Quite Mad: A Conversation with Sarah Fawn Montgomery

*CW: This post contains discussion of sexual violence.

Sarah Marcus-Donnelly: Your captivating new book, Quite Mad: An American Pharma Memoir, out this September from The Ohio State University Press, does an outstanding job of blending memoir and relevant mental illness history. Can you talk to us a bit about the importance of striking that balance? What was it like to examine your own personal narrative within the greater context of America’s problematic treatment background? You write: “Medical institutions have incredible transformative power over patients: a patient is renamed after diagnosis, their experience redefined by the new label.” Can you speak a bit about the act of writing about labels, particularly those applied to yourself?

Sarah Fawn Montgomery: The challenge with any nonfiction is to make a personal story a human story, so readers recognize themselves in the pages or learn something new about the world. The challenge felt heightened, however, when writing about mental illness, which is so stigmatized. Research became a crucial component to make “my” story, “our” story—“our” being both the mental illness community, but also the United States, which has increasing mental illness rates and a cruel history of patient treatment. I was also drawn to research by my desire to know more about anxiety, OCD, and PTSD, and to validate the experiences I felt as a patient, many of which were ignored or undermined by a patriarchal medical institution that does not always respect patient perspective. Sharing my story within this larger context gave me a sense of community, but also created urgency, and social and political contexts to resist and rewrite. As such, the research covers quite a bit—theories of pain, theories of illness origin, medical sexism and the legacy of madness as a “female” malady, the history of mental illness treatment in the United States, including asylums, various medications, lobotomy, and eugenics, and a discussion of America’s Big Pharma and rising mental illness rates.

As for writing about labels, diagnosis is a strange act of (re)writing and naming—it provides answers, but also becomes for many patients an identity they may or may not welcome. Writing about labels was transformative in many ways, because prior to writing about mental illness I hesitated to disclose my diagnoses, in part because of the stigma surrounding mental illness, but also because I’m quite shy. Writing about these labels required I confront my attitudes towards them, their positioning in popular discourse, and the medical, social, and political systems that create and enforce them. In doing so, I discovered I take pride in my positioning and power as a mentally ill woman, much of my writing about illness a reclamation of labels like “mad” or “crazy” that once sought to delegitimize patients.

Marcus-Donnelly: As someone who suffers from chronic illness, I felt especially moved by your examination of patient fault and responsibility. You write: “A sick person shouldn’t do that, goes traditional wisdom, which insists ‘good’ patients seek medical treatment and comply with all orders…Patients are free from blame so long as they comply with what is expected…While patients might not be at fault for having the illness, they are responsible for getting better.” Do you believe there is a way to shift these unfortunate perceptions? How does one navigate the role of responsibility in a system often set up to fail them? Is there a way to shift the stigma of mental illness as a weakness?

Montgomery: The United States has a troubled history of blaming patients for their illnesses—either because of sin or sloth, gender or race, lifestyle or willful noncompliance of medical advice—that has led to many cruel treatments, not just for mental illness patients. We continue to place a tremendous amount of pressure on patients to take responsibility for their conditions, as though they have any control. Doing so frees us of the fearful reality that science and medicine do not grant us safety or protection in all the ways we’d like to think. It also limits the responsibility we bear to care for one another, as evidenced by our current healthcare system. That patients are somehow at fault for their illnesses, and we do not need to fear for ourselves or care for others is an entirely American response, and one complicated by invisible illnesses, which allow for an even greater amount of skepticism and denunciation.

Navigating the role of patient in our current healthcare climate is hard, often a greater burden than illness. The most important thing to keep in mind, however, is that we can—and often must—advocate for ourselves, assuming responsibility for our care without assuming fault for our conditions. The most important shift in my care was my own perception that I was somehow not good enough at relaxing, as though my very complicated mix of anxiety, OCD, and PTSD could be replaced with peace with a matter of simple lifestyle choices and willpower. Once I realized I deserved to be heard and believed, rather than silenced and doubted, I was better equipped for a system often designed to fail those in need of care. The stigma is shifting, albeit slowly, but it will continue to do so as more of us come to voice, collaborate with our communities, and voice the superhuman might it takes to move through the world with mental illness.

Marcus-Donnelly: Your work addresses the construction of mental illness as a “female” malady while pointing out many of the violences women identifying people (from family, students, colleagues, partners, and strangers) suffer on a daily basis. These seemed both expected and guaranteed. I’m thinking about the students who refer to women as “that bitch,” “that slut,” or “crazy,” or are defending rape allegations against their fraternities, etc. or the female students who are unable to show up in the aftermath of surviving their own sexual violence. You also write about the silence surrounding enduring sexual violence and how this silence impacts generations of women, how so many of us have been raped and how we are taught to apologize for our rapes. You consider how doctors and medical professionals have routinely and constantly dismissed you and women in general. What role do sexual violence and the dismissal of women play in the way our society views mental illness as a “female” malady? Is violence against women and mental illness inextricably linked?

Montgomery: The relationship between violence, imposed silence, and mental illness is essential to consider when discussing women’s health. According to the Rape, Abuse & Incest National Network (RAINN), one out of every six American women has been the victim of an attempted or completed rape in her lifetime. And the risk for young women is far greater—women ages 18-24 who are college students three times more likely and women the same age who are not enrolled in college four times more likely to experience sexual violence. The impact of assault on mental health is well documented, as is the fact that women are more likely to experience and seek treatment for mental illness—the National Institute of Mental Health (NIMH) reports that nearly one in five U.S. adults lives with a mental illness, the prevalence higher among women and that young adults.

Yet while women are more likely to experience violence and mental illness, they are also less likely to have their pain believed. To be diagnosed with and treated for illness, yet not considered an authority of one’s experience is the great irony of women’s healthcare. And this too, is nothing new—the medical sexism of things like the wandering womb and treatments for hysteria is eerily familiar, as is the seemingly-outdated expectation that women are inherently weak, sickly, and mentally unstable. Yet when we start to unpack the relationship between violence against women and mental illness, it is amazing how similar the conversations surrounding both are. We impose silence on both victims of abuse and those with mental illness, the stigma around both pervasive. Victims and patients are both blamed for their circumstances and expected to apologize. And both victims and patients are seen as weak or damaged.

Much of what Quite Mad hopes to do is complicate the dialogue surrounding mental health to include discussions of trauma and gender and push against a centuries-old legacy of silence and erasure, both of which are continuation of this violence.

Marcus-Donnelly: What do you think the role of inclusive feminism should be in supporting or amplifying advocates and the voices of people with mental illness?

Montgomery: Disability is often left out of inclusive feminism altogether—conversation full of ableist language, accessibility an afterthought, disabled voices absent, erased. That inclusive feminism ignores disability when 1 in 5 Americans is disabled is not just silence, it’s a kind of erasure. If feminist discourse is to be inclusive, disability must be included in the conversation—and we need to listen to actual disabled folks, rather than their physicians, family members, and friends. We need to seek out disabled voices, hire disabled writers and teachers, believe disabled students. We must also remember that while we have very limited representations of mental illness from which to draw, mental illness does not discriminate. If we are to advocate we need wider representation that is as diverse as those who experience mental illness, along with a more open dialogue about how gender, sexuality, race, class, ability, age, and location impact access to and quality of care.

Marcus-Donnelly: You are also a celebrated poet as well as an essayist. Is it difficult to transition between the two genres? Do you have any advice for new memoir writers?

Montgomery: Thank you! I started writing poetry to escape nonfiction, because I had begun writing this book and wanted the chance to write in short form about different material. Writing poems allowed me to write about frogs and creeks and constellations, which were welcome distraction while slogging through my past and mental health research that was downright depressing. But I quickly realized that nonfiction and poetry are not the separate genres into which we so often silo writing—many poems are essays, and essays poems, and there is great power in mutability. Writing multiple genres helps me to think about my subjects from different angles, allows me to occupy different perspectives, and widens my craft choices. Writing and reading multiple genres is the first bit of advice I have for new memoir writers.

The other is to go for the jugular—writing about oneself is already vulnerable, so best to do it with ferocity. There is no better place to be honest and flawed than on the page, and while you certainly want to write with an audience in mind, you never want to write in fear of their judgment. Write it messy, write it fragmented, circular, strange. Don’t skirt around circumstance or sand down the rough edges—write what is hard, painful, scathing, sharp. Take readers to the very marrow of your story.

Sarah Fawn Montgomery is the author of Quite Mad: An American Pharma Memoir, and the poetry chapbooks Regenerate: Poems from Mad Women, Leaving Tracks: A Prairie Guide, and The Astronaut Checks His Watch. Her work has been listed as notable several times in Best American Essays, and her poetry and prose have appeared in various magazines including Crab Orchard Review, DIAGRAM, Electric Literature, LitHub, The Normal School, Passages North, The Rumpus, Southeast Review, Terrain, and others. She has worked as Prairie Schooner’s Nonfiction Assistant Editor since 2011 and is an Assistant Professor at Bridgewater State University.