March 23, 2025

Disability Books #2: Unshrunk

A critique of Laura Delano's memoir "Unshrunk," which claims that psychiatric drugs cause mental illness.

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Before I get to the main subject of this email, I want to link to two pieces of mine that ran last month:

• “Inhabiting and Disavowing Disability in A Different Man" in Bright Wall/Dark Room

• “‘Nesting’ Rejects the Easy Answers About Leaving Abusive Relationships,” an interview with Roisín O’Donnell, in Electric Lit

I haven’t written much recently because I have been so, so, so tired. Hopefully, you’ll be hearing from me again soon in the form of some casual capsule reviews. I also have two more pieces, an essay and an interview, coming soon elsewhere.

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CW suicide

I can’t remember the last time that a book made me as angry as Unshrunk: A Story of Psychiatric Treatment Resistance, by Laura Delano, so of course I tried to pitch an article about it. I wasn’t successful, but Judith Warner’s absolutely scathing review in the Washington Post—one of the most brutal book reviews I can recall reading in a mainstream paper—is so comprehensive and so damning that I don’t feel so bad about not having my say somewhere outside this newsletter. You can read that review here.

Delano, who is related to those Delanos (i.e., related to FDR), was diagnosed with bipolar disorder at 13 and spent the next 14 years of her life in and out of various forms of treatment (all kinds of medication, repeated stints in psychiatric institutions). At one point she made a serious attempt to commit suicide. The bare bones of this narrative are sympathetic and in the early stages of her (very well-written) account, Delano’s grievances with the system in which she spent so much time are legitimate. Her first psychiatrist diagnosed her as bipolar after one visit, for instance; she’s right that many patients with serious mental health issues are over-medicated (she was prescribed many, many different medications, often several at once to try to counteract the side-effects of other medications she was taking) and that American psychiatry is over-reliant on medication in general (because there are not enough therapists available, and many people cannot afford therapy); some of her other therapists seem unprofessional if not outright cruel. There is and always has been a lot to criticize about the institution of psychiatry, from its male-dominated beginnings to the abuse of young and disabled people in psychiatric institutions throughout the discipline’s existence. Like all institutions, psychiatry (as well as medicine) is flawed. Other people have written books along these lines, including Suzanne Scanlon last year. Scanlon’s memoir Committed describes the years she spent in a state psychiatric hospital, where she too was over-medicated and misdiagnosed.¹

Scanlon’s account is deeply ambivalent and draws on the experiences of many other mentally ill women throughout the twentieth century, broadening the scope of her narrative. She acknowledges that she will be on some form of psychiatric medication for the rest of her life, while also criticizing the hospital and doctors who treated her for grossly misdiagnosing her condition at the time. By contrast, Delano’s book is extraordinarily myopic and conspiratorially-minded. After deciding that her life would be better off medication, she decides that psychiatric medication is actually the cause of all mental illness, and makes it her life’s mission to encourage others to follow in her path. At one point, she works as a peer specialist in a public mental health organization in Boston, where, as Warner writes, she is more focused on promoting her own beliefs than helping patients:

The clients there weren’t interested, she found, in learning to “stand up against psychiatric coercion” or “spring themselves from locked wards,” or listening to how her story could inspire them to “get themselves off meds.” They were “desperate for help” and “typically uninterested in hearing about my own experience leaving psychiatric interventions behind.”

She does not last long in this job, you will be shocked to hear.

Frankly, Delano’s life post-pills doesn’t seem all that desirable to me; again, I’ll borrow from Warner’s excellent review:

Delano still experiences “intense emotional pain and paranoia and debilitating anxiety and unhelpful impulses,” too. To handle her “extremely sensitive” nature, she has learned to “sit with” herself. Now in her early 40s and a mother, she sometimes sits for an hour as the “waves of pain” wash over her. As she acknowledges, she’s fortunate to have the resources to spend so much time in this way.

Indeed, if you are going to “treat” your inner pain by sitting for hours on end, you had better be a Delano or have some other similarly impressive last name and the fortune to match. But it’s Delano’s choice whether or not to take medications, just as it’s any individual adult’s choice whether or not to go into a psychiatric ward.²

It’s the responsibility of adults to get vaccines (and have their children vaccinated) to keep vulnerable people safe from disease, but anti-depressants and anti-psychotics really do fall into the realm of personal choice. If Delano simply explained her decision, while critiquing the real problems that plague the medical establishment, I wouldn’t have a problem with her book. Anti-depressants have helped me enormously, but that doesn’t mean everyone with depression has to take them.

Instead, Delano is an evangelist and a zealot. It is absurd on its face to claim that psychopharmaceuticals caused what we now think of as mental illness. Did “mental illness” not exist before these drugs were invented in the twentieth century? Obviously not. There is plenty of writing about melancholia, hallucinations, and so on throughout the history of literature. Though some medical phenomena shift with our cultural understandings of illness (women did, for example, experience symptoms of “hysteria” in late nineteenth-century Europe), modern life did not invent depression, anxiety, psychosis, or suicide. The fact that these conditions (especially depression and anxiety) have increased so much recently is not a result of over-medication but a reflection of, first, the de-stigmatization of these conditions; and, second, a combination of factors including smartphones, social media, climate change, Covid-19, the rise of autocracy, and other things I probably can’t even grasp because I’m too old.³

I was too mad at Delano’s book to feel much sympathy for her, but if I felt any it was at how terrified she seems to be at the prospect of being labeled anything. She doesn’t want to be defined by being a mental health patient; she doesn’t want to be defined by having borderline personality disorder, a diagnosis she receives from another doctor;⁴ although she gains a lot of stability and support from AA she eventually leaves that organization, too, because she refuses to identify as an alcoholic. I found all of this depressing and tiresome. Like every millennial who writes a newsletter on the internet, I have depression and anxiety, but I’m not afraid of being known ONLY FOR THOSE TRAITS.

I do acknowledge that my experience cannot compare to Delano’s (I have never been institutionalized, for instance), although I have lived through a couple very frightening mental health crises. I think it is more productive to compare her experience to my experience of physical ill-health. Being physically disabled is a central aspect of my identity—but it also isn’t something I’m ashamed of or that I hesitate to talk about. Would I have chosen to have the conditions I have? Definitely not. Do I think everyone who has serious mental or physical health issues has to talk about them publicly? Also no. But Delano is clearly determined to reject every pre-existing framework that might be useful to her to understand herself. I just don’t have the hubris to think that I can or should invent human experience from scratch.

She also frames all structured forms of support (including talk therapy) as inherently suspicious. As with the patients she briefly tries to help in her peer support role, her goal (for herself and everyone else) is to leave every formal structure and authority behind. Instead, she repeatedly says, people should learn to rely on their inner resources to make it through difficult times (pull yourself up by your bootstraps!). I found this immensely depressing. What is life for except to make connections with other people? What are friends and family for if not to help us out when times are tough?

Ironically, despite this stated position, Delano runs a consultancy in which she advises people on how to taper off psychopharmaceuticals. She has no qualifications except her own personal experience. As reporting on her book has rightly acknowledged, going off these drugs can be difficult and doctors failed to sufficiently warn most patients of this fact for many years (if they understood the consequences adequately themselves; drug companies are probably most at fault here). In my experience, these risks are now discussed more. For example, one doctor prescribed me Cymbalta to treat fibromyalgia, and warned me that if I wound up taking it, eventually coming off of it would be extremely difficult. (I did not wind up on the drug because of side-effects.) I have also been warned about the addictive properties of benzodiazepines. But it’s true that many patients were left in the dark, and it’s not surprising that they shared experiences and resources online; I’ve done the same with other people with my conditions. You should never take a stranger’s advice as medical gospel, but when the medical establishment doesn’t have answers for your problems, it’s natural that people will try to cobble together solutions themselves. Patient knowledge can be very powerful, and in general patients should be taken more seriously as sources of knowledge on their conditions.

There is, however, a stark difference between sharing resources and experiences and charging $595 a month for a “group support system,” which the New York Times reports that Delano charges her clients. (For $30 you can be part of the Inner Compass Iniative, which includes a forum and other group resources; I assume without access to Delano herself, though the details are not made clear in the article.) This scam is particularly galling because in her book Delano claims that patients can be in withdrawal from these medications for years and years, when it is pretty clear that the “withdrawal symptoms” that any individual is having, say, four years after going off a drug is actually just a symptom of the original condition. I obviously don’t know the details of how long Delano’s clients see her, but this all seems extremely shady and exploitative to me.

Unsurprisingly, that same article quotes Delano’s husband (who shares her beliefs) praising Robert F. Kennedy, Jr.; near the end of Unshrunk, Delano also criticizes hormonal birth control. At the beginning of the book, she claims not to be opposed to psychopharmaceuticals, a disclaimer she clearly felt compelled to include to make herself look less extreme (or was forced to include by her publishers/their lawyers), but if you actually read the book her radical views could not be clearer. She is not only opposed to psychopharmaceuticals but medication in general. Given the current climate around science, medicine, and RFK Jr.’s opposition to antidepressants, it is despicable of Viking to publish this now. Yes, it will have been in development for some time, but these issues did not exactly appear overnight, even if the situation is much worse now than it has ever been.

I’ll leave you with this grim detail from the Times article:

Ms. Delano said the issue of suicide comes up regularly in withdrawal communities. “I know so many people who have killed themselves over the years, in withdrawal or even beyond” she said. In 2023, a young woman who joined Inner Compass died by suicide, she said.

Afterward, Ms. Delano and Mr. Davis consoled distraught community members, who worried that they should have taken some action to intervene.

But it’s just the drugs, right?