AUTHOR’S NOTE

T HE SUBJECT OF THIS BOOK is mental suffering, and its assumption is that everyone experiences mental suffering at one point or another. This includes diagnosed mental illnesses and disorders and undiagnosed or even undiagnosable anxieties, depressions, and burdens of life. It includes illnesses that have clear biological causes and ones that don’t have any clear cause at all. It includes the suffering of those who would say they have a “serious problem” and those who would vehemently deny that they have a problem at all. It includes examples from specific mental disorders and general experiences of mental distress. Although my subject is broad, it is not intended to be all-encompassing. I won’t try to describe the experience of every mental illness. But I do believe that what follows will resonate with most people who have endured mental affliction. Life is difficult, and we experience that difficulty in different ways and to varying extents, but we always experience it in our hearts and minds. That experience is the subject of this book.

In many ways my approach is described by the historian of science Anne Harrington in her book Mind Fixers. After tracing the successes and failures of modern psychiatry, Harrington advocates for an alternative approach:

Psychiatry has at least one possible alternative. . . . It could decide to return to a less hierarchical understanding of its place in the mental health and medical systems; one that . . . would acknowledge that mental suffering is a larger category than mental illness, and that even disorders with a likely biological basis are not just medical, because the experience of all human beings, ill or otherwise, are shaped by their cultural, social, and familial circumstances.1

Harrington’s recommendation for the future of psychiatry is based on an understanding of the basic human experience, one that I share and that forms the basis of On Getting Out of Bed:

We should keep in mind one very basic fact. Among the very many people who present with a mental affliction, some are (almost certainly) suffering from a real illness, one that is understandable (in principle) like any other mental complaint. By the same token, others are (almost certainly) not. Mental suffering takes many forms, only some of which have roots in disease. The suffering of those who are not really ill in any meaningful medical sense can still be acute.2

This book is for those who struggle with what Harrington calls “mental affliction.” It is for their friends and family members. It is for pastors, teachers, and parents—to help them understand their loved one’s suffering. It is for anyone who ever struggles to get out of bed.

I will not offer professional medical advice because I am not a medical professional. Neither will this be a memoir or a self-help book. In the spirit of Harrington’s broad approach to ...