This book vibrates with anger at the mental health system. The text itself is shot through with anger, and the acknowledgements afterward include a literal “fuck you” to the psych ward at St. Luke’s-Roosevelt.

Criticism of the mental health system is a minefield with me. I have so much skin in the game I end up on defense no matter who you want to criticize. Yes, inpatient mental health care is a critical need in this country, and yes, I can understand why a reasonable human would choose not to submit herself to that kind of care, because yes, inpatient mental health care can strip you of your civil rights and subject you to a hideous and dehumanizing invasion by people who listen to you not at all and just want to get through their shift. And yes, the mentally ill are people with rights who are worthy of respect, and yes, caring for the mentally ill day after day is draining, frustrating work, and yes, the staff who do this work sometimes abuse their positions and make decisions based on expediency rather than the best interests of the patient, and yes, the staff who do this work are underpaid and undersupported and undertrained.

LaValle navigates all of this beautifully. It’s a strange and impressive thing for a book to punch so hard at a complex machine like the American mental health system without the blow landing on any individual cog. Though the staff at the hospital can be stern, needlessly rule-bound, and at times outright abusive (our protagonist, Pepper, decides to turn down his meds, and the hospital staff thereafter refuse to give him his meals either), there are no Nurse Ratcheds here; just tired, frustrated people who aren’t getting paid nearly enough to bring their human compassion A-game day after day.

But while the author can show compassion and grace to each part that together makes up the sum of the mental health system, his criticisms of the whole are trenchant.

The jury’s verdict (at best) might’ve been: We really feel terrible for these people. (And here’s the hard part, they really would.) We feel terrible, but we have doubts. We doubt the world works this way, because it has never worked this way against us.

Ouch, right? And true, right? I don’t even know how much I actually liked this book qua book, because I was just so floored by the accuracy and empathy of LaValle’s portrayal of life in an inpatient ward. That he has lived this experience (which he evidently has) and can still write about it without vitriol is really, really impressive to me.

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