Book Review: The Complications by Emmett Rensin

Emmett Rensin is mad, and he’d be the first to tell you so. In THE COMPLICATIONS: ON GOING INSANE IN AMERICA, he writes about his life with schizoaffective disorder of the bipolar type. He’s been in and out of hospital, alienated many of his friends, but is considered ‘high-functioning’ because he can write.

He started acting out at age 13, raging at his family and running away from home to sleep on friends’ couches or wander the streets at night. This was explained away as adolescent shenanigans. His family sent him to a remote wilderness camp for difficult kids, which he seemed to enjoy. They also sent him to counsellors, whom he didn’t trust.

Later on he had hallucinations and paranoia: he would feel like his apartment was floating on the sea, or if he didn’t hear back from a friend right after he texted them, he’d send many texts and make many phone calls to find out why they weren’t talking to him. He wasn’t diagnosed until he was 24. Then came the struggle with finding the right medication, something that would stop him from believing that his roommate was going to kill him and sitting at the kitchen table with a knife throughout the night, ready to be attacked.

He’s now considered ‘stable,’ which means that the medications he’s on generally mitigate his symptoms, and he only has to go to the hospital psych ward every 18 months. Unlike some mad people, he diligently takes his medication and has managed to maintain a long-term relationship. But he still breaks down regularly and has to ignore the voices he hears.

He writes about Esmé Weijun Wang, who wrote THE COLLECTED SCHIZOPHRENIAS, and notes that they are both trying hard not to be associated with the man who talks to himself on the bus or the woman throwing things at people on the street corner. Because these people also have the same illness, but aren’t cared for in the same way Rensin is, as he can afford his medications and hospital stays. He notes, “…every time that I have looked at my medications and thought, if I stopped taking these, people would be disappointed. But if I kept not taking them, then soon enough nobody would expect anything of me at all.”

That’s the crux of the story, is that people fell through the cracks after the de-institutionalisation of the 1990s, when people in mental institutions were pushed out onto the streets as those institutions were closed. He also argues that mental illness (a term he applies to depression and anxiety, while he categorizes bipolar, schizophrenia, serious OCD, and major depression under the label ‘mad’) has become a catch-all for various ailments that society and the drug industry suggest people have.

This ties in with the book I reviewed last month, Misty Pratt’s ALL IN HER HEAD, in which she discusses how depression and anxiety are diagnosed and medications dispensed without considering other social or biological factors that could be causing the symptoms. The problem is multifaceted: family doctors are pressed for time and don’t have expertise in mental health, so are more likely to prescribe anti-depressants and anti-anxiety drugs than look for other problems. People are bombarded with advertising for these drugs, so start to think they have the required symptoms and should be medicated. People do have the symptoms, but don’t realize that “civilization has displaced responsibility for its own depravity onto the inability of its citizens to put up with such conditions,” as Rensin writes.

Rensin also argues that in the rush to reduce the stigma around mental illness we have only focused on depression and anxiety because they’re easy to understand and empathise with. But there is still stigma around being ‘mad,’ because it can’t be explained away as a social or environmental issue. “These new mentally ill are not like the mad. They are not lunatics, psychos, or crazy. Where the mad are terrifying, disorganized, crippled and degenerating; the mentally ill are just having a hard time…”

He argues that when the mad are lumped in with the mentally ill, they are assumed to be dealing with the same difficult social factors, and are just not trying hard enough to get better. But he’s clear that “the condition remains degenerative. It is difficult to stop the loss of cognitive function, particularly spatial and verbal reasoning…when I reached for long-familiar mental resources, I found that they were limited, obscured, or missing…my memory is shaky and my reasoning, particularly under pressure, has degraded.” How does that square with ‘not trying hard enough to get better?’

He skewers mental health advocates who don’t have mental illness, parodying their use of inclusive language and academic obfuscation. He notes that while they successfully address the “abuse of psychiatric practice against black people and queer people and women,” they fail to address what we should do with the mad people who remain. Instead, they spend time and effort on “the proper manners for the organization of disability studies conferences.”

Unlike the ‘person-first’ language that sensitivity readers suggest, i.e. “a person with schizophrenia” versus a “schizophrenic,” he identifies wholly as the latter. It’s who he is, it’s his life. “There is a tremendous amount of bullshit concerning the “real you” who emerges from “the illness” (which is not you), but this is backward. The real you is the sick you. The real you is the one who scares people…The medicated you is only better. Faster. Stronger—at least in theory.”

Rensin’s book made me think about my own journey with bipolar 2. When I write about it here, it’s a largely sanitized version of what I actually go through. I don’t write about the terrifying days when my head’s about to explode with intrusive thoughts and I think I have to go to the hospital but am scared to go because I don’t know what they’ll do to me. I don’t write much about the substance of my highs, when I stay awake at night writing article pitches and coming up with book ideas in my head, and madly send those pitches out during the day, sure that I will get a positive response. When I don’t, the high makes me feel like I can just pitch somewhere else, and somewhere else, and somewhere else, until I’ve sent five people the same pitch and am not sure what to do if more than one of them takes it. I’m not even sure if their outlet is a good fit, I just assume it’s great and they’ll take it.

I don’t talk about coming down from these highs, how I have to increase my medications significantly until I feel like I’m walking in a fog and can’t function in any capacity. I can’t write, I can’t go for a walk, I can’t do much of anything except sleep and hope the meds kick in. I don’t talk about the cognitive decline that Rensin describes. The times when I start talking but can’t remember what I was responding to in the first place. Sometimes the difficulty in talking, period. The difficulty with math and spatial reasoning. The difficulty in focusing on one thing and tuning out the rest when there are multiple things going on. The panic I feel in a crowd of people. I don’t talk about the weight gain the medications cause, and how embarrassed I am sometimes to be seen in public.

I don’t talk about my husband, who is my main caregiver and, even though he’s older than I am, sometimes wonders if he’ll outlive me. How he has to drive me to my counselling sessions because of my difficulty focusing. I can’t handle the traffic, the requirement to constantly be paying attention. I worry that I won’t see the person in the crosswalk because I’m distracted by whether or not the light is turning yellow. I worry that I’ll crash into another car in the traffic circle, because they didn’t see my indicator showing I was going to circle past them.  

I don’t call myself ‘mad,’ though (just like I don’t call myself brown)—I don’t agree with Rensin on this point. And I don’t have his aversion to calling what I have a mental illness. But I do think we see an awful lot of people being diagnosed with depression and anxiety that actually need social and/or environmental change or other interventions. As Misty Pratt notes in her book (see last month), psychiatrists claim to follow the biopsychosocial model of mental illness, but often just default to the biological aspect: the idea that a medication can fix your biology.

Rensin is brutally honest, outrageous, and provocative. He outlines in detail how his illness affects him and the people around him. He gets into the nitty gritty of his actions, not afraid to share things that might cast him in a bad light or make him seem ‘mad’ – because he is. His views on madness versus mental illness will surely put some people off. His ideas on ‘self-care’ might not be appreciated. He disdains the suggestion that “a little more mindfulness is all the cure anybody needs.” He grapples with the thorny questions of criminals being found not-guilty because of insanity, with the benefits and drawbacks of being committed involuntarily, and with what madness arises from. “No psychiatrist anywhere has been able to locate a definitive cause for any form of madness; genetic studies remain promising but inconclusive.” Also, because this is a book of essays, there is repetition throughout, which can be a bit annoying.

I would recommend Rensin’s book to anyone wanting to understand what life is like with serious mental illness. This includes people in academia working in disability studies or mad studies (yes this is a research field and it was pioneered in Canada). It includes people with family members or friends with serious mental illness. It includes those who have a mental illness and wonder how their experience compares with that of others in the same boat. Be prepared to be challenged, though—Rensin doesn’t sugar coat anything, from his own experiences to his ideas on madness in society.