Most of us have, whether we noticed or not, been reading about mental illness our whole lives. It’s in the books we were assigned in school, the horror novels we read under the covers, the book club picks passed around with wine. What I couldn’t stop noticing once I began writing a book where mental illness played a huge role, is how much these stories frame our understanding (or misunderstanding) of the disease.
Each story’s treatment of mental maladies reflects what society believed in that era. Many also changed and defined how we viewed mental illness—for better and worse. Ancient texts often attributed madness to demonic possessions, witchcraft, or divine punishment. Hippocrates introduced the idea of it being an imbalance of “humors.” As the science of psychology emerged in the nineteenth century, people like Philippe Pinel and Dorothea Dix advocated for understanding and more humane treatment of sufferers. It’s this time which defines much of how we think today.
The first (limited) effective medicines for the treatment of mental illnesses were finally found in the middle of the twentieth-century. Unfortunately, they’re not a cure. And treatment is still hampered by social beliefs and biases.
The Confession, The Secret, and The Monster
While Poe was never formally diagnosed with a psychiatric illness, his periods of intense creativity, recurrent bouts of melancholia (or depression), and severe alcohol abuse have led to speculation by historians and clinicians that he may have suffered from bipolar disorder. His story, The Tell-Tale Heart (1843), is narrated from inside a disturbed mind—”why will you say that I am mad?” The narrator’s mind is a haunted house we’re locked inside. The story conjured dread, imprinting in our minds that the mad could be unpredictable and dangerous.
Four years later, Jane Eyre (1847) gave us Bertha Mason, who “haunts” Thornfield. She’s a laugh in the walls, pacing, guttural cries, mysterious damage, and destruction by fire. She has a caretaker, Grace Poole, and an entire household that knows she exists and does not speak of her existence. When she finally appears, Brontë renders Bertha in the language of animals. Rochester protests that her family’s history of madness was hidden from him—justifying his disdain. The illness and the sufferer were a secret best locked away in the attic.
The Strange Case of Dr. Jekyll and Mr. Hyde was published in 1886 and is considered to be a defining book of the gothic horror genre. Ironically, the book had nothing to do with mental illness. It was an exploration of the duality of good and evil within an individual. However, Jekyll and Hyde has become synonymous with what was called multiple personality disorder (now dissociative identity disorder) and is often also used to describe the extreme mood swings of bipolar disorder. A metaphor from a book about a man who wasn’t ill has spent 140 years describing people who are and demonizing them.
Writing About Mental Illness in the Twentieth Century
Charlotte Perkins Gilman’s short story The Yellow Wallpaper, published in 1892, opens with a woman suffering from what we now recognize as postpartum depression, confined to her room to recover—no writing, stimulation, and limited human contact. The protagonist’s husband, a physician, prescribed the “cure” out of love and concern. Based on Gilman’s personal experience, the suffering woman narrates how the isolation worsens her condition and drives her into madness. Vivid and immersive, the story is an indictment of the practice and provides a new framework of understanding.
The Sufferer’s Experience
In 1963, Sylvia Plath expanded our understanding of depression in her novel The Bell Jar. Through Esther Greenwood, Plath helps us understand her experience of depression from within—the flatness, the distorted logic that feels like clarity, and the toll it extracts. Plath wrote about her thinly veiled breakdown and hospitalization under a pseudonym to avoid the cost of disclosure. She ended her life less than a month after the book’s publication.
Over the next decades, books based on the sufferer’s account of mental illness —Styron’s Darkness Visible, Kay Redfield Jamison’s An Unquiet Mind, and Susanna Kaysen’s Girl, Interrupted—became essential reading.
Fiction
Alongside the memoirs, the way authors write about mental illness splintered into many paths.
Catch-22 (1961) by Joseph Heller was written as a satirical novel about war, trauma, and the effect of contradictory rules created by systems where one lost no matter what they did. Not specifically about mental illness, the central paradox in the book centered on a sanity trap. Sufferers of mental illness use the term catch-22 to describe the circular traps that hinder their treatment and recovery.
Jack Torrance in Stephen King’s The Shining (1977), wasn’t diagnosed, but his alcoholism, rage, and loss of control continued in the gothic history of mental instability driving terror. Structurally, it was Bertha set loose in a corridor and an axe. Culture didn’t trade one understanding for another. It stacked them.
Toni Morrison’s Beloved (1987) was saturated with the toll of trauma—Sethe haunted, literally, by slavery and the unthinkable act she had done to spare her daughter from it. The town called her crazy. The novel pointedly did not. Morrison declines the diagnosis, I think, because pathologizing Sethe would locate the sickness in her rather than in what was done to her.
Written based on research and interviews, Wally Lamb’s 1998 novel I Know This Much Is True (a book with similarities to Hope and Madness and significant differences) opens with a shocking scene of self-mutilation, introducing a twin brother’s paranoid schizophrenia. Spanning 900 pages and three generations, I believe the book was less about mental illness and more about generational trauma.
Writing About Mental Illness in the Twenty First Century
Family Memoirs and Investigative Journalism
Augusten Burroughs’s Running with Scissors (2002) was maximum spectacle—a boy handed over to his mother’s psychiatrist, a household of unimaginable dysfunction, played at full volume for maximum shock. Lived experience, it turned out, didn’t guarantee compassion or understanding. Burroughs has received significant criticism, claiming he embellished and fabricated certain details.
Jeannette Walls’s The Glass Castle (2005) also shocked, not by shouting but by its quiet tone. The matter-of-fact voice of a child narrating chaos as if it were normal, because to her it was, produced a heartbreaking tale.
Pete Earley’s Crazy (2006), turned investigative journalism on the jail-and-hospital system. Interspersed with a personal journey with his own son’s mental illness and subsequent legal problems, the book carried readers inside a system meant to help that often harms. I posted a deeper look into this book here.
Hidden Valley Road (2020), by Robert Kolker, followed a similar framework to Earley’s book. A compilation of family memoir and investigative journalism, it read like a medical detective journey. Written with empathy, the book chronicled the contemporary history of schizophrenia and followed one of the first families to be studied by the National Institute of Mental Health. It worked to dispel the myth that schizophrenia is about multiple personalities instead of its accurate definition: a break with reality.
Fiction Where the Illness Flows Under the Surface
One of the quietest books on mental illness, Elizabeth Strout’s Olive Kitteridge (2008) never addressed mental illness directly. Depression ran beneath it as an undercurrent that became visible only at moments: Henry’s quiet suffering, Kevin parked at the marina with a gun in the car, and Olive’s own black moods. The format of the book mirrored how it’s ignored—managed by silence, absorbed into routine, woven into everyday life in a town that agreed, the way Thornfield’s household once agreed, not to speak of it.
Kristin Hannah’s The Great Alone (2018) brought Ernt Allbright home from Vietnam violent and unraveling, and largely skirted the clinical language. “Damaged by the war” carried the weight a diagnosis would. Hannah described it from the viewpoint of a young protagonist who lived with the effects of her father’s problems without understanding the illness.
Eleanor Oliphant Is Completely Fine by Gail Honeyman (2017) took trauma and isolation seriously, and then folded them into an arc of uplift. Eleanor’s voice was compelling enough to overlook how the book simplified recovery and dispensed healing on schedule.
All these stories were recommended to me by the internet, bookstores, fellow writers, and friends as books that sit next to Hope and Madness. Few did. But the congregation of them made me curious about the role of mental illness in stories, and how those stories define our perceptions.
I came into this essay with the general feeling that mental illness is often a plot device, a sort of literary boogeyman, or memoir territory for the sufferer. Piecing this together, I realized my initial view was oversimplified. The illness and the literature have performed a sort of dance, each affecting the other and reflecting society.