Author of The Mind Reels
By Sarah Kloth
In the mind reels, readers are brought into the unvarnished reality of living with bipolar disorder through the story of alice, a young woman whose journey avoids the clichés of romanticized madness and instead captures the pain, tedium, and consequences of severe mental illness. In this conversation, the author discusses the importance of telling the truth about mental illness, the decision to write fiction rather than memoir, and the ways literature can deepen our cultural understanding of psychiatric struggles.
The portrayal of mental illness in your book is incredibly raw and unflinching. What drove you to write The Mind Reels in such an honest and unromanticized way, especially when so many stories tend to glamorize or sensationalize mental health struggles?
FD: I think the second part of your question answers the first. We have a responsibility to tell the truth for its own sake, for one thing. For another, how people think about mental illness has huge stakes for people who are mentally ill. The relentless romanticizing convinces people that every sidewalk psychotic is secretly a philosopher or artist or political dissident, which makes it harder to build the structures necessary to get them the care they need. If every mentally ill person is actually just marching to the beat of a different drummer, if schizophrenia is an expression of an artist’s soul, if madness is really a deeper and more fulfilling way to live – if that’s all true, why fund treatment? Why build hospitals? Why investigate more and better psychiatric drugs? We don’t treat people for being dreamers and nonconformists. These sunny, false concepts of severe mental illness completely undermine our moral responsibility to find better treatments. And they lead to situations like that of Michael Laudor, once the world’s most famous schizophrenic. He overcame his disorder to attend and graduate from Yale Law School, and in doing so became a kind of celebrity, a person in whom many people invested their hopes for people with mental girlfriend to death. The narrative was so pleasant, the idea of the guy who rose above his disorder to become part of the intellectual elite, that nobody noticed how incredibly sick he was, and his girlfriend paid the price. You can’t see clearly through rose-colored glasses.
The reality is that almost everyone in the throes of a psychotic disorder is in terrible pain. It’s a horrific thing to go through, severe bipolar mania. It’s a nightmare of fear and paranoia. People suffering from it deserve simple and direct sympathy, not phony, idealized depictions in pop culture. And the loved ones of the sick need to understand that untreated psychotic disorders don’t lead to more vivid, less conformist lives. They lead to poverty, abandonment, and suicide. We can’t help people with severe mental illness by idealizing and depersonalizing them. You can ultimately only ever help people by telling the truth about them.
You’ve mentioned in your author’s note that you intentionally avoided the memoir route because you felt it would either be boring or misrepresentative. Can you talk a bit about how fiction allowed you to explore mental illness in a way that memoir wouldn’t have?
FD:I mean there’s a very practical level to this and a broader level. On the practical level, I simply don’t have stories to tell in my memoir because the actual experience of even very severe mental illness is quite boring. As someone who suffers from bipolar disorder, I have had long periods of euthymia, the space of stability between depression and mania; I’ve had depression, which is notoriously difficult to portray literarily and in terms of actual action involves sitting around, moving very little, and lots of sleeping; and I’ve had the long build-up phases of mania which are also typically not at all interesting, for me just gradually growing more and more paranoid, drinking alcohol by the gallon, working out like a demon, and not eating. The periods of peak mania, of actual psychosis, for me are mostly not wild experiences but long sick nights sweating in shitty apartments. I have had a very small number of violent incidents that have been more pathetic than exciting. Eventually I end up becoming so clearly unstable that someone forces me to get emergency treatment, and psychiatric hospitals in real life aren’t horrible torture prisons but drab boring spaces populated by generally competent medical staff. Ultimately I simply could not ever cobble together real experiences into a life narrative that any publishing house would want to pay for or any reader would want to read. And I’m afraid I’m not James Frey. So I had to do it as a novel.
In the broader, more philosophical sense (for lack of a better word)… the central premise of a memoir is that one’s worth telling. And that’s just not true, for me. The very small portion of mental illness memoirs that I value are those like Susannah Kaysen’s Girl, Interrupted, which is dominantly not about her actual experiences in the psychiatric hospital but about her interior life while in that space, her ambivalence and confusion. No matter how I did it, a memoir would feel like a lie. I thought that in fiction I could tell a story that both demonstrated the banality and grinding boredom of mental illness while still being worthy of reading. And I hope I did.
Alice’s journey in The Mind Reels is harrowing, as she navigates the intense highs and lows of mental illness. What aspects of her character are most personal to you, and how did you use your own experiences to shape her?
FD:Alice’s story shares a lot of the broad outlines of most anyone with bipolar disorder. You have what the call they prodrome, which is a period before your first mania where there are some telltale signs, although people usually only realize that after the fact. You have the arrival of depression, which can often result in a misdiagnosis of unipolar depression and (as with Alice) drugs that can trigger mania. You have the development of paranoia and delusion that alienate friends and family, you have hypersexuality, you have sleep disturbance, you have frightening weight loss. Finally you have psychosis which forces treatment. That general arc happens to almost all of us. The part that is most important to me is the hardest part of all, which is the loss of friends and relationships over time, the way that the accusations and the instability eventually force people to make the (entirely rational) decision to cut you out of their lives. It’s happened to me again and again, and it’s part of why I find the tendency to romanticize all of this so offensive. You lose people who you never get back, and there’s nothing good about it.
In the particulars, obviously, Alice and I have very little in common; I’ve never been a college-aged girl in Oklahoma. I wanted to keep a certain amount of authorial distance from the character in order to emphasize the universality of these conditions. It’s an interesting paradox – they prompt specific beliefs and delusions that are utterly individual in character, and yet they produce behaviors and ways of thinking that are remarkably similar in their broad outlines. Schizophrenics might fear that they’re being followed by the CIA or by vampires or by representatives of the Walt Disney corporation, but being surveilled in general is a commonplace that’s seen again and again. Bipolar patients can have remarkably different affective experiences, with some finding the early weeks of psychotic mania a period of elation and others experiencing it as a hellish time of heart palpitations of relentless fear. But ultimately paranoia everyone collapses into the relentless acceleration of everything, until you can feel nothing else. I wanted to inhabit Alice so that I could hold at arm’s difference that which was still fundamentally a story I shared.
I also confess that I’m taking advantage of society’s stereotypes, a bit, in that it’s just easier to shock people with a story about an ordinary adolescent girl than with an adult man. (One core experience I wanted to portray was hypersexuality, a very common symptom, which wouldn’t have been possible if my protagonist had been a college-aged man; college-aged men are always hypersexual.)
There’s a notable absence of dramatic moments in Alice’s illness, yet we still get a vivid sense of the grind and tedium of living with bipolar disorder. How did you go about capturing that ‘boring’ yet exhausting experience in a way that is both true to life and compelling for the reader?
FD:I tried very hard to depict the internal experience of depression and mania in a way that’s true to (my) life. This is of course a quixotic task, as psychotic disorders distort the very perceptual mechanism through which we experience our own experience, and I don’t think any writer is masterful enough to accomplish that. But the beauty of fiction is its capacity for metaphor and symbol, and so I felt free to come up with the best analogs possible to the experience of psychosis. Film depictions of mental illness are handicapped in that they can’t give you direct access to mental life, and screenwriters and directors are always trying to figure out a way around that limitation. With a novel I can just tell you what’s going on inside of her head. And I hope that what I’ve done is to demonstrate the connection between bipolar mind states and bipolar behavior. How does what Alice is doing lead to what Alice is thinking?
The book delves deeply into the impact of mental illness on relationships, from friends to family. How do you think society’s reactions to mental illness, both well-meaning and not, contribute to the isolation of those who suffer from it?
FD:I think the biggest thing is that the people who love you always want you to be okay. Sometimes that’s like an embarrassed parent or spouse who doesn’t want to face the stigma of being associated with a crazy person, but more often than not it’s just a profound and sincere kind of wishful thinking. And we don’t want to worry the people who love us and we don’t want to lose our freedom. So we tell the people closest to us that we’re alright when we’re not alright, and when things get bad again, it feels like a betrayal. Alice’s parents are in denial, and like most they never truly understand.
So you end up in an overtaxed medical system that would love to declare you in remission so that you can stop clogging a hospital bed, friends and family who have no frame of reference at all for your disease and want more than anything to just get past the difficult period, and your own denial and shame telling you to put your head down and push through. And that’s how you end up in a scenario where you can “forget” that you repetitively become psychotic, which only makes the next crisis that much worse.
You’ve described your book as a way to capture what it feels like to lose one’s mind. In your view, how does fiction give readers a better understanding of mental illness compared to non-fiction or memoirs?
FD:Well again, being able to match dramatic action to specific mental states, to make everything line up in terms of depicting behavior and internality, is an affordance you simply don’t have in honest nonfiction. Another reason I wouldn’t write a memoir is that I just don’t remember many core elements of my own story; I was diagnosed almost a quarter century ago, the condition itself damages your memory, and the drugs you take to control it do too. Years ago I did a kind of personal truth and reconciliation mission where I tried to piece things together, to figure out the dates of various hospitalizations, to understand how things went on for as long as I did. And I found pretty quickly that my memory was just deeply flawed. It was difficult to simply do a “this happened, and then this happened, and this happened after that” with my own history. I discovered that my casual timeline for my own illness in my head made no sense, and when I looked into one particular hospitalization I found that my recollection of when it happened was off by more than two years. With Alice, the timeline was whatever I wanted it to be, which meant that I was free to dramatize the process in a cleaner, more digestible style. Which didn’t mean that there weren’t timeline problems! In the galley’s there’s a reference to Alice’s landlord in a period where we’ve already established that she’s living in a dorm. That was easily fixed. I guess this is a banal answer, but man it’s a lot easier when you can just make the narrative up.
The novel doesn’t shy away from showing the limitations of the mental health system, from insurance struggles to ineffective treatments. Can you expand on how you wanted to address the shortcomings of mental health care in America through Alice’s story?
FD:I am a big believer in the value of establishment mental healthcare; I really strongly disagree with the antipsychiatry movement, which is a big part of my next nonfiction book, coming in 2026. and insurance; an unforgivable number of people still lack financial access to care. There’s also the fact that we have a problem with different specialties within medicine seeing very different financial futures. Psychiatry is notoriously hard on doctors, what with the tragedy of genuinely debilitated patients, but it also is poorly paying, especially compared to specialties like orthopedics, cosmetic surgery, or anesthesiology. And so unsurprisingly there’s a profound difficulty in finding psychiatrists to work outside of major urban areas. Two thirds of American counties do not have a single prescribing psychiatrist.
As far as the practice of mental healthcare itself, I think Alice’s story shows a few of the consistent problems. Everyone, even seasoned doctors, would prefer that you be alright, and there’s a tendency to try and probe until they find a reason to declare you fit for discharge, often missing serious illness. This is exacerbated for Alice because women are systematically under-diagnosed for psychotic disorders, which tends to happen because they’re seen as harmless. Unfortunately, too many doctors tend to see mentally ill patients in terms of their perceived threat level, especially GPs who are forced into assessing psychiatric health. And there’s also bit in the book that I find a growing problem, which is therapists who are obsessive about finding childhood trauma even when that’s not really helpful for the patients. The biggest thing though is that Alice’s arc, and mine, are far too common – if you don’t have a specific person who is very carefully following the progress of your treatment, going off meds is incredibly easy to do, and the next thing you know you’ve ruined your life again.
How do you balance the need to depict the painful reality of mental illness with creating a narrative that keeps readers engaged and emotionally invested in Alice’s journey?
FD:I think the brevity of the book was important there. There’s another version of this book (more theoretical than written down, although I did write some) that’s another 60-80 pages long. One of the things that people don’t understand is the repetitiveness of chronic mental illness, which is what will really kill your relationships. Friends and family members and romantic partners tend to really step up for a first psychotic episode; they love you and they want to help. You end up losing them because of how these psychotic events are so repetitious – even someone who is truly dedicated is going to find their fourth trip to fish you out of the ER really hard to take. And this other version of the manuscript was going to dramatize that. I ended up paring the whole thing down because I realized that no one was going to read the thing and I couldn’t do any good if no one was reading it. I wanted the book to be painful to read but not a slog.
That said, I think a lot of people are still going to look at this book and say, “No thanks.” But I knew that would be the case going in.
There’s a tension in the book between the clinical and the personal experiences of mental illness. Can you talk about the role of psychiatric treatments in the book and how they fit into Alice’s larger narrative of self-discovery and recovery?
FD:I hate One Flew Over the Cuckoo’s Nest (book and movie) with a burning passion. I think that its narrative has done really profound damage to how mental healthcare is perceived in this treatment. (And it’s protagonist is a rapist who has curiously become a folk hero.) The idea that every psychiatric hospital is a terrible dungeon of oppression, filled with fickle and cruel nurses and doctors, is just false and destructive. I’ve been inpatient six times, including several times in high-security locked wards. And certainly there’s a lot not to like about the experience. But almost universally I’ve found that the staff at those places are competent and eager to help patients heal. Alice finds what I think a lot of patients find, which is that in the real world “resisting” the psych ward is pointless and stupid and hurts no one but you. It’s when she’s inpatient that Alice is first taken seriously and her disorder understood as the life-threatening condition it is. The staff there give her the chance to save her own life, if she commits.
And, look, it’s all imperfect. I tried to make it plain that the drugs are genuinely, deeply unpleasant, that the side effects are brutal. Her experience at the ER is all too typical – I’ve been brought to the ER by concerned friends more than a dozen times, and in my experience most emergency room staff don’t think you’re their problem and will try to wait you out until you leave so you’re not their problem anymore. I’m sure being a triage nurse is a very hard job, but I will bear a grudge against triage nurses for the rest of my life. The reality is that there are problems with psychiatric medicine in just the way that there are with all other forms of medicine, but committing to taking meds, doing therapy, and seeing your doctor can save your life. It’s saved mine.
In your author’s note, you mention that the experiences of people with mental illness are often boring or tedious. Do you think society, through media and literature, misrepresents the reality of mental illness by only showcasing the extreme or sensationalized cases?
FD:There are some moments in mental illness that are genuinely dramatic, but the problem is that they’re brief and tragic. When someone with schizophrenia commits a terrible act of violence, sure, that’s dramatic, but that have an entire novel or movie dedicated to short bursts of tragic violence. So they tend to instead make delusion and psychosis into something they’re not, which is a cinematic experience, understandable fundamentally by looking at behavior. But psychosis is always internal before it’s external. Navigating that problem typically involves choosing between obvious external behaviors, which are easiest to depict as either dramatically violent or poetically artistic. And so we’re caught in this dichotomy between the old school of lurid depictions of frightening madness and the newer wave of portrayals that are so sympathetic they fail to tell the basic truth about how debilitating this all is. For that reason I find it so essential to dramatize the mundane daily existence of real psychiatric illness. I understand that pop culture always gravitates towards the sensationalistic, but because most people have no direct experience of severe mental illness, the risk of distortion is even greater.
Your novel has already drawn praise for its precision in depicting mental illness. What do you hope readers will take away from Alice’s story, particularly in terms of understanding mental health struggles in a broader cultural context?
FD:You know I don’t want this book to be perceived as didactic, like the point is to teach a lesson. There’s no quiz at the end. I do hope that there’s something entertaining in it for any reason, even as unpleasant as much of it might be. But yes, I do hope people might understand from this book that there’s no upside to this condition. Mania isn’t a period of intense happiness for most of us, and even for those who experience euphoria, the results are eventually the loss of jobs, legal problems, financial ruin, and broken relationships you can never get back. Alice’s illness isn’t some operatic madness. It doesn’t endow her with magical creativity. There’s no poetry or beauty in it. It’s an illness, a disorder, and it ruins her life. I needed to depict her from the perspective of later decades because any sense of romance you might feel for the disorder in your youth will be long gone in time. When you’re nearing middle age and your credit is a disaster and your resume is pathetic and when so many people have walked away from you, and you know that they made the right decision in doing so…. The ending of the book is most precious to me because it (attempts to) dramatize the immense sadness of a life scarred by bipolar disorder. And just by depicting someone with a psychotic disorder who’s over 30, whose madness doesn’t look sexy anymore, I think is valuable.
Lastly, mental illness has been a recurring theme in much of your work, but The Mind Reels is a departure into fiction. How did the shift from writing non-fiction to fiction impact your approach to storytelling, especially in terms of audience reception?
FD:I never wanted to be Mr. Mental Illness guy. I was in denial for fifteen years of my life, telling myself that my disorder was something I could handle on my own, in those rare moments when I admitted to myself that I had it at all. When I was coming back to writing, trying to rebuild a life ruined by scandal, I resisted writing about this stuff because I didn’t want to pigeonhole myself. Over time I got dragged into debates about it all and came to think that I had a responsibility to fight for my point of view. But essays and arguments, as important as they are, are cramped and limiting, and I wanted to just tell a story, one girl’s story, and as long as that story was true, it wouldn’t matter that it was fiction. And I think Alice’s story is true.
The mind reels challenges us to reconsider how we think and talk about mental illness. Instead of the extremes so often portrayed in popular culture, it asks us to confront the quieter, harsher truths—the boredom, repetition, and deep losses that mark these disorders. Alice’s story lingers as a reminder that compassion begins with honesty, and that understanding mental illness means seeing it not as a source of beauty or inspiration, but as a reality that shapes—and often scars—everyday life.
The Mind Reels
Fredrik deBoer
In a dorm room at her safety school, surrounded by corn-fed boys and contemptuous girls, Alice is losing her mind. Her first semester is spent clinging to middling grades between drunken hookups and roommate fights. The next brings sleepless nights, extreme weight loss, and effortless, compulsive energy, paused only by an unexpected summoning from the RA for evaluation. Thus begins an endless march of lithium, antidepressants, and Klonopin; doctors and therapists—when health insurance allows—along with overwhelmed parents and well-intentioned friends; all helpless bystanders as Alice descends deeper into chaos.
As chilling as a psychiatric case study, as wry and precise as Flaubert, The Mind Reels peels back society’s polite trappings to portray the experience of mental illness in all its complexity.
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Article originally Published in the Fall 2025 Issue.