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A Rocky Start

A Case Study in Letter

Clarion Review (4 Stars)

This is a gritty, often deeply disturbing, occasionally amusing story of a mentally ill everyman.

A Rocky Start: A Case Study in Letter is the epistolary memoir of Dirk Fisher, who suffers from mental illness and reveals his long struggle to forge an independent life by steering through “the system” despite his condition and its limitations.

Fisher’s letters and e-mails to various agencies speak of his childhood, his mental problems, his experiences with social and mental health services, and his comings and goings in a chapter called Shelter-Skelter. “I was raised largely by people I believe to be psychopaths,” he writes. School, he recalls, was “like Lord of the Flies.” His fondest memories are of being young in the nineties in San Francisco. But things changed in his teen years, when he had a severe mental breakdown. He never specifies his diagnosis, but ADHD, addiction, schizophrenia, and psychosis are all mentioned at various times. He underwent stints in youth treatment facilities, had electroconvulsive shock therapy, and encountered “psychological damage from unnecessary restraints and overuse of sedatives … very loud unit with unsafe conditions … violence by the employees … music played at all hours … endless amounts of simple starch.”

Thus began a long trek through California’s labyrinthine service programs: Social Security Administration, courts, health services. His disability payments were withheld, his belongings were placed in storage, and he struggled with mind-numbing medications. He felt coerced by the legal system, bullied by shelter staff, and undermined by what he calls The Dark Side: “the forced treatments and belligerent apes with PhDs and LCSWs.” Gradually, he began to try to cooperate, creating lists of plaintive promises to “get an injection,” “go to urgent care,” “talk with peers more,” “keep my mind active,” etc.

Fisher’s fervor to recount events and make his case is admirable, but some sentences can be rambling and lengthy to the point of distraction, and, though roughly chronological, the story jumps around in place and time. The letters have grip when he indicts, through a multitude of examples, the government and mental health systems he opposes, but they slip somewhat when he launches minor complaints against specific people. In general, however, Fisher’s natural intelligence drives the narrative, engaging the reader with its authenticity.

Once immersed in the gritty, often disturbing, occasionally amusing experiences of this mentally ill everyman, one finds a full portrait of Fisher’s struggle to overcome agony, anger, and humiliation while navigating treatment programs and trying to emerge with his basic dignity intact.

A Rocky Start feels like a potential classic: an authentic treatise on the state of America’s mental health establishment and the help or damage it metes out to people who desperately need its services, written by someone who knows that world intimately, from inside both its real and perceived walls. The cover of the book depicts, in stark black on gray, the silhouette of a guy in a ball cap, a guy who deserves what Fisher wants and so often has failed to get: simple politeness, understanding, and appreciation. In a poignant passage late in the book, speaking of the newly gained privilege of being allowed to take medications monthly rather than daily, he cites many positive effects, including “a renewed sense of hope in man.”

Fisher describes A Rocky Start as “a candid and rare look into one particularly complex life.” It is that and more. It should be read thoughtfully by mental health professionals, those who suffer from mental illness, and anyone with genuine concern for the plight of the mentally ill in America.

Barbara Bamberger Scott