This year marks the fiftieth anniversary of the publication of I Never Promised You a Rose Garden, the YA classic written by Joanne Greenberg based on the years she spent committed to a psychiatric ward as a schizophrenic teenager. The impact I Never Promised You a Rose Garden made upon its release in 1964 was fairly quiet. No excerpts were placed in periodicals; reviews, though complimentary, were printed on back pages. The book sold slowly until around 1969, when high schools and colleges began incorporating it into curricula.
Librarians and high school teachers and parents were all justifiably nervous that American youth were willfully courting madness as a means of rebellion. Charismatic figures like R.D. Laing and Timothy Leary preached a version of lunacy-as-transcendence, and educators and parents wanted to offer vulnerable young students a more realistic tale of insanity—one that took place in a locked ward rather than a field of flowers. Sales of the books shot up. It became a particular kind of classic, embraced not primarily for its prose, but for putting its finger on the pulse of a certain set of collective anxieties. Greenberg, who, by the mid-’60s was living symptom-free in Colorado, watched her sales rise. This year it sold nearly six million copies.
But not long after I Never Promised You a Rose Garden became canonical, it also became a lightning rod, and it is the contours of that controversy that make the novel still relevant today. Greenberg claimed full recovery, and many psychiatric professionals worried that this would inspire a false and dangerous hope. Schizophrenics, they said, simply cannot recover. German psychiatrist Emil Kraeplin, who coined the early version of the diagnosis “dementia praecox,” described the disease as “terminal.” The introduction of Thorazine in the 1950s offered some reprieve from the symptoms, but the best a schizophrenic could hope for was what Swiss psychiatrist Eugene Bleuler called “recovery with defect.” Doctors wrote articles that evaluated the novel as if it were a case history and re-diagnosed her autobiographical protagonist as a hysteric. In The New York Times an article headline read: “Schizophrenia in Popular Books: A Study Finds Too Much Hope.” One psychiatrist even repeatedly called Greenberg at her home to try to force her to admit she had been misdiagnosed.
It would be difficult to imagine mental health professionals going to such lengths to put Virginia Woolf’s corpse on the couch, or to attempt to determine a DSM code for Diane Arbus. Even Anne Sexton, whose laundry list of symptoms baffled her caretakers, didn’t inspire such heated speculation. In many ways, this is because these women reaffirm our modern belief about mental illness, namely, that it is biologically innate, all-consuming, and only in the best cases, manageable. Greenberg, by contrast, refutes the disease-centric model; her life continues to be full and stable—without the use of psychotropics. And while we tend to think of the disease-centric model as more humanitarian at its core—the aberrant behavior is not the fault of the sick person—one could easily see how it might actually contribute to, rather than negate, stigma against the mentally ill: a brain endemically miswired cannot be controlled, and the mentally ill, therefore, are bound to their labels for life.
The story of modern psychiatry, for many, is triumphant one. The quick-and-dirty history goes like this: Human ingenuity and scientific advances led us from the dark ages of hydrotherapy and solitary confinement to cognitive-behavioral therapy and expertly prescribed medications. While we used to believe the mentally ill were unwell as a result of wayward behavior or demonic possession, we now know that psychic anguish is the result of brain chemistry and nurture, and we’re working harder to analyze the former. We moved, in other words, from mental illness as a moral failure to mental illness as a medical condition.
But if you zoom in on the late 1940s through the early ’60s, a different battle is being waged—a battle between those who believed mental illness was biologically located in the brain, and those who thought mental illness was a matter of emotional disturbance. Back then, those intent upon transforming psychiatry into a reputable science (as opposed to a touchy-feely art) worked tirelessly to develop new methods of medical intervention for the mentally ill. The best-known method was “psychosurgery” (aka lobotomy), which was introduced by neurologist Egas Moniz in 1936. In 1949, Moniz won the Nobel Prize for his work on psychosurgery, and by 1951, the operation had been performed close to 20,000 times.1
Contrast this obsession with the physical brain—slicing it, shocking it, or tranquilizing it—with the ethos held by Chestnut Lodge, the elite private institution where Joanne Greenberg began treatment in 1948. The clinicians at Chestnut Lodge fervently believed that no patient, however psychotic, was impervious to psychotherapy. The champion of this viewpoint was the Lodge’s most famous employee, the gifted psychoanalyst Frieda Fromm-Reichmann. Fromm-Reichmann was Greenberg’s primary analyst and, in both the novel and in real life, led her from insanity to wellness. In the book, Fromm-Reichmann is “Dr. Fried,” and Greenberg so positively depicted the humble German that for years she received letters from struggling fans desperate to track down Dr. Fried and undergo analysis with her.
Fromm-Reichmann immediately recognized something special in her teenaged patient: Greenberg was quick-witted, well-read, and seemed to retain an appetite for life that many of the doctor’s older, chronically ill patients had lost long ago. Greenberg’s symptoms were often referred to as “florid”—interpretable, extravagant, and suffused with meaning, like a story. When Joanne was struggling, Fromm-Reichmann openly empathized. When she began to retreat, the doctor begged to follow. “Take me along with you,” Dr. Fried tells Deborah during a session. She insisted to her young patient that they must pose a united front. “I believe that you and I,” Greenberg has her say in Rose Garden, “can beat this thing.” And, together, that’s just what they did.
This narrative is a little too pat for our contemporary sensibilities. Perhaps that’s why the book is not as well known as, say, Sylvia Plath’s The Bell Jar. (The Bell Jar still sells briskly; the fiftieth-anniversary paperback edition is ranked 1,730 on Amazon, compared to Rose Garden’s 21,792.2) But Rose Garden does not appeal for another reason: It’s easier to think of the psychiatry of yore as entirely backward and as the poetic casualties of it—Plath, Arbus, Sexton—as victims of that ignorance. Their tragic stories, paradoxically, make us feel more secure in the march of psychiatric progress.
The demise of these women—and the subsequent autopsy of past mental healthcare failures that their paper trails encourages—permits us to rest serenely in the knowledge that the world is moving steadily toward a more scientific, humane psychiatry. But, one has to wonder if this is entirely the case. Frieda Fromm-Reichmann spent four years with Joanne Greenberg; she hiked up to the Disturbed Ward to see patients when they were lying limp in restraints. Now, psychiatrists evaluate patients for 45 minutes before diagnosing them and sending them off to fill prescriptions, and many patients go months between appointments. Efficiency is the goal here; medication the cure, meaningful human connection a distant second priority. It is increasingly rare to find a psychiatrist who also performs talk therapy, despite its many proven benefits.
This might be an even greater tragedy with regard to treatment of schizophrenia, where holistic treatment—that is, one that recognizes both the medical and the emotional components and allows for feedback between the two—might hold particular promise. According to Dr. Allen J. Frances of Duke Medical School and the author of Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life, “Cognitive therapy and social skills therapy are very valuable in treating schizophrenia, but they are rarely available.” And the idea of “complete recovery” is downplayed.
I don’t know what Greenberg’s “actual” diagnosis should be—perhaps she was not a schizophrenic—but I was so interested in her success story that, one day, three years ago, when I was about to release my own, highly personal memoir about my teenage effort to become anorexic (which I “succeeded” at, and then recovered from completely), I decided to write her a letter—an old-fashioned one that I sent in the mail. It wasn’t terribly difficult to track her down. Within weeks, a reply arrived, typewritten on textured, sky-blue paper. Her words to me were kind, smart, and so obviously honest. We struck up a correspondence. We’ve written letters to each other now for nearly two years. She was unabashed but not militant in her views on psychiatry. She told me about her experience writing Rose Garden, but also her daily life, which is filled with events at her synagogue, teaching at the Colorado School of Mines, dealing with the problems endemic to being eighty-something and an active EMT. She is a living example of someone who refused the fate prescribed to her and chose instead to be many other things: clever, attentive, kind, iconoclastic, and the author of more than fifteen books on wildly varying topics. Her life as a recovered patient is not a glamorous or a tragic or a particularly scary one—but it might be a truer one.
Gail Hornstein, Professor of Psychology at Mount Holyoke and author of Agnes’s Jacket: A Psychologist’s Search for the Meanings of Madness, wrote that lobotomy was “a lucrative sideline for many physicians,” which gives me an icky feeling similar to the one I have when I walk into my gynecologist’s office and see the walls plastered with advertisements reminding patients that Botox Available Here.
Plath’s death even spawned a theory that young female poets are more likely than other populations to suffer from mental illness, called, naturally, The Sylvia Plath Effect. (The existence of such a thing begs the question: The Joyce Carol Oates Effect? The Adrienne Rich Effect?)