Law and Conversation

November 30, 2012

Mantel’s memoir and mental health

In Hilary Mantel’s 2003 memoir, “Giving Up The Ghost,” she describes her harrowing, physically devastating, decades-long struggle with endometriosis. Doctors failed to diagnose it for years, suggesting that she must be pregnant; that her pain was imaginary; that it was caused by stress, caused in turn by (unfeminine and therefore inappropriate) overambition; prescribing powerful antidepressants that left her unable to read or concentrate and, later, antipsychotic drugs; and hospitalizing her for mental illness. Finally, in surgery motivated at least in part by a concern that she might have cancer, her ovaries and uterus were removed, and with them, of course, any hope of having a child. All of this, before she was thirty.

Until reading Mantel’s book, I had no idea how serious endometriosis could be. (I should note that I’ve done no research of my own on the condition.) In a small number of women, she says, endometrial tissue migrates throughout the body, growing, forming scar tissue, and causing problems wherever it happens to be – not only in the pelvic region, but also in the chest, in the legs, or in the head, for example. Mantel says she spent days when she was too tired to move. “I had known days of my life when everything hurt, everything from my collar bone down to my knees.” The migraine headaches from which she continues to suffer are probably the result of “a hormonal disarrangement” which, she says, frequently accompanies endometriosis.

Though this memoir is an eyeopener about endometriosis, what I found particularly memorable was how Mantel passionately highlights the deep prejudice against women, against sick people, and against sick women that, sadly, were harbored by a number of doctors and nurses whom she encountered back in the 1970s, when she was treated. “The odd thing…was that the staff [of the hospital where Mantel had her hysterectomy/ovariectomy] were inclined to treat the patients as malingerers….Young girls with flaky cervixes were probably no better than they should be, and anything in the pelvic inflammatory line attested to a vibrant sex life.”

Mantel’s description of her treatment after going to see a doctor because her legs hurt so much, before she’d been diagnosed with endometriosis, has a frightening ending: she accedes to being hospitalized and treated with antipsychotic drugs that turn her into a zombie. “It was in the nature of educated young women, it was believed, to be hysterical, neurotic, difficult, and out of control, and the object was to get them back under control, not by helping them examine their lives or fix their practical problems…but by giving them drugs which would make them indifferent to their mental pain—and in my case, indifferent to physical pain too.” Before her hospitalization, her psychiatrist, Dr. G., suggests that if she insists on persisting in studying law, instead of what he thinks would be a far better fit, working in her mother’s dress shop, she should be in a back office preparing the paperwork for real estate transfers.

Handling real estate transfers, while less glamorous than appearing in court to try or argue a high-profile or high-priced matter, can be quite complex and is certainly as important to a lawyer’s clients as any other matter. (See my article in the June 2011 issue of the Illinois Bar Journal on conducting residential real estate closings.) But Dr. G.’s suggestion to Mantel is transparently based on his own misconception that preparing deeds and other real estate closing documents is easy, mindless work, suitable for a female (read, an inferior being who doesn’t understand her place and proper behavior in the world).

While this doctor’s ignorance of what it takes to practice law is understandable, his arrogance in thinking he knew what members of another profession do is unpardonable. Even more so is his incompetent treatment of Mantel for a psychiatric condition that she never possessed. Topping that, when he visits her in the hospital and learns from her that she’s written a short story, he says forcefully that he doesn’t want her writing. Why? His answer reveals that he doesn’t really know, since he can think of nothing more to say than simply “Because.”

Now, looking back on her treatment, Mantel writes “I think, in retrospect, that it would have been better if I had denied that I had pains in my legs, if I had taken it all back, or brightly said that I was well now.” Neither she nor we can know what her physical condition would be if she had – she did not make clear whether removing her ovaries and uterus were necessary given the severity of her condition – but she still struggles with headaches and other unpleasant effects that resulted either from her condition or the treatment she received. But if you’ve glanced at literary news lately, you’ve probably noticed that Hilary Mantel just won her second Man Booker Prize in 3 years – an honor without precedent – for “Bring Up the Bodies,” the sequel to her first Booker winner, “Wolf Hall.” (That’s what inspired me to read her memoir; I’m partway through “Wolf Hall.”) Lucky for her and those of us who love her books that she didn’t follow doctor’s orders; perhaps it’s also lucky for her distinguished literary career that she dropped out of law school.

The outrageous medical treatment Mantel received occurred in the 1970s. For a doctor’s perspective on the dangerous but still not uncommon phenomenon of a physician’s reaching an erroneous conclusion and administering inappropriate treatment through stereotyping a patient and ignoring facts that do not fit into the stereotype, see Jerome Groopman’s thoughtful and well-written “How Doctors Think.” Read Mantel’s memoir for a really good story and a reminder why, whatever our occupation, we should all take some extra time to try to understand what’s going on with a person before making a snap, uninformed judgment.

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