Psychiatry under fire: novelistic challenges to biomedical psychiatry in American fiction 1961-1964
American novels of the early 1960s posed a direct challenge to the legitimacy and apparent objectivity of biomedical psychiatry. Taken together, my selection of texts by Richard Yates, Ken Kesey, Sylvia Plath and Joanne Greenberg question the scientific validity of diagnoses of mental illness, as well as treatments such as involuntary hospitalisation, shock therapies, lobotomy, and the use of psychopharmaceuticals. These novels suggest that biomedical psychiatry functions as a form of social control by regulating and enforcing the categories of ‘madness’ and ‘sanity’ on the basis of compliance with social responsibility and expected behaviours. Accordingly, themes of autonomy and self-determination run throughout these texts as a traditional cornerstone of American culture to which the increasing omnipotence of psychiatric power is considered as a threat. In each chapter, I match a novel with a psychiatrist of the same or similar historical period, reading the fictional text through the framework of each psychiatrist’s position on their own discipline. I thereby demonstrate how these fictional texts either anticipated the work of the so-called anti-psychiatrists or appeared almost simultaneously. In Chapter One, I read Revolutionary Road alongside David Cooper’s Psychiatry and Anti-Psychiatry and argue that both texts depict the mad individual as immediately delegitimised as a socio-political agent through psychiatric diagnosis. I also argue that Yates uses the figure of the madman to demonstrate the absurdity of socially expected behaviours, thereby presenting the ‘mad’ paradoxically as truth-tellers who seek to reveal the illusory nature of American middle-class freedoms (particularly with regards to consumerism). In Chapter Two, I step inside the asylum by reading Ken Kesey’s One Flew Over the Cuckoo’s Nest alongside the works of Thomas Szasz. I argue that these texts staunchly position involuntary hospitalisation as both custodial and punitive, motivated by a desire to readjust the socially maladjusted for return to a rigidly controlled community. Both Szasz and Kesey reject the legitimacy of psychiatric diagnoses and understand the use of shock therapies and lobotomy to be acts of violence. Equally, Szasz and Kesey also prioritize individual self-determination over social cohesion, which again, like Yates’s Revolutionary Road, aligns psychiatric intervention with enforced conformity and the loss of civil liberties. In Chapter Three, I read Sylvia Plath’s The Bell Jar through the framework of R. D. Laing’s The Divided Self. I argue that Esther Greenwood’s psychotic illness manifests itself as a Laingian ontological insecurity, and that alter-egos like Elly Higginbottom function as part of a false-self system intended to preserve the outward appearance of normality. I also demonstrate how Esther experiences both self-alienation and psychiatric persecution as a direct result of her rejection of conservative gender roles and the social expectations therein. Finally, I reject Esther’s ambiguous cure, positing instead that recovery is not possible within the society that caused Esther’s distress since socially expected gender roles are at the root of her trauma. Chapter Four occupies a unique position, offering a humane alternative to biomedical psychiatry. I argue that Joanne Greenberg’s I Never Promised You A Rose Garden, read in conjunction with works by Frieda Fromm-Reichmann, offers a vision of a different model of psychiatric engagement founded upon respect for patient autonomy and on self-realization rather than adjustment. In this text, Greenberg demonstrates the potential for asylums to be curative places of self-development, but only under very specific financial and ideological conditions. I suggest that, while Greenberg’s fictional version of the real Chestnut Lodge represents a highly elite and unorthodox facility, its approach towards patient care is a direct retort to the treatment of psychiatric patients portrayed in each of the other three texts.