According to the Encyclopedia of Mental Disorders, involuntary hospitalization “is an extremely controversial course of action.” In her 2019 book The Collected Schizophrenias, Esmé Weijun Wang steps into this controversy. She presents arguments from both sides. And she offers a unique perspective on the issue, having been involuntarily hospitalized herself, three times.

On the pro side of the debate, sometimes people who suffer from mental illness are in danger of harming themselves or others. Wang tells stories about people who wish to help a family member with mental illness and prevent negative outcomes, but feel unable to cope with the situation on their own. She points out that being a loved one of someone with mental illness can be challenging and, in some situations, can result in feelings of terror. She also writes of her personal desire to retain the option to put herself in someone else’s care to avoid committing suicide, if it ever came to that.

On the con side of the debate are, as Wang explains, “crucial issues of autonomy and civil liberties.” She clearly considers these issues of vital importance, as she brings them up not just in the essay on the topic of involuntary hospitalization, “Toward a Pathology of the Possessed,” but in many of the other essays throughout the book. She writes about many aspects of the collected schizophrenias; the issues of autonomy and civil liberties arise again and again.

Wang’s personal experiences in being involuntarily hospitalized were far from positive. She explains the intense fear of being in a small, unfamiliar place and not knowing when she will be allowed to leave. She explains the feelings of despair that arise from not being able to make simple decisions like when and what to eat. Further, it is very difficult, she points out, to say or do anything in a mental hospital and be believed and taken seriously. Here are her words about the situation:

“I maintain, years later, that not one of my three involuntary hospitalizations helped me. I believe that being held in a psychiatric ward against my will remains among the most scarring of my traumas.”

And here is what she writes about Julian Plumadore, a speaker and advocate for mental health:

“He’s better now, he tells me, because he was finally told that he himself knows better than anyone else what he needs. For him, that included harm-reduction techniques instead of involuntary rehabilitation, as well as estranging himself from his family.”

This rings true to me. It can be hard to watch someone make their own decisions. You want to reach in and make the decisions yourself, to make sure they are the right ones. The trouble is, your definition of right might not be the same as theirs.

When I was in the worst throes of my bout with physical and mental issues, I did not always know on a conscious level what I needed. I relied on doctors, counselors, family members, and friends to advise me on steps forward. But the advice I received was contradictory and irregular. Much of it did not reliably move me toward recovery. It was only when I began to listen to and trust my gut feelings that I found that I could reliably make decisions that helped, rather than exacerbated, the problems.

I do not claim that I always made the right choices. And I continued to listen to others’ advice, take it seriously, and act on it (if I thought it might help). But if I had not retained the freedom to follow my instincts, I would surely never have found my path to recovery.

It’s admittedly hard to justify letting people make their own decisions when there is reason to believe that they might harm someone (self or others). But it’s also hard to justify taking away someone’s autonomy, without which personal improvement is virtually impossible.

Who makes your decisions?

Hello, fellow residents of our beautiful planet! I am writing this blog post from a cute Danish cafe in London. Here is a photo I took from my seat in the cafe. If you know me at least a bit, and if you look closely at the photo, you may be able to guess my favorite part of it. However, as that detail is rather inconsequential, let me tell you something of greater importance. Let me tell you how I got here.

Oops! How I got here is inconsequential, too. I flew. (That last sentence was a clue, RE the detail in the photo!) It was a long flight—at least for a travelphobe like me. I finished a book. Exciting! I love finishing books. But in the scheme of things, that was not so exciting, really, so let me please get to my point. Let me tell you why I got here.

Four months ago, as I explained in my post from January 25 called Dreams, I had a dream. I dream vividly most nights; but only the rare dream manifests as a sort of lesson-cum-guidepost, express from my unconscious mind.

In the dream, I bought a flight to London. I bought the ticket amidst a group of friends, as part of a special discount rate; but each of us was traveling separately, and I would be traveling alone. Once I arrived in London, I discovered that my family was staying in nearby rooms. However, I decided to ignore them, since they wanted to do things that I didn’t. What I really wanted to do while in London was see a performance at the Paris Opera House; and that’s what I was making plans to do when I woke up.

Strangely enough, this relates to the book I finished on the plane. I’ll be writing previews of that book shortly. This story about my dream and how it influenced my life will perhaps be useful as we try to piece together the central philosophical problem laid out in that book. But I am getting off track again! So here’s what happened next.

Upon waking, I understood that the dream was important, but I wasn’t sure what it meant. In full—that is, partial—disclosure, there was also a segment of the dream that pertained to my love life. I would not like to share the details; I would merely like to note that the dream had multiple significances to me. (A multiple significance, in case you were wondering, is somewhat similar to a multiple orgasm, except that it’s not just for women; but I am getting off track again!) And so, realizing that my unconscious mind may have been trying to tell my conscious mind something, I kept thinking about the dream.

Within a few days, I was astonished to realize that I wanted to take a solo trip to London and Paris. This might not seem like such an astonishing wish to you; lots of people want to go to London and Paris. It was shocking to me, however, because I have always been a travelphobe.

There were so many things about travel that frightened me. I was scared my plane would crash. I was scared I would get irredeemably lost in trying to navigate public transportation. I was scared I would lose my passport or get beaten or harrassed or raped. I was scared I would spend a ridiculous amount of money, only to instantly get homesick for my garden and birds (that was another clue!). I was scared I would be obliged to do something touristy that I didn’t want to do.

But most of all, I was scared that the jostling and angled sunshine and lack of sleep that are inherent to travel would trigger a migraine. As I explained in my post from December 26 called Medical Mysteries (Part 2), I have suffered from periodic migraines for my whole life. They always last exactly ten days. They are debilitating, involving level-10 pain, aversion to light and noise, expulsion of stomach contents, and much moaning and rolling around amidst bedsheets.

As I explained in that post from last December, I had been unexpectedly rescued by magnesium in an easily absorbable form. I had not experienced a ten-day migraine since beginning my vitamin supplement regimen; and that happy streak continues to this day.

A miracle! Was it a god of travel—perhaps Hermes, a.k.a. Mercury—who had come to my aid?! But I will stay on track with this story, I promise.

The point is, my unconscious mind had realized, long before the “I” that I’m better acquainted with did, that my recent deliverance from periodic migraine hell opened up the door for me to travel. It further realized that my dilapidated and largely nonexistent love life would be a boon to me while traveling, for I would not have to compromise on how I would spend my time. Moreover, it realized that London was a perfect destination for doing things I love to do—namely, enjoying literature and music. Finally, it realized that the Paris Opera House is not that far from London, in the global scheme of things; and what, it mused, is the point of middle age, if not to fulfill fantasies you had while 12 or 13 years old?

Yes—in my youth, I had an obsession with The Phantom of the Opera, both the book and the musical. So I am going to go see that old building where some of the events depicted really occurred (and where some, being romantic exaggerations, did not). And I’m going to do many other literary- and musical-type activities in Paris; and I’m going to attempt to say something comprehensible in the language, and to understand something someone says to me. Because my adult, conscious mind has realized that the Paris Opera House is merely a sentimental excuse to force me to venture very far outside of my comfort zone. To experience something that, sure, lots of people experienced at a much younger age, but I have not yet: to be alone in a faraway culture of people who speak a language that’s foreign to me.

Speaking of language—I have been enjoying hearing British accents all around me. This is not a “pigeon” English, but the genuine article. (That was your third and final clue! If you have not solved the puzzle by now, I fear there is no hope for you . . . though perhaps the answer will come to you in a dream.)

But back to the point. The point is that the human brain has both conscious and unconscious parts. Managing the interplay between the two of them, in my experience, is key to living wisely. To be solely led by one or the other is a grievous mistake. In conclusion, here is a view of the interior of the Danish cafe, behind me. There are no hidden secrets in this photo . . . at least not that I know of. Those are elsewhere. Has your unconscious mind spoken to you lately?

Honoré de Balzac’s novel Eugénie Grandet seems to imply that, contrary to popular belief, money can buy happiness!

One of the main characters in the novel, Monsieur Grandet, glows with happiness upon learning of the multiplication of his funds, and when beholding his piles of gold. He even, upon receiving especially good news concerning his accounts, literally sings and dances.

But the novel also implies that an increase in money does not cause an increase in happiness for everyone, just for those rare people who are true misers. Monsieur Grandet’s wife and daughter do not experience greater happiness from the acquisition of money. In fact, as the reader is surprised to learn, they don’t even know how much they are financially worth, or that their fortune dwarfs the net worth of many of their neighbors combined!

The tragedy of this scenario is that Eugénie and her mother, not comprehending that they are multimillionaires, also do not comprehend the true nature of their “friendships.” Money-hungry men and their money-hungry relatives come regularly to the Grandet house to court Eugénie. Poor Madame and Mademoiselle Grandet think that these people like them for themselves, not for their money.

At the point that the reader learns of this wretched situation, Balzac tosses in the following aphorism:

“How horrible is man’s condition! He does not own one happiness whose source does not lie in ignorance of some kind.”

It’s a Balzacian aphorism; but is it true? I would like to debate this question with you. I would argue that Monsieur Grandet’s joy in acquiring money would be significantly lower if he were not so ignorant about its detrimental effects on his family, as well as on himself. Further, his wife and daughter would surely have been horrified to learn that the people praising them did not genuinely like them.

On the other hand, ignorance can lead to misery over the long term, as is evident by witnessing these characters’ deteriorating lives as the years pass. Thus, learning key facts about the world, and acting accordingly, can save one from sorrow. It can also bring one a quiet contentment that, while perhaps of a different nature than the bliss of ignorance, is still a form of happiness.

What do you think: is ignorance necessary for happiness?

One of the great things about the book The Body Keeps the Score, by Bessel van der Kolk, M.D., is that it is written for laypeople and practitioners alike. No matter whether you’re the one lying on the couch, so to speak, or the one with the credentials, the book contains massive amounts of research-based insights.

One point that Dr. van der Kolk makes over and over is that not every strategy works for every patient. The key, whether you are the person in search of healing or the therapist, is to find the strategies that work, and move forward with those. That sounds like wisdom to me! That being said, the doctor explains that an overriding principle applies when people seek to recover from trauma:

“Trauma robs you of the feeling that you are in charge of yourself, of what I will call self-leadership in the chapters to come. The challenge of recovery is to reestablish ownership of your body and your mind—of your self.”

This passage occurs on the first page of the last section of the book, “Paths to Recovery,” which takes up nearly half its pages. In this section, Dr. van der Kolk offers information on a variety of ways that people can move toward self-leadership. These strategies are as diverse as the people they help. Some require a group of people, some require one-on-one sessions, and some require the seeker of relief to be alone. Some require help from a trained professional (in psychology, yoga, theater, choir, or another area), and some require merely a willingness on the part of the seeker of relief to try something new.

Dr. van der Kolk further refines what it means to develop self-leadership. Here is his explanation of what self-leadership entails, no matter which strategies one uses:

“For most people this involves (1) finding a way to become calm and focused, (2) learning to maintain that calm in response to images, thoughts, sounds, or physical sensations that remind you of the past, (3) finding a way to be fully alive in the present and engaged with the people around you, (4) not having to keep secrets from yourself, including secrets about the ways that you have managed to survive.”

All four of these involve taking control over one’s life. Learning to be and remain calm is the same thing as learning to control one’s response to emotions. Learning to stay in the present (and not the past) is the same thing as learning to control one’s experiences. Engaging with other people is the same thing as taking control over one’s ability to receive something essential to all people: human companionship and love. And being honest with oneself is an essential first step in taking control over one’s life—as opposed to letting one’s fears control it.

In writing this post, I suddenly remembered a short story I read in college, “The Yellow Wallpaper” by Charlotte Perkins Gilman. At the time, I did not understand why my professor thought the story was so great. I reread it just now, and wow—do I understand now. (Oh, the things I wish I had picked up on at a younger age!)

“The Yellow Wallpaper” is about a woman experiencing “nervous depression.” Her husband and her brother, both physicians, insist that the cure is for her to do as little as possible. She must not do anything she loves, such as writing or visiting with loved ones! No, she must stay isolated at home, mainly in bed, until she recovers. The poor narrator trusts these authoritative men more than she trusts her own intuition. Things do not, needless to say, end well.

If you are hoping to recover from trauma, the last thing you need is for someone to further restrict your agency. And note that Dr. van der Kolk mentions both writing and loving human contact as strategies for developing self-leadership. But also note: the answer is not to stop listening to the advice of loved ones and professionals. Rather, it is to listen to them with a grain of salt. If your gut tells you a recommendation is a bad idea . . . it probably is. Even if the person giving you the recommendation is a doctor, your husband, or both.

Who’s in charge of your life?

Have you ever lived in a home with a fire alarm that was too sensitive?

It creates quite the scene! You’re innocently boiling water on the stovetop, when the merest thread of smoke happens to emanate from the burner. You don’t notice it. You can’t see it. You can’t smell it. Your husband across the room can’t smell it. Not even your dog can smell it.

And then—BLEEEET!!!! Ouch, your ears hurt! and you can’t think and you and your husband are crashing into each other as you lunge for the same towel and the dog is barking and howling and you try to fan the alarm, but it’s too high up and you realize you need to grab a chair and stand on it and meanwhile your ears, ouch! and you finally get the chair in place and stand on it and fan the darn thing, and it stops blaring. Whew! You decide to take out the battery, because this happened three times this week, and you put the chair away. But then you think, “What if there’s a real fire?” So you put the chair back and put the battery back in, and the darn thing starts blaring again because the water is now boiling over the sides of the pot and creating another minuscule emission of smoke so you fan it off again. You shut off the burner, and meanwhile it fails to occur to either you or your husband to notify the landlord, partly because the landlord is annoying to deal with, but mostly because you’re in your 20s . . . which is an excellent excuse for all kinds of mistakes!

I read the most amazing and scholarly and mind-blowing book recently. In it, the author compares a certain structure within the brain—the amygdala—to a smoke detector. This alarm system warns the body of danger and triggers a quick response. Trauma, according to the author, can cause the body’s smoke detector to become too sensitive. This creates an internal state as chaotic as the scene described above.

The Body Keeps the Score, by Bessel van der Kolk, M.D., is one of the best books I have read in the past year. It’s long, but every page is a gem.

The book means a lot to me personally. Trauma can arise in different ways; fighting in a war and being raised by a psychopath are only two of many possible causes. I feel confident in saying that I have experienced trauma. I also feel confident in saying that navigating the U.S. health care system to find the help I needed was a disheartening—and traumatic—experience in itself. That’s why passages from the book like this one mean so much to me:

“Psychologists usually try to help people use insight and understanding to manage their behavior. However, neuroscience research shows that very few psychological problems are the result of defects in understanding; most originate in pressures from deeper regions in the brain that drive our perception and attention. When the alarm bell of the emotional brain keeps signaling that you are in danger, no amount of insight will silence it.”

I tried so hard to heal myself through rational thinking! And others tried so hard to heal me by encouraging me to think rationally! But this failed. Using the logical, conscious part of the brain to try to heal trauma is like waving a towel at an overly sensitive fire alarm. Sure, it works . . . but only if you attend to it continuously and avoid doing anything else in life, for fear the alarm starts blaring again.

When I was in the thick of my struggles, each of these helped me significantly more than talk therapy:

• Yoga
• Neurofeedback and learning to meditate
• Unconditional support from loved ones and professionals, especially those who were empathetic listeners and who urged me to contact them anytime
• Joining a choir
• Attending spiritual services, as well as personal spirituality and prayer
• Medication

Most of these aren’t considered mainstream medical services in the U.S. Thus, most are not covered by health insurance. But as I read The Body Keeps the Score, I was astonished to see every one of these strategies pop up as effective and recommended treatments for trauma. Dr. van der Kolk devotes an entire chapter to yoga, for example, and another to rhythms and theater (which includes a discussion of singing and ceremony). As it turns out, the strategies I gravitated toward in my search for healing, some of which are classified as “alternative medicine”—a term often used pejoratively—are supported by research conducted by leading medical specialists. And yet the U.S. health care system has a long way to go in incorporating this research into practice.

Note that none of the strategies on the list involve rational thought. In metaphorical terms, none of them affect one’s ability to wave a towel. Instead, the strategies work by accessing and repairing (or, in the case of medication, artificially rigging) the smoke alarm itself.

How do you access the unconscious areas of your brain?