As I described in a recent post about the novel “Our Lady of Alice Bhatti”, the Wellcome Book Prize is celebrating its 10th anniversary this year and I decided to explore this year's shortlist a bit more. One of the judges of this year's award is Elif Shafak and one of the shortlisted books is Ottessa Moshfegh's “My Year of Rest and Relaxation”. While I'm naturally drawn to reading more fiction than nonfiction, this award encompasses both kinds of writing so it's a good chance for me to read a nonfiction book I probably wouldn't have got to otherwise. The prize centres around new books that engage with some aspect of medicine, health or illness. Arnold Thomas Fanning's “Mind on Fire” recounts his lifelong struggle with mental health issues. He vividly describes the unwieldy chaos of manic episodes where extreme feelings and fantasies lead him to take drastic action as he careens through cities and airports shocking or outright terrifying people along the way. It's powerful how he conveys that to his manic mind he's following a logical course of action, but of course on the outside his actions are insensible. He also discloses the sensations of debilitating depression when he sometimes physically can't move and his thoughts revolve constantly around suicide. He eloquently expresses how all-consuming these states are and that “Within it there is no without it.” This illness not only wreaks havoc on his own health, but severely impinges upon the lives of his family and friends as well. Fanning powerfully documents his heartrending, difficult journey.

One of the biggest difficulties in understanding manifestations of mania and depression is how these conditions can exist both as a mental health issue and normal human emotions. It's common for people who suffer from severe cases of this to not have it taken as a medical condition. Instead they are encouraged to buck up and smile instead of frowning as Fanning is encouraged to do by an acquaintance at one point. Fanning concedes that feelings may arise that “may be related to my bipolar disorder, but they are also common human experiences that I share with others. At times I am happy; at times I am sad and I suffer. I have good times, and not so good times. This is life, not illness.” The culmination of his journey marks a point he reaches where he's able to live a stable and productive life, but the extremity of his emotions in this period are very distinct from periods where he was unwell and unable to function. He cites the elements needed for recovery and wellness as being “therapy, medication, exercise, meaningful work (creative, as well as occupational) and a loving relationship and relationships with friends and family.” However, it's extremely difficult to achieve all of these things at once when resources such as money, health care or employment aren't available or support from friends or family isn't available. This combined with a stigma surrounding mental health issues and Fanning's own overwhelming feelings of self-defeat make his path to recovery a long and difficult one.

The book also meaningfully describes how recovery is never a state which will be absolute or constant. There are periods where he seems to have stabilised but due to changes in medication, pitfalls in his creative endeavours in playwriting and screenwriting career or his employment status and/or difficulties in his relationships or environment can send him spiralling into extreme episodes again. His story shows how the fear of relapse can add more anxiety to his state of being. Equally there can be a crushing sense of guilt surrounding the justified wariness from the people closest to him who've been negatively impacted by his breakdowns. Fanning's memoir poignantly conveys all these things and his overall journey gives a moving personal take on issues surrounding mental health. However, there were sections which lingered on details to do with his childhood, certain relationships or creative aspirations which detracted from the momentum of his tale and the impact of his message. I appreciate how he wanted to fully flesh out his life, but the focus at times strayed from the main focus of the issues involved. Nevertheless, I was touched by the honesty of his story and enlightened by the long winding journey of his struggles.

When I was young the mother of one of my best friends suffered badly from mental illness. It was a hardship he mainly bore in silence, but sometimes the disturbance it caused to their family life spilled out into the open. I witnessed the shame this caused him. The evident love the family held was twisted and broken by frustration. I saw the aggravation it caused her not being able to be the mother she wanted to be, but there was nothing she could do to prevent the terrors from plaguing her mind. We tried to accustom ourselves to what we knew was not normal, but, being young, it’s not easy to empathize with hardships you don’t understand or appreciate what makes people unique. So I felt a real connection reading this novel about a mother struggling with mental illness and her family’s struggle to help her.

How do you cope when a family member has a mental illness? For people who have a loved one that suffers from this disability, in whatever form it takes, they know the heartache caused by having their love tested year after year. The cold hard truth is that as Jerry Pinto writes in this novel: “Love is never enough. Madness is enough. It is complete, sufficient unto itself.” This is the experience represented so movingly and astutely in “Em and the Big Hoom.” It’s important to remember that for all the frustration, embarrassment and agony which can accompany caring for someone who is stricken by a mental disease there are also occasional moments of true happiness, humour and inspiration. This book is no romantic portrait. Rather, it's an inventively told story of a family who battle for years to save the mother from the ravages of her illness.

The narrator tells the tale of his family and his mother's disability in fragments. Most of the story is composed of dialogue between the narrator, his sister and mother, Em. They don't have the kinds of conversations you'd normally expect a mother to have with her teenage children. She is disarmingly confessional, flagrantly sexual and speaks with mysterious turns of phrase. Meanwhile, the father, nicknamed “The Big Hoom,” is the pragmatic voice of reason in the family. The narrator's account moves back and forth in time, occasionally reproducing selected letters or diary entries. The family's history builds slowly out of these fragments which recall the parents' courtship, Em's employment, early years of motherhood and her slide towards increasingly manic behaviour. I think the reason Pinto chose to unfurl the story in this piecemeal structure rather than giving a linear narrative is that no straightforward way of telling is appropriate for the experience. The narrator describes how “Conversations with Em could be like wandering in a town you had never seen before, where every path you took might change course midway and take you with it.” The narrative style reflects this. Em's story can't be neatly summed up because it would betray the confusion that remains for the narrator about his mother's life. Although he grew accustomed to the way her mental illness affected her behaviour, she remained a mystery to him – one he desperately wants to solve.

Excellent interview between Jerry Pinto and Madhu Trehan about the novel and writing

Em is a fantastically compelling character for the reader as well. She speaks to her children about sex. When discussing dates she comments that she doesn't see the point of a goodnight kiss because “why send the poor man off with a hard on? Unless you’re a tease.” She makes blunt comments which can be very insightful and funny such as “I don’t understand Zen. It seems if you don’t answer properly, or you’re rude, people get enlightened.” Other times her paranoia and mania rises to the point where she’s mercilessly cruel about her own children to their faces, expressing her hatred of becoming a mother: “I didn’t want to have my world shifted so that I was no longer the centre of it. This is what you have to be careful about, Lao-Tsu. It never happens to men. They just sow the seed and hand out the cigars when you’ve pushed a football through your vadge. For the next hundred years of your life you’re stuck with being someone whose definition isn’t even herself. You’re now someone’s mudd-dha!” This blunt honesty would be startling to hear in itself, but for her to be saying it to her own children is shocking. Of course, there are threads of honesty in it which are feelings probably common to many people. I don’t want to make crass statements about how the mad are not really mad or have special insights that those who are conventionally considered sane do not. What I think is important to consider is that people can’t be simply dismissed as mentally ill, but that there are external factors which those who are prone to mental illness can be particularly sensitive to and effected by.

This novel shows what the repercussions are for the narrator who cares for his mother and how his own identity is limited because he can’t have a life outside being her carer. His struggle with his own dark feelings is meaningfully conveyed. It also shows what strength and love the family has to stick by her. Some people are abandoned as in one scene in a mental institution when a warden remarks “This is a hospital but it is also used as a dumping ground, a human dumping ground.” It’s tragic to think of people’s mental health conditions exasperated by being left alone and that even if a recovery is made there is no home to go to. It’s all the more painful wondering if you’d have the spiritual strength to stick by loved ones who fall victim to conditions of mental illness. “Em and the Big Hoom” is a really powerful novel that challenges your assumptions.