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The release of the book described here comes amid a rising understanding that although we are 60 years into the antipsychotic era, these medications only partly help people with schizophrenia.
Sandra Allen has the byline for A Kind of Mirraculas Paradise, but it may be more accurate to say she is a co-author, an editor, a dogged investigator of her own family’s history, and a sharer of her uncle’s memoir-a man who received a diagnosis of paranoid schizophrenia in his late adolescence. The book alternates between chapters Allen wrote and chapters that her Uncle Bob sent-a 60-page, single-spaced, typed-in-all capital letters manuscript-for her to edit and share. The book is timely but will also stand the test of time as an excellent contextualized first-person narrative of schizophrenia.
The release of the book comes amid a rising understanding that although we are 60 years into the antipsychotic era, these medications only partly help people with schizophrenia. In reading about Bob’s travels throughout the US, one comes across instances where working conditions, friends, and neighbors propelled Bob to periods of productivity and meaningfulness, despite the psychosis.
Another element of the book that makes it particularly relevant is its description of the sexual abuse and coercion of patients witnessed by Bob during several psychiatric inpatient stays. The #MeToo movement has brought growing recognition of the scale of sexual harassment, abuse, and assault across all arenas where imbalances of power exist. We would all like to believe that the care of vulnerable psychiatrically ill patients who are often placed on locked units for their “own good” would be immune to this societal ill. But, at the same time we know that these Pollyannaish beliefs cannot be true. As the people charged with fiduciary responsibility for our patients, the book motivates us to do more to protect our patients.
A Kind of Mirraculas Paradise includes cringe-worthy psychiatrists and heroic ones. One psychiatrist consistently refuses to engage with Bob but instead makes medication decisions without examination. Later, Bob meets a psychiatrist who works in both inpatient and outpatient settings to develop a treatment that is consistent with Bob’s values and hopes. Similarly, there are hospitals that patients seek out for their peaceful and healing environments while others are like prison.
Psychiatrists may find Allen’s book useful when considering the sacrifices families make to help their severely and persistently mentally ill loved ones get treatment. The financial and emotional toll is huge for those who seek access to mental health care for their loved ones or for those who advocate for them in the criminal justice system. Although laws governing patient privacy often prevent us from being able to reduce this toll, awareness can lead us to be more sensitive caregivers.
As a psychiatrist, I have sought to understand the minds of my patients who exist in both the “real” world and in the delusional world. Bob’s writing offers the reader an eloquent way of seeing the way these worlds flow seamlessly from one to another and back. My hope is that it will become a classic and universally read by all psychiatrists.
Dr Forman is Assistant Professor of Psychiatry, Albert Einstein College of Medicine, and Director of the Addiction Consultation Service at Montefiore Medical Center, Bronx, New York.