Joan Didion on psychiatric trends and diagnoses

In her forthcoming memoir, Blue Nights, Joan Didion remembers the way her daughter’s (above, left) psychiatric diagnosis kept changing. Manic depression became OCD; OCD became something else, something Didion can’t remember now, but something that ultimately gave way to a succession of other conditions before “the least programmatic of her doctors settled on one that actually seemed to apply”: borderline personality disorder.

Diagnosis never seems to lead to a cure, Didion observes, only an enforced debility. But as with a psychiatric evaluation of herself conducted in 1968 and excerpted in The White Album (and quoted in part below), Didion sees and reflects on the truths of the assessment even as she ponders it at arm’s length.

I’ll have much more to say about her new book when it’s out in November, but this paradoxical blend of skepticism, acceptance, and astringent detachment in matters pertaining to psychology and its insights and connection to the culture has always characterized Didion’s writing. It’s one of the reasons I’m so drawn to her work.

In the title essay of The White Album, the one that begins with the famous line “We tell ourselves stories in order to live,” she recalls “a time when I began to doubt the premises of all the stories I had ever told myself, a common condition, but one I found troubling.” She continues:

I was supposed to have a script, and had mislaid it. I was supposed to hear cues, and no longer did. I was meant to know the plot but all I knew was what I saw: flash pictures in variable sequence, images with no “meaning” beyond their temporary arrangement, not a movie but a cutting-room experience. In what would probably be the mid-point of my life I wanted still to believe in narrative and in the narrative’s intelligibility, but to know that one could change the sense with every cut was to begin to perceive the experience as rather more electrical than ethical…

Another flash cut:

In June of this year patient experienced an attack of vertigo, nausea, and a feeling that she was going to pass out… The Rorschach record is interpreted as describing a personality in process of deterioration with abundant signs of failing defenses and increasing inability of the ego to mediate the world of reality and to cope with normal stress… Emotionally, patient has alienated herself almost entirely from the world of other human beings. Her fantasy life appears to have been virtually completely preempted by primitive, regressive libidinal preoccupations many of which are distorted and bizarre… In a technical sense basic affective controls appear to be intact but it is equally clear that they are insecurely and tenuously maintained for the present by a variety of defense mechanisms including intellectualization, obsessive-compulsive devices, projection, reaction-formation, and somatization, all of which now seem inadequate to their task of controlling or containing an underlying psyhotic process and are therefore in process of failure. The content of patient’s responses is highly unconventional and frequently bizarre, filled with sexual and anatomical preoccupations, and basic reality contact is obviously and seriously impaired at times. In quality and level of sophistication patient’s responses are characteristic of those of individuals of high average or superior intelligence but she is now functioning intellectually in impaired fashion at barely average level. Patient’s thematic productions on the Thematic Apperception Test emphasize her fundamentally pessimistic, fatalistic, and depressive view of the world around her. It is as though she feels deeply that all human effort is foredoomed to failure, a conviction which seems to push her further into a dependent, passive withdrawal. In her view she lives in a world of people moved by strange, conflicted, poorly comprehended, and, above all, devious motivations which commit them inevitably to conflict and failure…

The patient to whom this psychiatric report refers is me. The tests mentioned… were administered privately… shortly before I was named a Los Angeles Times woman of the year. By way of comment I offer only that an attack of vertigo and nausea does not now seem to me an inappropriate response to the summer of 1968.

Didion returns throughout the essay to the psychiatric evaluation, incorporating parts of it into her descriptions of her own state of mind, which she depicts as reflective — at least to some degree — of the cultural moment at which she entered it.

For her travels during that period, the late Sixties, she carefully followed the packing list that hung in her closet, but never had the one thing she really needed: a watch. And so,

Quite often I would ask the [motel] desk for the time every half hour or so, until finally, embarrassed to ask again, I would call Los Angeles and ask my husband. In other words I had skirts, jerseys, leotards, pullover sweaters, shoes, stockings, bra, nightgown, robe, slippers, cigarettes, bourbon, shampoo, toothbrush and paste, Basis soap, razor, deodorant, aspirin, prescriptions, Tampax, face cream, powder, baby oil, mohair throw, typewriter, legal pads, pens, files and a house key, but I didn’t know what time it was. This may be a parable, either of my life as a reporter during this period or of the period itself.

I’ve been thinking a lot lately — because of Emma Forrest’s Your Voice in My Head, because of Lori Gottlieb’s “How to Land Your Kid in Therapy,” because of Maria Bustillos’ investigation into David Foster Wallace’s self-help reading, because of Brian Dillon’s history of hypochondria, because of my own experiences, and because I’m (yes, still) finishing this draft of my novel, which is set in the past — about how the way we perceive ourselves and our afflictions and distortions and histories is further distorted by the times, while being reflective of them. And the site’s been quiet, so I decided to post this.

Screenshot of Didion with late daughter and husband taken from NY1.


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