I ran into this at www.schizophrenia.com. It’s old news but I thought it was interesting. Discussion followed on the boards. I can’t quote any of it because of the confidential nature of the boards, but I can say that there was some talk of whether Mark Vonnegut was part of the “antipsychiatry” crowd, and whether he was oversimplifying or generalizing. Someone pointed out that the DSM definition of schizophrenia has changed since the time Mark Vonnegut was diagnosed with the illness (1970’s), and if he were diagnosed today, the DSM-IV would have him classified as bipolar. I will give you my opinion shortly.
Mark Vonnegut Speaks at Convention
May 17, 2003
Mark Vonnegut, M.D.
I’m happy to be here. Thirty years ago I wrote a book about
going crazy and have been trying to blend in ever since.
It’s about time I came around to see what NAMI was all
about. I don’t rush into things.
Thirty-two years ago I was diagnosed with schizophrenia but
with newer definitions my disease is more consistent with
manic depression or bipolar disease, mostly because I’ve
gotten better. These labels can be more trouble than they
are worth. There are manic depressives who don’t get well
and look more and more like chronic schizophrenics as they
go along. With the deck stacked against them, a considerable
number of schizophrenics do get better. Until we have some
unambiguous diagnostic test, we are all talking through our
Whatever the diagnosis, the care for serious mental illness
is in disarray. Meaningful leadership and reform in my
opinion is more likely to come from patients and their
families. The needs of patients and families dealing with
manic depression, schizophrenia, autism, depression,
substance abuse are very similar. We need a commitment to
improving care and the means to do so…
I’ve been lucky. I received good care early, and have had a
small number of episodes. Rather than a suicide or
chronically disabled son, brother, friend, I’m what they call
A &W, alive and well. The turn around on the investment for
recovery is substantial. I’m happily married, have a
wonderful life and three strong handsome very smart sons who
would not otherwise be. I could be dragging down a dozen or
If nothing I say sparks any thoughts or identification, it’s
possible you’re taking too much medication. If it’s the
greatest talk you’ve ever heard, you’re not taking enough.
There will be some tangential thinking and loose
associations. Being crazy has had a definite effect on how I
think. Not all of my good ideas are good.
Family history. My mother’s mother’s father was an alcoholic
who I strongly suspect drank to keep the voices away. My
grandmother was a very smart very accomplished woman who was
in and out of psychiatric hospitals much of her adult life.
She warned my mother not to marry my father because there
was instability in his family. My father’s mother who was
addicted to barbiturates and wouldn’t come out of her room
for weeks at a time and who eventually killed herself on
Mother’s day, told him the same thing. I’m the fourth
straight generation in my family of people who hear voices,
have bizarre delusional thinking and hyper-religiosity.
We’ve each saved the planed earth several times. My famous
father Kurt is not manic depressive. He’s not particularly
well, but he doesn’t hear voices or get all pumped up.
My first episode was in 1971. I believe I would have gone
crazy eventually regardless of outside events although they
were very crazy times. The assassinations of JFK, MLK, RFK.
Kent State, the music, the drugs, the counter culture… My
father, was transformed from a not very good car salesman
who couldn’t get a job teaching English at Cape Cod C.C. to
a guru super star. By the time I started hearing voices so
many other unlikely things had happened it didn’t seem out
of line. I assumed everyone was hearing voices. To try to
find out and so as to not appear unsophisticated, I remember
sitting down next to someone and saying, “So what do your
voices tell you?”
There are many people who fully recover from major psychotic
episodes and go on to live full rich lives. Most of them
choose to keep quiet about it. In the middle of my illness
when I was far from sure that I would survive, I made a
promise to remember and tell the truth about whatever it was
that was happening to me. I think it helped. For me,
remembering and trying to tell the truth is part of my
defense against this disease.
Thorazine, ECT, massive doses of vitamins, were the initial
medical intervention tried on me. It should be noted that
I’m a very positive person. I’ve responded positively to
virtually everything that’s been tried on me. If you
sprinkle happy dust on me, I get happy, at least for a
little while. What I loved and continue to love about the
medical model more than the actual medical means, is that
it’s hopeful. It lessens shame and blame.
Now, just about everyone accepts the medical model. We have
more effective medications with fewer side effects. I should
be happy but I find myself uncomfortable. More and more just
about all the questions and all the answers about mental
illness are about medication. Mental illness causes poverty
and poverty causes mental illness. The same is true of
trauma, prejudice, lack of education, lack of skills, loss
of spiritual values. Learning how to live well in spite of
your illness is at least as important as medication.
I saw a study the other day showing that some atypical anti-
psychotic was at least as good as mood stabilizers in
preventing suicide. It’s a very good thing to decrease
suicide but we should care at least a little if I’m not
killing myself because I feel better or if I just can’t
remember where I put the damn gun. I want patients and
families to have more power. When the interests of patients
and families are not perfectly congruent with those of the
insurance and pharmaceutical industries, the patients will
I would never advise patients to waste as much time as I do
ranting and raving about the insurance and pharmaceutical
industries. What is much more important is to make, for
yourself, in your own terms, a clear distinction between
yourself and your disease and where you want to go as
opposed to where your disease wants to take you. Doctors,
therapists, medications can only be helpful when they are
helping you go where you want to go. Otherwise all the help
is just a bunch of crap strewn around a messy room. The road
to medical school started with a job mowing lawns I was far
from sure I could handle.
People with mental illness are very much like people without
mental illness only more so. What we loose with a psychotic
episode is the comforting assurance that we can’t loose our
mind. When most people look down they see solid ground. When
I look down, I’m no so sure.
Crazy thoughts are not the problem. Everyone has crazy
thoughts. Hallucinations and delusions tend to catch the
attention but aren’t the problem. The problem is that the
world becomes discontinuous. We can’t attend to the world
and take care of ourselves. So others try to take care of us
and they do an imperfect job of it. There is no substitute
for being well.
Patients and families should not be left to play one on one
with big corporations and providers whose resources dwarf
their own. Patients and families should not have to re-
ent the wheel over and over.
Even though I’ve only had 4 psychotic episodes and I am now
17 years and 4 months from my last hospitalization, I still
worry about it happening again. The bad news is that the
worry doesn’t go away. The good news is that worrying about
your mental health doesn’t have to stop you from having a
full life. I comfort myself with the knowledge that I’m a
hypochondriac in other areas. Headaches that last longer
than an hour might be brain tumors. George Gershwin died of
a brain tumor, why not me? Anxiety or chest pain might be a
heart attack. Just because they haven’t been yet, doesn’t
mean much, nor do the normal EKG’s or stress tests I’ve had.
Tests are often wrong. Doctors are all a bunch of miserable
quacks avoiding their own problems by hanging out with sick
My job was and remains, to be well enough to be able to
politely dis-invite the beneficent attentions of others as
many steps as possible prior to hospitalization and
It was not easy to go from being one of the seven righteous
pillars holding up the whole planet and human race to being
just another mental patient. I remember talking to a woman
who was ending racism and asking her if it was part of a
bigger program or if racism was the whole deal. As someone
who had gone back to the beginning of time and dealt with
issues of whether or not life itself was a good idea, I
wasn’t sure that just getting rid of racism was a big enough
When I got a good look at the inner workings of the universe
and sadly realized that I couldn’t go back to life on the
planet earth knowing what I knew, the voices suggested that
I could go back but it would have to be through a
psychiatric hospital with the cover story that I was crazy.
“Ya. Like who’s going to believe that?”
In the eighties when I was called out of retirement to
defeat communism, it was over my strenuous objections. “I
don’t even dislike communism all that much,” I objected. “It
seems so beside the point.” “The Republicans are going to
take credit for this and ride it into the ground,” I
correctly predicted. After winning many many preliminary
rounds which I honestly hoped I’d loose, I was smuggled into
what was thought to be just another psychiatric hospital
where the Russian bear took one look at me, declined to
dance, and the rest is history. My delusional world always
felt kind of tinny and hollow, but that never helped me get
out of it.
As a form of gross overcompensation with a chip the size of
Montana on my shoulder, I decided to try to go to medical
school. I applied to 21 Medical Schools. Most rejected me by
return mail, probably on the basis of my age and
undergraduate grade point average. I didn’t need a
psychiatric diagnosis to be a questionable applicant to
I gave serious consideration to saving the $50 and not
applying to Harvard at all. I honestly think that they
admitted me partly to prove that I wasn’t schizophrenic,
partly because they thought I’d be a good doctor, and partly
just because they’re Harvard.
It’s amazing that I’ve been through what I have and practice
medicine. Today I’m glad I don’t see any particular cosmic
significance or purpose in these events. I just feel lucky.
Today it’s nice to be able to entertain odd thoughts without
having to marry them all. Thank God. I can think whatever
the hell I want. Entertaining odd thoughts won’t make you
crazy. Refusing to entertain odd thought won’t make you
During my recovery from my last episode a very wise friend
told me that other people’s business was not my business. I
felt insulted that he bothered to tell me such an obvious
thing. He then said that what other people thought about me
wasn’t my business. Harder but still not earth shattering.
He then went on to say that what I thought wasn’t really my
business either, which has kept me puzzled ever since.
I’ve come to believe that I’m at my best and that it’s a
beautiful world when my feelings are like the weather and
that what I think is not my business.
A surgeon during my core surgery rotation said that he knew
who I was, but that he was going to treat me as if I were
normal. I sincerely thanked him and said I’d do my best to
act that way.
Are people who have been crazy held to unfair standards?
Of course, but it’s not in your best interest to complain.
If you’re paranoid and people are looking at you funny it’s
best to let it pass. Psychotic people have an uncanny knack
for making their own worst dreams come true. Depressing
things happen to depressed people way beyond what you would
expect from random distribution.
I don’t think the people today who start hearing voices,
stop eating and sleeping, and run amuck are likely to get
good treatment. Having more knowledge, better diagnostic
capabilities, better medications with fewer side effects,
can’t make up for the fact that most patients are being
treated by doctors, therapists, and hospitals, who are
operating under constraints and incentives that reward non-
treatment, non-hospitalization, non-therapy, non-follow-up,
non-care. Lost to follow-up is the best outcome a health
insurer can hope for.
I take Lithium and believe that it has saved my life. I wish
I didn’t need medication. I’m not wild about the tremor and
think I might be 20 lbs lighter without Lithium, but what I
really hate about medication is that it helps me, which
means I’m not nearly as perfect as I wish I were. I should
be able to maintain my mental health by the exertion of my
There’s a big difference between believing you can fly and
flying. The romance about creativity and mental illness has
come from the hard work of great artists struggling against
the illness not giving into it. The best defense against the
seduction that mental illness will make you creative, is to
actually be creative. Please don’t give the disease that
tried to kill me credit for my writing and painting.
Let me be clear that there’s no romance. I never want to
dance that dance again. The more times your wheels go into
that rut, the harder it’s going to be to get out. I dread
nothing more than the next break, and am certain of nothing
more than that there’s nothing positive for me in the
You can’t look a the paintings of Van Gogh, and other
achievements of manic depressives without concluding that
there are positive capacities associated with this illness.
But those positives are AS A RESULT OF FIGHTING THE ILLNESS
RATHER THAN GIVING IN TO IT.
What you do when you accomplish something is to say, “bugger
off disease.” This disease is never your friend.
My illness, my enemy, is a valuable compass. I can usually
figure out whether or not something is moving me closer to
or further away from a break. And I can lean from others
what things they think help defend them against the next
break. The way to live a healthy life is to get a chronic
disease and take good care of it.
It’s alarming that someone like myself with such a
pathetically underdeveloped respect for safety issues became
a pediatrician. When asked by parents about car seats, I
have to work at not letting it slip that I don’t really
care. I also can’t stand it when mothers talk to their
babies in high squeaky voices. It’s a true miracle I’ve
lasted as long as I have.
I’m supposed to tell adolescents about high risk behaviors.
I told one moth
er who asked me to give her son THE LECTURE,
that if one more person told her son about sex, drugs, and
alcohol, he was going to vomit. I told him I thought I
should have posters on the wall saying:
“If you’re having trouble with decisions, smoke marijuana.”
“Safe sex is better than no sex at all.”
“Drink yourself into a black out whenever you can.”
This is all by the way of leading up to say that alcohol and
drugs will almost make things worse for anyone recovering
from mental illness but each may have to learn that for
It’s possible within any given moment of any given day for
me to choose between self and disease. I am rarely faced
with big heroic choices that will settle the matter for once
and for all, though the disease likes to tell me otherwise.
I look for the smallest positive step. I try not to argue
too much. If I’m right, I don’t need to argue. If I’m wrong,
it won’t help. If I’m OK, things will be OK. If I’m not OK,
things don’t matter.
Thank you for your time and patience.