Pathological

February 15, 2022
Beware the 947-page Diagnostic and Statistical Manual of Mental Disorders. In this memorable memoir, dedicated to "everyone who's been diagnosed and misdiagnosed and overdiagnosed with a mental illness," Fay skewers the powerful psychiatric bible. Doctors use it to tell her she suffers from anorexia, major depressive disorder, anxiety disorder, attention deficit hyperactivity disorder, obsessive-compulsive disorder, and bipolar disorder, which are just a few of the 541 categories in the fifth edition of the DSM. In hindsight, she realizes that she too willingly accepted and even embraced these labels because she desperately wanted an explanation for her many ailments, from heart pains to headaches to suicidal thoughts. Over the years, Fay, a professor of English and creative writing, takes everything to the max, from barely eating to compulsively running to consuming large amounts of alcohol. Here she shares wisdom, some gleaned from the Stoics, such as curing anxiety by not worrying about the past or fearing the future. Nearly half of Americans will receive a DSM diagnosis at some point. Fay may convince many to take her advice and pause before blindly accepting it.

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March 11, 2022

This very personal and passionately written medical memoir is also a deep dive questioning the veracity, reliability, and use of The Diagnostic and Statistical Manual of Mental Disorders (DSM) as a diagnostic tool. Fay (English literature, DePaul Univ. & Northwestern Univ.), who is white, has lived through six separate diagnoses through her life (anorexia, anxiety, OCD, ADHD, bipolar, major depressive disorder), all based on the DSM, the diagnostic gold-standard for mental health practitioners. Fay writes that she was very young when she received her first DSM diagnosis, but it was years before she realized the impact of a paternalistic Western medical system, which dictated, "Believe what you are told, and don't question the diagnosis." As Fay's mental health became more complex, she started to question the health care system and conduct her own research. This book moves through each stage of her diagnoses, discusses the supports lacking from U.S. mental health care, and argues that diagnostic markers like the DSM are often unreliable. This is a raw, honest, and readable book whose goal, Fay writes, is to help and support others. VERDICT This would be a good purchase for collections with large memoir, consumer mental health, and medical sociology sections.--Elizabeth J. Eastwood

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Starred review from February 1, 2022
Fay's incisive, wide-ranging debut explores her decadeslong immersion in the mental health system. Beginning when she was a teenager, Fay was diagnosed with six different mental illnesses, sometimes one by one, sometimes in combination, and often based on the skimpiest of evidence. Therapists and physicians concluded that she was suffering from anorexia, major depressive disorder, anxiety disorder, ADHD, OCD, and bipolar disorder. They prescribed medications accordingly, and Fay dutifully swallowed both the diagnoses and the pills--and then found it nearly impossible to extricate herself from either. The narrative, justifiably soaked with anger but also darkly funny at points, does not follow the course of the usual mental health memoir, in which the subject finally receives and responds to the "correct" analysis of her problems and lives happily-ever-after. Instead, Fay, still troubled, still medicated, stepped out of the loop of therapy and began to refute its basic tenets. The author boldly combines three strands: an account of her trip down the rabbit hole of the mental health system, where she tried valiantly to persuade herself to accept diagnoses that didn't seem to correspond to her actual life; a dynamic critique of the various incarnations of the Diagnostic and Statistical Manual of Mental Disorders, which serves as a guidebook for many clinicians; and, unexpectedly but beguilingly, analyses of the ways punctuation can reveal and structure thought. While criticism of the DSM is not new, Fay's position as an insider suffering from the results of its application as a method of analysis gives her a unique perspective. Sharply personal and impeccably detailed, the book is bound to raise questions in the minds of readers diagnosed with any number of disorders about the validity of trying to cram individual experience into what Fay contends are essentially imaginary categories. A provocative and original examination of the flaws in mental health treatment.

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