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Pathological: The True Story of Six Misdiagnoses
In this stunning debut--both a memoir and a work of investigative journalism--writer Sarah Fay explores the ways we pathologize human experiences.
Over thirty years, doctors diagnosed Sarah Fay with six different mental illnesses--anorexia, major depressive disorder (MDD), anxiety disorder, attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and bipolar disorder.Pathological is the gripping story of what it was like to live with those diagnoses, and the crippling impact each had on her life. It is also a rigorous investigation into the Diagnostic and Statistical Manual of Mental Disorders (DSM)--psychiatry's "bible," the manual from which all mental illness diagnoses come. Yet as Fay found out, some of our most prominent psychiatrists have been trying to warn us that the DSM is fiction sold to the public as fact.
In Pathological, former advisory editor at The Paris Review and award-winning writer Fay calls for a new conversation about mental health diagnosis, one based on rigorous transparency. With exquisite detail and a precise presentation of fact, she digs up her own life at the root to finally ask, Is a diagnosis a lifeline or a self-fulfilling prophecy?
Powerful, mesmerizing, and unputdownable, Pathological sits alongside the other brave and inspiring classics of our time that explore a more intelligent, forgiving, and nuanced approach to human suffering.
Over thirty years, doctors diagnosed Sarah Fay with six different mental illnesses--anorexia, major depressive disorder (MDD), anxiety disorder, attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and bipolar disorder.Pathological is the gripping story of what it was like to live with those diagnoses, and the crippling impact each had on her life. It is also a rigorous investigation into the Diagnostic and Statistical Manual of Mental Disorders (DSM)--psychiatry's "bible," the manual from which all mental illness diagnoses come. Yet as Fay found out, some of our most prominent psychiatrists have been trying to warn us that the DSM is fiction sold to the public as fact.
In Pathological, former advisory editor at The Paris Review and award-winning writer Fay calls for a new conversation about mental health diagnosis, one based on rigorous transparency. With exquisite detail and a precise presentation of fact, she digs up her own life at the root to finally ask, Is a diagnosis a lifeline or a self-fulfilling prophecy?
Powerful, mesmerizing, and unputdownable, Pathological sits alongside the other brave and inspiring classics of our time that explore a more intelligent, forgiving, and nuanced approach to human suffering.
320 pages, Hardcover
Published March 29, 2022
81 people are currently reading
1236 people want to read
About the author
Sarah Fay
1 book26 followersSarah Fay is an author and activist. Her memoir Pathological: A True Story of Six Misdiagnoses (HarperCollins, March 15, 2022) is an investigation into the invalidity and unreliability of mental health diagnoses. Her writing appears in many publications, including The New York Times, The Atlantic, Time Magazine, The New Republic, Longreads, The Michigan Quarterly Review, The Rumpus, The Millions, McSweeney’s, The Believer, and The Paris Review, where she served as an advisory editor. Her essays have been chosen as a Notable Mention in Best American Essays and nominated for Pushcart Prizes. She’s the recipient of the Hopwood Award for Literature, as well as grants and fellowships from Yaddo, the Mellon Foundation, and the MacDowell Colony, among others. She is currently on faculty in the English departments at Northwestern University and DePaul University. She’s the founder of Pathological: The Movement, a public awareness campaign devoted to empowering people to make more informed decisions about their mental health. For more, visit www.sarahfay.org.
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Displaying 1 - 30 of 154 reviews
April 6, 2022
Review All memoirs are 'me' but there is a difference between 'me' and 'ME ME ME' and that's how the book read to me. That, and two other issues made me so not enjoy reading this book. The two issues are the diatribe against the DSM and the style of including far too much history which made tedious reading.
The first issue was that the book seemed to be a diatribe against the DSM with 493 references (see Reading Notes below). The author does not want to see, for example, Gender Dysphoria appearing in the book. This transgender term applies only to those in distress the DSM says. The author feels it is a hard one on transgender people to have to accept that diagnosis in order to get treatment. But says that removing Asperger's upset the Aspie community who liked the label and the access it gave them to treatment. This is what I mean about author making and the DSM, it can do no right. (I'm mostly with her on the DSM failings though but not entirely for the same reasons).
Medicine and medical insurance in the US are businesses, you can't expect a business to give anything away for free, you can expect them to want to maximise its profits and minimise unnecessary expenditure. The DSM is their bible telling them what would be a legit claim and what wouldn't. It seems the author is suggesting that transgender people ought not to have to bear the diagnosis but still get treatment, well whose going to pay for it if it isn't a 'condition'? Even in civilised health systems where treatment at point of need is free, there still needs to be a diagnosis in order to access that treatment. It's the way health care works. The only way around it is to go to a private doctor and pay for what you want. It's the way much cosmetic surgery works.
Secondly, everything that could be defined, say autism or stigma for example, was defined, the history was written, major players from antiquity to the present named and quoted, every possible reference that could refer to it and 'work' in the book was given. There was a lot of research done for this book, and far too much of it was included.
This isn't uncommon in non-fiction and I suppose that an author, or editor at least, needs to look at the intended audience. Is this audience likely to have read very little on any of these topics in books and need full explanations of every term? Or are they likely to have read in this genre before and know, from the media including documentaries, quite a lot about the subject and so only that which is strictly necessary or not common knowledge should be detailed?
I understood the anger and frustration of the author, but the author's personality failed to engage me so it was not an enjoyable or enlightening read to me. But this is just my opinion, others have had a much better experience of the book. 2.5 stars rounded down.
__________
Notes on Reading The failings of the DSM
The first issue was that the book seemed to be a diatribe against the DSM with 493 references (see Reading Notes below). The author does not want to see, for example, Gender Dysphoria appearing in the book. This transgender term applies only to those in distress the DSM says. The author feels it is a hard one on transgender people to have to accept that diagnosis in order to get treatment. But says that removing Asperger's upset the Aspie community who liked the label and the access it gave them to treatment. This is what I mean about author making and the DSM, it can do no right. (I'm mostly with her on the DSM failings though but not entirely for the same reasons).
Medicine and medical insurance in the US are businesses, you can't expect a business to give anything away for free, you can expect them to want to maximise its profits and minimise unnecessary expenditure. The DSM is their bible telling them what would be a legit claim and what wouldn't. It seems the author is suggesting that transgender people ought not to have to bear the diagnosis but still get treatment, well whose going to pay for it if it isn't a 'condition'? Even in civilised health systems where treatment at point of need is free, there still needs to be a diagnosis in order to access that treatment. It's the way health care works. The only way around it is to go to a private doctor and pay for what you want. It's the way much cosmetic surgery works.
Secondly, everything that could be defined, say autism or stigma for example, was defined, the history was written, major players from antiquity to the present named and quoted, every possible reference that could refer to it and 'work' in the book was given. There was a lot of research done for this book, and far too much of it was included.
This isn't uncommon in non-fiction and I suppose that an author, or editor at least, needs to look at the intended audience. Is this audience likely to have read very little on any of these topics in books and need full explanations of every term? Or are they likely to have read in this genre before and know, from the media including documentaries, quite a lot about the subject and so only that which is strictly necessary or not common knowledge should be detailed?
I understood the anger and frustration of the author, but the author's personality failed to engage me so it was not an enjoyable or enlightening read to me. But this is just my opinion, others have had a much better experience of the book. 2.5 stars rounded down.
__________
Notes on Reading The failings of the DSM
March 29, 2022
1.5/5 stars
Ugg... Nope. Nope.
The premise intrigued me. Pathological: The True Story of Six Misdiagnoses is a memoir about a journalist who was diagnosed with six different mental illnesses (anorexia, ADHD, OCD, depression, anxiety, and bipolar disorder). She suspects that her conflicting diagnoses, the labels she's been given, and the high doses of drugs she's taking are making her feel worse, not better. She learns that diagnosing mental illness is more complicated than she thought, and the Diagnostic and Statistical Manual of Mental Disorders (DSM) is mostly to blame.
I learned about this book through Fay's fantastic Longreads essay on loneliness. (The essay also appears in this book.) Know that I have nothing bad to say about Fay as a writer. She's very talented. She is not, however, a mental health expert, and she doesn't appear to want to listen to anyone who is. If you were interested in this book, I invite you to read this essay (and the other three books I recommend at the end of this review) instead, if you haven't already.
There is some truth to the claim that the DSM sucks. It's legacy is rooted in racism, sexism, homophobia, all that bad stuff... Many professionals and neurodiversity advocates disagree with some of its recent changes, and their concerns should be taken seriously. I'm not a mental health professional, but I do understand why some people think it'd be best to scrap the DSM. Maybe developmental disabilities, neurological conditions, and psychological differences shouldn't all be lumped together in one book. Maybe "personality disorders" are outdated, useless labels. Maybe dissociative identity disorder should be considered a symptom of PTSD rather than an illness on its own. Maybe we should experiment with labeling some mentally ill people with symptoms rather than diagnoses. All valid perspectives.
There is some truth to the claim that some mental illnesses are misdiagnosed or over-diagnosed way too often. Misdiagnosis of bipolar disorder is especially dangerous, as the medications have a lot of nasty side effects.
There is A LOT of truth to the claim that doctors, especially psychiatrists, don't take thorough histories on their patients. The best parts of Pathological are Fay's anecdotes about visit after visit with doctors who ask the wrong questions and make quick assumptions. I don't believe that psychiatrists don't care about their patients or giving correct diagnoses. Doctors are overworked and overbooked. It's nearly impossible to tell whether your patient has OCD, anxiety, and/or depression when you only have 10-15 min to do a physical exam and take a history. Someone else, please write me a whole book about that.
The biggest problem with this is book is that it makes the unnecessary and irresponsible leap from: "Our mental health care system, including the system used to diagnose mental illness, is broken. We should fix it," to "All mental health diagnoses are stupid and I KNOW for sure that the DSM is useless."
Here's the thing... I'm a nurse by trade and a medical science nerd. I've found that the more you learn about medicine, the more complicated and frustrating the idea of a "diagnosis" becomes. There are some illnesses that you either definitely have or you definitely don't: influenza, for example. The virus is either in your cells or it's not. But if you're suffering from something other than an infection, it's harder to be 100% certain what you have.
I get a lot of headaches. Are they tension headaches or migraines? My doctor doesn't know yet. Turns out, a little more goes into diagnosing migraines than just fitting all the usual criteria. If you have any kind of complicated illness, your primary care doctor is going to want you to see a specialist. When you finally see that specialist, they may or not diagnose you correctly the first time. This is a big problem in mental health care but it's not only a problem in mental health care.
Fay states that there are no reliable tests for depression and other mental illnesses like there are tests for Parkinson's and cancer. Welp... what if I told you that we have no idea what causes Parkinson's and that there is not, in fact, one single test for Parkinson's? Also, that there is a lot of debate over whether certain "cancers" should even be called cancer. Yes, there is less of a biological basis for mental illnesses than some other illnesses. (Not all! Migraines, TMD, fibromyalgia, long-freaking-covid... no perfect, organic evidence for any of these! Doesn't mean they don't exist!). Diagnostic criteria are always changing in every medical field. Take the guidelines for hypertension as another example.
Also, speaking of hypertension. Can we please not argue that a diagnosis must be invalid if it's commonly given? Yes, more than 50% of Americans will be diagnosed with a mental illness in their lifetime. That's a lot. 47% of adults currently have hypertension. 42% are nearsighted. Common doesn't mean it's not a problem. And for heaven's sake, all illnesses should be de-stigmatized. I don't care if it's common or "natural" or "the cavemen had it and it helped them spear an elephant" (not a direct quote, just a vibe), or if you're the only one on the planet with your illness. If something's bothering you, you should be empowered to get treatment.
So, I'm not sure if the DSM should be scrapped or just improved. I would have liked to read a few different perspectives on this topic. I would also have liked to have read a few different perspectives on the usefulness of mental health labels. Maybe someone like Fay (or myself) who suffers from anxiety and depression on and off with some features of other illnesses would feel more comfortable with the broad label of "mentally ill" than anything in particular. However, someone with anorexia, autism, bipolar disorder, or schizophrenia may find that their label helps them more than it hurts them. (Btw, I'm not even going to get into the dangers of giving someone permission to deny that they have an eating disorder... but yikes .)
TLDR: Just another non-medical professional making a bold and dangerous statement about mental health care. Skip it. Read The Noonday Demon: An Atlas of Depression,My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind, and The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness instead. These books all explore the complexity of mental illness labels and treatments in much more responsible fashions.
Ugg... Nope. Nope.
The premise intrigued me. Pathological: The True Story of Six Misdiagnoses is a memoir about a journalist who was diagnosed with six different mental illnesses (anorexia, ADHD, OCD, depression, anxiety, and bipolar disorder). She suspects that her conflicting diagnoses, the labels she's been given, and the high doses of drugs she's taking are making her feel worse, not better. She learns that diagnosing mental illness is more complicated than she thought, and the Diagnostic and Statistical Manual of Mental Disorders (DSM) is mostly to blame.
I learned about this book through Fay's fantastic Longreads essay on loneliness. (The essay also appears in this book.) Know that I have nothing bad to say about Fay as a writer. She's very talented. She is not, however, a mental health expert, and she doesn't appear to want to listen to anyone who is. If you were interested in this book, I invite you to read this essay (and the other three books I recommend at the end of this review) instead, if you haven't already.
There is some truth to the claim that the DSM sucks. It's legacy is rooted in racism, sexism, homophobia, all that bad stuff... Many professionals and neurodiversity advocates disagree with some of its recent changes, and their concerns should be taken seriously. I'm not a mental health professional, but I do understand why some people think it'd be best to scrap the DSM. Maybe developmental disabilities, neurological conditions, and psychological differences shouldn't all be lumped together in one book. Maybe "personality disorders" are outdated, useless labels. Maybe dissociative identity disorder should be considered a symptom of PTSD rather than an illness on its own. Maybe we should experiment with labeling some mentally ill people with symptoms rather than diagnoses. All valid perspectives.
There is some truth to the claim that some mental illnesses are misdiagnosed or over-diagnosed way too often. Misdiagnosis of bipolar disorder is especially dangerous, as the medications have a lot of nasty side effects.
There is A LOT of truth to the claim that doctors, especially psychiatrists, don't take thorough histories on their patients. The best parts of Pathological are Fay's anecdotes about visit after visit with doctors who ask the wrong questions and make quick assumptions. I don't believe that psychiatrists don't care about their patients or giving correct diagnoses. Doctors are overworked and overbooked. It's nearly impossible to tell whether your patient has OCD, anxiety, and/or depression when you only have 10-15 min to do a physical exam and take a history. Someone else, please write me a whole book about that.
The biggest problem with this is book is that it makes the unnecessary and irresponsible leap from: "Our mental health care system, including the system used to diagnose mental illness, is broken. We should fix it," to "All mental health diagnoses are stupid and I KNOW for sure that the DSM is useless."
Here's the thing... I'm a nurse by trade and a medical science nerd. I've found that the more you learn about medicine, the more complicated and frustrating the idea of a "diagnosis" becomes. There are some illnesses that you either definitely have or you definitely don't: influenza, for example. The virus is either in your cells or it's not. But if you're suffering from something other than an infection, it's harder to be 100% certain what you have.
I get a lot of headaches. Are they tension headaches or migraines? My doctor doesn't know yet. Turns out, a little more goes into diagnosing migraines than just fitting all the usual criteria. If you have any kind of complicated illness, your primary care doctor is going to want you to see a specialist. When you finally see that specialist, they may or not diagnose you correctly the first time. This is a big problem in mental health care but it's not only a problem in mental health care.
Fay states that there are no reliable tests for depression and other mental illnesses like there are tests for Parkinson's and cancer. Welp... what if I told you that we have no idea what causes Parkinson's and that there is not, in fact, one single test for Parkinson's? Also, that there is a lot of debate over whether certain "cancers" should even be called cancer. Yes, there is less of a biological basis for mental illnesses than some other illnesses. (Not all! Migraines, TMD, fibromyalgia, long-freaking-covid... no perfect, organic evidence for any of these! Doesn't mean they don't exist!). Diagnostic criteria are always changing in every medical field. Take the guidelines for hypertension as another example.
Also, speaking of hypertension. Can we please not argue that a diagnosis must be invalid if it's commonly given? Yes, more than 50% of Americans will be diagnosed with a mental illness in their lifetime. That's a lot. 47% of adults currently have hypertension. 42% are nearsighted. Common doesn't mean it's not a problem. And for heaven's sake, all illnesses should be de-stigmatized. I don't care if it's common or "natural" or "the cavemen had it and it helped them spear an elephant" (not a direct quote, just a vibe), or if you're the only one on the planet with your illness. If something's bothering you, you should be empowered to get treatment.
So, I'm not sure if the DSM should be scrapped or just improved. I would have liked to read a few different perspectives on this topic. I would also have liked to have read a few different perspectives on the usefulness of mental health labels. Maybe someone like Fay (or myself) who suffers from anxiety and depression on and off with some features of other illnesses would feel more comfortable with the broad label of "mentally ill" than anything in particular. However, someone with anorexia, autism, bipolar disorder, or schizophrenia may find that their label helps them more than it hurts them. (Btw, I'm not even going to get into the dangers of giving someone permission to deny that they have an eating disorder... but yikes .)
TLDR: Just another non-medical professional making a bold and dangerous statement about mental health care. Skip it. Read The Noonday Demon: An Atlas of Depression,My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind, and The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness instead. These books all explore the complexity of mental illness labels and treatments in much more responsible fashions.
April 7, 2022
I struggled with this one. The author asks some good questions and in fact much of what she says is true but she also uses heavily biased sources and presents them as facts. In addition, her tone at times seems to belittle those with the diagnosis she condemns. It’s hard to enjoy a memoir when you struggle to like the author.
ADDED: I have since thought about this review and wanted to add that the author makes the argument that all diagnosis in the DSM are fabricated and therefore non-existent. This has continued to trouble me. It takes a great amount of privilege to reject society’s measurement for mental health. Asking the public to dismiss the DSM completely (as the author asks) will cause a great deal of harm for many who can only receive much needed care because of a diagnosed mental illness (which is thanks to the DSM). I agree that the DSM needs revision and has an amazing amount of bias but to dismiss the entire manual outright without an adequate replacement would do untold amounts of hard.
In addition, the author makes the leap that her six diagnosis give her the expertise to make this argument without ever having spent any time in a level of care higher than a partial hospitalization. As someone who has spent significant time in psychiatric hospitals and residential treatment centers she cannot speak for the acutely mentally ill. In fact, the only time she even attempts to give voice to these individuals is when she interviews a criminal imprisoned in a psychiatric facility and for some inexplicable reason feels the need to include this in her book.
Overall, this memoir is less personal story and more platform for Fay to spout irresponsible beliefs about the DSM and the psychiatric system which she has had a relatively small experience within.
ADDED: I have since thought about this review and wanted to add that the author makes the argument that all diagnosis in the DSM are fabricated and therefore non-existent. This has continued to trouble me. It takes a great amount of privilege to reject society’s measurement for mental health. Asking the public to dismiss the DSM completely (as the author asks) will cause a great deal of harm for many who can only receive much needed care because of a diagnosed mental illness (which is thanks to the DSM). I agree that the DSM needs revision and has an amazing amount of bias but to dismiss the entire manual outright without an adequate replacement would do untold amounts of hard.
In addition, the author makes the leap that her six diagnosis give her the expertise to make this argument without ever having spent any time in a level of care higher than a partial hospitalization. As someone who has spent significant time in psychiatric hospitals and residential treatment centers she cannot speak for the acutely mentally ill. In fact, the only time she even attempts to give voice to these individuals is when she interviews a criminal imprisoned in a psychiatric facility and for some inexplicable reason feels the need to include this in her book.
Overall, this memoir is less personal story and more platform for Fay to spout irresponsible beliefs about the DSM and the psychiatric system which she has had a relatively small experience within.
This entire review has been hidden because of spoilers.
September 3, 2022
A good attempt at raising some concerns against psychiatry and a mental health memoir coupled with a quick recap in grammar of punctuation.
However a superficial understanding of psychiatry and the DSM - as is expected from a patient - manages to further stigmatise mental illness and treatment. Additionally this book romanticised suicide - a dangerous game.
A “truth bomb” is dropped in the epilogue - which is the basic idea raised at the beginning of any psychiatry teaching
This raises the concern that the medical establishment is terrible at communicating with patients.
An interesting read for mental health professionals to get a glimpse into the patient’s mind and world view - raises ideas to bring up with your own patients.
A dangerous read for patients or possible patients. Do not let this book stop you receiving help
However a superficial understanding of psychiatry and the DSM - as is expected from a patient - manages to further stigmatise mental illness and treatment. Additionally this book romanticised suicide - a dangerous game.
A “truth bomb” is dropped in the epilogue - which is the basic idea raised at the beginning of any psychiatry teaching
This raises the concern that the medical establishment is terrible at communicating with patients.
An interesting read for mental health professionals to get a glimpse into the patient’s mind and world view - raises ideas to bring up with your own patients.
A dangerous read for patients or possible patients. Do not let this book stop you receiving help
May 5, 2023
It's tempting to call Sarah Fay's new thoroughly researched memoir-cum-clinical-psychiatry-exposé Pathological: The True Story of Six Misdiagnoses "brave." It also feels patently wrong. As Fay herself introduces the book, "This isn’t a classic mental-illness memoir." Even filtered through the requisite lens of personal experience, the book isn't invested in an easy narrative of either triumph or tragedy. And, of course, there's the uncomfortable reinforcement of mental illness stigmatization inherent in the conception that frankly writing about it is somehow an act of "bravery." This same sort of stigmatization that Fay engages with directly in her concluding chapter.
But it isn't that "brave" alone feels wrong. Rather, Pathological puts the lie to the conception that the truth of things can be encapsulated by words, definitions, abstractions. After all, Fay argues, are these not exactly what constitutes a mental illness diagnosis in the first place? "Diseases like cancer and diabetes can be determined using an objective measure; DSM diagnoses were and are entirely subjective." Rest assured, Fay provides no shortage of evidence for her claims of the shortcomings of the Diagnosis Epidemic at large in clinical psychiatry, with a particular focus on the suspect role the DSM has played in helping legitimize such prodigious pathologizing. This alone would make the book well worth seeking out.
However, it does nothing to clarify just how excellently Fay conceptualizes the telling of her own story. Each chapter zeroes in a specific moment in her own life, intertwining the personal with relevant clinical history in the treatment of the specific "mental disorders," appearing in those chapters, whether one of titular six Fay herself was diagnosed with, or those affecting those with whom she comes in contact - often students dealing with their own systemic disenfranchisement. Alongside this structure are the recurring insertions of uses and histories of different punctuation marks that slip between the metaphorical and the tangible ways some of that punctuation is applied and misapplied in the DSM itself.
That punctuation element feels particularly important. Words themselves are subjective, even if given the rhetorical veneer of universality. Same goes for diagnoses - folding, erasing, mitigating the personal experiences of so many individual people into unscientific diseases that a capitalistic and dehumanizing health care industry masquerades as "truth." Punctuation is not concerned with the individual. Punctuation is the way in which the complexity of multiple definitions are held together and made coherent. The sort of coherency fallen by the wayside as nearly every facet of the spectrum of human emotion is pathologized.
I spent time in my early 20s hospitalized against my will as a threat to myself. While there, I was placed on a cocktail of new medications and restricted access to what had always given me peace. Music, in my case, but any number of people on the ward could've told you a different specific for the same experience. (There were whispers of a chimeric guitar floating somewhere around the hospital - always a day away. It finally manifested in the "recreation room" five minutes before my checkout.) No follow-ups on the new medication cocktails to treat my diagnosis of Major Depressive Disorder (or was it Bipolar II? [Or Generalized Anxiety Disorder? Never got a straight answer]).
Pathological doesn't pretend to provide answers. Rather, it engages with the endless potential for the complexity that has been so thoroughly paved over with the Pharmaceutical industry and the clinical psychology field's manipulation of people's need for an explanation of their suffering. Have a diagnosis. Have an identity. Have an answer, regardless of the truth or consequence. So Pathological isn't an answer. Perhaps it's a reclamation. But even then - stay cautious of definitions. Perhaps instead, Pathological is...
But it isn't that "brave" alone feels wrong. Rather, Pathological puts the lie to the conception that the truth of things can be encapsulated by words, definitions, abstractions. After all, Fay argues, are these not exactly what constitutes a mental illness diagnosis in the first place? "Diseases like cancer and diabetes can be determined using an objective measure; DSM diagnoses were and are entirely subjective." Rest assured, Fay provides no shortage of evidence for her claims of the shortcomings of the Diagnosis Epidemic at large in clinical psychiatry, with a particular focus on the suspect role the DSM has played in helping legitimize such prodigious pathologizing. This alone would make the book well worth seeking out.
However, it does nothing to clarify just how excellently Fay conceptualizes the telling of her own story. Each chapter zeroes in a specific moment in her own life, intertwining the personal with relevant clinical history in the treatment of the specific "mental disorders," appearing in those chapters, whether one of titular six Fay herself was diagnosed with, or those affecting those with whom she comes in contact - often students dealing with their own systemic disenfranchisement. Alongside this structure are the recurring insertions of uses and histories of different punctuation marks that slip between the metaphorical and the tangible ways some of that punctuation is applied and misapplied in the DSM itself.
That punctuation element feels particularly important. Words themselves are subjective, even if given the rhetorical veneer of universality. Same goes for diagnoses - folding, erasing, mitigating the personal experiences of so many individual people into unscientific diseases that a capitalistic and dehumanizing health care industry masquerades as "truth." Punctuation is not concerned with the individual. Punctuation is the way in which the complexity of multiple definitions are held together and made coherent. The sort of coherency fallen by the wayside as nearly every facet of the spectrum of human emotion is pathologized.
I spent time in my early 20s hospitalized against my will as a threat to myself. While there, I was placed on a cocktail of new medications and restricted access to what had always given me peace. Music, in my case, but any number of people on the ward could've told you a different specific for the same experience. (There were whispers of a chimeric guitar floating somewhere around the hospital - always a day away. It finally manifested in the "recreation room" five minutes before my checkout.) No follow-ups on the new medication cocktails to treat my diagnosis of Major Depressive Disorder (or was it Bipolar II? [Or Generalized Anxiety Disorder? Never got a straight answer]).
Pathological doesn't pretend to provide answers. Rather, it engages with the endless potential for the complexity that has been so thoroughly paved over with the Pharmaceutical industry and the clinical psychology field's manipulation of people's need for an explanation of their suffering. Have a diagnosis. Have an identity. Have an answer, regardless of the truth or consequence. So Pathological isn't an answer. Perhaps it's a reclamation. But even then - stay cautious of definitions. Perhaps instead, Pathological is...
April 8, 2022
I found this book tremendously frustrating. Fay is a really good writer and she has a tremendous amount to offer the world in her story. However, I felt that in focusing on the DSM and all its iterations, she missed telling her story story, and the complexities of mental illness and mental health care . The science behind mental illness and treatment is poor- for some illnesses more than others. We need better access to mental health care and better care- I feel that this is the issue that her book needed to focus on. The DSM feels like a red herring. I also felt that, though Fay was an honest reporter, she lacked introspection in her memoir. I was disappointed.
January 2, 2022
A scathing indictment of the DSM, Big Pharma and the changes to how mental health has been recognized, thought of, and treated, told through the author's personal experiences. Leavened with grammatical asides that are initially off-putting but quickly become an integral part of the book. This should be catnip for medicated librarians...
May 1, 2022
Beloved was Sethe’s THIRD child; she had two older brothers, Howard and Buglar, and then Denver was fourth. The house is 124, in part because Sethe’s child 3 is missing.
Surprised a fact-checker or copy editor did not catch the ethos-wrecking quip that Sethe killed her eldest child, written by an author who makes much ado about her lit PhD. Given the argument of the rest of the book (“the DSM is hogwash”), I find myself really unwilling to forgive this slip.
I like mental health memoirs as a genre but would recommend passing on this one. I have misgivings about the author casting doubts on mental health professionals when so many people now are struggling and desperately need some kind of help, even if it is a diagnosis with an ever-evolving psychiatric tool.
Surprised a fact-checker or copy editor did not catch the ethos-wrecking quip that Sethe killed her eldest child, written by an author who makes much ado about her lit PhD. Given the argument of the rest of the book (“the DSM is hogwash”), I find myself really unwilling to forgive this slip.
I like mental health memoirs as a genre but would recommend passing on this one. I have misgivings about the author casting doubts on mental health professionals when so many people now are struggling and desperately need some kind of help, even if it is a diagnosis with an ever-evolving psychiatric tool.
May 16, 2022
DNF @ 30%
Was really excited about the premise for this one. However her argument is deeply flawed and too specific to the authors experience to be used more generally. At the same time, the author has not been in any high level of care or long term continuous mental health treatment, which would realistically impact long term diagnoses. The privilege of only outpatient treatment and the autonomy she had in her treatment as a straight white woman is not sufficiently acknowledged.
Disappointed as the idea of this has a lot of potential and there is plenty of room in mental health system for critique. This just wasn’t it (for me).
Was really excited about the premise for this one. However her argument is deeply flawed and too specific to the authors experience to be used more generally. At the same time, the author has not been in any high level of care or long term continuous mental health treatment, which would realistically impact long term diagnoses. The privilege of only outpatient treatment and the autonomy she had in her treatment as a straight white woman is not sufficiently acknowledged.
Disappointed as the idea of this has a lot of potential and there is plenty of room in mental health system for critique. This just wasn’t it (for me).
May 2, 2022
Pathological is a memoir in part, a lesson in punctuation that is historical and metaphorical, and a book that asks us to seriously question the credibility and authority of the Diagnostic and Statistical Manual of Mental Disorders (DSM), presently in its fifth edition. I'm not sure who the audience with be for this, but I know just enough about the subject matter to say that Fay presents us with an extraordinary piece of research and a capable, interesting presentation that I expect it will interest to many people with less of a background than I personally have in her subject areas. I have been treated for major depressive disorder (my diagnosis) for fifty years and for ADHD (now called inattentive type) for thirty years. As a lawyer, I represented school districts when parents of special education students challenged their children's educational programing. Every one of these children had a DSM diagnosis and if a case went to a hearing, that diagnosis was central to the hearing officer's decision. I also majored in English and philosophy in college, making me a relatively knowledgeable reader. Writing well and using appropriate punctuation has been important to me for many, many years.
It never occurred to me, and it is completely obvious now, that the DSM is merely a theoretical framework, created by committee and it has no -- zero-- scientific validity. It is a compendium, describing as many variations of human "abnormality," with descriptions and checklists that aide a diagnosis. It arose, not from science but from committees of people who treat mental health patients. Many things that we take as truth, such as the idea that depression is caused by a chemical imbalance in our brains or that if a medication helps with symptoms it confirms the diagnosis it was prescribed to treat are completely based on theories and anecdotal experience. A DSM diagnosis ensures reimbursement from insurance companies when a medical professional codes it into a patient's invoice. Fay reminds us that pharmaceutical companies and the various professionals who conduct studies financed by them stand to gain a lot from the business of psychiatric treatments.
Is Fay saying that she and others cannot have experienced devastating, debilitating symptoms, suicidal ideation, disassociation? No. But she suggests hat there are other ways of framing these symptoms and perhaps of treating them, that it is problematic to misrepresent DSM diagnoses as being founded in established fact rather than theory. Fay challenges twenty-first century psychiatric norms, but she is not an all or nothing writer who would say that but for her six diagnoses of various mental health disorders, her life would have been fine. I like the attention she pays to the fact that many medications have serious side effects and/or are very difficult to discontinue. I continue to use antidepressants, but when changing medication I've gone through devastating experiences. In my family, there is a person who is so impacted by side effects of psychotropic drugs that a psychiatrist who has known her for years has taken her off everything. And the withdrawal from these medications was tough. She was overmedicated, by a different doctor, who did not listen to her and kept adding prescriptions that in fact were his attempt to even out her complaints about the side effects of the strong medications he put her on. She went in with postpartum depression and walked out a zombie on eight medications. His treatment left her incapable of caring for her child because of overmedication and her extreme sensitivity to prescription drugs. It took two years to detox her. His was a well regarded well known medical facility.
Fay suggests that having a DSM diagnosis may cause those of us with mental health issues to live life as if we are our diagnoses. And that is something that rings true. I would not say, this solves particular issues that come with having the undeniably serious symptoms of mental illness, but it is a refreshing way to remind oneself to step back and recognize that these are symptoms, not who we fundamentally are. Because she has strong, well-researched positions, a compelling story to tell and she is not strident with her ideas, but sharing them and substantiating her points, her book deserves a lot of attention from mental health professionals and patients.
It never occurred to me, and it is completely obvious now, that the DSM is merely a theoretical framework, created by committee and it has no -- zero-- scientific validity. It is a compendium, describing as many variations of human "abnormality," with descriptions and checklists that aide a diagnosis. It arose, not from science but from committees of people who treat mental health patients. Many things that we take as truth, such as the idea that depression is caused by a chemical imbalance in our brains or that if a medication helps with symptoms it confirms the diagnosis it was prescribed to treat are completely based on theories and anecdotal experience. A DSM diagnosis ensures reimbursement from insurance companies when a medical professional codes it into a patient's invoice. Fay reminds us that pharmaceutical companies and the various professionals who conduct studies financed by them stand to gain a lot from the business of psychiatric treatments.
Is Fay saying that she and others cannot have experienced devastating, debilitating symptoms, suicidal ideation, disassociation? No. But she suggests hat there are other ways of framing these symptoms and perhaps of treating them, that it is problematic to misrepresent DSM diagnoses as being founded in established fact rather than theory. Fay challenges twenty-first century psychiatric norms, but she is not an all or nothing writer who would say that but for her six diagnoses of various mental health disorders, her life would have been fine. I like the attention she pays to the fact that many medications have serious side effects and/or are very difficult to discontinue. I continue to use antidepressants, but when changing medication I've gone through devastating experiences. In my family, there is a person who is so impacted by side effects of psychotropic drugs that a psychiatrist who has known her for years has taken her off everything. And the withdrawal from these medications was tough. She was overmedicated, by a different doctor, who did not listen to her and kept adding prescriptions that in fact were his attempt to even out her complaints about the side effects of the strong medications he put her on. She went in with postpartum depression and walked out a zombie on eight medications. His treatment left her incapable of caring for her child because of overmedication and her extreme sensitivity to prescription drugs. It took two years to detox her. His was a well regarded well known medical facility.
Fay suggests that having a DSM diagnosis may cause those of us with mental health issues to live life as if we are our diagnoses. And that is something that rings true. I would not say, this solves particular issues that come with having the undeniably serious symptoms of mental illness, but it is a refreshing way to remind oneself to step back and recognize that these are symptoms, not who we fundamentally are. Because she has strong, well-researched positions, a compelling story to tell and she is not strident with her ideas, but sharing them and substantiating her points, her book deserves a lot of attention from mental health professionals and patients.
March 9, 2022
While interesting, this read much more like a book report on DSM bullshit (which I agree, the DSM is bullshit). I wanted to know more about her journey but then it would sidetrack into a lot of history of psychology, which got old after a while.
I guess I also didn't get the entire history of punctuation and why it mattered here? I mean, I get it, but...I really didn't care.
I guess I also didn't get the entire history of punctuation and why it mattered here? I mean, I get it, but...I really didn't care.
July 14, 2022
Somewhat of a mess of a book, actually.
It's mostly a very long diatribe against the DSM (psychiatry's Diagnostic and Statistical Manual of Mental Disorders) and the practitioners who don't acknowledge its shortcomings. Then we have the author's life-long challenges with her own mental health and a witch's brew of medications and a cast of therapists/psychiatrists. AND we have the delight of the history of punctuation and a very odd correlation between punctuation and how that defines her mental state.
And that's a mess of a book.
My eyes glazed over with the minutiae concerning the DSM and the memoir portions were in a completely different tone which was jarring. But hey, it also made it easier to skim the continuing saga of the history of the DSM and its revisions, which is the only way I got through this book.
2 stars instead of 1 because I was motivated to follow up with some articles about the DSM and SSRI's and to think through the efficacy and the downsides of my own years-long use of Citalopram. It's always valuable to self-reflect and re-evaluate.
It's mostly a very long diatribe against the DSM (psychiatry's Diagnostic and Statistical Manual of Mental Disorders) and the practitioners who don't acknowledge its shortcomings. Then we have the author's life-long challenges with her own mental health and a witch's brew of medications and a cast of therapists/psychiatrists. AND we have the delight of the history of punctuation and a very odd correlation between punctuation and how that defines her mental state.
And that's a mess of a book.
My eyes glazed over with the minutiae concerning the DSM and the memoir portions were in a completely different tone which was jarring. But hey, it also made it easier to skim the continuing saga of the history of the DSM and its revisions, which is the only way I got through this book.
2 stars instead of 1 because I was motivated to follow up with some articles about the DSM and SSRI's and to think through the efficacy and the downsides of my own years-long use of Citalopram. It's always valuable to self-reflect and re-evaluate.
October 13, 2022
The Diagnostic and Statistical Manual of Mental Disorders (DSM) attempts to catalogue, describe, and organize mental illness. The American public has accepted it as the authority on what is "normal" and what is disordered -- but how much scientific data was considered in the creation of the DSM? It turns out... not a lot.
Sarah Fay's story is part memoir, part diatribe on the shortcomings of the DSM-5, and part history of the invention and proper usage of punctuation marks. (Yes, you read that correctly!) I found it quirky and delightful and eye-opening.
While the author argues that DSM-5 diagnoses lack validity, she does not use this to discredit any symptoms a person may experience. Rather, readers are led to consider the origins (and possible consequences) of our current system of labeling.
I thoroughly enjoyed this book, but should issue one caveat: there are some very vivid descriptions of suicidal ideation and readers who may find those descriptions appealing should exercise caution.
Sarah Fay's story is part memoir, part diatribe on the shortcomings of the DSM-5, and part history of the invention and proper usage of punctuation marks. (Yes, you read that correctly!) I found it quirky and delightful and eye-opening.
While the author argues that DSM-5 diagnoses lack validity, she does not use this to discredit any symptoms a person may experience. Rather, readers are led to consider the origins (and possible consequences) of our current system of labeling.
I thoroughly enjoyed this book, but should issue one caveat: there are some very vivid descriptions of suicidal ideation and readers who may find those descriptions appealing should exercise caution.
September 11, 2022
I heard Fay on a Mad in America podcast and was intrigued. I am fully skeptical of the DSM and how psych meds are doled out these days, so I was ready to sink my teeth into this memoir. I enjoyed and was drawn in to her stories about her own struggles. Her descriptions of her experience of "shattering" are so evocative. Her critiques of the DSM seem to come down to the fact that psychiatry doesn't have a biological basis the way that non-mental health medicine is, and that doesn't seem quite right or justified. I also wanted more detail in her critiques as they were a bit too general and rhetorical for me.
February 16, 2023
Very intriguing!
While intriguing, it still feels irresponsible to completely write off MH diagnoses and to claim that you know FOR SURE that the DSM is useless. I think it’s good to always question everything, but Fay does exactly what she’s preaching against: thinking that her experience is the be-all end-all.
While intriguing, it still feels irresponsible to completely write off MH diagnoses and to claim that you know FOR SURE that the DSM is useless. I think it’s good to always question everything, but Fay does exactly what she’s preaching against: thinking that her experience is the be-all end-all.
June 12, 2022
Aggressively bad, overly pretentious, though fascinating if you enjoy trainwrecks.
June 23, 2022
Pathological is a memoir detailing a young woman’s journey through six misdiagnoses and her survival. It is a very well researched book that delves into the shortcomings and inadequacies of the DSM, which is the widely used tool used to aid in diagnosing mental illness and aberrant behavior. The DSM is an evolving work, being updated every so often and now in its fifth version. Is it absolute? Absolutely not and I believe many would agree on some of its limitations. However, it is all we have. There has to be such a diagnostic manual for the insurance companies, whether we like it or not. Practitioners must use the DSM’s codes when submitting claims to any and all insurance companies.
Fay spends a good amount of time criticizing the DSM, it’s use or misuse, seeing is as invalid, overused and unreliable. She has been through a lot and tells her story in a very relatable way. She was diagnosed with 6 different mental illnesses over thirty years. Does it mean she was misdiagnosed? I am not so sure. People change and their situations change so perhaps they were somewhat accurate at the time that they happened. In addition, one could have more than one diagnosis at the very same time. I don’t see her six diagnoses as mutually exclusive necessarily - anorexia, depression, anxiety, attention deficit, obsessive-compulsive, and bipolar. At the same time, I do agree that the DSM would benefit from more testing, review and refinement by a broader group of psychiatrists.
Pathological is a book that should be read widely by psychiatrists and psychologists and it should prompt a discussion to improve the DSM. Will it ever be perfect? I doubt it but it could be better.
Thank you to NetGalley and Harper One for an advance reader copy in exchange for my honest opinion.
Fay spends a good amount of time criticizing the DSM, it’s use or misuse, seeing is as invalid, overused and unreliable. She has been through a lot and tells her story in a very relatable way. She was diagnosed with 6 different mental illnesses over thirty years. Does it mean she was misdiagnosed? I am not so sure. People change and their situations change so perhaps they were somewhat accurate at the time that they happened. In addition, one could have more than one diagnosis at the very same time. I don’t see her six diagnoses as mutually exclusive necessarily - anorexia, depression, anxiety, attention deficit, obsessive-compulsive, and bipolar. At the same time, I do agree that the DSM would benefit from more testing, review and refinement by a broader group of psychiatrists.
Pathological is a book that should be read widely by psychiatrists and psychologists and it should prompt a discussion to improve the DSM. Will it ever be perfect? I doubt it but it could be better.
Thank you to NetGalley and Harper One for an advance reader copy in exchange for my honest opinion.
December 6, 2022
I was so excited to read this book as im in a clinical psychology graduate program- but my excitement quickly shriveled up the more i got into this memoir. Fay is a talented writer, but she is NOT a mental health professional and didnt want to listen to anyone who was, clearly. I understand her frustration with her multiple diagnoses. I agree that the DSM is outdated, written by old white men, does not account for many issues regarding POC, has homophobic roots, etc and needs lots of TLC. I also agree that people are absolutely, 10000% over-diagnosed, big pharma sucks, medication is given out way too easily, and that the mental health system is NO WHERE near perfect, but Fay just jumps straight to the extreme. essentially saying mental health diagnoses are all untrue and not to waste your time trusting any mental health professional, ever. She fails to realize that not every diagnosis looks the same in every person that has it/one person with the same diagnosis as another may be on different medications and just keeps going back to it being the DSM’s fault. Is the system perfect? Absolutely not, but Fay’s opinions took it to a whole other level. It was very invalidating to read as a young adult in the beginning of my career in the mental health field, ESPECIALLY since I have suffered from mental illness and being diagnosed changed my life for the better. I can literally list a million other things wrong with her content but then id have an essay…Also what was up with all the grammar talk it pissed me off. Hated this book and made me so irritated !!!!!!
August 28, 2022
This book would have been a 3 stars for me up until the epilogue, which was a glaring red flag. I read some of the other reviews and tended to agree with a lot of other folks who say Fay's anger and frustration is misguided. She makes a lot of excellent points about the flaws of the DSM which are pretty indisputable, but she puts far too much blame on the manual and not on the doctors and providers who were responsible for caring for her and were too quick to put a diagnosis on her after first meeting her. This has more to do with the problems of our healthcare and pharmaceutical industry rather than the issues with the DSM from my perspective.
Her anger and frustration is absolutely valid, but it didn't appear that she had much introspection or observation regarding her own situation to appropriately place blame or resolution. In fact, that was one of my biggest problems with this book; for a memoir regarding something so deeply personal, this read a lot like a research guide regarding the different definitions and uses of various mental disorders. I felt really disconnected from her as a narrator as she wrote very analytically about different experiences throughout her life (which could have been intentional, considering she is diagnosed as having depersonalization experiences[though according to her, diagnoses must not mean much[look, I'm using her stupid bracket technique]]).
Overall, this book pales in comparison to "What My Bones Know" by Stephanie Foo.
Her anger and frustration is absolutely valid, but it didn't appear that she had much introspection or observation regarding her own situation to appropriately place blame or resolution. In fact, that was one of my biggest problems with this book; for a memoir regarding something so deeply personal, this read a lot like a research guide regarding the different definitions and uses of various mental disorders. I felt really disconnected from her as a narrator as she wrote very analytically about different experiences throughout her life (which could have been intentional, considering she is diagnosed as having depersonalization experiences[though according to her, diagnoses must not mean much[look, I'm using her stupid bracket technique]]).
Overall, this book pales in comparison to "What My Bones Know" by Stephanie Foo.
July 9, 2022
I have always had a problem with how mental health is diagnosed. They have yet to be able to find a gene, a disease, or any biological explanation for how sometimes people’s brains process.
Don’t get me wrong - psychiatrists and psychologists have benefited so many people with their help and training. But too often, the DSM is used as the proof that mental disease exists, instead of acknowledging that it’s more disordered processing.
Pathological helps to show the problems of how the DSM is presented to the public, the issue of monetary gain for many, and the truth that each person needs the truth in order to make informed decisions.
This book does not pick a side. Rather it provides good information to help a person gain knowledge about a very real but challenging issue - mental health.
Don’t get me wrong - psychiatrists and psychologists have benefited so many people with their help and training. But too often, the DSM is used as the proof that mental disease exists, instead of acknowledging that it’s more disordered processing.
Pathological helps to show the problems of how the DSM is presented to the public, the issue of monetary gain for many, and the truth that each person needs the truth in order to make informed decisions.
This book does not pick a side. Rather it provides good information to help a person gain knowledge about a very real but challenging issue - mental health.
April 22, 2022
This read like what happens when you have too much material for an essay, but not enough for a book.
The structure of this book is dangerous. The author’s argument throughout is that DSM is unreliable and that psychiatry is controlled by big Pharma, but it’s only revealed in the epilogue that the author has chosen to remain on some medications because they help with a yet to be defined mental illness. If I hadn’t read the Epilogue I would have left this book thinking the author healed herself through newfound knowledge of evolutionary psychiatry and increased social connections. How many readers will abandon this book midway and decide to throw out their Big Pharma meds?
My favorite part was the grammar history and how the author tied it back to her story.
The structure of this book is dangerous. The author’s argument throughout is that DSM is unreliable and that psychiatry is controlled by big Pharma, but it’s only revealed in the epilogue that the author has chosen to remain on some medications because they help with a yet to be defined mental illness. If I hadn’t read the Epilogue I would have left this book thinking the author healed herself through newfound knowledge of evolutionary psychiatry and increased social connections. How many readers will abandon this book midway and decide to throw out their Big Pharma meds?
My favorite part was the grammar history and how the author tied it back to her story.
This entire review has been hidden because of spoilers.
November 24, 2025
Read this while converting OLD 8mm film to digital at local library-hours to just read and absorb and make LOTS of notes on post its!
Very interesting format of memoir and history and references to other important writing on mental health diagnosis and the state of the over diagnosed world today. In addition, the author wraps in the correlation she finds between punctuation and its use and origins and the mind
I might have to purchase this book so I can mark it up and refer back to insights that I find helpful
“Talking to a doctor about mental health conditions is like going to a lemonade stand and saying you’re thirsty. You’re going to get lemonade (medication/diagnosis.)
Question mark origin:
Egyptians used it in maps for unknown areas. The shape is made by a cat’s tail when surprised or nervous.
Definition and use of [ ]
“They represent our internal lives, our deepest secrets.”
REALLY made me think about how mental health issues diagnosed. I have personal experience begging a dr for a diagnosis because I thought I needed it to UNDERSTAND and FIX what was going on. But I have learned people don’t need to be fixed as much as listened to and acknowledged. Connection is key.
I also like how author recognizes that talk therapy does not work for everyone.
Now I was to learn more about Evolutionary Psychiatry-along with about a dozen other books, articles and poems mentioned by the author.
You hear SO much-“you should talk to someone.” [I thought I was talking to YOU?] “You could get medication to help”
After reading this, I plan to look UP more. Less screens. Say hello. Look people in the eye and smile.
More reaching…try to understand myself better and always listen.
Very interesting format of memoir and history and references to other important writing on mental health diagnosis and the state of the over diagnosed world today. In addition, the author wraps in the correlation she finds between punctuation and its use and origins and the mind
I might have to purchase this book so I can mark it up and refer back to insights that I find helpful
“Talking to a doctor about mental health conditions is like going to a lemonade stand and saying you’re thirsty. You’re going to get lemonade (medication/diagnosis.)
Question mark origin:
Egyptians used it in maps for unknown areas. The shape is made by a cat’s tail when surprised or nervous.
Definition and use of [ ]
“They represent our internal lives, our deepest secrets.”
REALLY made me think about how mental health issues diagnosed. I have personal experience begging a dr for a diagnosis because I thought I needed it to UNDERSTAND and FIX what was going on. But I have learned people don’t need to be fixed as much as listened to and acknowledged. Connection is key.
I also like how author recognizes that talk therapy does not work for everyone.
Now I was to learn more about Evolutionary Psychiatry-along with about a dozen other books, articles and poems mentioned by the author.
You hear SO much-“you should talk to someone.” [I thought I was talking to YOU?] “You could get medication to help”
After reading this, I plan to look UP more. Less screens. Say hello. Look people in the eye and smile.
More reaching…try to understand myself better and always listen.
September 1, 2025
This one is hard to rate because it’s a memoir and I do not feel that I have a right to rate someone’s opinion on their experience. It is a well written book and it made me think about the gray in psychology. The reality is I don’t regret reading it.
With that said, I personally do not agree with her claims but that does not take away that she can feel as she does. I agree wholeheartedly that psychology has so many things to improve on and that the DSM is by no means a perfect book and can be skewed. Treatment is skewed and psychiatrists can all give you their personal interpretation.
But the fact stands that mental illness is real. I do not believe that people only suffer from illness because they were given a “label”. Could self fulfilling prophecy exist? Sure. Can people lean into these labels they receive? Sure. But something was there to begin with. And at times I do feel she romanticizes suicide because she is so dead set on disproving that she had something wrong with her.
This does not mean that I don’t agree with today’s society over diagnosing. Especially with things that are part of just the human condition based on personal experiences and trials. This also doesn’t mean that I do not agree that psychiatric medications can be harmful. But people still need a starting point in receiving help with feeling that they should not have to experience everyday.
Reform is necessary yes, but to discredit all of modern day psychiatry is an oversimplification.
With that said, I personally do not agree with her claims but that does not take away that she can feel as she does. I agree wholeheartedly that psychology has so many things to improve on and that the DSM is by no means a perfect book and can be skewed. Treatment is skewed and psychiatrists can all give you their personal interpretation.
But the fact stands that mental illness is real. I do not believe that people only suffer from illness because they were given a “label”. Could self fulfilling prophecy exist? Sure. Can people lean into these labels they receive? Sure. But something was there to begin with. And at times I do feel she romanticizes suicide because she is so dead set on disproving that she had something wrong with her.
This does not mean that I don’t agree with today’s society over diagnosing. Especially with things that are part of just the human condition based on personal experiences and trials. This also doesn’t mean that I do not agree that psychiatric medications can be harmful. But people still need a starting point in receiving help with feeling that they should not have to experience everyday.
Reform is necessary yes, but to discredit all of modern day psychiatry is an oversimplification.
Read
April 16, 2022In this fascinating memoir, Sarah Fay researches the American mental profession as she is diagnosed with 6 different mental health disorders, starting with a diagnosis of anorexia in 8th grade. She becomes successful journalist and creative writing teacher. Fay looks at the history of the DSM (mental health diagnosis manual) and what effect it has had in our culture. (Oddly, the DSM is only used in the United States and Australia: other countries have their own set of diagnoses.) Fay also uses the cultural history of punctuation to help teach literature - such as the dashes that Emily Dickinson used in her poetry. And who knew that the semi-colon became the symbol for and anti-suicide campaign! A wonderful but scary and well-written memoir. Highly recommended.
July 16, 2025
Since half of us in the US will face a mental health diagnosis in our lifetimes, at least half of us need to read this book. Fay was given six different diagnoses and eventually concludes (with the help of a lot of quality research into the DSM and after a lot of needless/stigmatizing/debilitating care) that they’re neither helpful nor truthful. I’ve had 8 diagnoses and am in total agreement. If you’re not in the half being diagnosed, read this book to be a better support.
January 26, 2022
3 1/2 stars
Part medical memoir, part terrifying look at mental health misdiagnoses - Sarah Fay takes us down the rabbit hole of the mental health provider's bible, DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS.
She was misdiagnosed six times seemingly from various doctors looking up a menu of symptoms and picking one that they thought fit. With that came drugs that left her more anxious and with less of an idea of what was really going on in her body. Her story will scare you and maybe we should be. We need a wake-up call to the way we treat and approach mental health issues. My thanks to the publisher for the advance copy.
Part medical memoir, part terrifying look at mental health misdiagnoses - Sarah Fay takes us down the rabbit hole of the mental health provider's bible, DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS.
She was misdiagnosed six times seemingly from various doctors looking up a menu of symptoms and picking one that they thought fit. With that came drugs that left her more anxious and with less of an idea of what was really going on in her body. Her story will scare you and maybe we should be. We need a wake-up call to the way we treat and approach mental health issues. My thanks to the publisher for the advance copy.
did-not-finish
January 6, 2024Eek. Well written but I think this book is actually dangerous for those of us struggling with mental health with its central proclamation that because it’s all made up, we should reject diagnoses and treatments. I read the beginning and last 3rd and skipped the middle.
August 22, 2022
This is an important book as I learned a lot about the various problems surrounding DSM diagnoses. Though I didn’t agree with all of Fay’s conclusions, I found the book to be very well written, enlightening and thought provoking. It certainly spurred me to think about my own relationship to mental health diagnoses throughout my life.
July 14, 2022
I loved this book; it was an enlightening memoir filled with equal wit and vulnerability. Dr. Fay blatantly asks the question that seems to plague a generation of over diagnosed children turned adults: is this feeling a symptom of my mental illness, a side effect of my medications, or a part of the human experience? I hope the author writes more about her experiences. I am grateful to have found such an honest novel about an experience I heavily (and sometimes slightly shamefully) relate to. I highly recommend this book for anyone interested in Mental Health and Psychology. I will definitely be reading it again!
September 7, 2023
Insufferable. The common “punctuation” thread to illustrate ideas was silly, I skipped those sections every time they came up. The author’s continued diagnosis shopping was obnoxious, and her hostility toward the DSM was a touch hysterical. Why rally against the book, then continue to define yourself by it? Then go off meds? What’s the point of this book??
There’s no legacy, no restitution, no evolution. Just chronic doctor shopping, going on and off of meds, and bringing “pick me girl” energy every time she asks “am I bipolar??” to every healthcare professional in her orbit. Only to say, “oh this is all junk. I’m fine.” She’s anti-psychiatry, plain and simple.
I want my time back. Truly the worst book I’ve read this year, I should have put it down many times. This text completely overlooks the value pharmaceuticals have brought to millions. Psychiatry isn’t perfect, but it’s a framework that brings stability to a lot of people, this author is a narcissistic hypochondriac, and a bore.
This is the meanest review I’ve ever written, but it’s deserved because this book has the potential to be exponentially more damaging to a large swath of people in recovery.
There’s no legacy, no restitution, no evolution. Just chronic doctor shopping, going on and off of meds, and bringing “pick me girl” energy every time she asks “am I bipolar??” to every healthcare professional in her orbit. Only to say, “oh this is all junk. I’m fine.” She’s anti-psychiatry, plain and simple.
I want my time back. Truly the worst book I’ve read this year, I should have put it down many times. This text completely overlooks the value pharmaceuticals have brought to millions. Psychiatry isn’t perfect, but it’s a framework that brings stability to a lot of people, this author is a narcissistic hypochondriac, and a bore.
This is the meanest review I’ve ever written, but it’s deserved because this book has the potential to be exponentially more damaging to a large swath of people in recovery.
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