Tag Archives: reading

What I’m Reading: November 2022

Books! Lots of books! As always, said books are mostly narrative nonfiction about mental health, psychiatry, and trauma.

Photo of the cover of Emily Maloney's book "Cost of Living: Essays"

Cost of Living: Essays by Emily Maloney.

[Content warnings for this book: medical trauma, substance abuse, suicidality, suicide attempt]

A collection of essays from a fellow neurodivergent (ND) person (yay!) that offers a (narrow and fairly privileged) look at our fucked-up healthcare system from the perspective of a woman who interacts with it in a bunch of different roles (ER tech, EMT, bioethics student assigned to shadow med students, medical publications manager) after a suicide attempt lands her in the hospital with a shit-ton of medical debt that she needs to pay off. We get insight from her experiences as a patient (both medical and mental health) and debtor, too.

This book is very much a collection of personal essays that explores the author’s experiences as both patient and caregiver, which was informative and engaging enough to keep me reading. It’s not a deeply nuanced critique of the American healthcare system, though. So if you’re looking for that, look elsewhere.

Also, as an autistic person, I found her descriptions of her internal world to be so, so relatable—she does a good job defying the standard stereotypes and capturing what it feels like to be autistic (I clocked her as ND, probably autistic, literally three paragraphs in). If you read this book and find yourself relating to her internal world, gratz on the autism and welcome to the club. (The author does eventually reveal her diagnosis. It is not, much to my genuine shock, autism. To absolutely no shock, her diagnosis is one that many autistic people feel is a more palatable and ableist way of saying “autism,” in much the same way that “Highly Sensitive Person” is actually just autism. Let me put it this way: The Venn diagram of the author’s descriptions of her internal world and The Autistic Experience™ is a circle.)

Photo of the book cover for Kelly Sundberg's "Goodbye, Sweet Girl: A Story of Domestic Violence and Survival"

Goodbye, Sweet Girl: A Story of Domestic Violence and Survival by Kelly Sundberg.

[Content warnings for this book: domestic violence, substance abuse]

In her essay “In Defense of Navel Gazing,” Melissa Febos writes about writing about trauma:

“Listen to me: It is not gauche to write about trauma. It is subversive. The stigma of victimhood is a timeworn tool of oppressive powers to gaslight the people they subjugate into believing that by naming their disempowerment they are being dramatic, whining, attention-grabbing, or beating a dead horse. Believe me, I wish this horse were dead…But we shouldn’t write about it because people are fatigued by stories about trauma? No. We have been discouraged from writing about it because it makes people uncomfortable. Because a patriarchal society wants its victims to be silent. Because shame is an effective method of silencing.”

I don’t know if the author of Goodbye, Sweet Girl ever questioned the importance or value of sharing her story. As a person who has experienced similar trauma, my guess is that she did. I know how hard it is to write about your trauma (or at least, how uncomfortable and inconvenient it can be), especially when it’s perpetrated against you in your own home, by a person (or the people) you count on to protect you and to be a safe space for you.

This book is so well-written, and it does a great job of illustrating how abuse can happen slowly and subtly, and then suddenly and all-consumingly; about how difficult it can be to see it; and about how difficult it can be to walk away from once you do see it.

A related read: In the Dream House, a lyric memoir by Carmen Maria Machado about, as Roxane Gay says in her Goodreads review of the book, “the complexities of abuse in queer relationships.”

Photo of the book cover for Roxane Gay's "Hunger: A Memoir of (My) Body"

Hunger: A Memoir of (My) Body by Roxane Gay.

[Content warnings for this book: disordered eating, fatphobia, racism, rape]

Immediately yes. Read it. Right now. Especially if you’re not, and have never been, fat. Evocative, uncomfortable, necessary. This book is going to stay with me for a long, long time.

I think Hunger is an incredibly important book that has a lot to teach a lot of people. You’ll get the most out of this one if you approach it with an open mind and the willingness and ability to confront uncomfortable parts of yourself, and to ask yourself—and explore your answers to—uncomfortable questions.

(I have a lot more to say about this book. Enough to write a separate, entire post about it.)

Photo of the cover of Rachel Aviv's "Strangers to Ourselves: Unsettled Minds and the Stories That Make Us"

Strangers to Ourselves: Unsettled Minds and the Stories That Makes Us by Rachel Aviv.

[Content warnings for this book: ableism, disordered eating, filicide, suicidality, suicide attempts]

An exploration of how we understand ourselves, especially in moments of crisis and distress; of how a mental illness diagnosis can shape our understanding of ourselves, our experiences, and the world; and of how mental illness diagnoses can influence how others and the world interact with and experience us.

The book is structured into six chapters, each a case study of a different person and their mental health history, beginning with the author’s own experience of being admitted to an in-patient treatment program for anorexia when she was just six years old, and drawn from the history of psychiatry, philosophy, interviews with the subject of each chapter and their family members and doctors, and primary source documents, like unpublished memoirs. (Technically, the first and last chapters aren’t really chapters, they’re the prologue and the epilogue, but they’re important to the premise of the book, so I’m lumping them in with the chapters.) It’s well-researched, well-reported, and well-written—and I’m not quite sure what to make of it.

I had a lot of trouble getting into a rhythm with this book, and it took me a very long time to read—it just could not keep my attention. I don’t think the book is bad. I think I went into it wanting it to be something it’s not (I really wanted it to do what Pathological: The True Story of Six Misdiagnoses set out, and, in my opinion, failed to do), and I think that influenced my experience of it. That being said, I think the book does exactly what it sets out to do (re-read the first graf, above), and I think it does it very well.

Photo of book cover for "Trauma and Recovery: The Aftermath of Violence—From Domestic Abuse to Political Terror" by Judith Herman.

Trauma and Recovery: The Aftermath of Violence—From Domestic Abuse to Political Terror by Judith Herman

[Content warnings for this book: basically everything associated with all sources of trauma—accidents, domestic violence, kidnapping, natural disaster, sexual violence, war, etc.]

Of the Big Three trauma books—and the ones about complex trauma specifically—I liked this one the best. It’s also the first of the Big Three that was written (the other two are Pete Walker’s Complex PTSD: From Surviving to Thriving and Bessel van Der Kolk’s The Body Keeps the Score), and it’s the book that first introduced the concept of complex trauma and proposed it as a distinct diagnosis.

(Since 1992, the author of the book has advocated for the inclusion of Complex PTSD, or C-PTSD, as a distinct diagnosis in the DSM. To date, those efforts have been unsuccessful—C-PTSD is not an actual diagnosis in the United States because it’s not included in the DSM and therefore doesn’t have an associated billing code and therefore insurance won’t cover it (everything is about money). In countries that diagnose using the ICD instead of the DSM, C-PTSD is an actual diagnosis.)

Honestly, I don’t know how I hadn’t read—or even heard of—this book before this year??? Especially considering my entire-ass college degree is in psychology??? I digress.

This book covers a lot, and it does so in a way that feels cohesive and accessible and digestible. I appreciate that the author walks the reader through the evolution of the study and science of trauma, from the early days of hysteria to our current understanding of trauma as an unconscious and physiological response and process. I appreciate that she cites so much research, and that she presents it using plain language. And I appreciate that she talks about the therapist/patient (client) relationship (this is something that I think deserves more attention, in general, than it gets—especially when the patient/client is autistic and the therapist is not).

Personally, I found the discussion about trauma reenactment and the mechanisms that drive it to be the most helpful part of this book. If, like me, you find yourself wondering why you constantly, or consistently, end up repeating patterns that mirror trauma that you’ve experienced, or why a person doesn’t “just leave” an abuser or abusive situation, this book might be particularly helpful/relevant to you. And if you don’t find yourself asking such questions? This book is still worth a read. Big recommend for everyone.

Two critiques:

One: This book is 30 years old (which is weird because the 90s were only a few years ago), and as such, the way it talks about gender and gender roles is outdated and stereotyped. There’s a lot of good information in this book specifically re: domestic violence—in the context of cishet relationships. If you’re looking for a nuanced take on the dynamics of abuse in queer relationships, you won’t find it in this book.

Two: There’s zero mention, let alone discussion, of the intersection of (non-acquired) neurodivergence (e.g. autism) and trauma, to include approaches to therapy, trauma processing, and healing that are better suited for us. I mean. I didn’t go into this book expecting it to include such a take, but as I read it, it was incredibly obvious that such a take was missing—and is still very much needed in contemporary works on trauma and mental health.

What I’m reading: August 2022

Hi, hey, hello! I have a lot I want to blog about. I simply do not have the brain space right now. There are a fuck-ton of moving pieces in my life right now, which is an actual nightmare for my autistic ass, which does not handle change well and which cannot function without rigid structure, schedule, and routine. So. While I wait for things to settle down enough for my brain to be able to string together coherent thoughts, I’m sharing a few book recommendations for two books that I’ve recently-ish read, and one that I’m currently trying very hard to read (see previous note about lack of brain space).

Photo of the book cover for "On Immunity: An Inoculation" by Eula Biss. The cover is a detail from Peter Paul Ruben's c. 1630 painting "Achilles Dipped into the River Styx," which shows Achilles being dipped into the River Styx, held by his left ankle.

On Immunity: An Inoculation by Eula Biss.

I read this book over Fourth of July weekend and let me tell you, it was a trip to read this book when I did. Published in 2014, it references Roe v. Wade—several times—and in a way that assumes it will always be, which was particularly disorienting as Roe was repealed days before I read the book. And by way of addressing the inevitability of a future pandemic, it foreshadows Covid-19. Wild!

Biss is one of my favorite writers. Her writing is gorgeous, and she’s so, so smart. In this book, she merges sciences, medicine, personal history, cultural history, art, mythology, philosophy, metaphor, and ethics to discuss, as the title suggests, inoculation, vaccination, and immunity. In doing so, she highlights our interconnectedness, our responsibilities to each other, and the multidimensional nature of health. The result is, like everything else she writes (essays; books), stunning. My detail-oriented and pattern-recognizing autistic brain loves the connection of dots—the more dots, and the less seemingly related they are at first glance, the better. This book had dots. Lots of them. Big love.

Photo of the book cover for "Body Language: Writers on Identity, Physicality, and Making Space for Ourselves" edited by Nicole Chung and Matt Ortile. The cover shows brightly colored pink, red, blue, yellow, and green human-shaped forms arranged in a kaleidoscopic pattern.

Body Language: Writers on Identity, Physicality, and Making Space for Ourselves edited by Nicole Chung and Matt Ortile.

An anthology of previously published essays (culled from the Catapult archive) that describe and discuss the embodied experience(s) of health, disability, race, gender, sexuality, size, and shape. Didn’t love, didn’t hate, kind of liked, kind of didn’t. Ultimately, I think it’s a worthwhile read.

(I think my ambivalence lies in the book being an anthology, which means that although there’s a unifying theme that each essay is tied to, there’s inconsistency in overall structure, tone, and pace, because each essay is written by a different writer, and every writer has their own style. And, as we’ve established, my autistic brains likes consistency. That’s not the book’s problem, though. The book did exactly what it’s supposed to do. Also: What a great cover, right??)

Photo of the book cover for "All the Living and the Dead: From Embalmers to Executioners, an Exploration of the People Who Have Made Death Their Life's Work" by Hayley Campbell. The background of the cover is black, with a skull surrounded by a black bird, fern leaves, and a small assortment of orange-ish and pink-ish wildflowers arranged just below the center line.

All the Living and the Dead: From Embalmers to Executioners, an Exploration of the People Who Have Made Death Their Life’s Work by Hayley Campbell.

I ordered this book while listening to this NPR interview with the author. It sounded irresistible—and it is. It’s so good. I admit, though, that I’m biased—I have a thing for books that discuss death and dying and the funeral industry (I’ve been around death from a young age—from the death of many acquaintances and friends over the years (cancer, addiction, suicide, murder), to once being married to a man whose entire job every single day for many years was to conduct funerals for military servicemembers being buried in Arlington National Cemetery, to combat-related deaths of friends of friends).

Each chapter is a mini profile a different part of the death industry and a person or people who work in it: embalmers, international disaster response workers, a former corrections officer who was the state’s executioner, a man who owns a business that you can hire to clean a crime or trauma scene (once an investigation is over, the police do not clean up—the task is left to the families/property owners, to either DIY it, or hire a trauma cleaner), a funeral director, the director of an organ donation organization, a death mask sculptor, a bereavement midwife, a person whose job is to dig graves, the operator of a crematorium, and the president of the Cryonics Institute.

I’m about halfway through and so far I’ve found every chapter incredibly fascinating and nuanced. Also, I deeply appreciate that this book highlights the humanity of everyone involved—both the dead and the living.

Five related books that I’ve also read and recommend:

What I’m reading: June 2022

A Twitter thread, an essay, and a few non-fiction books about disability, health, and trauma.

A stack of three books atop a wooden table, with the spines facing the camera. The books are, from top to bottom, "Disability Visibility: First-Person Stories from the Twenty-first Century" edited by Alice Wong, "The Invisible Kingdom: Reimagining Chronic Illness" by Meghan O'Rourke, and "What My Bones Know: A Memoir of Healing from Complex Trauma" by Stephanie Foo.

First up, the short-form stuff.

There’s this Twitter thread about why many autistic people don’t watch (or otherwise support) Netflix’s exploitative and stigmatizing show Love on the Spectrum. The replies and quote tweets are amazing, too.

There’s also this excellent essay about the casual ableism in cooking from Gabrielle Drolet, a disabled journalist, essayist, and cartoonist. The main takeaway: Items that many people turn their nose up at and consider to be lesser-than or “lazy”—like jarred minced garlic, bottled lemon juice, pre-sliced produce, and shredded cheese—are accessibility tools for disabled folks who can’t do things like chop or peel or slice.

Alright. Onto the books!

Front cover of "Disability Visibility: First-Person Stories from the Twenty-first Century" edited by Alice Wong. The background of the cover is an off-white. The title and author's name is in black sans-serif font, against a collage of colorful triangles of varying size.

Disability Visibility: First-Person Stories from the Twenty-first Century edited by Alice Wong.

This is the first non-autism disability-related book I picked up, and I’m very slowly making my way through it. It is, as the title suggests, an anthology of essays by disabled folks, about what life is like as a disabled person in a very ableist society.

This book has been uncomfortable to read, and for those us with deeply internalized ableist attitudes, assumptions, beliefs, and behaviors (like yours truly), I think that that’s the point.

Of the essays I’ve read so far, “The Isolation of Being Deaf in Prison” by Jeremy Woody as told to Christie Thompson is the one that has stood out to me the most. You can read the full essay on The Marshall Project’s website.

Related to that essay: A book I read a few years ago, Insane: America’s Criminal Treatment of Mental Health by Alisa Roth, and a recent episode of the podcast Crime Show, which reports the story of a prisoner without teeth who was unable to eat yet denied dentures by the prison system because they only provide dentures if/when medically necessary and needing to eat was not considered medically necessary. Make it make sense!

Front cover of "What My Bones Know: A Memoir of Healing from Complex Trauma" by Stephanie Wood. The background of the cover is royal blue. The title and author's name are in a light yellow sans-serif font that appears gold-ish, with an arrangement of colorful flowers and crossbones.

What My Bones Know: A Memoir of Healing from Complex Trauma by Stephanie Woo.

The cover and the subtitle sold me—I’m a sucker for a well-designed book cover, and relatable memoir. So, a book with a gorgeous cover about a terrible thing? A real twofer, folks. Who could resist!

This book is exactly what the subtitle says it is, and the first of its kind: a memoir about healing from cPTSD. Specifically, childhood abuse and neglect, with a touch of generational trauma, and the science behind it, thrown in.

It’s a little slow to unfold for my taste, and I found it to be a little disjointed in places. Not sure if that’s a scoping issue or an editing issue. Maybe both. Whatever the case, I think this book is important and my own traumatized lil heart appreciates that more people are speaking so openly about trauma, abuse, therapy, and the hard work of healing.

A word of warning: There are some pretty detailed accounts of the author’s experiences that will be activating/triggering for some people. Reader discretion advised.

Another related-ish memoir: Carmen Maria Machado’s In the Dream House, a lyric memoir about domestic violence in a queer relationship.

Front cover for "The Invisible Kingdom: Reimagining Chronic Illness" by Meghan O'Rourke. The background of the cover is a lighter, sky-ish blue. The title and author's name are in a sans-serif font. A rendering of the human nervous system is in thin yellow lines, behind the title and author's name.

The Invisible Kingdom: Reimagining Chronic Illness by Meghan O’Rourke.

I’ve still got about 100 pages left but WOW. Very hard to put this one down, which I unfortunately have to do during the workday??? Dizazz.

Anyway. This book is well-researched, well-structured, and beautifully written. A great example of memoir combined with research and reportage. (In this way, it reminds me of another extremely bangin’ book: Leslie Jamison’s The Recovering: Intoxication and Its Aftermath, her memoir + cultural history + literary criticism + reportage about addiction and recovery.)

Like Disability Visibility, this book has been uncomfortable to read. Because like Disability Visibility, this book has me confronting my own ableist attitudes, assumptions, beliefs, and behaviors. It’s uncomfortable to confront shitty parts of yourself!

This book is also affirming to read, because it does a great job of capturing the experience of having an invisible disability—of what it’s like when what people see on the outside doesn’t match what you feel on the inside; of knowing something about you is…off (“wrong” in the case of chronic illness, “different” in the case of autism), and no one around you understanding or believing you.

To be clear, autism is not an illness/disease. It is an invisible disability. This book is about being chronically ill, not about being autistic. Chronic illness and autism are related, however, in that they’re both largely invisible disabilities, and the descriptions in this book of those feelings of invisibility are very, very relatable to me, an autistic person.

Also, I was delighted—yes, delighted—that O’Rourke quotes/references a few of my favorite contemporary writers—Eula Biss, Sarah Manguso, and Jenny Ofill. I was also delighted to see that Biss and Esmé Weijun Wang (whose essay collection The Collected Schizophrenias I recommended at the very bottom of my post about the memoir-reportage book Pathological: The True Story of Six Misdiagnoses) blurbed this book. I clearly have a type when it comes to writers and writing.

What are you reading?

“Pathological: The True Story of Six Misdiagnoses”

I recently read Pathological: The True Story of Six Misdiagnoses by Sarah Fay. It was…not what I was expecting, and I have mixed feelings about it.

Before we dive in: I recognize that mental health and mental illness are emotionally charged topics, and, in our society, politically charged ones, too. I also recognize that they’re complex topics. There is no one-size-fits-all approach or philosophy. I think there’s widespread consensus that we need a paradigm shift when it comes to mental health and mental illness, and many different ideas about what that shift should be and how that shift should happen.

I don’t have all the answers. Or any of them! I have my thoughts and my feelings and my opinions, which are informed by my experiences, which are informed by my unique combination of privileges, accesses, and opportunities. Some people will share my perspective, and some people will not. That’s okay!

There are many bits in this book that I think are informative and valuable, and there are some takes with which I disagree. I touch on a few of these takes below, and focus mostly on one.

Alright then. Shall we? Let’s shall.

A copy of the book "Pathological: The True Story of Six Misdiagnoses" by Sarah Fay is positioned on a book cart so that the front of the book is visible. The background of the cover is dark purple. The title of the book and the author's name are in tall, block letters, colored, from left to right, pink to blue. The subtitle is white and in a handwritten font, across the center of the book, between the title and the author's name.

Ostensibly, this book is a memoir about the author’s experience of being misdiagnosed over the years with six separate DSM diagnoses: anorexia, major depressive disorder, anxiety disorder, ADHD, OCD, and bipolar disorder.

This book is memoir in the loosest sense of the word. The author frequently references her personal experience, but there’s no introspection, reflection, nuance, or critical self-analysis that one expects from memoir, and no character development beyond the superficial (really, the only character “development” is the author ages, as one does in accordance with the linear progression of time). The author comes off as self-centered—not self-aware—in a way that’s frustrating (sometimes infuriating) and uncomfortable.

What this book actually is, is a history and critique—a rebuke, really—of the DSM. Many people know that the DSM, or the Diagnostic and Statistical Manual, is psychiatry’s “bible” and what clinicians use to diagnose mental illness. What many people don’t know, and what Pathological discusses, is that while the DSM has been branded as a definitive and scientifically sound document, it’s not. It has a problematic history, and remains a problematic—and scientifically unsound—document.

The main argument of the book is: Stop pathologizing normal human behavior, activities, and experiences. Which: YES! I agree with this. Emphatically. I understand that the DSM has a problematic history, and I agree that it remains a problematic document. I agree that there needs to be a paradigm shift when it comes to how we think and talk about, and approach, mental health and mental illness.

Where the author loses me is making the leap from “the DSM is a problematic document” to “not a single diagnosis in the DSM is real and its diagnoses aren’t helpful.” 

She makes this leap by staying stuck on only the scientific definition of the word “valid.” To Fay, all DSM diagnoses—with the exception of dementia and perhaps schizophrenia (her caveats)—are “hypothetical” and “opinions, not facts.”

I think that this is an extremely problematic take.

Using the scientific definition of “valid,” DSM diagnoses aren’t “real” in that they aren’t pathological. Meaning, Fay clarifies, they’re not medical disease or illness; there is no blood test or brain scan or other physical diagnostic exam that can conclusively diagnose anything in the DSM (with the author’s two caveats, noted above).

Okay. I understand that using this definition of “valid,” no DSM diagnosis is “valid” because no DSM diagnosis is pathological. And, per a previous paragraph, I agree that we should’t pathologize normal human behaviors, activities, and experiences. I don’t agree that an experience not being pathological means that it’s not real. And I don’t agree that grouping experiences using common language is unhelpful.

An experience does not need to be observable on a physical diagnostic exam to be “real” or “valid” in the non-scientific meanings of those words. These experiences are very real for the people having them, and they have an impact—often a significant, if not defining, one—on a person’s life. And in this ableist-ass economy, that impact is usually a negative one.

Let’s take autism as an example. I’m autistic. Or, using the pathologized language of the DSM, I have Autistic Spectrum Disorder (autism isn’t a disorder or a deficiency, it’s a difference). There’s no blood test or brain scan—or other diagnostic imaging or lab—that can conclusively confirm, or “diagnose,” autism. Because being autistic isn’t an illness or disease. It’s not pathological. That autism can’t be definitely measured by and irrefutably proven using a physical diagnostic exam doesn’t mean my experience of being autistic isn’t valid or real. Same goes for the other DSM diagnoses. To argue otherwise is hurtful and harmful. That’s called gaslighting. Gaslighting is abuse. Abuse can cause trauma.

DSM diagnoses are labels. Sometimes, labels can be limiting. Often, especially in the context of understanding who you are, and extra especially in the context of invisible and intangible aspects of identity, they’re incredibly useful. Spend some time scrolling through #ActuallyAutistic, #DisabilityTwitter, and #NEISVoid on Twitter and you’ll see how powerful having language for your experience can be.

Pathologization aside, DSM diagnoses are life-changing, even life-saving, for many because those diagnoses—those labels—give people language, context, community, and permission. Receiving my DSM diagnoses was the single-most affirming and empowering experience of my life (to date, and pathologization aside). They came with stigma and stereotype, sure. They also gave me the four things I mentioned above: language, context, community, and permission.

Language to describe my experiences.

Context for why I have the experiences that I have.

Community with other people who have similar or same experiences.

Permission to stop masking, to unlearn ableist attitudes, to cut myself a fucking break, to be me.

Doing away with—or refusing/rejecting—DSM diagnoses, as the author suggests, and indeed does herself, means doing away with those labels and the affirming and empowering—and sometimes life-saving—benefits they can offer.

Also, can we just take a moment to talk about the irony of the author writing an entire-ass book arguing that we should stop pathologizing normal human behavior, activities, and experiences, and then using outdated and pathologizing language throughout. LOL!

Not once did Fay make an effort to reframe pathologizing terms with less loaded and more neutral, understanding, and inclusive language. She doesn’t even address it in passing. It’s like the idea simply never occurred to her. Wild.

Reframing pathologizing language is easy. SO easy.

We can say “co-occurs” instead of “comorbidity.”

We can say “traits” or “experiences” instead of “symptoms.”

We can say “difference” instead of “deficiency.”

People can be “supported” and “accommodated” instead of “treated” or “managed.”

Fay knows language is important. She must. Her whole book is framed using punctuation as a device to illustrate exactly this. If punctuation matters, so too must the words it punctuates. And the author—A WRITER, AKA A PERSON WHOSE WHOLE ENTIRE JOB IS LANGUAGE—obviously understands this. That she neglects to acknowledge or elaborate on it is, in my personal, unsolicited, and correct opinion: deeply irresponsible.

If your goal is to stop pathologizing non-pathological things, one of the easiest and immediate ways you can help to do this is to change the language you use when writing about said things. It’s, like, incredibly fucking obvious that using pathologizing language to talk about non-pathological experiences…perpetuates the pathologization of said non-patohlogical experiences, no?

It’s also wild/frustrating to me that Fay fails to discuss—or even acknowledge—one: that health is holistic and intersectional, and two: the ways society and our environment can intersect with and impact our health. We can’t talk about mental health without also talking about other aspects of health, like physical and emotional health. Nor can we talk about any aspect of health without acknowledging that every aspect of our existence influences every aspect of our health.

To her credit, Fay does mention the medical model of mental illness. To her discredit, she does so only once—in passing and with no explanation or elaboration, 213 pages in—and she doesn’t mention or explain the social model of mental illness at all.

Essentially, the medical model says “the problem is you and your brain and/or body.” The social model says “the problem is society/your environment.” Obviously this is a very reductive and overly simplified description of these models. Please do your own research. This paper from Andrew J. Hogan gives a good overview of the history of the medical and social models. You might find it a helpful place to start.

To her credit, Fay does discuss the Big Pharma aspect of the Mental Health Industrial Complex. To her discredit, she doesn’t acknowledge or discuss capitalism’s role in mental health beyond that. There’s seemingly no awareness on her part of how our capitalist society contributes to (creates?) and reinforces/perpetuates the mental un-wellness that it pathologizes and then packages and sells to us as being a result of our supposedly inherently faulty brains, without the slightest consideration for the ways the shit-ass social conditions and contexts in which we live and seek care affect our health.

To her credit, Fay does discuss off-labeling and over-prescribing, and the very real problems that too many people with too little education and training are permitted to diagnose using the DSM, and many people doing the diagnosing are misdiagnosing (lots of overlap between those last two things). I don’t think she digs as deeply on these last two things as she could have. There’s a lot of talk that it’s happening, and very little talk about why it might be happening. And certainly no talk about ways we might approach change.

I’m also confused by her suggestion to eliminate spectra, and I don’t think she adequately acknowledges her privilege, or the impact that gender, sexual orientation, race, and/or socioeconomic status in particular have on clinicians’ tendency to pathologize peoples’ behavior and experiences. The few mentions she makes of these things feel very superficial, contrived, and CYA-y.

As I read, I kept waiting for Fay to disclose her “real” diagnosis. Spoiler: That never happened. There is no neat ending. Which: fine. I don’t need a neat ending. I do like a cohesive and coherent one, and I don’t feel like I got that from this book. At the end of the book (literally), what we get from Fay is her rejecting therapy and all her diagnoses. She waits to do this until the epilogue.

“When I stopped labeling and talking to myself as a sick person, I no longer was one,” she writes 250 entire pages in. “I reject a diagnosis because none has been proven, but I have or had a mental illness—broadly and without definition,” she continues two pages later.

I have mixed feelings on this. Part of me feels like this is an extremely privileged decision that gives off very toxic positivity “denial disguised as ‘the power of positive thinking'” energy. Maybe it’s her delivery, though, not her message. Part of me gets it. Over the years I’ve had therapists insist—though not formally diagnose—that I was depressed, and “suffering” from PTSD. I knew in my bones that neither of these diagnoses fit—so I rejected the suggestion, and, eventually, found new therapists (a very privileged move).

I don’t know. To me, Fay sounds angry, perhaps scared and alone, and full of internalized ableism. And I think those things overpower the main message of her book.

(Honestly, I was waiting for Fay to reveal that she’s autistic. Each of the six DSM diagnoses that she outlines in the book either commonly co-occur with autism, or are commonly misdiagnosed before a person learns that they’re autistic. And the way she talks about her life experiences, both past and present, sound like so many other experiences that autistic people describe having.

I cannot stress this enough: Although it’s included in the DSM, autism is not a mental health condition/illness. Autistic people often experience adverse mental health conditions/illness as a result of living in an unaccepting and ableist society, but autism itself is not a mental health condition/illness.

I recognize that the phrase “mental illness” is…pathologizing. As are the words “diagnosis” and “diagnoses.” I also recognize that it’s the language that we have right now, to best convey the significance of many peoples’ experiences.)

Overall, I think the book is worth reading or listening to. While Fay fails to acknowledge or discuss many aspects of her argument that I think are crucial to the conversation she’s trying to have, she does make many excellent points about a few things. The book is well-researched, and the information she provides re: the history and usage of the DSM is especially important and valuable—albeit devoid of critical thinking or meaningful calls for action. Plus, there are things she discusses in the book that I’ve not touched on at all here. Respectfully, you should form your own opinion about the book by reading the book, not this post.


Fay uses punctuation as a device to frame the argument that language (or, I guess, punctuation) matters. It’s an interesting and fun choice. Given my love for language and history, I’m surprised it didn’t work for me.

Two books about the history of punctation that I’ve read and love and enthusiastically recommend to my fellow word nerds:

Semicolon: The Past, Present, and Future of a Misunderstood Mark by Cecelia Watson

Shady Characters: The Secret Life of Punctuation, Symbols & Other Typographical Marks by Keith Houston

While we’re at it, a rec for a book about the dictionary and how—and why and when—words end up in it:

Word by Word: The Secret Life of Dictionaries by Kory Stamper

And two books that are, broadly, about mental health, and that I think offer a more nuanced, responsible, and compassionate take on such a complex topic:

Divergent Mind: Thriving in a World That Wasn’t Designed for You by Jenara Nerenberg

The Collected Schizophrenias: Essays by Esmé Weijun Wang