The people she meets are sometimes kind, sometimes downtrodden, but they can also be irritating and self-obsessed. Vincent tries not to pity herself, in spite of her depression, and she doesn't let her fellow patients get off lightly either. You might think that this sounds like a pretty bleak read but there's actually a lot of humour in these pages. Even with the best facilities and caring doctors, most of the patients Vincent encounters have patterns of destructive behaviour that go back many years and most of them don't have much left in their shattered lives to help them to sustain any progress they do make whilst in hospital. Even here though, there are more stories of failure than success. Allowed her own room in a shared apartment and able to make her own meals, she finds herself in a stable environment where she is allowed to get well on her own terms, with personalised support. It is here that the author has her most positive experience. The third place Vincent stays is a more progressive facility, keen on individualised therapy as well as exercise and arts and crafts. It's interesting to see how these small concessions to humanity have an effect on her state of mind but, overall, her experience still seems to be that sitting around with a load of whining, self-indulgent depressives is counter-productive. Her wrist isn't tagged and she has a room of her own.

Here, she is given more autonomy - the freedom to make snacks and take regular breaks for fresh air. The second place Vincent visits is a private, rural clinic that caters principally to middle-class depressives and addicts. Indeed, she suggests that it is the lack of autonomy in institutional life, even for those patients who voluntarily commit themselves, that makes it so hard for them to rebuild independent lives when they finally leave the institution.

The process of being institutionalised breaks her sense of self-worth down astonishingly fast. Soon, the author finds that her latent depression (which led her to do the book in the first place) is returning. In this hospital, the doctors are overworked and jaded and medication is always the answer. The first is an urban, public hospital that houses mainly homeless, psychotic patients, many of whom are addicted to drugs. Voluntary Madness is journalist Norah Vincent's account of her visits to three mental health facilities in America. Summary: A quirky, behind-the-scenes look at what life is like for the patients of the American mental healthcare system.

Voluntary madness by norah vincent