It is not often that one has an opportunity to read an account of someone who has traveled through Hell; return tickets across the River Styx are hard to come by and cannot be charged to your American Express card. "Welcome Silence" is an account of just such a trip, and a valuable book both because of its rarity and because the reader can almost feel the flames of the inferno.
Hell in this case is the disease of the human brain we call schizophrenia, and the traveler, Carol North, is a young woman who recounts a journey lasting eight years. Early manifestations of her disease began in childhood, but its full flowering awaited her late teens, as is characteristic. First there were the voices, coming and going, advising, criticizing, confusing, suggesting, interfering, commanding--one, many, voices, voices, voices. There were also visual hallucinations of patterns in the air, paranoid delusions that people were trying to kill her, delusions that people could read her thoughts, periods of catatonic immobility in which she could not move, and multiple suicide attempts.
Her thinking is often illogical as well, a common symptom of schizophrenia. For example, when a psychiatrist asks her, "What did you see?" when she went to her apartment, she describes what happened next:
"The sentence 'What did you see?' echoed around in my head several times until I didn't know whether I'd said it or he'd said it or maybe even the voices had said it. He looked as if he expected me to say something. I didn't know what we were talking about anymore."
Finally, after much thought, she responds to the psychiatrist: "I am breathing King Tut and I have swallowed Joan of Arc." Hell, in short, consists of being crazy.
Those of us in the psychiatric profession are accustomed to describing this state, clothed in clinical jargon, from the outside looking in. To have an individual write about it, using her diaries, from the inside looking out is something else again, a rare and terrifying experience. The only book that is comparable is Marguerite Sechehaye's "Autobiography of a Schizophrenic Girl." The widely read "I Never Promised You a Rose Garden," by contrast, pales beside "Welcome, Silence" in terms of accuracy, sensitivity and eloquence.
It is not merely the description of the psychotic experience that makes the book memorable, however, but the fact that Carol North was going through college and two years of medical school during the period when she was intermittently sick. An academic pilgrimage of this magnitude is ordinarily story enough, but to carry it out while fighting off hallucinations and delusions qualifies one for special honors. Her schizophrenia went into remission at the end of her second year of medical school, which she then finished and went on to do a residency in psychiatry. She writes, then, as Carol North MD, now a practicing psychiatrist.
Media portrayals of individuals with schizophrenia range from driveling idiots to homicidal maniacs and the fact that North, a successful and respected physician, has also had this disease forces us to confront our stereotypes. Most individuals who have recovered from schizophrenia spend their lives trying to hide their history (e.g. "Well, yes, Carol had a slight nervous breakdown during college but it went away and she is fine now. Just a case of the nerves I guess") and this is especially true of professionals. The 1.2 million individuals with schizophrenia in the United States today have a new advocate in their corner.
A minor criticism of the book is that the author does not emphasize how unusual her outcome is. After a single attack of schizophrenia, approximately 25% of individuals recover completely and do not get sick again. After the disease has lasted eight years, however, the chances for a full recovery without ongoing medications is very rare. Even more unusual is the way North's recovery occurred. She was one of the first people to be tried on renal dialysis for schizophrenia, and this apparently produced the cure. Controlled scientific studies have shown that most people with schizophrenia do not respond at all to this treatment.
Nevertheless, we should be grateful that a cure took place so that North could share her story. Most of those who suffer from schizophrenia, living in mental hospitals, halfway houses, public shelters or with their families, must suffer quietly. Those of us who are well have little means of appreciating their private hells. Carol North offers us a rare opportunity.