An unflinching, rare account of living with severe mental illness that is also a bold commentary on how we misunderstand this often debilitating disease.

The Complications is an intimate portrait of what it’s like to live with schizoaffective disorder of the bipolar type as well as a biting, revelatory critique of America’s mental health culture. Emmett Rensin has written and edited articles for major national media outlets, and taught writing and literature at prestigious schools. But he has also lost jobs and friends, been hospitalized and institutionalized, and cycled through a daunting combination of medications. With scorching honesty, he reflects on his messy, fragile attempt to live his life, his periods of grace, and his near misses with disaster and death.

Going beyond the usual peans against “stigma” and for “understanding”, Rensin confronts the dysfunction in current mental health narratives, contrasting what he calls mental illness “high culture”—in which we affirm the prevalence of anxiety and encourage regular therapy, insisting that the “mentally ill” aren’t dangerous or even weird—with even progressive society’s inability to contend with people with more severe forms of mental illness: those people we pass on the street talking to themselves, those caught in a loop between hospitals and prisons, or even those who we cannot tolerate in our own schools, offices, and lives, including himself.

With raw honesty, Rensin invites us into every aspect of his life, from what it’s like see four different psychiatrists in one year and the nature of psychotic breaks to a harrowing diary that logs exactly what happens when he stops taking his medication and the unexpected kinship he discovers with an incarcerated spree killer with schizophrenia. Going beyond pure memoir, he reflects on the uncertain “science” of diagnosis, the nature of art about and by the insane, political activism, and the history of madness, from the asylum to the academy.

A compelling, often devastating, blend of memoir, cultural commentary, and history, The Complications elevates the conversation around mental illness and challenges us to reexamine what we think we know about what is to go insane.