Mind on Fire: a Memoir of Madness and Recovery, by Arnold Thomas Fanning, Penguin Ireland, 274 pp, £14.99, ISBN: 978-1844884292
Mind on Fire describes a decade in the writer’s life which is disrupted and dominated by serious mental health problems. Through his courageously revealing narrative and the immediacy of his writing, Fanning engages the reader powerfully in the story of the turbulence and chaos caused by his mood swings. We meet him when he is twenty-eight, an aspiring writer resigned to suffering a period of depression every summer since his mother’s death in August nine years earlier. During these periods, he writes, “all my energy dissipates, and my thinking becomes blackened by pessimistic ideas and self-hatred …” Then, like the flip of a coin, “when the depression lifts, I am infused with enthusiasm and energy. At these times I feel all is well, all is wonderful in fact, and always will be.”
Early in the memoir, this pattern becomes more extreme, with a depression followed by his first episode of psychotic mania, leading to hospitalisation and diagnosis of bipolar disorder. Fanning is reluctant to accept or tell others of this diagnosis – “It feels like a shameful, fearful label … Fear grips me: the thought that I will never be able-minded again, never be able to concentrate on anything, to work, to live by myself, to get back to writing; that I will always be mad.”
Fanning’s reaction to his diagnosis reflects prevalent stigmatising attitudes towards mental health problems. This was over ten years ago, and in a recent radio interview Fanning said that he thinks attitudes have improved. It is true that stigma has decreased over the last decade, but it still exists. Mental health problems are ranked at or near the bottom with regard to public acceptance of difference. Surveys by the National Disability Authority repeatedly find that people are relatively less comfortable about having a work colleague or neighbour with mental health difficulties than with other disabilities. St Patrick’s Hospital carries out an annual survey of attitudes and in 2017 the CEO wrote that “year on year we are disappointed to find that despite the many public awareness campaigns being run, Irish attitudes to mental health are still fraught with stigma and negativity”.
Fanning’s fears of lifelong marginalisation are also not unfounded. In Ireland only 15 per cent of people with serious and longstanding mental health problems are in employment.
His reluctance to accept his diagnosis is supported by a therapist to whom he is referred and whom he sees on and off for years. This therapist repeatedly encourages him to stop taking the various medications he has been prescribed. Overall, this figure seems to have played a counterproductive and possibly dangerous role in Fanning’s life.
The first hospitalisation is succeeded by several others. Fanning describes well his time in various hospitals, capturing the general air of lassitude, the ward routine interspersed by occasional outbursts of anger or distress, the friendships which develop but seldom survive discharge.
Fanning also describes vividly the craziness, agitation and urgency of psychotic mania. Written in the present tense, as is most of the book, the immediacy of these passages brings the reader along at breakneck speed, worrying about what on earth the protagonist will think of or do next. The reader also has a strong sense of danger and of Fanning’s vulnerability. “A million things going round in my head … And that breathless head-rushing feeling.” Of course this is followed later by “shame and terror [at] how I behaved during my previous episode”.
Towards the end of the decade, a prolonged depressive episode involving a number of suicidal gestures morphs into psychosis – paranoia, hallucinations, coded messages on the radio. Fanning impulsively decides to go to London to get away from the snipers he knows are on the roofs, waiting to slaughter everyone in Dublin. In London he further loses touch with reality, begging on the streets, sleeping rough. Eventually he is picked up by the police and referred to a psychiatric hospital, where he spends a month. While there, he reads an NHS leaflet about bipolar disorder and has an epiphany: “Into my consciousness the idea plants itself and is finally absorbed and accepted: what has happened to me, what is happening to me, is an effect of bipolar disorder … The diagnosis the doctors have applied to me is correct and appropriate.” He starts taking a mood stabiliser. Nearly ten years after his initial diagnosis of bipolar disorder, Fanning begins to accept it.
After this, things improve, though haltingly at first. Fanning takes part in a recovery programme, obtains a job in a bookshop. His play is staged at the Dublin Fringe Festival and receives a rapturous reception. “Now I am a playwright. Now I don’t feel like someone who will always be labelled mentally ill.” However, he emphasises that this in itself did not constitute recovery, which is a far more complex and ongoing process. “My recovery … required effort, action, agency and the help of others. It was only when I stopped waiting passively and took active steps to help myself that recovery really took place …”
Fanning’s active approach to getting back in control of his life is congruent with the philosophy of the mental health recovery movement. This movement has existed in various forms for about fifty years and was founded by people who didn’t want to continue to be passive psychiatric patients, just taking medication and waiting to improve. Rethink (Schizophrenia UK) defines recovery as “a personal process of tackling the adverse impacts of experiencing mental health problems, despite their continuing or long-term presence. It involves personal development and change, including acceptance that there are problems to face, a sense of involvement and control over one’s life, the cultivation of hope and using support from others.” Recovery in this context does not imply cure. It is about empowerment, rather than becoming “symptom-free”.
There isn’t a recovery template to suit all: the path to recovery is an individual one. Fanning writes: “I’ve learned that for me, recovery and wellness depend on five elements: therapy, medication, exercise, meaningful work … and a loving relationship and relationships with friends and family. All these are essential for me to live a normal life, devoid of madness, a life that leads to contentment: happiness even.” The book concludes on this note of hope.
Mind on Fire is one of a long line of mental health recovery memoirs and is better written than most – in fact it is extremely well written. For this, and for the insights it provides into depression, mania and recovery, it has earned a place on the 2019 Wellcome Prize longlist. Fanning has written a brave, illuminating and inspiring memoir.
Marie Rooney is a psychologist.