“Searching for normal, when what I really needed was kindness”: an Interview with Sarah Fawn Montgomery

Starting Quite Mad: An American Pharma Memoir by Sarah Fawn Montgomery—out today with Mad Creek Books, an imprint of Ohio State University Press—was difficult. It’s always somewhat nerve-wracking to approach a book that deals intimately with an identity and subject-matter that is close to your heart, and so as a mentally ill person, reading books about madness tends to have a great effect on me. And boy howdy, did this one have an effect. Weeks after finishing it, I’m still thinking about it often, daily, and that haunting quality is part and parcel of what makes the book so incredible.

Early in the book, Montgomery boldly states that “Obsessed with mental health, America labels mental illness both imaginary and epidemic.” (9) Much of the narrative going forward proves this. Montgomery shares her upbringing in a loving yet chaotic family that left her feeling askew, like a half-erased sentence on a blackboard, uncertain of whether she was allowed to have a self. She tells us how, even as her parents told her that she needed medication for her anxiety, her father didn’t believe (and doesn’t, to this day) that mental illness is real. This doublethink, Montgomery reminds us, isn’t limited to stubborn dads—it’s in the very fabric of how the American medical system treats mental illness. On the one hand, it’s a failure to be mentally ill in a country where we must all strive for happiness. On the other, commercials full of grayscale hues that turn to technicolor sell us medications to treat our mental illness. The bar of failure is adjusted—it’s okay to be mentally ill, as long as we participate in the marketplace and remain silent. If medications don’t help, and if we talk about that—well, that’s where true failure appears to lie.

Though a memoir,Quite Mad brings in social critique and research into its pages as well. Halfway through the book I stopped to wonder why that is, and realized that the mentally ill must carry the burden of proof—we don’t get to tell our stories without demonstrating that we are rational, sane enough to make a compelling argument. Montgomery knew this. Needing to become her own advocate through the American medical industrial complex, a system rigged against the very people it’s meant to serve, Montgomery became an expert in the nonsensical ways research into pharmaceuticals has been manipulated to garner the most profit. Her expertise didn’t matter to her doctors, though—in fact, Googling one’s own symptoms and meds creates more suspicion, as if patients are trying to play doctor rather than merely understand what is happening in their bodies. Even Montgomery’s favorite psychiatrist, the one who least doubted her, was still unable to accept Montgomery’s experience of symptoms, such as her medication-induced hair-loss.  

Quite Mad is Montgomery’s story, but it is also the story of many others, especially women: “We seem to have made a world for women,” Montgomery writes, “where it is easier to blame their sanity than their circumstance. It is easier to point to a part of women’s bodies—uterus and ovaries, serotonin and cortisol—than to point to a world that faults them. It is easier to believe women broken than bruised.” (93) Montgomery reminds us too of how we have come to judge all who are violent as mentally ill, jumping to conclusions with every school shooting, with every bad presidential decision.  

With each confession, Montgomery’s raw honesty shines through, an honesty that is rational, sincere, self-aware and self-critical as only those who spend hours and hours trying to understand their own brains can be. It isn’t a story of recovery—it’s too serpentine for that, winding back and forth in time as Montgomery both moves through the years of her diagnoses and treatment and doubles back to find the stressors of her upbringing, trauma, and societal expectations. But stories of mental illness shouldn’t be about recovery, especially in a country that treats the condition as chronic, not acute, a self-fulfilling prophecy that keeps so many of us tied to helpful medications we distrust but take anyway. Instead, this is a story of understanding, of learning ways to be kind to oneself, of becoming a person with—not despite, not apart from, not even resentful of—mental illness. 

I had the pleasure of interviewing Sarah Fawn Montgomery about Quite Mad; our conversation is below. – Ilana Masad

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There is research into medication history and the medical history of mental illness woven into this memoir, and I wondered: how and why did you decide to use research in what is, after all, an intensely personal writing space?

Sarah Fawn Montgomery: I first turned to research like so many patients—to learn more about my conditions and treatments. There is much left unsaid and uncertain after the ten-minute visits we get with healthcare providers (if we are so lucky as to have them at all), so patients often assume the burden of becoming their own advocates. As I looked into my diagnoses and treatment options, I found quite a bit of contradiction, uncertainty, and misinformation. Sorting through so much conflicting information in contemporary medicine about the origins of mental illness, the best treatment options, side effects, and so forth got me interested in the history of mental health care. I began researching not only the various medications I’d encountered, their chemical components and effects on the body and brain, but also the history of their creation and drug companies, the history of drug therapy itself, and earlier treatments like talk therapy, insulin shock therapy, lobotomy, the rest cure, asylums, and those cruel treatments our nation likes to forget, including eugenics. The frustrations and difficulties so many contemporary patients face echoed throughout history in alarming ways and seemed an essential part not just of my story, but our nation’s story.

I also added research because mentally ill folks face the added burden of disbelief. We must fight for others to believe our realities, our experiences, our pain. We are often seen as weak, unstable, disconnected, even dangerous, so research became a way to ground my experience in fact. It lent credibility and provided a juxtaposition to my story of “madness,” but over time, the research about America’s understanding of mental illness, its medical treatments and trends, its cultural attitudes and conversations began to look suspect and illogical. While the research initially allows readers to trust my narration, it eventually, I hope, makes my story the more rational, honest one.

There is a lot in this book that is incredibly personal and refers to your family, your siblings by blood and by adoption, your parents. At one point, you tell us your mother won’t be reading the book. What is the scariest part of sharing your story, with their stories tied into it, with the world?

The most worrisome part—and believe me, as an anxious person, I have many worries!—is that I will hurt my family by telling my story, our story. I come from a large family—eight siblings, many adopted, spanning age 50 to 15—which lends itself to the painful difficulties I describe in the book, but also to a fierce sense of familial protection. While I am honest about the ways my upbringing impacted my mental health, I do not want to assign blame to those I love, many of whom suffer from a range of mental illnesses themselves. Quite Madis at once my unique story, but it is also our story, because I write about our collective family experience and legacy of mental illness. I feel a tremendous responsibility to get it right, which is why I factchecked with my family throughout the writing process, and in some cases asked permission from family members to disclose their stories. The protection I feel towards members of my family far outweighs the fears I have about being so open with my personal story. As writers, we have control of our narratives, but it takes fearlessness and forgiveness to be the friend, family member, or partner of a memoirist.

How do you navigate the space between sharing your story with the world and still being a private person? Have you encountered the false intimacy that readers of your book may feel with you?

I’m an incredibly private person—this book marks the first time I’m sharing many of these stories—and also someone who is cautious in everyday life about taking up space with my words. Much of this comes from inherent shyness, but also from tradition that women should be seen and not heard, that domestic stories are not valued, that stories of pain are inherently stories of weakness and therefore not worthy of interest. Writing a memoir, and one that might be considered “confessional,” was challenging in that I had to work against this (self)imposed silence. But it was also empowering—taking up space on the page has allowed me to take up space in the world in ways I’m not sure I would have attempted prior to writing Quite Mad.

And I appreciate when readers contact me with their thoughts on the book or their personal stories. Mental illness is such an isolating experience and so many of us are blamed or told we are broken that finding strength in community is a joy. While it still sometimes surprises me that strangers know my intimate history and have found their ways inside my very brain and body, I’m buoyed by the thoughtfulness of those who reach out.

This memoir doesn't have a “recovery” trajectory (for which I'm immensely grateful) but rather has a “learning how to live with mental illness” trajectory. In some ways, your prose follows this trajectory too—at the start of the book you consider your anxiety separate, an illness clinging to you with eager, unfair arms. Later, though, the diagnosis becomes less separate, and as you discuss the way both you and your husband must navigate mental illness, you accept it as part of your identity. Doctors and therapists, I’ve found, push against this idea, trying to remind patients that they are not their illness, but for many of us, that’s an impossible separation to live with. Do you remember when or how that specific change come about for you, from diagnosis vs. self to self w/diagnosis to simply self?

The narrative that folks are somehow “separate” from their illnesses has always troubled me because it implies that illness is some silent invader, that patients are somehow “wrong” or “broken,” which disconnects us from our lived experience and dehumanizes us in many ways. The reason recovery narratives are perpetuated so often is that they imply control, reassuring folks that what is frightening and unknown is somehow within our power to cure. Many people, including many readers, require inspiration if they are to engage with pain. But recovery is simply not true for everyone—patients experience mental health and illness on an ever-changing spectrum and there is often no concrete resolution, only an acceptance and managing of symptoms.

Early on I felt a lot of shame for being unable to “recover” despite trying various medications and therapy, diet and yoga, and so many other wellness fads well-meaning folks like to suggest to those of us with chronic illnesses. Each time these attempts “failed,” the burden of blame grew heavier, and each new treatment meant another round of self-scrutiny and self-experimentation. Interrogating my body and brain so much, searching for normal, when what I really needed was kindness, was exhausting. It was also counterintuitive. I reached a turning point where I simply could not continue accepting there was something about me that needed “fixing,” jumping from treatment to treatment, searching for “health,” when it too is an abstract concept. There came a time when accepting myself—including panic and compulsion—seemed the kindest, sanest choice. And I found that doing so, and not attempting to revise or rewrite myself, actually helped me manage my symptoms and find a kind of calm amidst the chaos of mental illness. 

In the chapter entitled “The Female Malady” you connect the dots between gender and mental illness both historically and in present day (a notion that returns in your epilogue). How do you think mentally ill women can resist (or can we resist?) the way our anger is deemed madness and our madness deemed unimportant/whiny/self-indulgent?

Acknowledging the ways in which we pathologize gender and medicalize emotion is crucial to understanding America’s history of mental illness rates and treatments. Women have long been diagnosed and medicated for mental illness at much higher rates than men, and they are much more likely to have gender roles and performances included in discussions of their mental health. Despite being historically labeled sad, weak, afraid, and therefore “crazy,” women—we know—are angry. We voice the same frustrations “mad” women a century ago voiced, and yet this justified rage is still used against women to diagnose and treat deviance. 

By exploring the rising rates of mental illness, particularly for women in this country, I wanted to critique the ways anger is simultaneously denied to and weaponized against women. For me, resistance became about making space for anger in healthcare narratives, and making space where anger is not a symptom. Reframing anger in our discussions of mental health is crucial—we have a right to be angry about stigma, about access to treatment, about the way trauma and abuse and violence against women impact mental illness. We have a right to be both hurting and angry, and a right not to conflate the two. It is time anger is seen as action rather than ailment.