Escaping the straitjacket

A Harvard-trained M.D. talks about going ‘crazy’ and the struggle to stay sane

Escaping the straitjacket

Max Whittaker/Getty Images

When Mark Vonnegut sat on the Harvard Medical School admissions committee, he used to ask the congenital overachievers who came before him a simple question: what is being a doctor going to do for you? Conditioned to talk about saving lives, advancing science, or just making the world a better place, the candidates frequently struggled to articulate what the more selfish gains from their chosen profession might be. But after more than three decades of practice as a Boston pediatrician, Vonnegut has a ready response when the query is turned back on him—stability. “Being a doctor has been enormously grounding,” he says.

“Having to go to work and deal with a rash or a 102-degree fever snaps me out of my own head. It allows me to be in the world in a useful way.”

Maintaining a daily presence in the here and now is no trifling concern for the 63-year-old son of the late author Kurt Vonnegut. In 1971, at the age of 23, he suffered three major mental breakdowns while living on a hippie commune in British Columbia. Diagnosed a schizophrenic, he found himself locked in a Vancouver psychiatric hospital while he conversed with Abraham Lincoln, Mark Twain and Fyodor Dostoevsky, painted with Van Gogh, and played sax with John Coltrane. Four years, and much medication later, he wrote The Eden Express: A Memoir of Insanity.

Cleaned up, reconnected with reality, and confident in his own willpower, Vonnegut went on to Harvard Med, and then a hard-driving career at one of America’s best hospitals. Married with two kids, a nice home and a generously stocked wine cellar, he figured he had mental illness beaten. Until 1985, when his cold-turkey efforts to quit drinking and using prescription sleep aids triggered another psychotic episode. This time the voices told to him to leap through a third-storey window at his house. He shattered the pane, but failed to fully exit. Instead, Vonnegut left home in the company of the police, swaddled in a straitjacket.

Fourteen years between breakdowns is a lengthy span, but it took the doctor even longer to publicly address what had happened. “It just seemed messy to me. You know, you don’t tell everybody about when you have bloody diarrhea,” he says over the phone. “I was mad that I ended up in a hospital again, and had to go through all that humiliation. I didn’t have perspective.”

But now, remarried with a young son, and a quarter-century removed from what he calls his “fourth and hopefully last crack-up,” Vonnegut explores it all in detail in his new memoir, Just Like Someone Without Mental Illness Only More So. Older and wiser, he felt he had to correct the record laid down by his 28-year-old self. “I sort of thought, to some extent, that I had pulled myself up by my bootstraps, or had used my intelligence or strength to get better,” he says. “But now I know it’s more about luck and grace, and favourable circumstances.”

The stigmatization of mental illness remains a huge hurdle to recovery, says the physician. Too often, patients are treated via “hushed-up” hospital stays, and “massive overdoses” of medication. Family and friends shy away, in a way they never would if it was a heart attack or cancer. And the afflicted often devote more energy to pretending to be “normal” at home and work than to staying healthy. Vonnegut cites his own experience: to this day, his voices remain, just a little more offstage, and less intelligible. “My perceptual instabilities to some extent let me know, ‘Hey, you need a little more sleep,’ or ‘Hey, you need to clean up your diet a little bit,’ or whatever,” he says. “Not being all well acts as a compass that lets me know what is healthy for me.” Conversely, feeling too strong is a sure sign of trouble on the horizon.

Vonnegut never felt better in his life than just before his breakdowns. Now he knows euphoria is a signal to up his daily lithium dosage.

The doctor is clear-eyed about the role genetics had in laying the groundwork for his eventual breakdowns. His maternal great-grandfather drank heavily to keep away the voices. His daughter—Vonnegut’s grandmother—was institutionalized for the better part of seven years. And Jane, Mark’s mom, received messages from licence plates and traffic lights for pretty much her entire life.

An unusual and impoverished upbringing on Cape Cod also played a part. (Kurt’s first great literary success, Slaughterhouse-Five, was published when Mark was 21. For most of his childhood, his profoundly anti-social dad eked out a living as a not-very-good car salesman.) “I was mostly left alone to figure things out,”

Vonnegut writes in the new memoir. “If I had been raised by wolves, I would have known a little less, but not much less, about how normal people did things.” Kurt was proud of the fact that his son had no friends, and to this day Mark suspects that his dad taught him chess primarily to ensure that he didn’t fit in with the locals.

The arrival of four cousins—orphaned when their father died in a train crash, and their mother of cancer in the same week—further complicated the domestic scene. Vonnegut says he became a perfectionist almost overnight, in an effort to compete for his parents’ affection. It wasn’t until he quit drinking and recovered from his last breakdown that he truly learned to “give and accept” love, he says.

The flip side is that those same forces of nurture and nature provided Vonnegut with the tools he needed to recover his equilibrium, and prosper both spiritually and materially. Art—his father’s great legacy—saved his life, he says. “I never saw it as therapy but writing made my mind bigger and stronger, and painting as well.”

The much-discussed link between creativity and madness is real and intrinsic in his experience. “I don’t understand how people who don’t have flights of ideas, or loose associations, get anything done,” he says. “There’s something about the mental quickness, seeing associations a millisecond before anyone else, that is related to seeing things that aren’t there at all. As a physician, I think that’s an advantage.”

Vonnegut sees progress. In the public sphere, society has become more accepting of mental illness in the decades since he wrote his first memoir. (Although, he notes, that may have more to with deinstitutionalization, which has put patients on the streets, making them harder to ignore.) In his own life, he finds comfort in the idea that generation to generation his family seems to be getting better at controlling the disease. (None of Vonnegut’s three children have any issues.)

And he hopes for more improvement. One positive change, says the doctor, would be taking the focus off hair-splitting diagnoses, and putting it on patient care. “Knowing whether someone is bipolar or schizoid isn’t really all that helpful,” he says. “You use the same medications. You use a lot of the same treatments.” To him, the only important distinction is whether or not the illness has become disabling. Going crazy is, after all, a destructive process. “A fire can’t burn that brightly without melting circuits,” he writes. Functional recovery becomes increasingly less likely with each breakdown. All the more reason to focus on managing the disease.

When he was really sick, Vonnegut’s delusions tended toward the grandiose. In the 1970s, they centred on metaphysical questions of human existence that he debated with historical figures. The last time around—at the height of the Reagan era—he was engaged in a heroic struggle to end Communism and avert nuclear war as the very embodiment of free-market capitalism. “It all boiled down to me against the Russian Bear,” he writes in the new book. “The hopes and fears of all the world are met in thee tonight.”

Twenty-five years on, Vonnegut sees the irony that he is still engaged in a lonely campaign to change entrenched attitudes. But ill or healthy, you are who you are. “Of course I’m trying to save the world,” he writes. “What else would a bipolar manic-depressive hippie with a B.A. in religion practising primary-care pediatrics be up to?”

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