Dreamland

The stigmatization of mental illnesses has a long history, stemming from lack of knowledge and resources dedicated to studying mental health disorders. For much of recorded history, people diagnosed with a mental illness were isolated apart from the public, often believed to be possessed by a demon or manipulated by witchcraft. Mental illness was often viewed by the public as a failure of character or upbringing, provoking those who suffered from them to feel shame and guilt. The extreme end of available treatments subjected patients to torture, experimentation, or sterilization.

Recent decades have seen improvement in public policy and greater awareness of some mental illnesses, principally depression, but others have continued to be stigmatized. Recent studies have shown that even when people understand that a mental illness stems from genetics and brain chemistry, they may be reluctant to associate with those diagnosed with certain mental illnesses, including schizophrenia and bipolar disorder, both of which can include psychotic episodes.

One of the main characters in Dreamland, Paige Beverly Mills has bipolar I disorder, a mood disorder characterized by manic and depressive episodes, sometimes alternating and sometimes experienced simultaneously. During periods of mania, a person may experience feelings of euphoria, increased energy and activity, and irritability. During a depressive episode, a person may experience sadness, hopelessness, lack of interest in activities, and exhaustion.

According to some estimates, approximately half of bipolar patients and two-thirds of bipolar I patients experience psychosis—a state of mind in which the patient experiences a loss of contact with reality. Psychosis is not considered an illness but a set of symptoms that a mental illness can trigger. These symptoms can include hallucinations (seeing hearing, tasting, or smelling something that is not there), delusions (false beliefs of persecution, grandiosity, jealousy, paranoia, or a combination of these feelings), confused thinking (irrational, disordered, and/or racing thoughts), and lack of self-awareness that can provoke distress and fear in the person experiencing a psychotic state.

One of the novel’s two narrative points of view belongs to Paige during a state of psychosis, when she believes that she is on the run with her young son from her abusive husband. The reveal that she’s been at home the whole time and that the narrative comes from inside her psychotic episode is not made clear until the final part of the book, but readers familiar with the symptoms of bipolar I disorder may recognize how they unfold in the narrative of Beverly/Paige. Through her point of view, Sparks also depicts the guilt and shame that people with bipolar disorders can experience. Her brother Colby’s reticence to share his sister’s condition with new people in his life illustrates his fear that she will be stigmatized.

Treatment options for bipolar disorders include medications such as mood stabilizers, antipsychotics, and anti-depressants, as well as psychotherapy and self-care. Schedule regularity and routine are also considered important for treating bipolar disorders. The stroke suffered by Colby and Paige’s aunt disrupts Paige’s routine, causing her to forget to take her medications, which ultimately leads to her psychotic episode. Taken together, treatments have enabled people with bipolar disorders to live healthy, productive, and fulfilling lives, as Sparks demonstrates in his characterization of Paige as a successful artist and entrepreneur who raised her younger brother after their mother’s suicide and saved the family farm from bankruptcy.