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Quarterly Essay #85

Not Waving, Drowning: Mental Illness and Vulnerability in Australia

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Around one-fifth of Australians will suffer from mental illness in any given year. And the pandemic is making things worse, especially in schools. Our mental health system is under stress and not fit for purpose. What is to be done?

In this brilliant mix of portraiture and analysis, Sarah Krasnostein tells the stories of three women and their treatment by the state while at their most unwell. What do their experiences tell us about the likelihood of institutional and cultural change?

Krasnostein argues that we live in a society that often punishes vulnerability, but shows we have the resources to mend a broken system. But do we have the will to do so, or must the patterns of the past persist into the future?

191 pages, Kindle Edition

Published March 21, 2022

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Sarah Krasnostein

9 books254 followers

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Displaying 1 - 30 of 39 reviews
Profile Image for Nick.
252 reviews10 followers
April 28, 2022
I am a psychologist and academic, with a specific focus on the treatment of personality disorders. Our research lab is tasked with promoting effective treatment of personality disorder within mainstream public mental health facilities.

Picking up this quarterly essay on mental illness treatment in Australia, I fully expected it to be on anxiety and depression, or other such 'common' diagnoses that are likely to affect any number of typical Australians (and which also increasingly threaten to burst our currently floundering mental health system - anyone else noticed the months long waitlists for therapy?)

Instead, I was delighted to find Krasnostein's essay shining a light into the dark little corner of a world that consumes most of my daily thinking. Delighted, and dismayed, as it highlighted the abject failure of the current system for individuals with more severe mental health difficulties - such as personality disorder (specifically BPD).

On a bad day, this essay perfectly reflects the nihilism I feel inside, trying to promote change within a system that is on an ever increasing trajectory of individualism and neoliberalism. On a good day, I'm glad that a story like this can be written, and that awareness is raised. I hope it translates to meaningful change - there is still a ways to go.
Profile Image for Schizanthus Nerd.
1,319 reviews305 followers
May 15, 2022
Mental illness is so prevalent that it’s likely either you or someone you love will have lived experience. If it hasn’t impacted you personally, it probably means that it hasn’t yet, not that it won’t.
Almost half of all Australian adults will experience mental ill-health during their lives, and almost one in five will meet the criteria in a given year. These numbers have likely risen during the pandemic.
In this essay, Sarah Krasnostein traces the way mental illness has been managed (or perhaps it would be more accurate to say, poorly managed) over time in Australia. They outline the trauma experienced by convicts and the “increasingly lethal, state-sanctioned attempt to eradicate Aboriginal people” (a minimum of 270 massacres over 140 years, beginning in 1794!!) before exploring our asylum days, beginning with Tarban Creek Lunatic Asylum, Australia’s first purpose built psychiatric facility.

Krasnostein evaluates our current system, where money buys you care if you’re cis, heterosexual and white, while pretty much everyone else has to fight for the scraps, if they can find any.
What is known as “the mental health system,” for example, is really just billions of human interactions. And that is where the problems lie.
We go down the rabbit hole of how people with mental illness are marginalised, looking at the failure of individuals, institutions and society at large. I grew weary hearing about the cascade of inquiries into the mental health system that consistently result in recommendation after recommendation that are not acted on.

We can memorise the stats and read the policies but what really stays with me are peoples’ lived experiences. You can intellectually know that people with mental illness disproportionately experience homelessness and that the ‘service gaps’ are really service chasms, but that doesn’t tell you the whole story.

Being introduced to Rebecca, who despite being found not fit to stand trial and not guilty because of mental impairment, was imprisoned and kept in solitary confinement for up to 23 hours a day simply because there was nowhere else for her to go? Her story is going to stay with me. So is Daylia’s, a woman with a history of setting fires in order to try to gain control over her life.

The story of lived experience that stood above all others for me, though, was that of Eliza. A young woman who has survived extensive childhood trauma and is living with a diagnosis of borderline personality disorder, Eliza is now a peer worker, working to reform a system that in many ways has failed her. To say that I am impressed by her resilience and courage is an understatement. We need to be listening more to people like Eliza.

Quote I loved whose context I can’t remember but would be appropriate in so many situations:
absence of evidence is not evidence of absence
From the ‘I bet whoever approved this name didn’t give it a lot of thought’ files:

The Australian Institute of Health and Welfare have spreadsheets collating cause of death called General Record of Incidence of Mortality (GRIM).
Because there is no systems change without relational change - and no relational change without personal change - perhaps our best hope lies in a critical mass of those who are privileged by the current economic and social model following the lead of those people with lived experience and making the radical choice to normalise their own vulnerabilities - not just by refusing to participate in the stigmatisation of mental illness, but by calling out Othering in all its pernicious forms.
There were a couple of quotes from the Correspondence section about Jess Hill’s The Reckoning that I wanted to make note of:
Adrienne Rich wrote that when a woman tells the truth, she creates “the possibility for more truth around her.”
- Hannah Ryan & Gina Rushton
Silence and withdrawal by the many is what enables crimes by the few.
- Malcolm Knox

Content warnings include alcoholism, bullying, death by suicide, domestic abuse, drug addiction, eating disorders, homophobia, mental health, physical abuse, racism, self harm and sexual assault.

Blog - https://schizanthusnerd.com
Profile Image for Catherine.
78 reviews1 follower
April 29, 2022
this was the best quarterly essay i have read in a very long time and i really love quarterly essays. i am biased because i adore krasnostein’s work but this was an absolutely brilliant but saddening look into the mental health crisis in australia. she looked at the issue through many different stories, judicial, personal, current, historical and political ones, all as fascinating as the next, leaving me often unable to put the essay down.

perhaps my only criticism would be that the essay is very victoria focused, and often doesn’t mention the rest of australia, but i do understand krasnostein is melbourne based lmao
Profile Image for Mentai.
220 reviews
June 28, 2022
Sarah Krasnostein appraises Australia's mental health system through emotive narrative and powerful case studies.
However I found myself yearning for more analysis after certain points were introduced. My favourite section was where she addressed stigma (Goffman) and 'normal' via disability studies. I think this could have been extended and revisited in the conclusion. Or perhaps through another social/political lens rather than the psychological one Krasnostein returns to.
The historicising of Australia's failing mental health system from the penal colony on at the beginning of the essay is excellent.
6 reviews
April 28, 2022
Wanted to love this, but I just can’t get behind SK’s writing style. I had the same hesitations about Trauma Cleaner. Interesting information but the way it’s presented without much analysis just made it feel like I was reading a list of stats at times. Things like the rates of violence or suicide being higher in people with severe mental illness without comment that these, often, are diagnostic criteria seemed like it was there to serve a narrative and not be analysed, which felt odd in the context of stigma. SK has a bad habit of asserting emotion by telling the reader how she felt instead of presenting information in such a way that lets the reader share the experience - this was what forced me to put down Trauma Cleaner several times and the same thing here. I didn’t feel moved or educated after reading this, so I can’t recommend it.
Profile Image for Nathalie Bilinsky.
286 reviews1 follower
January 5, 2026
This was such a good read. Quite depressing too when you realise how little has changed, how we keep spinning the wheels - doing the same thing and hoping for a different result, having enquiries and cherry picking recommendations that don’t have the desired impact when taken in isolation of the whole … and how much there is still to do in the mental health system in Australia. There was a focus on borderline personality disorder which was very interesting. One of the best quarterly essays I’ve read.
Profile Image for Hazel P.
147 reviews3 followers
May 5, 2024
I recently watched the play “The Almighty Sometimes” and would like to get to know more about how the mental health system operates in Australia. Through this reading, I gained insight into the severity of service gaps and the under-resourced system in Australia. This not only hinders individuals of different age groups from seeking early help for mental health concerns, especially those without private insurance and from minority ethnic and non-heterosexual backgrounds, but also leads to dehumanizing outcomes within the criminal justice system, particularly for female inmates. One striking example the writer mentions is a woman who had to remain in prison because there was insufficient suitable housing available outside of prison for her.

I also appreciate the writer's discussion on systems change and believe this idea can be extended to address other social problems.

Lastly, like the writer mentioned, I hope that the concept of government in Australia can align more with that of Nordic countries rather than America.

🔖 p124 Systems change is characterised by: curiosity, an emphasis on understanding of (and respect for) local contexts, power sharing over top-down leadership, self-reflection and personal accountability. Apart from being structural and relational, such change also needs to be mental. Those who hold power must do the interior work of identifying their own assumptions and prejudices. Likewise, an organisation’s capacity to change is constrained by its own internal practices and norms.
Profile Image for Addie.
237 reviews7 followers
March 22, 2023
'We lose much – personally and collectively – by remaining perniciously incurious about what is kept in the darkest, oldest rooms of ourselves.'

Thoughts:
- A short but compelling read about the state of Australia's mental health care system (especially in Victoria), with a focus on the mishandling of more severe mental health conditions.
- I wish some things could have been unpacked and explored further, but on the whole it was very interesting (and not gonna lie... a good way to revise uni content without feeling like I'm revising uni content). I liked the discussion on the legacy of the penal colony, I hadn't thought of it that way before.
- Krasnostein's pen has teeth. Some stand out quotes:
- 'Public inquiries are a ritual of Australian society through which the violated moral order is condemned and an idealised image of the collective is restored. However, our lack of loyalty to their findings indicates that, as an electorate, we value optics over operationalisation.' (p. 12)
- 'If the stories we tell ourselves about the world can be compared to houses, unknowns are the basements and attics and sheds we fill with the detritus collected over a lifetime: fear and blame and rage.' (p. 55)
- 'What is known as “the mental health system,” for example, is really just billions of human interactions. And that is where the problems lie.' (p. 78)
- 'In the taxonomy of politicians, there are those who consider their judges to be future generations and those more concerned with the immediate accrual of power.' (p. 110)
Profile Image for Carly.
52 reviews6 followers
June 27, 2022
Sarah Krasnostein manages to bring an incredible sense of humanity to everything she writes, and this Quarterly Essay is no exception. Deftly weaving analysis with insight and empathy, Not Waving, Drowning explores the failings of our fragmented mental health system through the personal stories of three women with lived experience. Krasnostein uses these (often distressing) stories to shine a light on severe mental illness, as well as the gaps in our social services systems that prevent the most vulnerable in our communities from accessing the care they need.

Like Krasnostein’s brilliant novel The Trauma Cleaner, this essay is as much about trauma as it is about resilience. Although it dishearteningly traces many failed attempts to fix a broken system, it also continues to push for the possibility of systemic change.
Profile Image for Carolyn Polley-Peters.
91 reviews
April 24, 2022
A well balanced contemporary essay, threading through being Woke, and other pertinent identifying factors into the nations psyche as social determinants of mental health. I enjoyed, well not entirely, but it resonated with me. My work place, where we struggle between siloed service systems to find appropriate supports for people not disabled enough to get the NDIS and not psychotic enough to get an admission. Or too poor to afford ongoing psychiatric support. We are the lucky right, well only if you have money.
Profile Image for Sib Hare.
52 reviews8 followers
May 4, 2022
Krasnostein is an incredible writer and takes the reader on an immersive story of the policy failings of Australia’s mental health systems, using some truly unbelievable case examples to illustrate her points. A perfect synthesis of the social and political determinants of mental Ill health in aus, including the impacts of colonialism and stigma, she ties it masterfully together with a vision for future systems change and clearly points the finger of blame at inept and short sighted government policies that entrench the status quo.
Profile Image for Andrew.
Author 2 books3 followers
December 23, 2024
I'm not sure how I missed this Quarterly when it came out, but I'm glad I finally got to it. While it's very Victorian focused, the conversation inside is a national one, and that alone makes this one of the essential Quarterly essays to read.
Profile Image for Chris Sharp.
92 reviews
April 3, 2022
Sarah is very good at contextualising the 'global to local' by framing the known issues at say a Commission level against the stories of the women at the essay's heart and their experiences of having mental health issues in Australia.

I feel like it also explores using clinical frameworks of understanding mental health issues and applies them to systems, which I found a compelling way to discuss system problems.

It also does a thing where it explores the impact of Australian history on our current mental health cultural landscape.

Having part of my workplace reflected back at me through the eyes of system users, peer workers, and clinicians outside the community mental health networks was important.

For me, the essay seemed to simultaneously strike me as both states of expected/unexpected, which I'll probably need to unpack.
Profile Image for Rob Donnelly.
Author 2 books8 followers
March 20, 2022
I fully recommend this current Quarterly Essay. The great advantage of a long form essay is it gives time for a deeper consideration of the topic. One of the striking points highlighted in this essay is the Australian resistance to change. We call commissions and enquiries - convince ourselves that we have taken action - recommendations are made but then cherry-picked or thoroughly ignored. This essay not only explores the problems associated with mental health systems but the social resistance to real systemic change.
Profile Image for Karletta Abianac.
Author 8 books4 followers
September 21, 2022
I listened to the audiobook. I found this essay validating of my frustrations, rants and advocacy attempts. Gave some context to my interactions in Australia's public health and mental health "care" system. The NDIS... I won't go on. Basically, I've been right in the times of saying the health system (and public housing as well) have abandoned me.
But hey - I've got a beaten in "You make the most of a bad situation" attitude, a seemingly unstoppable will to live, and I know my needs. Like that I'm better off trying to cope on my own than with support people - and people in the health system - who make me worse.
Partway through this book, it got me out the house partway - just for human connection. To do it I disassociated pretty much the whole time. Trip to the shops. Bought maybe 4 things. Good outing though. Barely stuttered - even in the taxis. Took almost a week to rest and recover from the outing.
733 reviews5 followers
July 7, 2022
Searing reading. Thought provoking - the historical thread of the stigma of mental illness in Australia - intriguing and also makes sense. Not 'just' about anxiety or depression, the essay addresses the more complex cases and how 'the system' has and is failing individuals. (If you don't fit into a 'box' you can fall through the gaps of service). How mental illness also encompasses access to housing.
I hope it encourages discussion and reflection, however the system is so broken, especially for those who are ill how do they find help if it's so complicated? (of course, unfortunately many do not). Hopefully there are optimists who do not share my fatalism.
Profile Image for Alexander Walter.
9 reviews1 follower
May 6, 2022
I purchased this essay, published in book form, based on the title and blurb, which indicated it would be about mental illness in Australia. It ended up being a political opinion piece, with the Author's opinion leaning further left than my own. I was very disappointed by the essay, as I found it quite bias, and overtly misleading. If you are interested in political opinion, then this may be a great read, but if you are interested in mental illness, then save our money and purchase a different publication.
Profile Image for Benjamin Stahl.
2,282 reviews74 followers
July 17, 2022
Pretty sad and at times harrowing, Kransnostein does a pretty good job here, and is certainly not without a heartfelt passion that permeated this most recent addition to the Quarterly Essay series. Nevertheless, I found it a bit too left-wing at times. Of course, it was always going to be, and I will not deny that a right-wing position of the subject matter would have most likely been horrendously inhumane. But still, the heavy focus on LGBTQ people made it a little harder for me to resonate with personally.
Profile Image for Sarah Eagle.
27 reviews2 followers
May 3, 2023
Having worked as a forensic clinician in Australia, none of this is news to me. I've given this 5 stars because it provides a good understanding for those who are not aware of the human rights issues of incarcerating people who have intellectual disability, mental illness and significant childhood trauma.

Our prisons are filled with people who need intensive trauma therapy by highly trained supports- not solitary confinement.
Profile Image for Abbey.
80 reviews
January 17, 2024
3.5 maybe, good but covered so much in so little that I felt myself longing for clarity in certain parts, or more discussion and explanation into things I found incredibly interesting and harrowing but the author deemed as quick side notes. Amazing to hear about mental health in Australia specifically, untethered from the rest of the world.
Profile Image for Jenny Esots.
538 reviews4 followers
May 1, 2022
A comprehensive retrospective of the treatment of mental illness in Australia, seen from the astute eyes of a writer, academic and lawyer.
Needs a further reading to fully appreciate all that has been written.
Profile Image for X (Utopia is Now).
35 reviews18 followers
June 19, 2022
Short and incisive, Krasonostein deploys her words very eloquently to deliver a strong message.

Although we all intuitively understand that mental health is a growing issue within society, her storytelling, use of key facts and figures, as well as her recounting of the history of mental health institutions in Australia really demonstrates the utter failure that is the current system.

I have been drawn to the topic of mental health since going to a therapist towards the end of the pandemic, which has been a paradigm-shifting experience that has allowed me to have a greater appreciation of the importance of effective mental health systems.

Through the combination of going to therapy and reading this book, one of the most damning insights I have come to is understanding the true cost of having poor mental health. It can lead to abusive behaviours, relationships, and a poor quality of living overall, but ultimately to me, it seems that having poor mental health leaves people in chains. These chains prevent people from truly engaging in a life that people want to live. People may feel/think they have to live a certain way because they feel so deeply that there is no other way to live. In my case, my deep sense of inadequacy drove me to want to perform at the highest level in every domain of my life, ultimately leaving me incredibly exhausted and constantly comparing myself to my peers. Never happy. Never satisfied. A forever-moving goal post that ultimately leads to burnout.

How do we allow people to be free of these chains? Well, providing access to mental health services is critical, as was in my case. However, as Krasnostein points out, not only are governments poorly equipped to deal with mental-health-related problems, but they are also poorly resourced.

To tie this shit-sandwich all together, it is clear through the case studies that Krasnostein uses that, inherent within the criminal justice system is the belief that wrong-doing of any sort should be punished, even if the perpetrator has grown up in the worst of circumstances and is not provided with adequate resources to deal with the loss, suffering and pain that drove them to commit the acts in the first place. As stated so clearly, "we continue to mislocate our hopes for safety in the criminal justice system which cannot resurrect the dead or prospectively redeem the living."

The topic of mental health is not only one concerning wellbeing, it is a topic concerning justice. We ought to consider the implications of maintaining the status quo and what message we send to people who need help if we keep allowing them to fall through the cracks.




Profile Image for Sophie.
300 reviews
August 15, 2022
While not quite as good as #84, I did enjoy this essay, which tackled some big topics from some different angles. Very Victoria centric.
The correspondence didn’t add much to Hill’s essay, which I guess is testament to it!
Profile Image for Greg.
573 reviews14 followers
November 17, 2022
Some interesting information and case studies but I found the book disjointed and I struggled to understand the main points of the author's arguments. There was no clear conclusion at the end to draw it all together.
Profile Image for Georgia.
6 reviews2 followers
May 1, 2023
An intelligent and sobering account of the state of Australia's mental health. An extremely engaging read directed by thought provoking case examples of people with more stigmatised diagnoses who have fallen through the service provision gaps. Unfortunately, a bit of context focused on Victoria.
Profile Image for Simon Sweetman.
Author 13 books73 followers
April 7, 2022
Love Quarterly Review. This one in particular seemed timely. So passionate and well researched and well written. Sadly all for nothing in the political scheme of things. Which is heartbreaking.
Profile Image for Sarah.
297 reviews10 followers
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May 24, 2022
Sarah Krasnostein is an incredibly strong and compassionate writer. Here she turns her attention to the underfunded and badly structured mental health system in Australia.
139 reviews
June 2, 2022
Well written and deeply informed. Sarah Krasnostein looks at our mental system from different perspectives, change may not possible without this type of analysis and understanding.
Recommended
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