A Brain Is Not a Computer: A Review of Linda Boström Knausgård’s Novel October Child
Each year National Mental Health awareness month comes and goes, but for those living with mental health conditions, navigating daily life continues. At age thirty-three, I was diagnosed with bipolar 1. Since then I’ve sought out books about mental illness that speak about the experience of involuntary hospitalization, which allows a state to detain an individual with a mental disorder for seventy-two hours or longer, sometimes much longer—an experience I know well.
As I read Linda Boström Knausgård’s novel October Child, instead of feeling triggered I felt a wave of relief course through my body because someone in the world, in this case in Sweden, understood what it’s like to exist in a liminal space between worlds—the well and the unwell—belonging not to oneself but to the court system.
October Child captures the sense of dislocation, loss of power, humiliation, shame, and the physical and emotional pain that often accompanies involuntarily hospitalization. I experienced this in 2014 when I had my first psychotic episode. Even as my mind branched from reality, I understood the necessity of inpatient treatment—there was no better alternative than a locked ward until a judge, via a doctor’s assessment—okayed my release, which, in my case, happened to be nearly a month later.
Friends and family were unable to recognize the person I’d become during my psychotic episode, and being committed was the best option for me. At the same time, I hesitate to say that it was the best option for my health, because it took me years to recover from the various techniques and treatments used to manage severely mentally ill patients. It wasn’t until this year, when I read on the National Alliance on Mental Illness website that “mental illness is a traumatic event,” that I truly understood there is the illness itself and the fallout surrounding it.
October Child is about a woman named Anna who, from 2013 to 2017, is repeatedly hospitalized and treated with electroconvulsive therapy (ECT) against her will in a place she calls “the factory”—a conveyor belt that spits out supine patients at a rate of “twenty procedures a day.”
Early on, Anna recognizes the sound of a hollow promise from the mouths of hospital staff: “They said it was a gentle treatment, like restarting a computer.” She adds that “difficult patients were given a higher voltage. Everyone knew that.” The book opens with an admission from Anna that “her brain was shot through with so much electricity that they were sure I wouldn’t be able to write this.” ECT has been linked to memory loss. For Anna, who is a writer, a mother, a daughter, a wife (then an ex-wife), losing her memories signifies the death of her art.
The author of two other novels, The Helios Disaster and Welcome to America, Boström Knausgård said in an interview in The Independent: “I’ve always written about my own experiences but I call them novels.” She makes clear that she considers October Child neither autofiction nor memoir; it is fiction—a lyrical exploration of nonlinear time that focuses on a woman’s life when she is at her most vulnerable and alone. Much of the book stays close to Anna while she’s hospitalized. Through her eyes, readers grasp how difficult it is for her to understand why these treatments are happening.
In the same interview, Boström Knausgård says that she received ECT for bipolar disorder, sometimes against her will: “I think it’s a crime…. They told you that there is a risk of memory loss, but also, if you’re there by force, you can’t say ‘no’ to this treatment… you’re in a state where you can’t really decide what’s best for you.”
In October Child, Anna is worn down by doctors with the common refrain, “[t]he treatment is gentle. It can be compared to restarting a computer.” She states: “And they don’t need the consent of those involuntarily committed, which I was. They could go right ahead. A table decked out for you Mondays, Wednesdays, Fridays.”
When I pan out from the novel, I understand there are medical studies claiming that ECT is effective for treatment-resistant depression (or depressive episodes that do not respond to medication). My intent isn’t to demonize a treatment that those facing critical mental health conditions have, in some instances, found life-saving. In a 2018 BBC article titled “The Surprising Benefits of Electroconvulsive Therapy,” Alex Riley states that “ECT is about 10 times safer than childbirth,” a statistic I find deeply odd yet relevant because it brings up gender. According to another article in The Guardian, women and people over the age of sixty are more likely to receive ECT.
The issue I want to address is patient rights: Who gets to decide? The patient? The hospital staff? The family of the patient? The insurance company? The country where the patient and hospital staff reside?
“Eighteen treatments,” Anna says. “I don’t remember much.”
From experience, I know how difficult it is to talk about what happens in a locked ward: tranquilizing shots, restraint beds, isolation rooms—some padded, some not. I imagine it’s particularly difficult to talk about receiving ECT.
In my research, it took some digging to find nonfiction accounts that feature ECT. Vincent Scarpa wrote a beautiful piece in American Literary Review called “The Sound of Silence” about his decision to try ECT after other treatments for bipolar had failed. He writes of the improvements he saw in other patients, but he didn’t witness the same improvements in his own health. He writes: “I have forgotten more than I’ll ever know, and with every day I’m made aware of new forgettings.”
In October Child, Anna recounts how she was prepared for each treatment. She was asked questions such as, did she “have any loose teeth”? Electrodes were affixed to her forehead and chest. And oxygen was inhaled. “Cold anesthesia was injected into the blood through a pre-prepared cannula. Like drinking darkness,” Anna says.
Then after she’s asleep, there’s a bite guard and a muscle relaxant to keep her limbs from flailing. “The voltage had to be high to provoke a seizure.” The seizure is the element thought to reboot the brain. After the seizure, “patients lay side by side on narrow cots, so close we were almost touching. Each and every one of us in our own darkness in a sleep that can’t be understood.”
This private darkness is a theme that arises in both of Boström Knausgård’s previous novels, which focus on the inner landscape of adolescent girls suffering with mental illness. In her first novel, Welcome to America, the child narrator, a girl named Ellen, is stricken with selective mutism after her father dies. Her second book, The Helios Disaster, homes in on themes of mental illness passed on through generations, from father to daughter. (Boström Knausgård’s father had bipolar disorder as well.) A young girl named Anna is the main character and at the end of the novel she’s committed to a psychiatric ward, coming face to face with her father.
October Child is Boström Knausgård’s most vulnerable novel because, as an adult woman, Anna is aware of the stigma surrounding her illness. She is not able to fulfill her roles as mother and wife, and feels her family backing away from her—unable to filter out who she is from the symptoms of her illness. Referencing the breakup of her marriage (with the writer Karl Ove Knausgård), she writes: “My illness dragged us all down. He hadn’t wanted this existence. Love became an itchy sweater that had to go. Get rid of that sweater and everything will be fine.”
A character named Sister Maria keeps reminding Anna that she must get better for the sake of her children. After treatments, Anna is in a bad state, “recoiling from the slightest touch.” Sister Maria tries to offer comfort:
She asked me if I remembered my children and I said, Of course I do.
What are their names? She asked.
I tried to reply, but as I was about to say Anna a pain spread behind my eyes, like it does before the tears push through, and once I started crying I couldn’t stop.
Sister Maria thinks Anna is weeping because she is remembering her children. She doesn’t comprehend the sort of agony she’s provoked for Anna, who realizes that she was about to give her own name instead of the names of her children.
In my research on ECT, I stumbled across an article that terrified me. Published in 2019 in the National Library of Medicine, the abstract mentioned that ECT impacted “the length of hospital stay and costs” for inpatient treatment, stating that, “There were marked reductions of inpatient costs ($25,298 to $38,244) and average hospital stay (16 days) when ECT was initiated within the first 5 days of admission compared with later during the hospitalization.” Five days is a stunningly short amount of time to decide whether someone should receive ECT.
In the state of Texas, patients admitted involuntarily have the right to refuse ECT, provided they are not incapacitated, in which case that choice is left up to their guardian. A guardian can decide what they believe “the ward” would do if they were able to choose. Guardians are typically for individuals under the age of eighteen or the elderly. For those without guardians who are deemed incapacitated, the decision is made via the recommendation of hospital staff.
When length of stay and costs are considerations for private and public hospitals, I shudder to think what this means for patient rights. In the state of Texas, “if you are under the age of 16, ECT may not be used under any circumstances.”
When I was a teenager growing up in the 90s, I was diagnosed with clinical depression. At one point, my psychiatrist told me that if I remained unresponsive to depression medications, ECT was something to consider. I had an odd response. I couldn’t wait to tell my friends that “my shrink had advised that I get shock treatment.” Now I could sing the Ramones song “Gimme, Gimme Shock Treatment,” and it would take on new meaning. Before I turned eighteen, I was hospitalized three times—twice for suicide attempts.
Years later, studies would show that antidepressants can cause suicidal ideation in adolescents. A growing brain is a delicate brain, and I’m grateful that I did not receive ECT as a teenager.
At one point in October Child, Anna addresses the reader, saying, “You can exit this story any time you like and that’s what makes this arrangement so rare.” As readers we can choose not to listen, to close the book, to say this story doesn’t apply to me or my life. October Child is as much about what it means to be free as it is about what it means to have a mental illness—that’s what makes Anna such a compelling character. She has to rebuild herself out of the memories that remain. As she says, “I’m like a beginner at life in every moment.”
Linda Boström Knausgård is a Swedish author and poet. Her first novel, The Helios Disaster, was awarded the Mare Kandre Prize and longlisted for the National Book Award for Translated Literature 2020. Welcome to America, her second novel, was nominated for the prestigious Swedish August Prize and the Svenska Dagbladet Literary Prize in her home country, and was also nominated for the Best Translated Book Award in the USA.
Julie Poole is a poet and writer. Her debut book of poetry, Bright Specimen, was published by Deep Vellum in 2021. She lives in Austin, Texas. More of her writing can be found at juliepoolejp.com.