In the everyday world, you don’t see the people who end up on psychiatric in-patient units, or at least you don’t see them sick … I saw a man brought in for treatment because he had been found in his kitchen, holding his wife’s bloody heart in his hands, a carving knife beside him on the floor. I remember a woman, a graduate student in comparative literature in one of the best schools in the country, with long, golden hair. But she hunched over with her hair across her face and her misery was so palpable that my throat choked up as if I would cry.

Most people who end up in a psychiatric hospital are deeply unhappy and seriously disturbed, and many of them lead lives of humiliation and great pain … It used to be fashionable to say that madness didn’t really exist at all, that it had been created when society’s quest for order defined some people as deviant. Grand sociologic theories claimed that psychiatry punished those who were merely eccentric or unconventional. Madness is real, and it is an act of moral cowardice to treat it as a romantic freedom.