Writers have bad readers; in private life, these critics are called psychiatrists. The catastrophe suffered by the lunatic is unlike that visited on any other patient. While the cardiologist, the oncologist, the gastroenterologist may be imperious and arrogant, refusing to listen to the poor ignorant civilian who has nothing at all to contribute to her own case, the psychiatrist does nothing but listen. He listens for hours, days, weeks, years as the patient unfurls her life before him: her perceptions, her emotions, what she takes to be the most significant events of her story. Then the doctor tells her that she is wrong. She does not understand her own story. She does not understand her own thoughts, her own senses or feelings or place in the world at all. She is wrong about herself. She is so wrong that she is sick.

Psychiatric pathology is not located in the organs or the blood. It is not even located, so far as anyone can prove, in the brain. It is the person who is pathological. The patient has a disease of perception, a disease of affect, an interpretive disease, a disease of subjectivity itself. She cannot reliably describe the world around her, or she cannot explain her place in it. She does not understand her dealings with other people, or she cannot account for her own habits. This inability to interpret has left her unable to manage her own life. She cannot form ordinary relationships. She cannot summon the proper feelings or any feelings at all. She turns suicidal or violent, strange or reclusive, all according to the interior logic of a mistake.

The cure begins whether or not the patient accepts this interpretation, whether she is resistant or defensive or enthusiastic or ambivalent. Treatment may range from gentle conversation to psychopharmacology to incarceration for hours or weeks or years with chemical and physical restraint. The treatment depends, often, on both the diagnosis—the genre of faulty self-conception—and also on the critical school, the so-called orientation from which the doctor reads her. But the doctor is, in every case, reading: identifying errors, editing, correcting, attempting to make the patient see herself as the critic sees her, as the world sees her. The best outcomes are said to depend on the patient attaining insight—that is, assent to the doctor’s reading—at which point the patient becomes a collaborator, a co-editor of the disease. There is nobody alive who does not believe that psychiatrists, like any readers, are often full of shit. It is bad enough that these readers have the backing of the police force. But even worse is that they are sometimes right. Sometimes the doctors see what the author of a life cannot. Sometimes the doctor and his tools—his therapies, his medications, his restraints—are all that stand between the patient and more misery, more damage, terror, disaster, or death.

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The plot of this particular life is not in dispute. Laura Delano was born in New York in 1983, the child of a money manager and a stay-at-home mother, the oldest of three siblings, all girls, and a relative, on her father’s side, of the American president with whom she shares a name. She excelled in her classes and in squash. She was elected president of her middle school. In 1996, when she was thirteen years old, she looked in a mirror and, as she would later write, became “riveted by the sight of my face, my eyes. This face, these eyes. That girl’s face and her eyes. A stranger now in front of me, someone I don’t recognize.” She became terrified. She “disintegrated into a million pieces.” She repeated to herself over and over, I am nothing. I am nothing, then, Who am I? Who am I? She struggled to “make sense of what this means, to differentiate what’s real from what isn’t.” She began withdrawing from her social life, cutting herself, and fighting with her parents. Later that year, her parents took her to a therapist. He referred her to a psychiatrist. The psychiatrist informed her that she had bipolar disorder and that she would have this disease forever. She was then prescribed Depakote and Prozac.

In 2001, Delano matriculated at Harvard. There she deteriorated further: she drank, she took drugs, she was told by doctors that she was promiscuous. Her new psychiatrist gave her the Sixties housewife special: Provigil—an amphetamine—to fight off the medication-induced drowsiness that found her nodding off in class, and then Ambien—a sedative—to help her sleep at night. She was hospitalized for the first time in the fall of 2004, during what should have been her senior year; she took a year off and graduated in 2006. After college, she struggled to find steady employment. She worked as a squash coach and an unpaid research assistant at Massachusetts General Hospital. A full-time job for a state agency that partnered with school districts ended after she stopped coming in. Her resignation was tendered by her parents while she was hospitalized. They covered her expenses while she figured things out. Mostly, she spent her time, as she would later write, “rip-roaring drunk, alternating between arguing” with her boyfriend, “crying, and staring numbly at the wall.” She continued to work with her doctors to find the right combination of medications, trying Seroquel, Effexor, Lamictal, and Klonopin in various doses and combinations. She also continued drinking and snorting cocaine and regularly felt suicidal. On at least one occasion, she locked herself in a bathroom, terrifying her boyfriend.

Through it all, she identified readily—eagerly—with her role as a patient. She was sick. She was disabled. She had a lifelong disease. These facts provided a comfort: they made sense of the world. And they provided a purpose: follow her doctors’ instructions and live the best life she could under such dire circumstances. It was not always easy to stay on track. On Thanksgiving in 2008, while staying with family in coastal Maine, Delano wandered into the woods and sat down on a cliff over the sea, poured every pill she had out of their bottles, swallowed them, and washed them down with a bottle of wine. She woke up in an I.C.U., intubated and catheterized. Once she had stabilized, she was transferred, first to a step-down unit at Massachusetts General Hospital, later to a locked ward at McLean psychiatric hospital, in Boston.

Over the next several years, Delano was hospitalized twice more. After another stay at McLean, she was referred to an outpatient program for the treatment of borderline personality disorder, a diagnosis she would later say had been withheld from her throughout her previous care. By this point she was taking lithium, Abilify, Lamictal, Klonopin, and Antabuse and beginning dialectical behavioral therapy. She had joined A.A., having already quit drinking. But something, she later wrote, was not working: “If psychiatry had such effective treatments, wouldn’t I have started to feel relief somewhere along the line?” In 2010, while wandering the aisles of a bookstore in Vermont, she found Anatomy of an Epidemic by Robert Whitaker, a former health reporter. A decade before, he had become famous for Mad in America, a critical history of American psychiatric practice. Anatomy of an Epidemic was a revelation to Delano. In reading it, she discovered that her treatment not only had not helped her, it had harmed her, disabled her—perhaps caused every symptom that had followed what would have otherwise been the ordinary unhappiness of a teenage girl. Delano had read Mad in America during college, but without interest. Now she was ready to receive the message and to adopt a radically different interpretation of her life’s story. This new interpretation gave her a sense of, as she says, “agency” for the first time in her adult life.

Delano became convinced that psychiatry and its medications were “instruments of behavioral control” which medical professionals who, she says, “saw it as their right to decide what went in my body” had manipulated her into accepting. She informed her doctors that she was going to quit her medications, and did so, going cold turkey. The process, she later wrote, produced its own protracted withdrawal, which she says lasted six months and was worse than anything the drugs had been prescribed to treat. Shortly after reading Anatomy of an Epidemic, Delano contacted Whitaker directly. They met at a coffee shop, where he encouraged her to write about her experiences for Mad in America, his website dedicated to critical reporting on psychiatry. Delano was the site’s first guest contributor, and over the next five years she wrote more than fifty items for it, including a twenty-six-chapter account of her own psychiatric experience. Her posts were read widely within the small world of psychiatric dissent. She had fans, followers, and she became an inspiration for others trying to make sense of the ways psychopharmacology seemed to make their lives worse. She moved to Boston, once again floating on family money, and ran mutual aid groups for people trying to come off their own medications. She became an enthusiastic participant in what is popularly known as the mad movement. (She prefers the phrase “ex-patient movement” because she does not identify as “mad.”) She ran a support group in a rented church room; she served on the boards of anti-psych organizations; she protested outside annual meetings of the American Psychiatric Association.

In 2014, a donor approached Delano at a Mad in America–sponsored film festival and suggested that she found a nonprofit dedicated to, as she puts it, “helping people make informed choices about medication tapering.” The woman offered Delano a seed grant, and later that year she incorporated the Inner Compass Initiative, a 501(c)3 that describes itself as an organization “working to shift culture, science, and policy away from medicalized responses to human suffering” and functions primarily as a resource for people seeking information about psychiatric medication and diagnosis outside the conventional medical framework. The organization launched publicly in 2018, offering a free self-directed tapering manual and information and resources on psychiatric diagnoses, drugs, and withdrawal, later supplemented by an online support community called the Exchange. In 2019, Rachel Aviv profiled her in The New Yorker. That same year, she married Cooper Davis, a former peer support worker for a state-funded alternative mental health organization in Connecticut who had come to his own reckoning with psychiatric medication after a period of Adderall dependence; their wedding celebration, delayed by COVID-19, took place in 2022.

Last year, Viking published Delano’s memoir: Unshrunk: A Story of Psychiatric Treatment Resistance. It was a hit, and interest in Delano herself intensified. She appeared on podcasts and television programs, including a two-hour sit-down with Tucker Carlson. She testified before the House Oversight Committee about how, during her many years of treatment, nobody had ever warned her that “these drugs” could physically and mentally disable her, how they had likely caused her suicide attempt, how when she “missed a dose or tried to stop a med,” the pain and distress she felt “was withdrawal symptoms, not a return of an underlying condition.” Unshrunk was selected for book clubs and must-read lists. Delano was hailed by some as a vital and important voice in resisting the abusers of psychiatry, by others as a dangerous crank whose reckless tirades against vital psychiatric interventions would get people killed. Her newfound stardom brought more people than ever to the Inner Compass Initiative; so many that in December 2025, the organization convened its first annual conference at the Delamar Hotel in West Hartford, Connecticut, where, for just shy of five hundred dollars, some several hundred attendees could spend two days connecting, socializing, and attending more than a dozen speeches and panel discussions featuring journalists, doctors, luminaries of the movement, military veterans, online influencers, and many others, before listening, during the gala dinner at the conference’s end, to Delano’s keynote address in which she declared a revolution. Indeed, “we already have that power,” she said. From West Hartford to the rest of the United States, it was time to “build places for care where the system can’t follow.” It was time to bring that power to bear on “this culture,” to “this moment.”

That is the plot. But what this story means—whether Laura Delano is a revolutionary or a crank, a danger or an inspiration, a victim of psychiatry or a patient still resisting the meaning of her life, whether she is advocating the end of psychiatry or simply telling her story in the name of pluralism and “informed choice,” what “this moment” and her movement mean to the long dance between psychiatry and its discontents—all of that is yet to be determined.

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The first person to talk to me is Eli, a very tall and very nervous nineteen-year-old gripping a copy of Unshrunk with dozens of colored sticky tabs sticking out between the pages. He tells me that he’s studying psychology at Bard. I had been lurking on the periphery of a room off the lobby of the Delamar Hotel, outside the double doors to the ballroom proper, where the speeches and panels would take place the following day. But on the eve of the conference, attendees have been invited to gather here at 5:00 P.M. for a cocktail reception. At 4:30, the open bar is not yet serving and the room is still mostly empty. I wonder if turnout will be depressed by the weather: it was difficult to find parking near the hotel and the best option required walking a few minutes through the cold. Eli asks me if I’m a fan. He’s a fan. He’s hoping that Delano will sign his book when she turns up, if she isn’t too busy, and is willing to talk to him.

We are standing between a merch table and some enormous banners, one with the Inner Compass Initiative logo and another with the title of the conference: THE FUTURE OF MENTAL HEALTH IN AMERICA. The immediate future of mental health in America is that I’m scheduled to take some of my own medication: lithium (mood stabilizer), Abilify (anti-psychotic), Lamictal (mood stabilizer), Vraylar (anti-psychotic), and benztropine (a Parkinson’s medication that lessens the motor side effects of the anti-psychotics). I tell Eli that I’m not sure if I’m a fan yet and then excuse myself to the bathroom on the other side of the lobby to get some water from the sink.

I have never liked taking my medication. It feels, as Delano would put it, like compliance. This is the first time that it has felt transgressive, like sneaking off to smoke cigarettes behind the high school.

The cold, it turns out, is not a deterrent. When I come back from the bathroom a few minutes later, I can’t even see Eli anymore in the crowd filling the reception area. This does not look like any version of the movement that I have ever seen. The kid was the exception. Almost everyone here is older, wealthier: old guys in sports jackets, old ladies in evening wear, the few younger people in cocktail dresses and shirtsleeves. The scene looks like the corporate-sponsored parties I snuck into at the 2016 Democratic National Convention where donors and delegates got a few free drinks and five minutes with one of the Pod Save America boys. But it feels closer to the Star Trek convention I attended in Pasadena when I was twelve years old. It is loud, excited, slightly awkward—suffused with the nervous, almost giddy energy of enthusiasts finally surrounded by other enthusiasts, eager to gush as soon as the names and where-are-you-froms are out of the way. Once the drinks start flowing, the nerves relax, but the crowd’s energy stays up: business cards are passed back and forth, names of medications, years, “so-called diagnoses.” I keep hearing the word “escape”: I escaped that, I escaped in . . ., I hope people can escape.

When Delano arrives, fifteen or twenty minutes in, it is like she is surrounded by a magnetic field, simultaneously drawing people to her and holding the more self-conscious at a distance. Every time I look over she has been pulled into a clutch of old friends or new fans, people eager to meet her for the first time or to see her again after five, ten, fifteen years. She is smiling, hugging, talking, with the relentlessness and enthusiasm of somebody who cannot, on some level, believe that she has finally arrived in the promised room where she is the center of the universe. When she sees me, she asks if I have everything I need, if I had any trouble getting in. Delano is unfailingly polite; she says she’s super excited to have me here, and the effect is as flattering as intended—but that is all the time I’ll get today.

On the far side of the room, I meet an elderly couple from Florida: they have been following Delano for years. They love her, just love her. Across the room I notice Lyman Delano, Laura’s father, standing near the bar, surveying the scene. And I see Robert Whitaker himself, scheduled to speak the next morning, standing with a gaggle of admirers a few feet from an older, bald man who so resembles the actor Ronald Guttman as he appeared on Mad Men that I briefly consider that it is Ronald Guttman, except that he is unaccountably wearing a full, velvet cape. I later learn that this is Jeffrey Tucker, the founder and president of the Brownstone Institute, a think tank dedicated to “coming to terms with what happened” during the pandemic-era lockdowns. An hour and a half in and it is loud in this small room. There are at least one hundred people here, milling, smiling, shaking hands and hugging, talking about escape. I finally catch sight of Eli again, hovering ten or fifteen feet from Delano, too nervous to approach.

At last Cooper Davis, who serves as the executive director of the Inner Compass Initiative, takes the mic and proposes a toast. He is beaming, close to tears. He tells the crowd how excited he is, how he is almost choked up and so glad to see people “with such different backgrounds and incentives and orientations” in the room, “nonetheless willing to come here together and talk to one another about these very thorny, subtle, but also important and exciting and weird issues we’re here to talk about.” It is stunning, he says. He can see it very clearly and he is sure it will become clear to most of us before the conference’s end. “It means so much,” he says, “I am really heartened to see the faces in this room, to feel the energy already. It’s sort of electric.”

The Inner Compass Initiative is nine years old at this point. But, as Davis explains, this is the first conference because he and his wife “wanted to let it all ripen” before they tried anything ambitious. And “things feel really ripe right now.” The rest of the toast is housekeeping. Those attending the “unfortunately titled” V.I.P. dinner should be ready to leave in fifteen minutes. The V.I.P. dinner costs twelve hundred dollars per ticket, and it was made clear to me by Delano’s P.R. people—led by Paul Bogaards, a former Knopf editor whose other clients include the Dunne–Didion estate and Robert Caro—that I will not be attending. That’s okay: for everybody else, there will be two a documentary screened about the excesses of “therapy culture.” It’s a great movie, Davis tells me before he leaves for the dinner. You should check it out.

Before all of this, Davis, like Delano, was adjacent to the more radical psychiatric survivor movement. He freely admits that a cocktail hour at a three-hundred-dollar-a-night hotel does not resemble that old scene at all.

“Most people attending this conference would not think of themselves as psychiatric survivors,” he tells me. In fact, since psychiatry went mainstream, most of the people impacted by these medications do not even identify as “mental health patients.” Rather, they are “mostly people consuming pharmaceutical products.” That has upsides for the movement: because psychiatry extends its reach to the middle class, the privileged, the normal, it has perhaps produced a more empowered class of skeptics. But many of them—including many at this conference—lack a sense of history. “A lot of the heritage of that psych survivor movement—the intellectual, political, and strategic heritage from the last go around—has not yet carried over,” Davis says. “Those lessons haven’t yet been transmitted.” That is what makes his organization, this conference, and Delano herself “unique,” Davis says. She “has a foot firmly planted in both of those worlds.”

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Davis and Delano’s two worlds are, of course, only two of many, a legacy of transmissions reaching back some two hundred years in this country. For as long as there has been organized American psychiatry—and indeed for as long as there has been somebody, somewhere, willing to appoint himself responsible for the official care of the insane—there has been anti-psychiatry, psychiatric skepticism, critics, and apostates. The two are engaged in a long dialectic, in the proper sense of the term: each continuously remakes itself in response to the other, absorbing advances and critiques into its own vocabulary, transforming, over the years, into versions of themselves neither could have envisioned without their opposite.

Even Delano’s role is not original. The line of patients turned memoirists turned activists, nearly all of them women, stretches back through the early American republic. Throughout the nineteenth and twentieth centuries, memoirs, pamphlets, and testimonies by lunatics and asylum inmates appeared continuously, begging the public to understand that the story of the madhouse was not one of regrettable necessity. One of the most notable, Elizabeth Packard, was committed to Jacksonville Asylum by her husband in 1860. She sued for her release, wrote The Prisoner’s Hidden Life; Or, Insane Asylums Unveiled, and founded the Anti-Insane Asylum Society. In the mid-twentieth century, there was Mary Jane Ward, whose 1946 novel The Snake Pit, a lightly fictionalized account of her own commitment to Rockland, became a bestseller, then an Oscar-nominated film. The list goes on: Janet Frame, Shulamith Firestone, Judi Chamberlin, and many more to the present day.

Early American psychiatry had very little to offer those it claimed to treat. Madness itself was attributed to sin, to bad blood, to animal passions allowed to run roughshod over the rational mind, the weak constitutions of women, and the weaker moral faculties of the poor. Its treatments were custodial and punitive. The critics of this period agitated, variously, for more humane asylums to the abolition of the asylum entirely. They found some success on the first front. By the early twentieth century, American psychiatrists had grown marginally more concerned with the appearance of medical compassion and scientific foundation; the worst abuses documented in the patient memoirs of the nineteenth century gave way to the merely routine cruelties of the early twentieth. But the populations of American asylums continued to grow, and the treatments remained useless.

It was not until the middle of the twentieth century that a convergence of overwhelming pressures forced psychiatry to remake itself again. Patient testimony and agitation, combined with a series of exposés, provided fuel for a strange alliance of concerned liberals and civil libertarians to bring about the Community Mental Health Act of 1963. Waves of de-institutionalization followed. The vast majority of American insane asylums were shuttered. Budget hawks massively reduced federal funding for such ventures. Civil commitment laws were tightened, and community treatment models were proposed in their stead. (These largely failed to materialize.)

The triumph of anti-psychiatry was aided, too, by psychiatry’s own re-invention. In 1954, the antipsychotic Thorazine came on the market. It was the first drug that appeared to allow the treatment—or control, depending on how one interprets this history—of patients outside the walls of the hospital. Miltown (1955), Tofranil (1958), and lithium (1970) followed in succession. American psychiatrists no longer saw themselves as prison wardens but as prescribers. The asylum, so long the potent, organizing symbol of the management of human minds, was replaced by the pill.

As psychiatry remade itself from the literal warehouse to the diffuse medicalization of the pill, anti-psychiatry’s old campaigns against involuntary commitment transformed in turn into something more theoretical and ambitious: arguments not merely against particular psychiatric abuses or laws but against the entire framework by which human suffering is translated into a medical diagnosis and managed for the patient’s own good. Throughout the 1960s, 1970s, and 1980s, Thomas Szasz, R. D. Laing, and David Cooper argued that “mental illness” was itself a category error, an unprovable pseudo-scientific gloss on the old social desire to contain people whose real trouble was that they had been burdened with intolerable lives. Psychiatry, in the usual telling, emerged like any other field of medicine: from old medieval superstition through the mishaps and mistakes of early modern pseudoscience into the empiricism and progress of twentieth-century service. The critics told a different story: of an ancient mode of social control, now disguised in a lab coat behind the smile of a pharmaceutical rep.

Those left behind by the failed community health centers, those still suffering the after-effects of de-institutionalization, and those who had come, inevitably, to see psychiatric medication itself as little more than a subtler version of the old asylum shackles began coalescing into a loose and radical movement. It called itself, variously, the mad movement, the ex-patient movement, the psychiatric survivors’ movement, the Mental Patients’ Liberation Project, and—in the spirit of the Seventies—the Insane Liberation Front. This was the era of the Madness Network News, published out of Berkeley, and of Judi Chamberlin, a former asylum inmate and perhaps the most influential figure of the era, who in 1978 published On Our Own, a sweeping argument for the position that patients are capable of running their own services, their own peer support groups, their own alternatives to the doctors and hospitals that have failed them. This was radical work. Those who carried it out were mostly poor, often black, suffering or alleged to be suffering from ancient and spectacular forms of madness: manic depression, psychosis, schizophrenia.

Although psychiatry continued to grow, it was the skeptics who prevailed in the interpretive theater of the public imagination. By the end of the 1980s, it was widely understood by nearly anyone who had been paying the slightest bit of attention that psychiatry was often quackery or worse; that a “mental patient” was not some frothing animal in desperate need of a professional but one of the fun gang of kooky gals from Susanna Kaysen’s Girl, Interrupted, or Jack Nicholson, or Chief, flying over the cuckoo’s nest.

The movement persisted well into the 2000s, in time for Davis and Delano to find it at the beginning of last decade. But the thesis and antithesis in the psychiatric saga that made the crowd in West Hartford possible—that made it possible for a wealthy Greenwich girl to find herself “psychiatrized” at Harvard in the first place—began in 1980 with the publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders. Prior editions had been brief, vague, shaped by the needs of the American military that had first commissioned its foundational work and by psychoanalytic theories now fallen out of scientific fashion. The D.S.M.-III was a schema, a textbook, a doorstop. In response to the critique that their field lacked the scientific rigor of true medicine, the authors of the third edition radically expanded diagnostic categories, organizing disorders around checklists of observable symptoms and standardizing the criteria by which clinicians could arrive at a diagnosis.

The D.S.M.-III was, depending on how you read the story, the means by which psychiatry became either a field of grown-up medicine or a billing manual. In either situation, the book made it possible to diagnose at a rate unimaginable a decade prior, to name the pathologies undergirding the ordinary miseries of ordinary life. Some of this is perhaps best explained by another field concerned with dialectics and political economy. After the gutting of the state hospital system, psychiatry found itself with a patient population—the severely ill, the chronically psychotic, the poor—who could not generally pay their bills. The D.S.M.-III paved the way for a resolution to this intolerable situation in the form of a far more profitable constituency: everybody else.

In 1987, the F.D.A. approved Prozac for the treatment of depression. Within a few years, it was one of the most prescribed drugs in America. The explanation of mood disorders as “chemical imbalances” arose directly from a Prozac marketing campaign; no chemical imbalance has ever been observed in the brain of any patient. Still: it was the phrase under which Delano, in Unshrunk, recalls identifying with a cartoon from one such advertisement: a sad blob under a gray cloud, waiting to be lifted. By the mid-1990s, psychiatry had begun telling the same story about anxiety, panic, stress, attention deficit disorder (a diagnosis that proved particularly convenient for the parents of privately educated children hoping to juice their S.A.T. scores), about nearly every category of human difficulty incorporated into the expanding catalogue of the D.S.M. In 1997, the F.D.A. relaxed the rules governing direct-to-consumer pharmaceutical advertising; today, you may be told as often as seven times per hour that if your anti-depressant is not working, ask your doctor if Vraylar—never explicitly identified as an anti-psychotic—may be right for you.

By the time Delano was in withdrawal agony in Boston, the percentage of Americans who reported taking a psychiatric medication in the past month climbed from a small fraction to something approaching a quarter of the population. Psychiatry no longer lived in the mental hospital but now resided in the suburban doctor’s office. Patients no longer imagined themselves as patients at all but as ordinary people, managing their mental health, dealing with normal and destigmatized conditions with a little harmless psychopharmacological assistance. The patient memoirs of this era—Lori Schiller’s Quiet Room, Elyn Saks’s Center Cannot Hold, Kay Redfield Jamison’s Unquiet Mind—were not about resistance but recovery, their plots not about the violence they endured as patients but about the peace they found by accepting the help they needed.

The movement, in its traditional form, had by now largely retreated into the academy, coalescing into a field it called Mad Studies. While An Unquiet Mind became perhaps the most popular psychiatric memoir in the history of the world—it played no small part in psychiatry’s return to public respectability—radicals wrote little-cited journal articles debating whether or not Jamison’s enthusiastic endorsement of lithium made her a kapo. They engaged in internecine fights about whether they should use the United Nations Convention on the Rights of Persons with Disabilities to fight commitment laws or whether doing so would require conceding that they had a “disability,” a surrender to “the biomedical model.” They did not notice these new, affluent patients. But Robert Whitaker did, and Laura Delano did too.

By the 2010s, psychiatry had become so thoroughly destigmatized that it was approaching the status of fashion. The old stigma of the diagnosis gave way to a new culture of self-diagnosis, of volunteering for a label, of patients who were no longer coerced but eager, strategic, arriving at their appointments with a set of symptoms rehearsed from TikTok. So many people now identify as “neurodivergent” in one form or another that, if the claim is taken seriously, they will soon become the neuro-normative by flat majority. The old psychiatry patients have not disappeared. They are still here, more resource-starved than ever, some of them still splintering into what remains of radical activism, most simply watching their lives fall apart. The same forces that produced the homeless schizophrenic on the subway platform also produced the overprescribed yuppie—but until Delano came along, the yuppies lacked the influence, the potential as an organizable base, the outsize role in public consciousness that they had wielded only a few decades before. That, in any case, is what Delano saw by 2016, when she moved out of activism and toward what she calls education. These new patients were often wealthier, better educated people who were often scarcely aware of the risks entailed by submission to psychiatry until it was far too late, who did not feel oppressed but scammed. They were deprived, as Delano puts it over and over, of “informed choice.” Now, as Delano declares in Hartford, they had the power to bring their brand of information, their criticism and their skepticism, back into the mainstream, and even into the law.

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At 8:30 the next morning, Davis is once again on the mic, standing on a wide stage at the head of the Delamar ballroom before a crowd of some two hundred people seated at dozens of round tables. In the back, several large cameras are streaming the proceedings to an additional two hundred “virtual attendees” watching online. He is once again excited, thrilled to be looking out at this happening so long in the planning. He explains the vision of the conference: we are not here, he says, to waste time “arguing about the facts”; the “epistemic backbone” of the conversation can already be found on the organization’s website. Instead, we are gathered here to advance three pillars: education, community work, and advocacy. Education is the most important. The purpose of Delano’s work, he says, is “helping people make more informed choices about drugs and treatment.” He repeats: people should have “all the information”; they should make “an informed decision”; they should always make an “informed choice.” Choice is the key word here. Choice, Davis explains, is active. It is not merely informed consent, which is still, of course, consent—submission, with disclaimers—to the alleged expertise of doctors. This conference is itself a form of “community building,” an extension of the community already found in the organization’s drug-tapering guides and forums. As for advocacy, Davis boasts, it had been an “electric year.” There is, at long last, a political culture with “active interest” in re-imagining “the mental health system.”

I am seated near the back, at a table with half a dozen other attendees and a reporter from the Epoch Times. My closest neighbor, Wynne, is a therapist from Chicagoland. She tells me that over the past few years she has been troubled by how readily her practice colleagues, particularly on the prescribing side, became “really comfortable” handing out drugs to children, to young adults, to people who did not seem mentally ill in the traditional sense and who might be better served by talk therapy alone. The trouble was that she couldn’t really have these conversations at work. She discovered Delano by accident on a podcast. She has not even read Unshrunk. But Delano’s story, she says, “struck me as something that I actually watch my own clients go through,” particularly people being diagnosed and medicated without full consent “and then having these long, long, long, long-term effects as adults.” She was here to learn more and to have those conversations in a space open to these ideas. Each member of the table had come here by slightly dissimilar paths. One young man was following Delano’s guide to taper off S.S.R.I.s. An older man was a veteran of what he called the “medical freedom” movement. One mother had seen Delano on T.V. and was trying to decide whether or not to keep her children on A.D.H.D. medications. An older woman just loved Unshrunk, was moved by it, and did not know yet, she told me, what she “made of all of this.” She was curious.

The morning session is given over to the experts. Whitaker is the main attraction here, and he delivers a version of the speech that he has given for over twenty years. It is the case that has made him the most staid and respected psychiatric critic in the country. Even the studies conducted by pharmaceutical companies, he says, do not support the benefits that they claim their drugs confer in public. And “relapse studies” on anti-psychotics show that many returning symptoms are better understood as withdrawal. Finally, as many as two-thirds of first episode psychoses, left untreated, resolve within a year. His lecture is restrained, professional, and geared toward consensus. (Whitaker will later confide to me that this was the only convention he had ever attended with “a ticket price.”) There is little that cannot be found in the classics of psychiatric skepticism; none of this, I imagine, could be unfamiliar to the sort of person attending a conference like this one. But I am wrong. As Whitaker approaches the midpoint of his speech, one of my tablemates—the mother—nods over and over, taking notes in a small pad without even looking down. When he finishes, she shoots a look across the table: “Huh. Wow. I had no idea.”

During the twenty-minute break, Davis returns to the stage and encourages us all to check out the “sound bowls” being played by a member of their community to the left of the stage. The bowls—of a variety of sizes, some of them enormous, played with a wooden stick—produce a kind of strange, sonorous ambience. Davis calls them “singing bowls,” although, he tells me, he knows “they get called ‘sound healing’ or ‘sound bath’ in more woo-woo contexts.” This is not a woo-woo gathering: he and Delano just did not want to have “some stock Spotify playlist.”

After the break, there is one more panel before Delano takes the stage. When she appears, the applause is uproarious. Beside her is Jan Baszucki, a novelist and philanthropist who founded the organization Metabolic Mind. But Baszucki is not here to discuss that work. She is here to discuss her son Matthew. “I can already feel myself getting emotional,” Delano says. “I know what you’ve been through as a mother because I’ve been through it as a daughter, and my family has been through it too.” What Baszucki went through—what her son went through—was the sudden onset of what they believed to be a “nervous breakdown” during his junior year of high school. This condition persisted and worsened throughout his college years. He was diagnosed with manic depression, hospitalized repeatedly for psychosis, attempted to withdraw too quickly from his meds, and suffered a brutal relapse. “For five years, we were in that madness,” Baszucki says, by which she means the madness of the mental-health-care system, with Matthew “prescribed twenty-nine different medications, including nine different anti-psychotics.” These drugs only partially alleviated his symptoms while transforming him into somebody who was “not himself.” But at last the family made contact with a psychiatrist who began tapering Matthew off his drugs and put him on a ketogenic diet. Within three months, Baszucki says, he was healed and entered a remission that has now lasted years, during which time he has continued to taper slowly—very slowly—off the last of his prescription drugs.

Baszucki is a moving speaker. And her story performs another important function: “I think part of what makes your family’s story so powerful,” Delano says of Baszucki’s son, “is that the experiences that Matt has had in his life are not just a rough patch of some down moods. He, like so many of my friends and fellows and colleagues, has gone through what psychiatry would label psychotic episodes.” That, she explained, “is oftentimes the kind of go-to question that critics of those of us who are critiquing the mental health industry turn to.” Defenders of psychiatry might concede that the worried well might not benefit from medication. “What about those people who are quote unquote ‘psychotic,’ ‘schizophrenic,’ whatever so-called serious mental illness label you want to give them? And part of what makes your family story so powerful is that question can’t be used as a way to diminish or discredit the incredible transformative journey that your family has been on.”

Delano then turns the stage over to a panel of licensed psychiatrists to discuss how the pressures of their industry can make them question their own judgement and values. The moderator begins with what she calls “the elephant in the room,” the fact that “we’ve heard your bios. You’ve been educated at prestigious universities. You’ve published in mainstream journals. You either currently work or have worked in hospitals, or you’re the product of institutions. So what made you feel compelled to be here today?” The first answer is telling: “I’m here to be a change maker,” says one doctor, to be “a part of honoring humanity and dignity . . . but also holding up the mirror to a system that harms everybody.” He wants to re-humanize himself, to humanize other people. When it is over, somebody at the next table nudges his neighbor and whispers, “Struggle session.” The neighbor replies, “Good.”

By lunchtime, any nerves or inhibition have shaken off. In the ballroom and the lobby and on the streets outside the hotel, I listen to chatter, excitement, introductions, revelations, people eager to tell their story to one another—the story of how they came here; the meds; the family members; the curiosity; the institutions; Delano herself; her tremendous, incredible, inspiring book; the desire to take the fight further. What the fight consists of is an open question. By bringing doctors, therapists, patients, activists, journalists, and historians together, the Inner Compass Initiative has tried to fashion its movement into what in politics would be called a “big tent.” This is consistent with the organization’s stated—and repeated—dedication to pluralism, to choice, to a break with the older and less effective radicalism of movements past. It means, for example, that when I wander through the Whole Foods down the street from the hotel, I overhear two men, both from the conference, making friends. The first is an “old hippie” whose objections to psychiatry are part of the old crusade against “systems of control.” The second is a younger man with curly hair and a pressed white shirt who found his way to West Hartford through the M.A.H.A. movement, the fight against “chemical control” (a natural extension of his beef with vaccines), abhorrence of “gender ideology,” and a disdain for ultra-processed foods—“all the crap they make us put in our bodies.” It is, I am certain, the first time that these two men have seen eye to eye in their lives, and one of the only situations in recent years where they might have occasion to speak.

After lunch, the attendees settle back in for the home stretch: six more presentations over the following three and a half hours. I have been to many conferences before, and this is the point at which they tend to flag. The coffee runs cold, bathroom breaks linger in the hallway, a lot of emails finally receive replies. But here the crowd remains attentive. Yet during one of these afternoon sessions, the “big tent” vibe of the conference—the smiling insistence on pluralism, choice, and autonomy—encounters its only hiccup of the day. At the beginning of a panel called “The Future of Therapy,” the moderator asks each of the panelists—Nicole Laurent, David Walker, and Roger McFillin—to briefly introduce themselves. Laurent explains that she was a licensed mental health counselor, in practice for eighteen years, and is now in her eighth year of offering specialized ketogenic metabolic therapies to clients. Walker, among the most soft-spoken presenters of the entire conference, recounts briefly his work in general practice and the influence of his father—a psychoanalyst—on his approach to patients seeking alternatives to medication. Then McFillin takes the mic.

“I’m still moved by the last presentation,” he says, referring to the popular podcaster Mollie Adler’s account of her recent pregnancy. “I think what occurs when you create life, when you carry life, when you produce life and you have a child, I think it really does change you. And what I’ve been observing within our culture is really a battle, an anti-human approach to the human experience. I see that as purposeful. I see it as an intentional act against our interconnectedness. One of the things that I love about being in a collective group like this is that you experience an energy. And that energy is related to, I think, the fact that there are souls here and have embodied into this human experience for a mission that’s much greater than them.”

He then proceeds to elaborate on the nature of this battle, and this mission, for nearly nine minutes. He explains how we all feel it, how “the psychiatric industrial complex has been a weapon of war, a weapon of war to sever you from your internal experience.” This war is being waged to “decimate a culture,” to “create mental suffering, create disease, make it prolonged and chronic.” It is “a war with nature and a war within yourself,” an “attack on humanness.” This is no mere metaphor: if you “really reflect historically on materialism and scientism,” you would see that it was “a systematic psychological operation” designed to sever man from God.

“I mean, that’s like a bad word now,” he says. “We can’t even say the word God.” The result is a “mass poisoning of our culture,” the risk of “abandoning our sovereignty and our freedom of our mind because there’s a battle for our mind and our soul.” Since August, he confesses, he hasn’t turned on a television at all, despite being a huge Eagles fan. “And guess what? I feel so much better. No more beer commercials. I’m not getting pushed to free pornography, gambling, competition, and feeling I have some connectedness to the outcome of a game from men who are making millions of dollars.” We’re in a culture of decline, he says. The “mental health industrial complex” is “severing us from the divine.” After his tech cleanse, he can feel his body “buzzing with energy,” proof, he says, that “post-materialist science is a stronger science than the materialist, atheist science.” The culture of drugs, food, and sex are making us sick. We have to fight back. “Telepathy exists,” McFillin says. “We can heal ourselves. The placebo effect is not some nuisance to try to get a drug to market; it’s the body in alignment with nature and a belief in your own ability to heal yourself. Love isn’t a hallmark card; it’s an energy force. It’s an energy force that can heal.”

We’re surrendering “our authority, our independence to the medical establishment,” he says. That’s “why you have eighty percent of Americans forcibly taking an mR.N.A. experimental vaccine to change your D.N.A. I don’t think it’s an accident. I don’t think it’s good people with positive intentions because it makes no sense.”

A few hoots break out across the hall, some scattered clapping. There is a pause. “So,” the moderator says, “I think we’ve heard the term patient-centric mentioned a lot today.” She invites the panelists to explain how they work to regain the trust of disillusioned patients. After the panel, Lauren Kennedy West, a popular YouTuber, gives a talk about the dangers and the comforts of assenting to the authority of the doctor’s interpretation, of the seduction of becoming “in many ways a professionally mentally ill person,” how she “stopped just having a diagnosis, and I started being it.” Finally, two young TikTok mental health personalities discuss using the “influence” of personal stories to reshape culture. It’s a slightly underwhelming finale.

At some point during the hour and a half between the final panel and the gala dinner, I bump into Delano near the bar. I ask how she is feeling. She says she loves this, the day has gone incredibly, she still can’t quite believe it. She is a little nervous for her keynote, but after all the years of speaking, she knows that once she gets up there it’s always fine. We talk for a few more minutes. At one point, in the course of describing some of the attendees, I casually refer to “people in anti-psychiatry,” and Delano visibly twitches.

“What do you mean by that word?” she asks.

Nothing, I say. It’s just a common word for skeptics and critics. She relaxes. It’s okay. She just feels a little defensive when she thinks she’s going to be labeled “anti-science,” she says, especially when that’s the opposite of what she’s trying to do. She smiles. Am I having a good time? Do I have everything I need? We should talk later.

It is true that in the course of the day—in Delano’s book and in her innumerable appearances and interviews—neither she nor anybody else here has ever said, Stop taking your medication. If some panelists and attendees are skeptical of the medical basis of any kind of mental illness at all, well, that is just one of the many perspectives that you’ll encounter in a space open to dialogue, dedicated, in Delano’s word, to pluralism, to helping everyone decide what makes sense to them, what works for them, and making an informed choice.

There is a history to be written about attempts to organize around paeans to choice and education: about the Rallies to Restore Sanity, the March for Science, the whole premise of the Democratic Party’s technocratic turn in the twilight of the Obama years. However sincere the effort, it is not at all clear that such a thing is possible. Throughout the day, I see hundreds of people who, by many different paths, have seen themselves, or their friends, or their parents, or their children failed by what they had previously believed to be a certainty about the nature and treatment of the mind. Some are already dedicated to the cause and others only have questions; for some, this is their first exposure, beyond perhaps Unshrunk itself or even one of Delano’s many podcast hits, to any of the ideas transmitted from the last generation of skeptics and critics. In West Hartford, they encounter another story, one told over and over, all day long, by patients, parents, even doctors who refer so often to the “failed system” or the “system of control” or the lies of pharmaceutical companies that these become obvious, almost clichéd. They encounter a new story that does not simply offer choice or information but a new way to make sense of what has happened to them or to their loved ones, a story that, unlike the helplessness they felt in the face of psychiatric professionals, allows them to feel empowered, to become participants in a process in which they could previously only observe and comply.

Delano would later tell me that the conference was about hope and solidarity. And it was. But solidarity must come from some impulse in the human spirit, and “informed choice” does not quite stir the soul. It does not bind you to the people you have met over the course of the past two days and make you giddy with relief that you are not alone. Many of the speakers at the conference are powerful, their stories moving—despite the occasional cranks and less-than-charismatic panelists, it is as effective an organ of political education as I have ever seen. This is simply the nature of such happenings, no matter the intention: you enter with questions and leave with a worldview. You leave with a bond, with a purpose. Delano likes to say—something that is repeated by many others over the course of the day—that psychiatry works in part by giving patients an identity, a mode of self-understanding that resolves difficult questions about their suffering. She’s right. It does. And by the time we gather once again in the ballroom, white tablecloths spread over the tables and a prix fixe menu featuring seared Scottish salmon, pommes dauphinoise, and crème brûlée before us, the big tent has the feeling, as one of day’s presenters later puts it to me, “of a tent revival.”

Laura takes the stage and calls for her revolution. Her speech is funny, impassioned, even joyful. She asks whether or not the tables can be moved for dancing. She repeats, once again, her dedication to choice: “We don’t believe that the system needs to be destroyed tomorrow and all these drugs need to be banned,” she says. It is only that “no one should ever be forced or coerced to engage with that system.” Her own journey has been about education, about arming herself with information, about writing her own story, about deciding what that story meant. She knows that there are people out there—not in this room, but out there—who have read her book and “decided for me that actually I am borderline, no matter what I say.” They know who they are. “I still have plenty of darkness,” she admits. “I cry all the time. I have intense urges of anger. I’m a very angsty person. I would definitely qualify for various diagnoses”—that is, if she “gave a shit about that. And I don’t.”

While Delano speaks, her people respond. They look at her with an intensity that I have rarely seen. They behold, in their own ways, something that her many fans have seen in her for years. When the dinner is finished and the bar opens up again outside the ballroom, she is mobbed once again. People pour into the space, surrounding her, hugging her, talking to one another as they wait, promising to keep in touch, to follow up, to keep talking. Many people are crying. The party lingers for hours. Sometime later in the night, I run into a woman I have met before, a mother of a daughter who had been diagnosed with manic depression years ago but who, for all the medications and hospital stays, does not seem to be getting better. This woman has taken her child to the people she had believed for all her life were there to help with things like this; after today, she is determined to go home and begin looking into tapering, ketogenic therapy, and lifestyle cures. It has all been so terrible, she tells me. It is so painful. “You seem like you know a lot about this,” she says to me. “Please: just tell me that it was all a mistake.” But I can’t. When I leave an hour later, Delano is still talking, inexhaustible, to her disciples.

✥ ✥ ✥

It occurs to me, in the days and weeks following the conference, that no two people understand Delano in precisely the same way. This is common enough with any public figure: the interpretation of another, particularly when it is carried out along parasocial lines, is as much a matter of projection and transference as anything else. But in the decade since she became this country’s most prominent avatar of—what? Anti-psychiatry? Psychiatric skepticism? Patient autonomy? Drug-tapering research advocacy? Even what she is meant to explain is not yet settled—and particularly in the year since the publication of Unshrunk, Delano has been claimed, denounced, diagnosed, celebrated, and read with an intensity ordinarily reserved for politicians and murderers. If there is pluralism here, it arises only in the aggregate, in the way that each particular interpreter is fiercely attached to his vision of Laura Delano, his sense of her significance, of what she represents, of the real Delano, the one her other readers are so clearly missing, the one he, in particular, has managed to comprehend.

To Wynne, the therapist who sat at my table (and who, I later learned, has been featured in the Chicago Tribune after losing her job at a community center in Oak Park, Illinois, because she refused to comply with the COVID-19 vaccine mandate), Delano is a victim of psychiatric overreach and proof that the children she saw could thrive without psychiatry. To Clint, the black-sheep grandson of a Texas oil magnate who had dropped out of college and spent fourteen years in psychotherapy (becoming, along the way, a kind of seeker, who explained to me via a Grok-generated summary the many paths he had explored en route to insight), Delano is a fellow traveler in holistic health and medicine, somebody else who, like him, is “following the breadcrumbs.” He describes himself as “an R.F.K. guy” who had met Davis at a party in San Francisco and came to the conference in Connecticut to “support the brand.” To Jane, a mother who describes her teenage daughter’s descent into the psychiatric system as shocking, dumbfounding, and horrible, Delano is validation that she is “right to be angry” and a source of “guidance” for what comes next. To Russell, a retired school psychologist from Rochester, Delano is a counselor. A dozen years ago, he took his daughters, both of whom had been diagnosed with serious mental illness, to see her. “Somehow I got her email,” he tells me. “I called her. And she very graciously agreed to meet with us. She spent time with my daughter.” She provided one of the last memories he has of his family whole, before one of daughters threw herself from a moving vehicle while in the throes of obsessive-compulsive disorder and the other was resigned to a life on psychiatric medication, where she remains today.

Not long after the conference, I call Lauren Kennedy West. She has always seen a peer in Delano—another young white woman who has struggled to break free of her “identity” as a mental patient. But she worries that her work is “veering a little bit too far into an anti-psychiatry space.” She doesn’t know “how productive being so extreme is in terms of actually being able to make meaningful change, not getting written off as being extremist, or a kind of conspiracy.” But, like so many of the attendees, “the actual experience of being there, of hearing the talks, of meeting with the people” was far “more difficult and challenging and powerful” than she had anticipated. She now feels that she confronted her anger and her guilt in its entirety, perhaps for the first time in her life.

Whitaker, who has known Delano longer than anyone else I spoke to, and who is largely responsible for her ascent over the past sixteen years, sees her, more than anything, as a symbol. Delano is “emblematic of someone who was trapped into the psychiatric system who would never have been trapped into the psychiatric system before.” He is proud of her and her work, but her true significance lies in the new constituency for psychiatric skepticism in the United States. She represents how “if this could happen to a Harvard person,” couldn’t it happen to anyone else?

When Unshrunk debuted in the spring of 2025, its reception became a proxy for the war of interpretation over Delano, over the general meaning of psychiatric skepticism in the twenty-first century. In perhaps the most famous review on Goodreads, the essayist Fredrik deBoer called Unshrunk “a fanciful and absurd treatise on how everyone should just be tough and committed to sanity like her and they will magically no longer have a mental illness, which by the way is not a real thing, at least according to a woman who has never interacted with someone who mutilated their own genitals thanks to their schizophrenia. An ugly, deluded, self-obsessed, horribly irresponsible book by a frivolous and pathetic person, a book which will literally get real people actually killed.”

When I write to deBoer, he tells me that Delano’s significance is not complicated. Her last name is Delano, “as in ‘Franklin Delano Roosevelt.’” She is “an immensely privileged person who has had very mild impairments from her illnesses, for which she received white-glove care in tony, expensive private hospitals.” She doesn’t “know fuck all about the actual lived experience of 90+% of SMI patients.” All of the interest in her is similarly easy to explain: she and her husband have received “an absurd amount of rose-colored media attention . . . because they’re telling brownstone liberals what they want to hear: mental illness isn’t that bad. But of course you think that if you’ve only ever done inpatient in Club Meds. Go spend a few months in a forensic ward and discover how bad bad can be.”

The case against Delano is simple enough. No matter one’s concerns about the over-prescription of anti-depressants and A.D.H.D. medications, the exaggerations of pharmaceutical companies, and the historical failures of psychiatry, it is clear that for so long as human beings have recorded their history, some of us have gone insane and that this malady runs, despite the dearth of particularly identifiable genes, through family lines. The truly mad often live miserable lives, hated or abandoned, desperate, dangerous, and in danger. They are in need of help, no matter how imperfect. Despite Delano’s repeated reminders that most psychiatric medications have no verified mechanism of action, were never subject to long-term efficacy studies, and sometimes entail dangerous side effects, it is evident that millions of people have found themselves able to lead lives that would otherwise have been impossible without these drugs—a population among which I count myself. I am not planning to go off my medication. I can simply feel, and tell you, that for all my sympathies to psychiatric critique, I have experienced these medications as miraculous; their disappearance would leave me unable to live my life. I know this. That these drugs can be ineffective or even harmful is no better an argument than it would be when marshaled against blood thinners or chemotherapy.

Despite the fact that Delano has not said, in any venue I am aware of, that any particular person should go off medication, it is not surprising that many, many people—her fans and critics alike—have taken her book, her many interviews, her public statements, the work of the Inner Compass Initiative, the whole premise of her celebrity to imply a belief that mental illness is not even real, much less the basis for anybody to spend their lives on psychoactive drugs. Although nobody, including Delano, is willing to speak much about it on the record, both the conference and my subsequent conversations with her critics and admirers contained incessant whispering—some enthusiastic, some extremely worried—that Delano and her husband were working behind the scenes to bring their grievances to the attention of Robert F. Kennedy Jr. and the Department of Health and Human Services. And in May 2026, Delano did appear with R.F.K. Jr. at the Mental Health and Overmedicalization Summit in Washington, D.C., hosted by the MAHA Institute. About two weeks later, Laura appeared on Kennedy’s podcast in an episode entitled “The Truth About Psychiatric Drugs.” For some of Delano’s allies, these steps are an obvious and rare opportunity to influence federal policy. For others, none of whom would say this on record, it risks discrediting their entire movement, associating a legitimate critique of psychopharmacology with medical unseriousness.

The case for Delano, meanwhile, is also simple: she has a point. Psychiatry has rarely needed help to discredit its own mission: its history, even through the present, is violent, coercive, and frequently disastrous. It is difficult to deny that many millions of Americans, including many children, are currently taking psychiatric drugs that they do not need, entailing long-term consequences of which they are not sufficiently warned. Should they discontinue these drugs, there is almost no official medication guidance on the proper way to taper off without risking serious, even dangerous withdrawal. Nobody, anywhere, has ever been able to prove the biological foundation for psychiatric illness; the D.S.M. is best understood as an insurance reimbursement fiction. Quite a lot of what is regarded as mental illness in the twenty-first century is specious; even many instances of first-episode psychosis are not the appearance of a lifelong illness. “Personality disorders” are more suspect still: it is unclear how even a collection of difficult personality traits, of descriptions, may add up to a thing, to a disease entity to be diagnosed and treated.

She is right, too, that there is a kind of violence in the psychiatric encounter, a force or seduction by which some authority persuades you to imagine you will spend your whole life dependent on its care, and may, in some cases, force you to do so. She is right, as Foucault was right, that the mad were incarcerated before they were treated, and that the appearance of doctors was in many ways little more than a changing of the uniforms worn by the prison guards. She is right that she went off all her medication and is not observably unable to manage her own life; she has not, despite the warnings of her doctors, descended back into addiction, insanity, and suicidal tendencies. She was right—as the entire history of anti-psychiatry has been right—to believe that if you called for those who have seen psychiatry fail with their own eyes to gather in some church basement or hotel, many people will come, and they will only need to tell the truth about what happened to them. The Future of Mental Health in America was amenable to both these readings: cynical or joyous, an evolution or a disguise, a new constituency of desperate people finally giving a voice to their unwelcome stories or a gathering of privileged cranks radicalizing one another at a fancy hotel while poor schizophrenics die in the streets.

These cases are so easy to make, in fact, that they are sometimes adopted by the other side. One of the most curious facts about the broader reality of the psychiatric and anti-psychiatric dialectic in the present decade is how each side has begun to soften, to work its mouth around the elements of its opposite that it is preparing to swallow and make part of its next form. Delano is not—no matter whether one interprets this as a matter of cynicism, strategy, or disposition—outwardly strident in the manner of her predecessors or even herself a decade past. Her conference is filled with doctors; she acknowledges, at least rhetorically, to the possibility that some people are aided by psychiatric medication; she will admit, when pressed, that there are people for whom heavy anti-psychotics are the only possibility, only insisting that we call this “sedation”—necessary sedation—and not “treatment.”

Meanwhile, nearly every American psychiatrist is slightly ironically detached from the indignities of his profession: it is difficult to find one who will not readily concede that the D.S.M. is bullshit, a necessary evil. And for all their mutual antagonism, Delano and deBoer have nearly identical critiques of the glamorized diagnosis-as-identity fad overtaking American youth culture. Awais Aftab, a psychiatrist and essayist who represents, for many people, the public face of thoughtful contemporary psychiatry, was eager to interview Davis on his Substack. More recently, he released an essay conceding the statistical likelihood that the majority of psychiatric diagnoses are incorrect before arguing that this had no effect on his confidence in medication, which is, after all, designed to treat broad symptomology. What would occur if figures like Lauren Kennedy West—those who believe, and who seem to offer some limited evidence, that at least some psychotic disorders originate in the intestines—were proved correct? I suspect that the psychiatrists would read this as a breakthrough: proof, at long last, of the firmly biological basis of disease, and an explanation for why they so far have failed to find it by scanning the wrong organ. This is not, I suspect, how Delano or her fellow travelers would interpret such an event.

In the ordinary course of reporting, one puts aside one’s prior judgements and tries to build a vision of one’s subject by collage, by finding what is common in the judgements and impressions of others. Contradictions, when they arise, are generally an indication that something is not on the level. But I find that even when I return to my earliest sense of Delano—I have been aware of her for nearly a decade, read her blog posts, watched dozens of hours of her interviews, read Unshrunk and found it strange and effective and disjointed in ways that are difficult to explain—I have neither a clear vision nor the suspicion that some version of her is more real than the others. Each of the Lauras I have seen with my own eyes and through the eyes of others seems to exist simultaneously, superimposed, contradictory and yet entirely extractable from the available facts, the known plot of her life and works. It would be simple, here, to make the case for any of them: the covert radical, the committed pluralist, the psychiatric survivor, the truth-teller, the cynic, the con artist, the unreconstructed borderline personality, the inspiration, the crank, the charismatic leader.

Whitaker was right to observe that the most significant fact about Delano is the way that her particular story and particular talents have caused so many people to respond to her, euphorically and skeptically and angrily, in a way that no other figure or story has managed to achieve in the better part of fifty years. It is in response to her that the porous boundaries between the psychiatric and skeptical interpretations of the world tend to snap shut, to force the players into a firm reading. This is, perhaps, because all those players are aware, on some level, that this era of malleability, of synthesis, will inevitably give way to the next phase of the dialectic of American psychiatry. How Laura Delano—her book and her organization and the whole movement of mainstream psychiatric consumers in the era of destigmatization—is ultimately interpreted will play an outsize role in setting the shape of that next era as it hardens into place.

✥ ✥ ✥

On a cold morning in early April, I drive to Laura’s house on an unremarkable suburban street in Hartford County. On the way, she texts me to apologize for the fact that there is a POD in her driveway, the result of a slow “decluttering” process. Davis and their children aren’t home right now, but when Laura greets me at the side door, ten or fifteen feet back from the street, she notices a tiny sneaker just outside: “Oh shit,” she says, “his shoe is there.”

Indoors, she introduces me to her cats—two brothers and one foster sibling, all of indeterminate mixed breed, named Snipp, Snapp, and Snugg. Will I put it in the newspaper that they are “the cutest cats you’ve ever seen?” I have seen many cats, have owned cats my entire life—a recent study reports evidence of an “association between childhood exposure to pet cats and later diagnosis of schizophrenia”—and I don’t like to pick favorites. But one of them follows us to the kitchen table and rubs his head against my leg while Laura makes tea. The house is not terribly large—two stories, with an overgrown backyard—and feels, if not precisely cluttered, filled with the odds and ends of living.

Before we can begin, Laura has what she calls questions. She would like a sense of the story. She is curious if I will give her quote approval. She would also like to know how I plan to interpret her. Rachel Aviv, when she was writing a profile of Delano for The New Yorker in 2019, was “great” in that way: anytime Aviv “was interpreting or representing me or my perspective on things, she ran it by me to say, is this a fair interpretation? . . . And almost all of her interpretations were fair. I just remember there were a couple where I was like, it actually really isn’t my perspective. And then she adjusted it.” This was a rare positive experience: by the time Aviv’s profile appeared in new form in her 2022 book Strangers to Ourselves it was “very different, in my opinion.” A 2025 New York Times profile by Ellen Barry was “not an accurate capturing of many things.” This is not the first time I have heard this concern from Laura. In the five months it has taken to arrange this meeting, there has been an undercurrent of wariness, a worry about the “lies” that have appeared about her, which in some cases mean factual inaccuracies but in others more resemble inferences that Laura would call “unfair.”

“I’m all into having debate, differences of opinion, hardy, robust discussions,” she says, “as long as my perspective and my book and my work and I.C.I. are represented accurately, that’s all I care about. If you have critiques of me, that’s totally fine. I just want to make sure I’m represented accurately.” It’s fine, too, if I plan to quote her critics. But she would like a chance to respond. “For example, if you’re quoting someone who’s calling me anti-psychiatry: I’m not anti-psychiatry. If you’re quoting someone who’s saying, ‘She’s encouraging people to come off their medications,’ I don’t do that. So how does that get handled? If there are factually inaccurate things that other people are saying about me?” It is not unusual for public figures to attempt to control the way in which they are covered. What is unusual about Laura is the lack of calculated defensiveness in these worries, the lack of a demand placed from the superior position of the well-known, guarded subject of a profile. Instead, her worries—about representation, about unchallenged criticism, about the factually inaccurate things that other people say, about interpretation—came across as a raw emotional need for assurance.

We talk for a little while about psychiatric memoirs. We had both released one in the past few years. We note that the most popular psychiatric memoirs of the past few decades—those by Lori Schiller, Elyn Saks, Kay Redfield Jamison—are best understood as “recovery memoirs,” stories interpreted by their authors as tales of acceptance, of submission to a doctor’s healing touch. We talk about Judi Chamberlin, how that era at the peak of the movement was “pretty impactful” to Laura as she began her own journey. “I just barely missed meeting Judi,” she tells me. “She died one town over from where my aunt and uncle lived, where I was living when I was coming off meds. And she died like six months before I came off everything.”

Quite a lot has changed since Chamberlin’s day, of course. It is unfortunate that the conference—a “really successful event,” Laura reflects, one that “people needed”—nonetheless required setting a price point that meant “it was not accessible to everyone.” But, she says, class is an important element in all of this. She is aware of how often it was raised in efforts to discredit her. But “I always talk about the issue of class when I share my story,” she explains, “because it took me several years to actually figure out how to be an adult in the world. And because I was born into a family who could help provide for me materially in those early years” she says, she was able to survive her withdrawal, the consequences of a life held hostage for so many years by doctors. She is a kind of champagne socialist in that way: in her view the tragedy is that so many people did not have that “opportunity to ease themselves” into adult life. There is, at any rate, no winning: the consulting work she began to do—“a hard decision to make, to charge money for what I had been doing freely”—in order to finally cover her own expenses, to reject, in part, the accusation that she is a privileged dilettante, became the locus of a new critical interpretation: here was this woman charging hundreds of dollars to coach people coming off their medication while denying that she has ever encouraged anyone to do that.

I raise the impression—my impression, and the impression as it had been put to me—that the conference had the feel of a tent revival. The day had been emotional, intense. I had gotten the sense of people very rapidly coalescing around a worldview as the day went on.

“How would you describe the worldview that you sensed?” she asks.

I describe how a person might arrive with questions, or might be familiar with one element of her institute’s critique—discomfort with prescriptions for children or with medical incarceration, for example—could experience a day of panel after panel and feel himself drawn into a much larger set of issues, into a cause. The day was very effective. “It’s really hard to organize around the position that it’s just a big tent, that we are being sensible and circumspect and making an informed choice,” I say. People at the Delamar Hotel felt something more than that.

“Yeah, I mean, I think I have a different impression,” Laura says. “I think it would be hard to draw a conclusion about the conference in that sense because who of us had the chance to talk to every single person who was there?”

“I’m just thinking about the vibe,” I say. “It wasn’t academic. It was, I think, very emotional for a lot of people, and it’s hard to feel emotional about just having information.”

“But you could argue that that’s based on a premise that people are very competent or capable of navigating this internal mix of strong emotion and information,” she responds. “Couldn’t you make the case that it’s a bit patronizing to say, ‘Oh, these people are vulnerable and impressionable’? . . . The mental health industry itself is based on the premise that the people coming in are vulnerable and impressionable and aren’t really the best judge of their own reality, and you have a responsibility to make sure they think the right thing and do the right thing. I just have an inherent belief that people can figure out for themselves what makes sense.”

I say that it strikes me that “reasonable,” “calm,” and “balanced” are not so emotionally satisfying.

“The emotions that I felt were hope and a sense of solidarity and possibility,” she says. “We’re tribal beings. We need that.”

“Well, I suppose that’s what I mean. It’s hard—it’s a sign of how successful the day was—to have a strong, emotionally bonded, tribal solidarity around the premise that we just want everyone to make up their own minds.”

“Why not?”

“It doesn’t contain an imperative.”

“But what’s the whole point—one of the main reasons driving this so-called mental health crisis that we’re in is that there is this pervasive tendency in our culture to want to be told what to do. Given quick fixes. I want to defer my life to you to tell me what to do. And that’s a big part of why there’s so much suffering. I think because people are disconnecting from their own inner compass. Not to be cheesy about it. Part of the work to be done is to actually interrupt that default of just deferring to some outside expert to give you a near, pretty clear presentation of this is what it all is.”

One of Laura’s cats hops up on the table. I notice that it has a large G.P.S. tracker in place of a collar. They were indoor cats, Laura explains, but one day Snapp got out and after that he began clawing at the windows all day. So now they are outdoor cats. Laura makes us another round of tea.

It might be the case that Laura just believes in the human capacity to simply take in information, to resist the “quick fix” of another person’s judgement—really, Laura’s whole adult life has been, in some way, organized around such resistance—but I have spoken to many of her fans, I have read the positive reviews and newspaper quotations, I have heard the way she is talked about by the many thousands and thousands of people who look to her as a kind of role model, as a leader, as a symbol of hope. You’re right, I say, that people are inclined to this form of deference, to subsuming their identity into an external judgement, and, well, I say, “I wonder if they’ve just replaced their psychiatrist with you.”

Laura pauses. Something registers on her face, although I am not fast enough to read it. She repeats another version of what she had said before about the “unconscious need to have someone tell you what to do, or tell you what’s true, or what’s real.” Then she allows that this has been difficult for her. While the negative interpretations, the criticism, the lies have of course hurt her in their obvious way, it is particularly painful to be misread in this way by her admirers.

“Over the years,” she says, “tons of people have emailed me or come up to me at conferences and they say, ‘So, tell me what’s actually going on here. Tell me what to do.’ And it’s painful to get that kind of response because of course all I can say is ‘I don’t have your answers. I know what my own path has looked like and what’s been helpful for me and what’s been helpful for a lot of friends and colleagues of mine, but I have no idea what you need. I don’t know who you are. I don’t know what your answers are.’ And so I do often find myself having to—with gentleness and compassion—to push back against the impulse to guru-fy.”

But why, she asks, should this bad reading, this misunderstanding, mean that she “shouldn’t then do what I’m doing?” She is just trying to have conversations. “I resist the notion that because people have that impulse, therefore it means I shouldn’t share my story. I’m curious what you think about this phenomenon, when I am literally just sharing my own story, I’m not even talking about anyone else—I’m curious why do you think some people hear me sharing my own story as me making a statement about everything, about other people? What do you think that psychological phenomenon is?”

I suggest that there is a distance between words and their gestalt; when you tell someone what has been helpful to you, what has been helpful to friends and colleagues, when you write a book and stage a conference and give interview after interview telling that story—doesn’t that contain a suggestion? “If you say something like ‘We don’t even know if these drugs work in the long term because we haven’t studied that question’—if you asked a computer what that means, it would say you were just making a factual statement about drugs. But wouldn’t any human being infer the additional cause, which is ‘Therefore you should not take these’?”

“I don’t think any human being would,” she says.

Okay. I try another approach: “If you say, ‘Look, we’re going to stay in this house now. And we have not studied whether or not the foundation is secure, or if it meets the fire code, and many people, myself included, have been trapped in fires in similar houses’—wouldn’t anyone hear, ‘Well, I probably shouldn’t stay here’? That is not confusing to me.”

It does, however, appear to be confusing to Laura. I have not, until now, seen her incredulity, her suspicion that she would, once again, be read unfairly. The true unfairness, she suggests, is that unlike her, psychiatrists and therapists do want to tell people how to live. She is “intimately aware of what it’s like to be in a largely self-directed position of powerlessness, where you’ve surrendered yourself to other people. So I’m sensitive to—it’s uncomfortable for me, anytime someone says, ‘Help me,’ or ‘Tell me what to do,’ it’s uncomfortable for me because I have this deep conviction that I don’t have that power over this person. I’m not going to empower them with anything. I don’t have it. They have it.”

Does simply telling her story nonetheless have an effect?

“Yeah, I’m aware that when I share my story and people hear parts of themselves in it” they respond, because we’re all human “and we have these archetypal experiences of life.” But she has a “firm boundary, a firm message that I don’t have your answers.”

In the months between the conference and the day that we finally meet, I had prepared myself for several possibilities with Laura. I had been prepared for the firm radical, a child of the movement more willing to adopt the opposition posture of anti-psychiatry with me than she had been on mainstream television. I had been prepared for a cynical Laura, ventriloquizing paeans to “choice” and “pluralism” in order to lead a movement where its more strident predecessors have failed to go. What I had not expected was this: this thing, at times like speaking to a very friendly alien or communicating through the superficial constraints of some translation software. I had not expected this utterly sincere belief—and I can only assure you that it was sincere, firm, plaintive, almost wounded—entirely contained within itself, that Laura believes, more than anything, in “pluralism,” in information, that she is, as she says, a “libertarian” about these things, someone who knows plenty of people on psychiatric medication and accepts that people indulge in “risky” actions all the time to cope with the pain of human life, who has ever only told her own story, and who is baffled—there was no other word that occurred to me over the four hours that we sat together but baffled—by the insistence of so many people, both fans and critics, followers and enemies, that her words, spoken in her book, or from her conference podium, or on television, or podcasts, or radio, over and over, containing phrases like “instruments of behavioral control” and “faith-based ideology” in reference to the D.S.M., or calling for a revolution in West Hartford—that all of this could not be understood to come with the disclaimer this is not intended as advice just because she said so. Who, maddeningly, is perfectly willing to express any number of views and advance any number of claims about science, medicine, and society from which the implied vision for others naturally follows.

“Sometimes, I think the people writing about me don’t even realize how skewed and distorted what they’re saying about me is,” she says. “Because they themselves are so deeply invested in the very ideology that my whole story calls into question. They don’t even realize what they’re doing. People are free to have whatever opinions they want about me. But when facts—whether it’s my life or my work or my book—when statements are made as facts that are actually factually inaccurate . . . I mean, you can read countless reviews of my book where people are saying, ‘She’s telling people to come off medications.’ I have literally never told anyone that. You can scour the internet. It’s important people understand that I’m not actually saying that because first of all, I’m not actually saying that. And second of all, if those false statements mean someone isn’t going to pick up my book because they’re just assuming it’s like a diatribe against medications, telling people to come off, that’s a bummer, because maybe that person actually would’ve found the benefit in reading my book.”

What benefit would that be?

“I would say I want my story—especially for someone who has yet to meet the mental health system—I want my story to catalyze a pause, at least. That doesn’t mean I’m saying don’t do what I did. It’s just saying, ‘Just be aware of the risks that might befall you.’

“Do you feel like you’re getting what I’m saying?” Laura asks. “Tell me if I’m wrong, but I get the sense that you think I’m talking around what I actually think or something somehow. Do you know what I mean?”

No, I say, I think that she believes everything that she told me.

She does not, she adds, have a persona for the media. “For better or worse, I can’t not say what I actually think,” she confesses. “I spent enough years of my life performing, so I literally can’t. I mean, it’s a flaw of mine because I can be really blunt and say things.” Still, she says, she is “careful” with language. “I really want to be understood as closely to what I’m trying to say as possible, so I’m going to speak as carefully as I can.” It is so easy to be misunderstood when discussing these topics. That was why she had flinched when I said “anti-psychiatry” when we spoke at the conference. “If you were going to say I had a kryptonite, it would be that label,” she says. “A, because it’s factually inaccurate. And B, I think that phrasing is often used deliberately to silence and discredit someone, like ‘Oh, they’re anti-this, anti-that.’ It’s just a way to say, ‘Don’t take this person seriously because they’re an extremist.’” Anti-psychiatry, of course, does not literally mean any of those things. But Laura is right: it’s a reasonable inference.

I ask her, one final time, if she would believe Kay Redfield Jamison or Lori Schiller, if they said that their books—great paeans to the power of psychiatry and medication—were not intended to suggest that other people take their medication.

First of all, Delano answers, we should remember that Kay Redfield Jamison is a psychiatrist, so surely she has told people to take their medication. But more important, “That kind of personal advice is not seen as dangerous. A message that is ‘Comply with the doctors’ orders.’ That’s the important phenomenon. Let’s say, hypothetically, in my end note, I was like ‘I hope you guys all go off your meds, that you decide the same thing that I decided for myself.’ Again, I didn’t fucking say that. But that would be called dangerous. That itself is what I’m fascinated by.”

Laura, at any rate, is her own believer in a kind of dialectic. Readers of her book are not “vulnerable or helpless.” Any influence she might have depends upon the audience. She herself had read Mad in America when she was nineteen years old and it had done nothing for her; it would be years before Anatomy of an Epidemic, read at the right place and at the right time, changed her life. If someone reads her book, “If they actually read the whole thing and actually had a shift in their perspective in some ways, that’s not anything I did to them. That’s something that arose from within them.”

It is getting late. Laura has to take a call soon, and we have been speaking for the better part of four hours. Having reached the natural conclusion of Laura’s self-image, we talk a little bit about lithium, about Freud. We had agreed in advance not to waste this time having a fruitless debate over our different levels of belief in mental illness. I had asked her at one point whether schizophrenia exists—whether, once one put aside all of the other causes she liked to point to for psychosis, from sleep deprivation to metabolic health to drugs to drug withdrawal and all the rest, there was any remainder, in her view, any population that had, by whatever cause, a chronic, as-of-yet-incurable brain disease, the kind of disease that I believe myself to have. But she only offered that “there’s so much we don’t know, so much mystery” in all of this. (In any case, she does not judge me for taking all those meds.)

We talk a little bit about her own alleged diagnosis, borderline personality disorder, the one she freely admits—as a kind of preemptive, diffusing joke—to “meeting the criteria” for in many of her interviews, and how the violence of that diagnosis comes in a way that cannot take no for an answer, how it interprets resistance to its reading as confirmation of the fact. She was amused by the way her book appeared to reverse the situation. She remembers people saying that “because I’m so borderline, the reason this whole thing happened to me is because of how borderline I was, that I had this extreme relationship with psychiatry where I was all in and then I rejected it.”

“You were splitting on psychiatry.”

“Yeah. I find that particular interpretation humorous. It almost confirms my whole point. And in that sense, I appreciate it, because it exemplifies the very phenomenon I’m demonstrating in the book, of a credentialed person taking it upon himself or herself to decide they have a more accurate or truer sense of you just because they have letters after their name.”

It is time to go. As we walk to the door, Delano asks me what I think of the whole chat. I say I don’t know. I am not much of an auditory thinker; it will not be until I have the transcript before me, when I can read it as a text, that I can begin to decipher its meaning. But at the door, followed by one of Delano’s cats, I do know that I like her. It is difficult to convey, but she is genuinely warm, friendly, charismatic in a way that does not read as a performance. And yeah, sure, maybe this is all a cynical con and I’m a dupe, totally taken in, and you may think so, but I don’t think so, and I am just telling my story here. In the Times profile of Delano, the one she doesn’t care for, there is a moment where she is talking to one of her consulting clients, a man named Daniel, who is in the process of tapering off lithium. Nine months in, he is anxious and unable to sleep. His thoughts are racing. He is afraid. In the story, Delano listens to him and then tells him a story of her own, about how after quitting her medication, she took a long walk through the night and felt her senses build to a crescendo. Although concerned at first, she decided that these were not symptoms. This was healing. This was coming alive. She tells Daniel that she could not promise he won’t have another manic episode, but her own fear had left her over time. “I get to write my own story from here on in,” she tells him. I believe that any reader of this story would understand Delano to be interpreting Daniel’s experience, to be suggesting that he stay on course and follow in her footsteps. But she understands herself literally: she is only telling her own story.

That is all she ever believes herself to be doing. She believes that. It is true. And that is what I read, standing by the door: this is a woman whose life is defined by the violence of interpretation, who spent years under the thumb of nurses and therapists and doctors who insisted on telling her the meaning of her life’s story, who revolted, who became an activist, who wrote a best-selling autobiography, and gave hundreds of interviews, and testified before Congress, and spoke at a conference she had brought together by sheer will, telling her story over and over, asserting, over and over, her interpretive authority over the meaning of her own life, only to discover, like all autobiographers, that she had traded the clinic for the madhouse of public attention, that people would not stop reading her, interpreting her, deciding what she meant to say and what she meant to society, that even her fans and admirers did this, despite how much she insisted and asked for them not to, that there was no way, so long as she existed in the gaze of any other person, that this would ever stop, that it never stops for any of us, even if she hasn’t quite yet resigned herself to that fact of human life. And here I am, at her door. As I leave, she asks if I hug, and we hug, but I think, Now I have to go and begin the cycle yet again. I will have to read you, to see you, to interpret you, and we will never be friendly like this again.

✥ ✥ ✥

In the borderline personality, a disorder that neither Laura nor I believe properly exists, the patient is said to suffer from an inability to stabilize her self-conception. The psychiatrist John Gunderson, who did more than anyone to define the clinical category and who treated Laura, all those years ago, at McLean, insisted that the core feature of the disease is not the self-harm or suicidality or even the tempestuous emotions but an extreme sensitivity to the attitudes of others. The borderline radar, he says, is always on and always scanning; the reaction to pings of dismissal or misreading produce intense, involuntary distress. It is painful. The experience of being misrepresented, overridden, or denied, particularly by those in a position of authority, leads to what the psychoanalysts Bernard Brandchaft and Robert D. Stolorow call “violent negative reactions,” not physical but emotional and relational: the cliché of unstable patient suddenly turning on a former friend or lover, attacking them with the same intensity with which they once desired their approval.

Theory holds that these reactions stem from an inability to integrate contradictory aspects of the self or of others into a coherent whole, what the psychologists Anthony Bateman and Peter Fonagy call a “failure of mentalization.” While most people can toggle imperfectly but functionally between an internal sense of self and an awareness of how they are perceived by others, the borderline personality cannot tolerate the stress. One vision—one interpretation—must prevail, and the patient either collapses into the external view, internalizing it as the whole truth, or regards it as a dangerous lie to be rejected. There is no middle position available.

The most famous symptom of the borderline personality is called splitting. This is generally understood as a tendency to divide the world into categories entirely good or entirely bad and to oscillate between these positions. The borderline personality is perpetually re-assigning people, institutions, and ideas between the two camps as the pressures and demands of her sensitivity require. Splitting is generally understood as a relational failure, its instability the anti-social characteristic that raises it to the level of pathology. But it may also be understood as a desperate, if unstable, search for a coherent story: of who you are, of what the world is, of how to make sense of those phenomena of human life that are inexplicable and painful. It is not so unusual to want that: to feel certain of what is going on, at least for a while, to find a story and stick to it, to feel its stabilizing influence and the control that comes with it. This does not strike me as pathological, or even unusual. It is the premise of sour grapes. It is work undertaken in the aftermath of every breakup, as the ego detaches from what was once irreplicable and precious. It is politics: “polarization” and “epistemic bubbles,” the Trotskyites at Brooklyn College who shifted, with the same ferocity that had animated their communism, into the foundations of neoconservatism. It is the long dance of psychiatry and anti-psychiatry: the need to know, once and for all, what is going on when one of us, some one or two in every hundred, suddenly and violently detaches from reality.

The alternative is horrifying. Set aside the worried well, the speed freak children, the disease-mongering, the mistaken bowel diseases, the whole immense body of the sane who have only fallen for a bit of pharmaceutical conglomerate profit-seeking. Go back to the Bronze Age with its graveyard filled with trepanned skulls. Read the writings of Aretaeus of Cappadocia, contemporary of Marcus Aurelius, a physician who found his patients “suspicious,” “irritable without any cause,” who wrote of people who “sometimes go openly to the market crowned, as if victors in some contest of skill” and other times “rend their clothes and kill their keepers, and lay violent hands upon themselves.” See the madmen of the Middle Ages, chained to the pillars of cathedrals, beset by wodness, the inmates at Bedlam, at Charenton, at the Salpêtrière, ranting and raving to nobody. Walk the New York City streets, circulate for a while in a locked ward, find me when I was twenty-two years old, trying to extract my lymph node from my neck with a kitchen knife to remove the demon poisoning me from the inside. Imagine yourself a mother, watching your daughter descend into agony. It would be so much easier if it were you. But it’s your kid, and she’s miserable, and frightened, and in pain, and you can’t stop it and you are so scared of what is happening to her. You have been told for your whole life that there are experts who know what this is and what to do, a story about disease and how to treat it. Imagine that she only gets worse. You are so terribly afraid. What is there to do but find another story, another theory of what is happening, another guide, another guru, and pray that this one proves correct, to think, This better work, because otherwise there is nothing left? There is nothing but this horror that comes sometimes in human life, this wretched, unfair rending of the child from the world, this obliteration of a person, this pain. And nobody can quite say what it is. And nobody can quite tell you what to do. Nobody can help you, nobody can stop it, nobody can promise. Three thousand years and nobody can make sense of it at all. Staring into that abyss: it’s enough to make you go crazy.