Moments like these illustrate the true toll that schizophrenia has taken on Sylvia. Her lucid moments allow the reader to see her as something other than a crazy person, which, in turn, make the later scenes—when her illness rears up again, when she is delivering nonsensical diatribes to her fellow patients or screaming about Jesus to her terrified family—all the more devastating.

*****
Back in the late 1970s, before mental illness became a frequent topic of public debate, families with a schizophrenic child had to contend with enormous ignorance and stigma. This, in turn, ensured that the family would often become its own sort of closed institution, not unlike Creedmoor itself. I cannot remember my grandfather ever talking frankly about his daughters’ mental illness. The notion of having a journalist at the dinner table, taking notes with a plan to write about our family’s most taboo topic? It’s impossible to imagine.

And yet as deeply as Sheehan dives into life inside Creedmoor, she goes just as deep in her reporting on the Frumkin family. Sylvia’s parents and older sister are strong presences throughout the book, offering a window into the ways in which severe mental illness can warp every aspect of family relations. Sylvia was hospitalized at Creedmoor for the first time at age 16. By the time Sheehan enters the picture, Sylvia is 30, and the endless ups-and-downs of her illness—the psychotic episodes, the slapping and punching of her parents, the ambulance trips to the hospital, the search for a competent psychiatrist—have thoroughly exhausted everyone.

The Frumkins’ hospitality doesn’t buy them favorable treatment. Rather, Sheehan slices through the denial, shame, and frustration to deliver a brutally honest account of everyone’s shortcomings, whether it’s the mother’s refusal to visit Sylvia in Creedmoor because their relationship had become so toxic, or the father’s insistence that she swallow megadoses of vitamins to try to cure her schizophrenia, though there’s no evidence this works.

One night, when Sylvia is home from the hospital, Sheehan goes over to the Frumkins’s house in Queens for dinner. The conversation turns to a young woman, Sonya Finkel, who had been a patient at Creedmoor on the same ward as Sylvia, and who had recently committed suicide by throwing herself onto the subway tracks. The Finkel parents had always wanted to move to Arizona but didn’t because they didn’t want to leave their daughter when she was so sick. After her death, they relocated to Phoenix. Sheehan recounts the dinner-table conversation:

Mrs. Frumkin: “Since Sonya killed herself, Isadore Finkel hasn’t had another heart attack. The Finkels come to New York to visit every few months. I saw them a while ago, and they looked so gorgeous. It’s no wonder. The cause of all their trouble was removed.”

Sylvia’s response: “Ma, are you trying to tell me something?”

At this moment, Sheehan commented years later, “I wished I could crawl under the table.”

The entire final section of the book is horribly uncomfortable, as the reader can see the whole Frumkin family cracking under the strain of Sylvia’s illness. And as she oscillates between lucidity and madness, you can predict her decline: her violent outbursts, her medication mismanagement, her ultimate return to the hospital. Once she’s back at Creedmoor, she picks up right where she left off. She dabs blue eyeshadow on her lips, ties a white T-shirt around her neck, and sashays through the ward.

“I first met Geraldo Rivera when I was in Elmhurst,” she says. “I think the Cowardly Lion was secretly married to Judy Garland. I’m going to marry Lyle Waggoner, who plays Steve Trevor. I’m going to take Lynda Carter’s place on Wonder Woman when I marry Steve. I want to have my own show, a show called Sylvia’s. I’m my favorite person. I only wish I could get along with everyone as well as I get along with me.”

*****

In some ways, Sheehan’s greatest achievement boils down to the fact that she was able to get this book published at all. My own experience writing about mentally ill people—or prisoners, juvenile delinquents, addicts, and others on the fringes of society—has taught me how hard this can be. Tougher than the challenges of reporting and writing can be the ineffable task of trying to excite an editor enough to get your story into print.

Jennifer Gonnerman is a contributing writer for New York and Mother Jones. Her book Life on the Outside: The Prison Odyssey of Elaine Bartlett was a finalist for the 2004 National Book Award.