger” or “violence” of those with mental illness is reflected in contemporary conversation, as are discussions over who has the right to control treatment, who is more likely to be diagnosed with mental illness, and the notion that mentally ill folks are burdensome to others, childlike, or mostly women. This book is not so much an examination of how far we’ve come in our understanding of and attitudes toward mental illness as it is a recognition of how little has changed.
One of the things that resonated with me in this book was your discussion of pain, and how it resists language. You reference Elaine Scarry’s The Body in Pain: The Making and Unmaking of the World and go on to elaborate on some of her assertions, explaining that
“We cannot describe our pain to others because pain separates our realities. For those suffering, there is no existence beyond pain — it frames the world. Those not in pain have an alternate reality, separated from the sufferer by way of the body. Sufferers cannot articulate their truths and those without pain cannot begin to comprehend. What exists for those in pain is unreal to those without it.”
… So, I can’t help but notice that much of this book attempts to do exactly what Scarry and you say cannot be done — making the pain of someone who suffers from mental illness understandable to those who do not. At what points in this book did you most feel that the pain you wanted to convey resisted language, and what did you do to get past those points and connect with readers?
Patients face a lot of disbelief — I have to constantly justify my dread and symptoms. Anxiety is an illness of imagined fear turned real, with both mental and physical symptoms, but for those who have not experienced it, this can be difficult to understand. Explaining what it is like to experience anxiety, OCD, and PTSD was important to me, but so was explaining the pain that comes from having the world doubt not only your sanity but your hurt, to invalidate your experience with their skepticism. The book focuses on the agony of doubt as much than the physical and psychological pain of mental illness.
One of the most interesting things I found as a writer was how accepting my imagined audience was. Trust is essential with nonfiction — the reader needs to be willing to believe the writer — and this is complicated when writing about mental illness, an experience that alters reality and memory, and that readers have likely not shared. I found, however, that the burden of trying to explain mental illness was lifted while writing, for creative writing provided a wonderful freedom from everyday conversation that often centers on symptoms, diagnosis, and cure. Creative writing allowed me to be contradictory, discursive, frantic and fluid, to tell my story as my mind remembered it and without the challenge of inspiration, recovery, or any other tropes that patients are so often expected to incorporate into their narratives. The focus then became conveying pain as it happened and telling a story, without worrying about convincing readers whether or not it was real.
Women are disproportionately diagnosed with and treated for mental illness. Among the many troubling observations this book makes, this one comes up frequently, right up to the chilling last lines. I want to give you the chance to talk about some of your thoughts and research on this disproportionality here. Go!
As a patient, I encountered many examples of medical sexism — disbelief of my symptoms, an assumption I was being “hysterical,” blaming symptoms on my reproductive organs, silencing my story in favor of medical (often male) authority. What I found most frustrating and fascinating was that the angrier I got about this sexism, the more this anger was used as justification for my madness. There were clear ways to behave as a patient — particularly as a female patient — and consequences for those who did not comply.
My research into the history of treatment for mentally ill women in the United States was like looking into a strange mirror, things like the rest cure, prescription treatment, even sterilization eerily familiar. Women are still encouraged to assume subservient domestic lives, still far more likely to be medicated for mental illness compared with men, and conversations surrounding who should have children have not gone away — forced sterilization without consent still happens, though we like to think the eugenics movement is far removed from the present moment. Terms like “crazy” or “hysterical” are still used to control women’s behavior, just as women were once likely to be diagnosed with mental illness for refusing to obey the men in her orbit, refusing a partner or children at all, for wanting to work or run or shout. It is maddening that women are less likely to have their pain believed, yet more likely to be diagnosed with and treated for mental illness, and even more maddening that we rarely consider that women are more likely to experience abuse, trauma, domestic burden, low wages, and many other contributing factors to mental illness.
Obviously, Quite Mad brings up some heavy topics and dark moments. But I want to end the discussion of the book itself on a happier note, and say how much I love the way you talk about your relationship with your partner, Brady. In the middle of this book, which is in many ways about suffering and injustice and a failure to understand, the sections about Brady seem to demonstrate people’s ability to heal and understand each other, if only in an imperfect way. Now that I’ve made myself cry just describing it, can you speak to this a little?
There is a strange preconceived notion that folks with mental illnesses are somehow unlovable, that caring for a mentally ill partner, family member, or friend is somehow a burden. This stigma is perpetuated in television and film where the “real” hero is the partner who doesn’t abandon their ill spouse, who falls in love with a sick character, or the family that loves a member “despite” their illness. The real burden is that patients have to expect limited support from those around them, that they should somehow suffer in silence and have superhuman cheer in the face of chronic pain.
But while this has certainly been true of some of my experience as a patient, I’ve also found tremendous tenderness from those within the mental illness community. As you mention, I’m lucky enough to have a wonderfully supportive partner, whose care comes without conditions, and whose own experience with bipolar disorder means my mental illness is never questioned or judged. Making my way through the world with a mentally ill partner, but also with many friends and family members with mental illness is a comfort — I don’t have to justify my experiences; I feel no shame or pressure. Though the world tries to convince mentally ill folks that we are unlovable, our rich community reminds me time and again we are deserving of love, nurturing, and support, and that these have nothing to do with illness.
How do you get yourself to write when you don’t feel like it?
The same thing I tell my students, which is “butt in chair.” The writing is not going to accomplish itself, and I find that even writing fueled by a caffeine-induced rush of inspiration needs the same care and revision as writing that comes at a glacial pace. Writing is a practice just as it is an art, and so I try to practice as often as I can, which isn’t as often as I’d like. It can be hard to write with mental illness and the host of physical pain symptoms that anxiety, OCD, and PTSD present, so my practice is also about caring for other aspects of my life so that I can be well enough to write. I also try to have patience, as we all should, when I am not well enough to write. I know I will write again when I am able and this keeps me going. And I cannot say enough for reading — a dedicated writer is a dedicated reader — for in addition to helping my craft, reading sustains me when I don’t feel well.
You’re a prolific reader. What books have made a lasting impression on who you are as a writer or a person?
Oh, goodness! I always feel I haven’t read nearly enough. Books have the most powerful impact on me when I engage with active voices in the publishing world. For the last year or so I’ve mostly read poetry because there have been so many utterly fantastic collections released by writers like Erika Sanchez, Danez Smith, Jennifer Chang, Javier Zamora, Lynn Melnick, Chen Chen, Ariel Francisco, Hieu Minh Nguyen, and Steven Sanchez. The power and timeliness of these collections helps us as humans moving through a cruel and calculated moment in history, but also reminds us of the real-world impact of poetry.
Tell me one thing that you’re preoccupied with right now that isn’t writing-related. (I mean, not directly — I know anything could be writing-related if you end up writing about it …)
I have a fairly obsessive personality (this comes with the OCD territory!), so I love to immerse myself in new research or food or music — I admit, without shame, that I wrote most of Quite Mad while listening to Cher’s complete discography on repeat. For the last eight months, I’ve been fascinated by vegan cooking, and I’m waiting for the next thing to geek out on.