Through playful videos hashtagged #LiveLaughLexapro and #LexaproGirly, Tiktok and Instagram creators have transformed the selective serotonin reuptake inhibitor into a selective, if relatable, lifestyle for the enlightened and empowered—stigma be damned. Our society is preoccupied with chemical selfhood[1], with mental illness arguably normalized to the point of sun-kissed romanticization. 

Psychopharmaceuticals receive a different treatment in the snow-blanketed mansion of The Housemaid, based on Freida McFadden’s same-named novel and directed by Paul Feig. (Spoilers ahead for the campy thriller!) 

Millie Calloway (a mostly lackluster Sydney Sweeney), who is on parole, becomes the titular live-in maid for a wealthy family. She finds Haldol, an antipsychotic, in the medicine cabinet of her erratic boss, Nina Winchester (a delightfully unhinged Amanda Seyfried). This discovery leads Millie to believe that Nina is mentally ill, confirming the story that the latter’s husband Andrew (an initially charming Brandon Sklenar) and gossipy so-called friends have been building: that Nina is deceitful and dangerous. 

In reality, Nina’s outbursts and mood swings are in part a reaction to Andrew’s abuse. But she also uses the perception that she is unstable to her advantage, exaggerating her behavior in an attempt to engineer her escape. 

By locking both of its female leads, at one point or another, in an attic room, The Housemaid alludes to the “madwoman in the attic” trope, theorized in 1979 feminist literary criticism by Sandra Gilbert and Susan Gubar. In their seminal work, they explore how 19th-century women writers used their texts to resist the patriarchy.  

The quintessential example is Bertha Mason, the first wife of the eventual husband of the eponymous narrator of Charlotte Brontë’s Jane Eyre. Another example: the postpartum protagonist of Charlotte Perkins Gilman’s “The Yellow Wallpaper,” whose physician husband prescribes her a rest cure and confines her to an upstairs nursery. Her resulting insanity is an embodiment of, and protest against, the subjugation of women. As literary critic Elaine Showalter[2] writes, the madwoman “refuses to speak the language of patriarchal order.”  

Albeit to a lesser extent than Nina, Millie is also cast as a madwoman. Toward the beginning of the film, she seems anxious and hyper-vigilant, and her specific crime is kept secret, leaving her reliability ambiguous. And, at first, Nina’s freedom—her rebellion against the patriarchy—comes at the expense of Millie’s, hardly an example of women supporting women. 

But Nina’s 7-year-old daughter Cece (Indiana Elle) encourages her mother to rescue Millie, who ultimately defeats Andrew. The police officer (Alexandra Seal) notices inconsistencies in Nina’s account but, owing to a plot contrivance, investigates no further. The Housemaid ends with Millie accepting a new job, once more as a knife-savvy housemaid for an abused woman. 

Rebecca Sonnenshine’s twist-filled screenplay is highly entertaining, but it is no masterpiece. That said, we can examine The Housemaid through the lens of mad studies, a field of scholarship that places mental distress within broader social and political contexts. This approach extends the notion, often attributed to psychiatrist R.D. Laing, that insanity is a “perfectly rational adjustment to an insane world.” Bradley Lewis[3], another psychiatrist, maintains that “psychic difference from the norm” can, in some cases, be something “to celebrate.”  

Mille’s vengeance-driven crimes are ethically understandable; however, they are legally questionable, and most mad-studies scholars would likely not exalt them. But instead of pathologizing her and Nina’s actions, we can read them as efforts to combat Andrew’s patriarchal control. 

Additionally, as Lewis underscores, healthcare professionals must seek to understand how social and political forces shape the lives of their patients and center their perspectives and narratives. Had Nina’s clinicians taken her seriously, she, Cece, Millie, and even Andrew would have been spared much pain. 

Millie finds an unflushed pill in a toilet, suggesting that Nina doesn’t take her Haldol. Unlike #LexaproGang members, she has been prescribed medication against her will. Admittedly, medication can play an important role in managing mental illness, but The Housemaid emphasizes that it cannot substitute for structural change. Even if mental illness has in part been commodified by social media, the film reminds us that what is labeled madness may, in fact, be an attunement to a world that too often denies women credibility and agency—a problem that demands not merely treatment, but transformation. 

The Housemaid. Directed by Paul Feig, performances by Sydney Sweeney, Amanda Seyfried, Brandon Sklenar, and Indiana Elle, Lionsgate, 2025. 

[1]Metzl, Jonathan M. The Protest Psychosis: How Schizophrenia Became a Black Disease, Beacon Press, 2010. 
[2]Showalter, Elaine. “Representing Ophelia: Women, Madness, and the Responsibilities of Feminist Criticism.” Shakespeare and the Question of Theory, edited by Geoffrey H. Hartman and Patricia Parker, Routledge, 1985, pp. 77-94. 
[3]Lewis, Bradley. “Rethinking Psychiatry with Mad Studies.” Mad Studies Reader: Interdisciplinary Innovations in Mental Health, edited by Bradley Lewis, Alisha Ali, and Jazmine Russell, Routledge, 2024, pp. 435-455. 

Web image by Medhum.org

The Names opens with a woman, Cora, accompanied by her very talkative 9-year-old daughter Maia, on her way to register her newborn baby son and officially name him. She is married to an abusive husband who expects her to name him Gordon, the name that has been given by long-standing family tradition to every first-born son. Knapp immediately confounds expectation by then splitting the narrative into three distinct streams. She creates a novelistic triptych based on whether Cora, in fact, submits and names the baby Gordon, uses a charming alternative, Bear, offered by her chatty daughter, or substitutes a name of her own choosing, Julian, that she hopes will honor and be appreciated by her husband even if it represents a break in the line of Gordons.  The choice of each one  of these three names results in a distinctly different narrative arc that emerges over the 35-year span of the book. In the Gordon stream, Cora and her children  remain trapped in the tense and hostile domestic environment. In the second, Bear version, Cora accepts her daughter’s suggestion for a name. When her  husband returns from work that day, he goes berserk  and, in a rage, commits a savage murder. He is imprisoned and the mother and children achieve some degree of independence. Finally, in the third, Julian, narrative, where Cora gives the baby the name of her choosing, the husband grows increasingly violent and kills his wife a few years later. The children end up being raised by their maternal grandmother in Ireland and are forced to grapple with the untimely loss of both parents. 

Flashlight is the story of a Korean man, Serk, who leaves his native country as a child with his family for a better life in Japan and grows up there. He moves to the United States as a young man​,​  marries a beautiful but mysterious woman, Anne, from the Midwest, and is hired to join the science faculty of a small mid-level college. They have a precocious daughter, Louisa, who is an amalgam of her parents’ genetic input and more than match for both of them. The novel opens with Serk and the 10-year old Louisa walking along the beach in the early evening. The following morning, the girl is found unconscious and hypothermic at the water’s edge​,​ and the father has vanished. The presumption is that he slipped among the rocks jutting into the ocean, was swept away by the waves and drowned at sea. All is not, however, as it seems. There is international skullduggery involved, though it would be unfair to disclose more. Regardless of the cause of the father’s disappearance,  just as in ​The Names​, the lives of all the main characters in  ​Flashlight​ are ​ irrevocably ​changed by the sudden unexpected event at the beginning of the narrative. The mother-daughter relationship, which can be fraught in the best of circumstances, is profoundly disturbed. The mother, who suffered for many years from undiagnosed multiple sclerosis, is unable to overcome her own physical disability and achieve inner peace. The daughter, despite her obvious intellectual and physical gifts, is incapable of empathizing with others and develops a nearly feral persona. Serk’s story resurfaces in a surprising turn of events. Although there is constant switching of viewpoints and time frames, ​Flashlight​ has a more conventional structure than ​The Names​. 

​​​Why review these two books together? Doctors are taught and are obligated to treat patients one at a time. The guiding principle is that each person who seeks care should be evaluated and managed as an individual. The underlying cause of disease should be identified as precisely as possible​,​ and the therapy should be prescribed that has the highest likelihood of success and matches each patient’s expressed life goals and priorities. However, patients are almost never seen in isolation. Doctors are trained to compare and contrast the men, and women and children that they encounter, to find commonalities and differences among them in the hope that this wider, more nuanced  field of vision will sharpen their diagnostic acumen and improve their therapeutic recommendations for each patient that they treat. 

I suggest that reading these two novels together provides a literary example of how an analysis of two books that at first appear to be similar reveals different insights about the ramifications of sudden, life altering occurrences.  This is concretized by the contrasting authorial  ​​tone, warm and fuzzy in The Names versus cool and detached in Flashlight, and how we as readers engage with these two books. 

​​The Names​ details the consequences of Cora’s impulsive decision about what name she should give to her newborn son. ​Flashlight​ recounts the unspooling of the characters’ lives after one of them disappears while walking along the beach with his daughter. In ​The Names,​ the fateful event is a personal human choice, in ​Flashlight​ it is an inscrutable act by an unseen, hostile foreign government. This stark difference is manifest in the way readers experience the subsequent stories. As one moves through the 35-year span of ​The Names​, each 7-year interval in which Knapp picks up the story of the “three” sons feels organically linked to preceding period. The actions of Cora, her children, and the supporting cast of characters follow a trajectory that feels smooth and organic. It is true that while unexpected events intrude into each named narrative – Bear, Julian, and Gordon – the global sweep feels grounded and recognizable. There is admittedly a temporary sense of disorientation and a need to regain one’s footing ​in the plot ​as Knapp switches gears and advances to the next 7-year interval in the story of the triply named son. The narrative scenery and settings are abruptly changed​,​ and it can take the reader a few pages to get oriented and mentally  ​​settled. But within each tale, there is pervading tenderness and a sense of human initiative.  

In contrast, ​Flashlight​ has a staccato disjointed feel. The novel changes location and time period without clear reason. The nature of the characters, why they do what they do, and the basis for the choices they make, seem inexplicable, as if they are acting randomly and have no control over their lives. ​​Unlike the protagonists in ​The Names,​ who one wants to see overcome their difficulties, ​ and ​for whom one subconsciously roots for their ​well-being​, there is a reluctance to embrace or even sympathize with the characters in ​Flashlight​. They feel remote and distant until nearly the end of the book. It is Choi’s brilliance as a writer that maintains the cohesiveness of the composition and ensures that the reader remains fully committed to the novel and motivated to ultimately understand and come to grips with the plight of the people who populate the literary world she has created. 

Occasionally, as readers, we may encounter two novels that complement one another. ​The Names​ and ​Flashlight​ fell into that circumstance for me. As a pediatrician, I was taught to try to understand the impact of primordial events on the life trajectory of my patients, how singular experiences can have long lasting repercussions for health and disease. But these events are not all the same. Some are internal, reflecting private human decisions, and others are external, reflecting trials and challenges imposed unpredictably by the outside world. The warmer narrative of ​The Names​ reflects the former circumstance while the opaque tone of ​Flashlight​ mirrors the arbitrary and cruel act that launches the story. ​For physicians, ​appreciating the disparate impact of vastly different life events on people will improve our understanding of patients’ experiences and help us provide more compassionate care. These two books, taken together, illustrate the underlying objectives of MedHum, namely, to explore how humanities can meaningfully shed light on ​the ​human experience and the practice of medicine​.

The Names  
Florence Knapp  
Pamela Dorman Books/Viking, New York  
2023, 328pp  

Flashlight 
Susan Choi 
Farrar, Straus, Giroux
2025,  450pp 

Web image created by Medhum.org

Demon Copperhead is nothing if not a novel centered on social concerns. It tells the story of a child born to a drug addicted mother in an oxycontin-ravaged community in western Virginia. He is delivered inside an intact amniotic sac, an anomaly that foreshadows a life-long fixation to see the ocean, any ocean. His mother has abysmal taste in men and repeatedly chooses to live with men who abuse her and physically threaten Demon. When she dies of a drug overdose, Demon is placed in foster care and forced to work countless hours as a virtual slave under horrible circumstances, without any consideration for his safety, by the person who is supposedly responsible for his wellbeing. He runs away and has a miserable encounter on the road with a streetwalker who entraps him and steals the hard-earned money that he has secretly saved and stashed away. Against all expectation, Demon reconnects with his dead father’s family, and they place him in a much more stable and secure environment – the home of the venerated coach of the local high school football team.  

The coach takes a liking to Demon. He recognizes Demon’s hidden strengths and talents and encourages Demon to try out for the football team. Much to his surprise, Demon achieves star status as a tight end, no longer a faceless hillbilly from the back country of mobile homes. But true to the trajectory of the novel, Demon suffers a major injury to his knee. He refuses surgery and tries to tough it out. Pain medication is key to this strategy and, of course, this being Appalachia in the late 1990s, oxycontin is too easily prescribed by doctors and too accessible to patients. A painful decline into addiction and despair ensues. Many of Demon’s peers fall victim to the oxycontin plague. But unlike them, Demon is resilient. He is a talented artist, and from early childhood he would draw cartoon-like sketches to escape from his desultory life.  

With the help and support of an art teacher who takes him under her wing during high school, Demon creates a comic strip that dramatizes life in the backwoods of Virginia and that gains regional notoriety. As the novel nears the end, there is a dramatic passage in which Demon confronts his social nemesis on a mountain ridge during a windswept rainstorm. It evokes a climactic episode in Kingsolver’s earlier prize-winning book, The Poisonwood Bible, where the life of a key character is threatened by an attack of army ants in the middle of the night. Ultimately, Demon enters drug rehabilitation, perseveres through the rigors of withdrawal, and gets clean. Against all expectations, Demon finds love and redemption. The woman of his dreams has been there all along, but when it happens, you cannot help but smile as you watch the two lovers acknowledge their feelings for one another. 

The title of the novel is a dead giveaway of who inspired it and Kingsolver acknowledges her debt to Charles Dickens in the postscript. Like her Victorian predecessor, Kingsolver is writing to protest the neglect and abuse that people, but especially children, living in post-manufacturing America have been forced to endure at the end of the 20^th century and into the next. In her vision, the grim experiences of people like Demon and his family, whose lives are attached to the land, are profoundly different from city dwellers. After their land was stripped of its natural resources, the rural communities in states like Virginia and Tennessee were left to languish economically and fall victim to predatory pharmaceutical companies which promoted the use of drugs that the proprietors knew would increase dependence and addiction.  

There is a relentlessness to this story and Kingsolver’s voice in many respects echoes the Biblical prophets. For some readers, the book is almost too depressing. But I think that fails to give enough credit to her Dickensian style and outlook. The sequence of episodes in different locations and with a revolving cast of characters is reminiscent of the publication of Dickens’ novels in serial installments that can almost stand alone. The narrative pulsates with non-stop action and there is an optimism that Demon will always pull through. He is an engaging character, blessed with emotional reserves and intellectual gifts that enable him to overcome his baleful surroundings. In that sense, his story, like Dickens’ novels, may strike some as unrealistic. Perhaps that is the most effective way a writer can successfully enlist readers to rally to her social cause, by offering a vision of personal triumph over social and cultural adversity. 

Coming back to the question I asked at the outset, can a novel inspired by social protest survive its era and outlive the conditions that spurred the author to put pen to paper, or fingers to keyboard? Novels like David Copperfield and The Grapes of Wrath are affirmative answers. I predict that the artistry of Demon Copperhead will ensure that it will still be read long after the environmental damage incurred by the coal mining industry and the human devastation of the opioid epidemic recede into history. Demon’s voice is so alive, his character is so engaging, and his tale is so moving that I am confident that the book will be on bookshelves or in data storage tools in a hundred years. It may be necessary to add notes to explain the ins and outs of the coal mining industry and how oxycontin was approved and marketed to an unsuspecting population, but those will be details that will not obscure the deep humanity of the book.  

Oprah In Conversation with Barbara Kingsolver

DEMON COPPERHEAD 
Barbara Kingsolver 
Harper Collins Publishers, New York, 2022, 548pp 

Web photo by George Hiles 

The story, “A Jury of Her Peers” by Susan Glaspell (1876-1948) tops the list of all the classic fiction pieces I used in more than three decades of teaching in a medical school. It is vivid, accessible, and moving – and it conveys important historical messages while also holding up a mirror to current affairs and professional identity. 

The Pulitzer-Prize winning-author, was inspired to write this powerful tale, following her coverage as a journalist of the 1901 trial of woman who had murdered her husband. First she wrote it as a play, “Trifles,” in which she played a role when it opened in Providence RI in 1916. The following year she adapted the play as a story. A moody thirty-minute film was produced and directed by Sally Heckel in 1980, making use of Christina Rossetti’s poem “In the Bleak Midwinter,” set to the music of the Gustav Holst. A rather blurry version can be found on youtube. 

On a cold winter day, Mr. Hale has found his neighbor, Mr. Wright, strangled to death in his own home. Mrs. Minnie Wright claimed not to know who killed her husband, but she had already been arrested and was awaiting charges in jail. County Sheriff Peters brings Hale, his wife Martha Hale and his own wife Mrs. Peters to the isolated. Wright home. The two wives are to gather Minnie’s clothing and see to her preserves. The men mock women’s “trifles” and jokingly tell them not to miss any clues, before they turn to the “more serious,” manly work of finding a motive. In a basket of patches destined for a quilt, the women find a strangled canary. In quilt-like fragments, they piece together the difficult life of the absent third woman. The kitchen contains many signs of Minnie Wright’s life of abuse and violence, signs that are clearly visible to the women and ignored by the men. With silent understanding, they destroy the evidence that could incriminate her.  

Considered to be one of the earliest examples of feminist literature, this story is a wonderful teaching tool. Written before women could sit on juries, it raises important issues about the discriminatory aspects of justice, the contingency of laws, and the construction of psychiatric diagnoses, especially insanity in criminal defense. Minnie’s “peers” are her female neighbours who scarcely knew her, but who easily imagine the hardship of her life and the abuse that she (and perhaps they too) suffered.  

Over many years, I had the unforgettable experience of reading this story with a combined class of law students and medical students co-taught with my law-school colleague Mark Weisberg.ⁱ All the students believed that Minnie deserved to be acquitted. But their reasons differed along professional lines, and this same difference appeared every year we taught with the story.  

The future lawyers wanted her to find pardon in a medicalized solution: they longed for an insanity defense in the battered wife syndrome, a diagnosis which did not become available until the 1970s.  

The future doctors believed that Minnie was far from insane; her actions, they thought, were taken in reasonable self-defense; they wanted a legal fix that would change the laws to allow women to sit on juries and to recognize the harm of domestic abuse. In fact, women as jurors evolved slowly over many more years at different times and places and involved several legal cases on appeal.  

The class discussion centered on why members of each group sought to preserve the rightness of their own professional canon even when they understood that the rules expressed in the story were decades out of date.  

1, Mark Weisberg and Jacalyn Duffin, 1995. “Evoking the Moral Imagination: Using Stories to Teach Ethics and Professionalism to Nursing, Medical, and Law Students”; Journal of the Medical Humanities 16. 4: 247-263 Reprinted in Change, The Magazine of Higher Learning, 27. 1: 20-27.

An earlier version of this review was published in the NYU Literature, Arts, and Medicine Database (Litmed).
Web image by Brajendra Singh

A Jury of Her Peers from Internet Archive (Open in New Window)

A Jury of Her Peers Directed by Sally Heckel in 1980

Charles Glass is a news correspondent who has written several books. His latest, Soldiers Don’t Go Mad: A Story of Brotherhood, Poetry, and Mental Illness During the First World War gives an account of a remarkable bit of history. Craiglockhart, a hospital near Edinburgh that had previously served the “worried wealthy,” is requisitioned in 1916 for the treatment of victims of “shell shock.” Although the facility operates as Craiglockhart War Hospital for only thirty months, during that time it treats 1801 officers. Two of those men, Wilfred Owen and Siegfried Sassoon, meet and become friends there and go on to be remembered by posterity as the two most celebrated British World War I poets. 

The author makes it clear that, at the time, the very idea of treating shell shock (nowadays PTSD) is revolutionary. The condition is barely known, but as the result of new weapons and means of waging battle, it has quickly escalated into an epidemic. As a result, only four months into the war the British Army has lost 10% of officers and 40% of enlisted men. The situation is not helped by the widely held perception that those with symptoms are malingering. Desertion is punishable by death. Many “treatment” facilities dispense nothing but electric shocks and verbal abuse “to eradicate what [the doctors there] define [ ] as cowardice rather than mental illness” (p. 238). In contrast, it is the aim of the psychiatrists at Craiglockhart to adapt Freudian psychoanalytic methods for use with this population, and to show that humane treatment yields superior results. (Albeit that the measure of those results is how quickly a soldier could be returned to the front.) 

In 1917, Wilfred Owen arrives at Craiglockhart. He has witnessed horrors, and he suffers from “trembling limbs, halting voice, and confused memory” (p. 77). He has only written a few poems, but within two months he becomes editor of the hospital’s literary journal The Hydra. A few weeks later, Second Lieutenant Sassoon is admitted. He has already made a name for himself as a poet and has been decorated with the Military Cross for bravery. 

At first Owen puts Sassoon on a pedestal, while Sassoon dismisses the less experienced poet as “a rather ordinary young man” (p.154). As each thrives in his therapy, their friendship blossoms, they critique each others’s work, and their poetry rises to extraordinary heights. At first, Owen’s “bellicose dreams” (p. 146) are filled with “images of caves, bulging eyes, demons, and blood” (p.179). After he manages to harness this imagery for his writing, his psychiatrist observes that “he fears them no longer” (p.181), and he produces the landmark poem “Anthem for Doomed Youth.” 

Owen’s return to the front has been repeatedly denied by the medical boards. Once he is transformed from “a trembling shell-shocked subaltern [to] a self-confident officer capable of leading men in battle” (p. 216), he finally gets the approval. He is killed at the age of 26; in a sad irony, his mother receives the “dreadful telegram” (p. 276) on Armistice Day. 

The subject matter of Soldiers go Mad is a fascinating chapter in the history of psychiatry, and the book provides a convincing example of the healing power of poetry. 

The celebrated novel Regeneration by Booker Prize winning author Pat Barker (1991) was also based on Craiglockhart and features many of the same characters. 

The building that was formerly Craiglockhart Hospital is now a part of Edinburgh Napier University. One can visit the War Poets Collection and see original issues of The Hydra: https://www.napier.ac.uk/about-us/our-location/our-campuses/libraries-and-heritage-collections/heritage-collections/war-poets-collection. 

Penguin Press, New York, 2023,  352 pages