Voices carry

By S.I. ROSENBAUM  |  October 21, 2011

The child is also aware, somehow, that her disfigurement is a birth defect caused by her mother's alcoholism during pregnancy. Perhaps, Marty thinks, that's why her mother is so cruel to her.

"It must have tore her up every time she looked at me," Marty says. "The guilt she must have had. She was the kind of person who would hit you and then hold you and cry and ask for you to love them. How could you love them?"

Her father comes home from work and asks, Which one of you children put a hole in the wall?

The children laugh: Mom did it, Mom did it.

Later, Marty won't remember when the voices start, but she'll remember what they say.

It's either you or your mother. It's a man's voice, low and resonant. It's not in her head; it's in the room. It sounds as if he's standing a little to her right. You or your mother. Decide now, because one of you has to go.

It doesn't seem stranger than anything else that has happened to the girl with the scarred mouth.

"It was normal," she'll remember, "because everything was insane."



In the early decades of the 20th century, it looked like the psychological view of madness was winning out.

The Talking Cure was in its golden age, and for Freud and his followers, the symptoms of madness were loaded with meaning. Analysts sought the roots of illness in the traumas of childhood, the unloving mother or the abusive father.

For doctors who took the biological view, therapeutic tools were few and crude — the electric shock, the insulin coma, the ice-pick lobotomy.

But it was also the dawn of the age of modern chemistry, when scientists the world over were experimenting with new compounds, looking for ways to use them.

In 1946, a French pharmaceutical company discovered that a particular chemical — originally developed as a synthetic blue dye — had a curious effect on surgical patients. It calmed them without knocking them out, inducing "a euphoric quietude," a state of dispassionate, unsedated clarity. The company developed it as a tonic for the anxiety and agitation associated with psychosis.

Within a few years, the new drug was in use in asylums throughout Europe and the US. It was marketed as Thorazine.

Thorazine was a turning point for psychiatry. It wasn't just that there was finally a pill for insanity: the drug offered an explanation for insanity itself. Since Thorazine changes the amount of the neurotransmitter dopamine in the brain, it seemed to stand to reason that psychosis was caused by a dopamine imbalance. This was evidence of a real, physical cause of madness — one that doctors could correct, just as they could correct the imbalance of insulin in diabetics.

For so many people with mental illness, and for their families, the medicalization of madness was a relief. If schizophrenia was a physical problem, it meant that no one was to blame. The mad could no more be blamed for their condition than can diabetics or quadriplegics.

The problem of madness seemed to have been solved.

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