I love mental health memoirs, especially those that call into question the establishment and the DSM's definitions of diagnoses, but this goes too far without empathy. It is a memoir, of course it is author-centric, but after reading Rachel Aviv's "Strangers to Ourselves" it was obvious how much this centered the writer's personal experience over those of others. That's a dangerous game in mental health treatment. I know it's just one person's perspective, but I really wasn't feeling it.

Intriguing premise, adequate execution.
Was I really that busy that I needed 2.5 months to finish it or was it too much of a slog? Sarah is an excellent writer, and while I found the frame of punctuation a bit clunky/forced, I am enough of a grammar nerd to enjoy Sarah's grammar-nerdiness.
Separate from its pacing and density, I couldn't get fully behind <i>Pathological</i> because of the conclusions she draws. While her book is meant to be provocative, I was constantly questioning her overall argument because the logic didn't quite seem to check out. I say all this as someone with little medical knowledge but also as someone who has been attempting to manage chronic illness for years—who's been chasing down a diagnosis, trying treatment after medication after treatment—it seems like much of medicine isn't as black-and-white as she expects it to be. Her gripes with the DSM and psychiatry shouldn't be dismissed, but I couldn't get on board with the way she approaches her critique.
There seemed to be a tone shift in the conclusion that was necessary for me to finish the book without excessive frustration. Still, her clear anger shines throughout compellingly, and my investment in her story was enough for me to stay through the end.

Pathological is a memoir detailing a young woman’s journey through six misdiagnoses and her survival. It is a very well researched book that delves into the shortcomings and inadequacies of the DSM, which is the widely used tool used to aid in diagnosing mental illness and aberrant behavior. The DSM is an evolving work, being updated every so often and now in its fifth version. Is it absolute? Absolutely not and I believe many would agree on some of its limitations. However, it is all we have. There has to be such a diagnostic manual for the insurance companies, whether we like it or not. Practitioners must use the DSM’s codes when submitting claims to any and all insurance companies.

Fay spends a good amount of time criticizing the DSM, it’s use or misuse, seeing is as invalid, overused and unreliable. She has been through a lot and tells her story in a very relatable way. She was diagnosed with 6 different mental illnesses over thirty years. Does it mean she was misdiagnosed? I am not so sure. People change and their situations change so perhaps they were somewhat accurate at the time that they happened. In addition, one could have more than one diagnosis at the very same time. I don’t see her six diagnoses as mutually exclusive necessarily - anorexia, depression, anxiety, attention deficit, obsessive-compulsive, and bipolar. At the same time, I do agree that the DSM would benefit from more testing, review and refinement by a broader group of psychiatrists.

Pathological is a book that should be read widely by psychiatrists and psychologists and it should prompt a discussion to improve the DSM. Will it ever be perfect? I doubt it but it could be better.

Thank you to NetGalley and Harper One for an advance reader copy in exchange for my honest opinion.

This memoir reviewed Fay's journey through multiple mental health diagnoses. Fay shares her experience with multiple psychiatrists and counselors as she attempts to find appropriate treatment, spicing it up by analyzing different punctuation marks. It sounds random, but actually blends together well. Fay focuses on her concerns about the DSM and the history surrounding development of the manual. Her concerns do make sense, and are compounded by the lack of communication between the various service providers she reaches out to for treatment.

Pathological is a memoir in part, a lesson in punctuation that is historical and metaphorical, and a book that asks us to seriously question the credibility and authority of the Diagnostic and Statistical Manual of Mental Disorders (DSM), presently in its fifth edition. I'm not sure who the audience with be for this, but I know just enough about the subject matter to say that Fay presents us with an extraordinary piece of research and a capable, interesting presentation that I expect it will interest to many people with less of a background than I personally have in her subject areas. I have been treated for major depressive disorder (my diagnosis) for fifty years and for ADHD (now called inattentive type) for thirty years. As a lawyer, I represented school districts when parents of special education students challenged their children's educational programing. Every one of these children had a DSM diagnosis and if a case went to a hearing, that diagnosis was central to the hearing officer's decision. I also majored in English and philosophy in college, making me a relatively knowledgeable reader. Writing well and using appropriate punctuation has been important to me for many, many years.

It never occurred to me, and it is completely obvious now, that the DSM is merely a theoretical framework, created by committee and it has no -- zero-- scientific validity. It is a compendium, describing as many variations of human "abnormality," with descriptions and checklists that aide a diagnosis. It arose, not from science but from committees of people who treat mental health patients. Many things that we take as truth, such as the idea that depression is caused by a chemical imbalance in our brains or that if a medication helps with symptoms it confirms the diagnosis it was prescribed to treat are completely based on theories and anecdotal experience. A DSM diagnosis ensures reimbursement from insurance companies when a medical professional codes it into a patient's invoice. Fay reminds us that pharmaceutical companies and the various professionals who conduct studies financed by them stand to gain a lot from the business of psychiatric treatments.

Is Fay saying that she and others cannot have experienced devastating, debilitating symptoms, suicidal ideation, disassociation? No. But she suggests hat there are other ways of framing these symptoms and perhaps of treating them, that it is problematic to misrepresent DSM diagnoses as being founded in established fact rather than theory. Fay challenges twenty-first century psychiatric norms, but she is not an all or nothing writer who would say that but for her six diagnoses of various mental health disorders, her life would have been fine. I like the attention she pays to the fact that many medications have serious side effects and/or are very difficult to discontinue. I continue to use antidepressants, but when changing medication I've gone through devastating experiences. In my family, there is a person who is so impacted by side effects of psychotropic drugs that a psychiatrist who has known her for years has taken her off everything. And the withdrawal from these medications was tough. She was overmedicated, by a different doctor, who did not listen to her and kept adding prescriptions that in fact were his attempt to even out her complaints about the side effects of the strong medications he put her on. She went in with postpartum depression and walked out a zombie on eight medications. His treatment left her incapable of caring for her child because of overmedication and her extreme sensitivity to prescription drugs. It took two years to detox her. His was a well regarded well known medical facility.

Fay suggests that having a DSM diagnosis may cause those of us with mental health issues to live life as if we are our diagnoses. And that is something that rings true. I would not say, this solves particular issues that come with having the undeniably serious symptoms of mental illness, but it is a refreshing way to remind oneself to step back and recognize that these are symptoms, not who we fundamentally are. Because she has strong, well-researched positions, a compelling story to tell and she is not strident with her ideas, but sharing them and substantiating her points, her book deserves a lot of attention from mental health professionals and patients.

Thank you NetGalley and Harper One for this e-ARC in exchange for my honest review.

Very unique and powerful debut memoir! This book did not read like a regular memoir. There was a lot of detailed research about the Diagnostic and Statistical Manual of Mental Disorders (DSM) that was especially eye-opening. There was also a lot of research on punctuation on it's proper use, which was a little confusing at first, but then I was able to understand what the author was trying to express. I loved how open and honest Sarah Fay was with her journey of being (mis)diagnosed with 6 different conditions. From my own personal experience with anxiety and panic attacks, I could definitely relate to what the author went through with medical professionals.
Diagnoses don't define you and what you're capable of. The problem is that doctors, psychiatrists, psychologists, and other medical professionals have to provide a specific diagnosis for insurance purposes. It's important to remember you know your body and mind better than anyone else and always advocate for your own health--mental health included!

Thanks to @harperonebooks for an advance review copy of Pathological by Sarah Fay!

Pathological is a mental health memoir: in it, Fay reckons with our broken health care system and her experience with the six diagnoses she’s received in her life.

I am 38% of the way in, and have been blown away by the amount of information I’ve been exposed to, including:
-the history and evolution of the Diagnostic and Statistical Manual of Mental Disorders
-the relationship between advertising and prescribing (which reminds me so much of Dopesick by Beth Macy)
-the idea that diagnosis is more significant for insurance and billing than it is for actual treatment
-how psychiatric diagnosis is complicated because mental illness cannot be quantified in the same way as physical illness

Fay walks us through various points in her life where she has dealt with mental illness and how it has affected her relationships, her work, and her perception of herself. Interspersed throughout is her knowledge of the healthcare system, gleaned after years of frustration with a world that has never seemed to understand her. It is also a memoir of her journey as a teacher: of her relationships with her students and her relationship to punctuation and grammar, which is an apt parallel: Fay is initially afraid to admit her lack of knowledge surrounding punctuation and grammar but later masters it and, understanding the power she now wields, works to empower others to do the same.

I didn’t rush through this book for the sake of finishing it before it’s publication date — it’s one I’ve been taking my time to read — but I’m looking forward to finishing it!

TW: anorexia, suicidal thoughts, alcoholism, hypochondria, depression, anxiety, obsessive compulsive disorder (check for other TW/CWs)

I really enjoyed this! It combined great research with the author's own personal experience. I love how the introduction started by saying this is not the "typical mental illness memoir". I love books in this genre so I was excited to read a copy of this thanks to the publisher. The cover art is also beautiful.

This book takes an empathetic approach and gives bite size approaches and allows you to have kindness and patience with yourself when dealing with life. This is so necessary for everyone to read in life. Highly recommend. Especially loved the reflection to true life to humanize my feelings and relate. I received an advance review copy for free, and I am leaving this review voluntarily.

Well researched! Such an interesting book that combines the author’s personal experience with historical information about mental illness and medical conditions. I loved the author’s writing style. This book kept my interest and I ended up reading it for hours at a time because it’s so interesting! Loved it! Thank you NetGalley for the opportunity to read an advanced copy!