From the outset, then, those in the legal profession are aware of the stigma that attaches to admitting to treatment for mental health conditions, even if that treatment is, like insulin, successful at controlling the potential effects of the condition. James T.R. Jones examines one aspect of that stigma in A Hidden Madness, a memoir of his work as a Wall Street lawyer, federal appellate court law clerk and law school professor while suffering from bipolar disorder.

Since 1986, Jones has been a professor at the Louis D. Brandeis School of Law at the University of Louisville. He has yet to hold a license to practice law in Kentucky. Why? Because, among other things, the application asks if the applicant has been diagnosed with or treated for a number of mental health conditions within the last five years, including bipolar disorder or major depression. Over the last 30 years, Jones treated continually for that condition and was hospitalized for it several times. Jones so feared the stigma of revealing his condition that he kept it a secret from virtually everyone. In fact, he didn’t disclose it to either of his wives until he was seriously considering asking them to marry him.

Jones now believes it is a condition that had its roots in childhood and that it was tied in with an inferiority complex he developed. Yet despite those struggles, Jones was a successful student and able to intentionally plot out and make the career moves he believed necessary to become a law professor. He tells his story chronologically and doesn’t hesitate to thank those who aided him along his way. Whether due to the academic setting or intentionally, A Hidden Madness at times takes what feels like more of an objective tone than a subjective one. This also means that while the effects are unquestionably difficult to convey, the book seems to be more detached than some other memoirs by individuals confronting mental health issues.

The fact Jones has succeeded doesn’t mean it is or has been easy. It’s unlikely any of us not afflicted with the condition can really understand its effects. Jones tells of periods, such as after a divorce, where even with lithium therapy he struggled to fulfill his job duties. He talks of stress pushing him toward the extremes of the condition, often being “constantly hopeless” and irritable, lacking energy and being “chronological suicidal.” He recognizes the lithium and other medication controlled the symptoms enough that he could work but still experienced peaks and “horrible valleys.” Although unlikely meant that way, Jones makes an serious observation inn which many of those who have attended law school may well find humor: “It is difficult to teach Decedents’ [Estates] at the best of times, let alone when severely depressed, sometimes suicidal.”

Jones’ occasional suicidal ideations may reflect the dichotomy of bipolar disorder. Jones has long had an interest in guns. Even though he and others recognized they pose a risk for someone who is suicidal, he had what he considered legitimate reasons for keeping them. “I wanted to to have them around both to show I would not use them and to have them available as the tools to end my life if I chose to do so,’ Jones writes.

Jones describes some of the effects of the disease in the private practice of law, noting there were days when he was an associate in a Jacksonville, Fla., firm where he was so depressed he couldn’t put in the necessary billable hours. Yet another aspect of that depression was to ruminate over that inability, creating a vicious cycle. Although A Hidden Madness touches on this, it has an inherent limitation in addressing mental health issues in the legal profession. For example, while it unquestionably has its own pressures, most law professors aren’t subject to the pressures and deadlines their job demands, many imposed by courts and clients. Moreover, academia affords the protections of tenure. In contrast, the practicing attorney faces a conundrum. If they don’t seek treatment, they may be harming their client or forced to quit practicing law. Even those who seek treatment fear disclosure because it may result in loss of clients or perhaps even opposing counsel seeking to take advantage of the condition.

Another area Jones occasionally touches on but does not explore in detail is the advantage professionals with mental conditions may have — resources. Jones points out that his insurance paid for his hospitalization. He observes that part of the reason he was able to maintain ongoing treatment is that insurance also paid for his it and his prescriptions. Likewise, he had the benefit of disability payments. In contrast, many people who face mental health issues in today’s America have none of those things. It is almost impossible to imagine a person staying on drugs like lithium or them remaining effective without ongoing visits with a health care provider. If they lose their job, the only income replacement may be unemployment.

What A Hidden Madness perhaps explores best is the fear of disclosure. The stigma of mental illness can be too much for even highly intelligent and rational people whose mental health issues are treated and under control. Even though Jones had episodes where he needed hospitalization, in part due to the fact physical side effects of lithium forced him to stop taking it, he has maintained a highly respected job for decades. Yet even he deeply feared going public with his story. He points out the fear an applicant for law school or admission to the bar may have in disclosing what is likely their most closely held secret and perhaps even disclosure of their most personal medical records. it is clearly a conundrum. The failure to disclose could result in denial of their application; disclosure might produce the same result.

Jones makes a strong argument against the stigma that attaches, encouraging others not to be held captive by it like he was for decades. recognizing it held him captive for decades and encouraging others. As such, he is one of many professionals lending their voices to what Jones considers to be “the most stigmatized group today,” those who have and treat for mental health conditions. It is only through efforts such as his that such people and their treatment may no longer need to stay hidden.

James T.R. Jones, A Hidden Madness

The list of those who should be required to read the book is long: every decisionmaker and policymaker in the Department of Defense, every NCO and officer in the military, and every member of Congress. It better be on President’s Obama’s list of “books I read this summer.” What It Is Like to Go to War should be assigned reading at every military academy and in any fundamental leadership course for non-academy military training. In fact, it is a book that should be read by everyone who relies on the military. In other words, it should be read by all of us.

Marlantes combines personal experience, philosophy, history, mythology, ethics, psychology and spirituality in examining how we train our warriors. Marlantes has a range of ideas on how we can better prepare them for the jobs we assign them and, equally as important, to return home with the least damage to their psyche. Much of what he suggests comes from his own experiences as a combat Marine in Vietnam (some of which will be familiar to those who read his highly praised Matterhorn: A Novel of the Vietnam War) and as he tried to cope with post-traumatic stress disorder after the war. Even though that war was fought decades ago, Marlantes now has the benefit of perspective.

He argues persuasively that not only do today’s soliders face many of the same issues he did, the ability to kill remotely, and seemingly antiseptically, with drones, cruise missles and the like may raise other issues. Yet while recognizing modern warfare, What It Is Like to Go to War occasionally also looks to the past. Marlantes argues that some “primitive” societies better prepared their warriors for the toll combat takes on the body and the mind. Among other things, he suggests “rituals” to aid combat veterans, including some that would be performed immediately after a firefight. He also suggests that spiritual (not necessarily religious) guidance not only be part of military training, but available in the combat zone and afterward, particularly since our wars are fought by the young of society. At least from a layperson’s perspective, much of what the book suggests does not seem to be difficult to put into practice or disruptive of military training.

There is no question Marlantes, a Rhodes scholar, thought long and hard about the personal consequences of combat, how we prepare our soldiers for it and how to help them deal with it afterward. The book is stunning in the breadth of knowledge on which it draws yet is written to remain highly accessible. It is an important book, far too important to ignore.

Karl Marlantes, What It Is Like to Go to War

One thing I realized in preparing this post is that I read both of this year’s “best” books on my nook. I hadn’t realized that at the time of my “year of the nook” post earlier this week. But it reminds me of another drawback to many ereaders. Because I don’t have the color nook, all the photos in the ebook version of the best nonfiction work were in black and white — not handy when the picture captions refer to differences in color.

BEST NOVEL

I’m sure many people will disagree but I was fairly unimpressed with the fiction this year. The books seemingly getting the most attention — e.g., Freedom and The Passage (as to which see below) — I found okay at best. As a result, Emma Donoghue’s Room tops my list for 2010. As most commentators have observed, the voice of the novel — a 5-year-old boy — is fairly compelling given the somewhat horrific premise. I felt, though, that the book struggled toward the end so, while it is probably the best published this year, it isn’t one I would necessarily proselytize about.

Whether indicative of my predilections or the state of fiction in American in 2010, my two honorable mentions for best fiction published in 2010 are both science fictional. On the surface, Charles Yu’s How to Live Safely in a Science Fictional Universe is the story of a time machine repairman in a flawed, alternate universe. It really is a story about the search for self, one where Yu has an uncanny ability to use humor to strike at the heart of how we become what we are, whether we like it or not. Similarly, Gary Shteyngart’s satirical dystopian love story (yes, those words all go together in this case) Super Sad True Love Story looks at who we are in a too-much-information age.

NONFICTION

Comparatively speaking, 2010 was stronger for published nonfiction although, again, nothing struck me as drop dead great. Ultimately, I would have to say Rebecca Skloot’s The Immortal Life of Henrietta Lacks was the best of the year. Skloot’s book could serve as a primer on how to write science journalism. Just as cell research, the subject of the book, takes us to basic levels of the human animal, Skloot takes us to the at times compelling human level of the story behind the science. Some may complain about how Skloot becomes part of the story but had she not done so we may never have known it.

The “honorable mention” also features science journalism and a couple memoirs. Mary Roach looks at science in her inimitable way with Packing for Mars: The Curious Science of Life in the Void. Perhaps because I grew up during the space race, I found this to be the most intriguing and enjoyable of her works to date — although I wouldn’t discourage anyone from reading any of her prior books.

It’s the humor — both subtle and not-so-subtle — that are the hallmarks of the two memoirs on the list. Mark Vonnegut’s Just Like Someone Without Mental Illness Only More So was a very strong contender for my favorite book of the year. The follow-up to his memorable The Eden Express: A Memoir of Insanity, Vonnegut looks at the years of his “recovery from” schizophrenia and bipolar disorder — and his fourth psychiatric breakdown “when the voices came back” more than 14 years after his last breakdown. Despite the serious topic, some of the flavor of his father Kurt’s writing style makes the book that much more enjoyable. Less subtle is Justin Halpern’s Sh*t My Dad Says, one of the few books I’ve read in the last number of years that actually had me laughing out loud. I did find it a bit frightening, though, that I think I tend to sound like Halpern’s father.

BOOKS I WISH I’D READ THE YEAR THEY WERE RELEASED

This category exists because it is not uncommon for me to come across books I love a a couple years after they are first published. What makes this grouping unique in 2010 is that all of the books works in translation and were first published in the U.S. in 2009.

Probably my favorite and what some may consider a bizarre choice is Jonathan Littell’s The Kindly Ones. In fact, one might be surprised that a 975-page novel about World War II and the Final Solution from the standpoint of an SS officer who was neck deep in the slaughter could be considered a “favorite” read — or at least question the ethos of the person who considers it such. Yet the book, originally in French (but written by an American) and translated by Charlotte Mandell, is a compelling read. I don’t find it surprising it won France’s two most prestigious literary awards — or that it’s done poorly in the United States. It is an overlooked literary accomplishment.

Close behind is another French novel, Philippe Claudel’s Brodeck. Like the The Kindly Ones, it takes a different perspective on the concept of guilt. Claudel examines the concept of collective guilt of an occupied community about acts taken regarding both longtime residents and outsiders. Translated by John Cullen, Brodeck also deserves far more attention than it has received in the United States and would serve as a outstanding introduction to anyone who wants to know why modern translated literature is important. Either it or The Kindly Ones may have earned “Best Novel” status had they not been published last year.

Moving from World War II inspired fiction, two other foreign works I loved this year and highly recommend are Santiago Roncagliolo’s Red April and Gerbrand Bakker’s The Twin. The books, though, are quite inapposite. The Twin, a Dutch work translated by David Colmer, is a reminiscence on or exploration of life, obligations and aging. Both topically and in terms of pacing it is akin to Marilynne Robinson’s Gilead and highly deserving of its place on the longlist for the 2010 Best Translated Book Awards. In contrast, Red April, translated by Edith Grossman, is a political thriller based on the Peruvian government’s repressive battle against the Shining Path movement. It is one of those books that grabs you early on and is difficult to put down.

WORST RATIO OF QUALITY TO HYPE

In terms of hype, Jonathan Franzen’s Freedom might take the cake. After all, not many novels are declared the “novel of the century” some 10 years into the century. Still, it had some relative quality and value. There is no such balancing of scales with The Passage by Justin Cronin. This was THE MOST ANTICIPATED book of the year. In actuality, it was basically “a calculated attempt to make money, not literature” or, in other words, a “hackneyed, overwritten pile of poop” resulting from “naked opportunism.” I am surprised how many “best of” lists I saw it on at year end.

BIGGEST DISAPPOINTMENT

I know that in the world of American Lit Mark Twain is “he who must not be impugned.” Yet it’s quite very easy to point to Volume 1 of his autobiography as falling far short of my expectations. After a while my brain and eyes were glazing over so often that I, like Garrison Keillor, started “turning the pages two and three at a time.” Unlike Keillor, though, I gave up entirely about a third of the way through. It wasn’t the only book I abandoned this year but it was the most surprising of them.

Mark Vonnegut, Just Like Someone Without Mental Illness Only More So

Normally, a person wouldn’t think a memoir about being forced into frozen labor camps during World War II is the type of work that examines luck. Yet Stefan Waydenfeld’s The Ice Road: An Epic Journey from the Stalinist Labor Camps to Freedom shows the full range of good and bad fortune and how capricious it can be.

Waydenfeld was a teenager in Otwock, Poland, a city not far from Warsaw, as the European continent moved toward the outbreak of World War II. The son of a medical doctor and a medical bacteriologist, Waydenfeld enjoyed the benefits and opportunities afforded by a comparatively comfortable life, one he even terms “idyllic.” That would end rather abruptly when Germany invaded Poland on September 1, 1939, and become even worse when the Soviet Union invaded the country from the east 16 days later. Waydenfeld’s father, who had served as a medical officer in the Polish Army, was mobilized before the German invasion. Five days after the German invasion, Waydenfeld, then 14, set off on foot with friends toward a mustering point to the east to join the Army. He and his friends wouldn’t join the Army on their trip — and he would not see his home for another eight years.

Through a fortunate turn of events, Waydenfeld’s father located him when he took shelter with another family. And, by chance, his mother joined them just as they were going to attempt to return to Otwock to find her. Yet the Waydenfelds faced a dilemma: try to return to the portion of Poland occupied by Germany or stay in what was now the Soviet occupied section. They ending up staying in the Soviet-controlled area. Ultimately, although not technically prisoners, hundreds of Poles were deported in crammed cattle cars to Siberian labor camps in 1940. The Waydenfelds ended up in Kvasha, a camp in far western Siberia with a subarctic climate. “Here you shall live,” they were told.

Kvasha was not a prison camp. There was housing and food available. Yet survival depended on working in the great forests of the area cutting and removing timber. The phrase frequently heard from the Soviet officials at the camp was, “He who does not work, does not eat.” Although in his teens, Waydenfeld performed a wide variety of difficult tasks in the camp. The worst, which gives the book its title, was when he and his father were part of a crew charged with maintaining “the ice road.” The road consisted of iced ruts on which sleds would transport felled trees in the midst of the winter. Maintenance required traveling up and down the road gathering water from the adjoining river and resurfacing the ice in the ruts. Often working at night, the task not only involved working outdoors in sub-zero temperatures but often being coated with ice as a result of the water they were required to spread on the road. The physical burdens and distress of the work almost beggars the imagination.

After Germany invaded the Soviet Union in June 1941, the Soviets released the Poles, although they were limited to places within the Soviet Union and were responsible for their own transportation. Although this meant the Weydenfelds would leave Kvasha, it also embarked them on a journey of thousands of miles through Kazakhstan, Uzbekistan and Turkmenistan by rail, on foot and by truck. They scavenged local markets for food and took up housing where available, aided by the senior Weydenfeld’s ablity to occasionally find employment thanks to his medical degree. The family and numerous others eventually found passage to Tehran and outside Soviet and German influence.

Waydenfeld recounts events with an excellent eye for detail, both in terms of events and the family’s surroundings. Some readers might even wonder about the extent of the detail given that he did not keep a diary and only started making notes of his experiences some 15 years after. Regardless, The Ice Road tells a compelling story about the treatment of the Poles during World War II, an aspect of the conflict that is often overlooked. Additionally, the book includes a look at the Polish deportations and the formation of a Polish Army corps, which Waydenfeld joined once outside Soviet control.

Despite the hardships it recounts, The Ice Road is a story of good fortune in that the Waydenfeld family survived. Yet a couple items in his recounting show just how fortuitous they may have been. For example, in May 1940 the Waydenfelds stood in line for a German repatriation train that would have returned them to Otwock and the part of Poland occupied by the Germans. The family ahead of them in line filled the quota of returnees and they were told to go back to where they were staying and wait for the next repatriation train. There was never another and they were deported to Siberia.

Or they could look back just a bit more. In May 1939, the Waydenfelds took a cruise to the Mediterranean. They picked it over one slated to go to New York City in August 1939. That ship was in New York City when the war broke out — and the passengers spent the war in the United States.

In the introduction to that book, Vonnegut, the son of author Kurt Vonnegut, described himself as “a hippie, a son of a counterculture hero, a B.A. in religion [with a] a genetic biochemical predisposition to schizophrenia.” He and friends established a commune in a remote area of British Columbia but the mysticism he sensed he was experiencing led in 1971 to his hospitalization in a psychiatric hospital in Vancouver for what was diagnosed as paranoid schizophrenia. Eden Express details that journey, two subsequent hospitalizations and his efforts toward recovery.

Although Vonnegut has since come to believe what he really suffered from was a combination of what is now know as bipolar disorder and schizophrenia, his recovery has been equally remarkable. Not only did he return to “normal” life, he attended Harvard Medical School and has been a practicing pediatrician in the Boston area sine the early 1980s. With his follow-up memoir, Just Like Someone Without Mental Illness Only More So, he takes readers on that journey — and his fourth psychiatric breakdown “when the voices came back” more than 14 years after his last breakdown.

As a fan of Eden Express, I must admit I approached Just Like Someone Without Mental Illness Only More So with a bit of trepidation. I didn’t want anything to take away my favorable impression of the first book (although rereading it before the new book arguably may have increased that risk). Yet the new book drew me in as much as the first and I found it just as compelling. Not only does Vonnegut he again provide insight into the lives of those who confront mental illnesses, the book gives us a real glimpse of the type of person and doctor he is, his bout with alcoholism, and a look at how the practice of medicine has changed in the last 25 years. (“Every bright idea that was supposed to improve medical care has made care worse, usually by increasing costs and restricting access.”)

Eden Express was marked by its frank yet conversational tone. A similar approach helps make Just Like Someone Without Mental Illness Only More So as good as the predecessor. The two books, though, are different. The new one break the story into smaller segments as opposed to lengthier chapters. It also has more echoes of his father’s style and wit. For example, if he’s been doing so well, why does he continue to see a psychiatrist? His response is a simple, Vonnegutesque one: “Over the years I’ve come to care about Ned and, and I think I go mostly to make sure he’s okay.” This approach enhances the readability of a story that gives an idea of the life of a “regular” person dealing with existing or quiescent mental illness and how easy it can be to slip into a manic-depressive or schizophrenic state.

Still, Vonnegut never suggests he possesses some unique quality or strength that gave him advantages in recovering.

None of us are entirely well, and none of us are irrevocably sick. At my best I have islands of being sick entirely. At my worst I had islands of being well. Except for a reluctance to give up on myself there isn’t anything I can claim credit for that helped me recover from my breaks. Even that doesn’t count. You either have or don’t have a reluctance to give up on yourself. It helps a lot if others don’t give up on you.

Yet even that doesn’t ensure there will never be recurrences. In fact, Vonnegut’s fourth breakdown found him taken by police from his home in a straitjacket when he tried, unsuccessfully, to run through a third-floor window to prove to God that he was worthy of saving and “not just a selfish little shit.” Vonnegut says that when the voices he heard in the early 1970s came back, “it was like we picked up in the middle of a conversation that had been interrupted just a few minutes earlier.” The manic part of his bipolar disorder manic depression makes it that much more difficult. Vonnegut describes the slide into mental illness as a “grammatical shift. Thoughts come into the mind as firmly established truth. … The fantastic presents itself as fact.”

Once again, though, the hospitalization, together with medication and support, allowed Vonnegut to return to a normal life, including the practice of medicine. He forthrightly examines not only the role of medication but the treatment he underwent in the 1970s and explores the extent to which family heredity can play a role in a person’s psychiatric state.

Fortunately, Vonnegut did not just return to the practice of medicine but also to memoir. Taken together, Eden Express and Just Like Someone Without Mental Illness Only More So are an excellent survey of a life affected by mental illness. Yet with its style, tone and frank manner of addressing serious issues and events, Just Like Someone Without Mental Illness Only More So earns a place on anyone’s bookshelf on its own merits. It is the most insightful and enjoyable memoir I’ve read in a long time.

Mark Vonnegut, Just Like Someone Without Mental Illness Only More So