What's the difference between sanity and madness anyway? We all play headgames with ourselves. We all have baggage. We all cope somehow. I'm not sure if I'm mad or sane. I mean, I hold my life together, I pay my bills, I raise my kids. But the world is so polarized and bizarre now that for some people, none of these these things matter if they're not wearing the right shoes or don't have the right credit score or a fancy family car. Some people think the most important things to worry about are handbags and tan lines. Meanwhile, war and crime and poverty unfold all around us, and we ignore it. In that environment, how can we even begin to talk about sanity and madness?

In the absence of any therapy, the mentally ill of the 20th century were chained, shackled, straitjacketed, kept nude, electrocuted, half-frozen, parboiled, violently hosed, wrapped in wet canvas, confined to “mummy bags”, subjected to insulin-induced hypoglycemic comas, forced into seizures with massive doses of the stimulant Metrazol, injected with camphor, drugged into three-week comas with barbiturates and tranquilizers, involuntarily sterilized, and surgically mutilated. Rape by hospital staff was common, as was humiliation and verbal abuse. One reporter noted that a state hospital patient had been restrained for so long that his skin was beginning to grow around the leather straps.

Did I imagine the castle, the dungeon, the ritual orgies and violations? Did Lucy, Billy, Samuel, Eliza, Shirley and Kato make it all up? I went back to the industrial estate and found the castle. It was an old factory that had burned to the ground, but the charred ruins of the basement remained. I closed my eyes and could see the black candles, the dancing shadows, the inverted pentagram, the people chanting through hooded robes. I could see myself among other children being abused in ways that defy imagination. I have no doubt now that the cult of devil worshippers was nothing more than a ring of paedophiles, the satanic paraphernalia a cover for their true lusts: the innocent bodies of young children.

The men and women who continue to hold Lynn's mind hostage against her will believe the future will be tilled with terrorism, death, destruction and a challenge to the survival of America. They believe Lynn and the other lab rats must still respond to their programming for they are the second line of defence against enemies from within and without and the first line of offence in a catastrophe which would require the recreation of America's constitutional government. They are still intent on preparing Lynn for the day when she will he necessary for battle. One summer day, all these dark realisations came flooding upon Lynn and she knew if she was ever to free herself, she needed to get immediate help.

Public stigmaStereotypeNegative belief about a group (e.g., dangerousness, incompetence, character weakness)PrejudiceAgreement with belief and/or negative emotional reaction (e.g., anger, fear)DiscriminationBehavior response to prejudice (e.g., avoidance, withhold employment and housing opportunities, withhold help)Self-stigmaStereotypeNegative belief about the self (e.g., character weakness, incompetence)PrejudiceAgreement with belief, negative emotional reaction (e.g., low self-esteem, low self-efficacy)DiscriminationBehavior response to prejudice (e.g., fails to pursue work and housing opportunities)Understanding the impact of stigma on people with mental illness. World Psychiatry. Feb 2002; 1(1): 16–20.PMCID: PMC1489832

I'm the girl who is lost in space, the girl who is disappearing always, forever fading away and receding farther and farther into the background. Just like the Cheshire cat, someday I will suddenly leave, but the artificial warmth of my smile, that phony, clownish curve, the kind you see on miserably sad people and villains in Disney movies, will remain behind as an ironic remnant. I am the girl you see in the photograph from some party someplace or some picnic in the park, the one who is in fact soon to be gone. When you look at the picture again, I want to assure you, I will no longer be there. I will be erased from history, like a traitor in the Soviet Union. Because with every day that goes by, I feel myself becoming more and more invisible...

Holding one's self responsible is a critical feature in stigma and in the generation of shame since violation of standards, rules, and goals are insufficient in its elicitation unless responsibility can be placed on the self. Stigma may differ from other elicitors of shame and guilt, in part because it is a social appearance factor. The degree to which the stigma is socially apparent is the degree to which one must negotiate the issue of blame, not only for one's self but between one's self and the other who is witness to the stigma. Stigmatization is a much more powerful elicitor of shame and guilt in that it requires a negotiation not only between one's self and one's attributions, but between one's self and the attributions of others.

Her parents, she said, has put a pinball machine inside her head when she was five years old. The red balls told her when she should laugh, the blue ones when she should be silent and keep away from other people; the green balls told her that she should start multiplying by three. Every few days a silver ball would make its way through the pins of the machine. At this point her head turned and she stared at me; I assumed she was checking to see if I was still listening. I was, of course. How could one not? The whole thing was bizarre but riveting. I asked her, What does the silver ball mean? She looked at me intently, and then everything went dead in her eyes. She stared off into space, caught up in some internal world. I never found out what the silver ball meant.

Mental illness People assume you aren’t sick unless they see the sickness on your skin like scars forming a map of all the ways you’re hurting. My heart is a prison of Have you tried?s Have you tried exercising? Have you tried eating better? Have you tried not being sad, not being sick? Have you tried being more like me? Have you tried shutting up? Yes, I have tried. Yes, I am still trying, and yes, I am still sick. Sometimes monsters are invisible, and sometimes demons attack you from the inside. Just because you cannot see the claws and the teeth does not mean they aren’t ripping through me. Pain does not need to be seen to be felt. Telling me there is no problem won’t solve the problem. This is not how miracles are born. This is not how sickness works.

...if in the heat of the dispute he insists and asks, 'Am I not the master of throwing myself out of the window?' I shall answer him, no; that whilst he preserves his reason there is no probability that the desire of proving his free agency, will become a motive sufficiently powerful to make him sacrifice his life to the attempt: if, notwithstanding this, to prove he is a free agent, he should actually precipitate himself from the window, it would not be a sufficient warranty to conclude he acted freely, but rather that it was the violence of his temperament which spurred him on to this folly. Madness is a state, that depends upon the heat of the blood, not upon the will. A fanatic or a hero, braves death as necessarily as a more phlegmatic man or a coward flies from it.

In the life cycle of an intense emotion, if it isn't acted upon, it eventually peaks and then decreases. But as Dr. Linehan explains, people with BPD have a different physiological experience with this process because of three key biological vulnerabilities (1993a): First, we're highly sensitive to emotional stimuli (meaning we experience social dynamics, the environment, and our own inner states with an acuteness similar to having exposed nerve endings). Second, we respond more intensely and much more quickly, than other people. And third, we don't 'come down' from our emotions for a long time. One the nerves have been touched, the sensations keep peaking. Shock waves of emotion that might pass through others in minutes keep cresting in us for hours, sometimes days.

It's an unfortunate word, 'depression', because the illness has nothing to do with feeling sad, sadness is on the human palette. Depression is a whole other beast. It's when your old personality has left town and been replaced by a block of cement with black tar oozing through your veins and mind. This is when you can't decide whether to get a manicure or jump off a cliff. It's all the same. When I was institutionalised I sat on a chair unable to move for three months, frozen in fear. To take a shower was inconceivable. What made it tolerable was while I was inside, I found my tribe - my people. They understood and unlike those who don't suffer, never get bored of you asking if it will ever go away? They can talk medication all hours, day and night; heaven to my ears.

            Tempting as it may be to draw one conclusion or another from my story and universalize it to apply to another's experience, it is not my intention for my book to be seen as some sort of cookie-cutter approach and explanation of mental illness, It is not ab advocacy of any particular form of therapy over another. Nor is it meant to take sides in the legitimate and necessary debate within the mental health profession if which treatments are most effective for this or any other mental illness.            What it is, I hope, is a way for readers to get a true feel for what it's like to be in the grips of mental illness and what it's like to strive for recovery.

Some alters are what Dr Ross describes in Multiple Personality Disorder as 'fragments', which are 'relatively limited psychic states that express only one feeling, hold one memory or carry out a limited task in the person's life. A fragment might be a frightened child who holds the memory of one particular abuse incident.' In complex multiples, Dr Ross continues, the `personalities are relatively full-bodied, complete states capable of a rang of emotions and behaviours.' The alters will have `executive control some substantial amount of time over the person life'. He stresses, and I repeat his emphasis, 'Complex MPD with over 15 alter personalities and complicated amnesic barriers are associated with 100 percent frequency of childhood physical, sexual and emotional abuse.

There may not be any romance to mental illness but who needs romance when the preferable route is agency? The prevailing conversation around mental health issues is agency and the lack thereof on the part of the mentally ill. But what do you do if you’re a paid-up member of the mentally ill populace in question? Do you curl up into a ball and give up? No, you look for solutions. Ultimately, it’s about keeping despair at bay and sometimes simple things like running, taking up a hobby, doing charity work, painting or, in my case, writing can be a galvanizing part of the recovery process. Keeping the brain and the body active can give life a semblance of pleasure and hope. This is what writing has done for me. I took every traumatic element of my condition and channelled it into something useful.