there is a difference, of course, between lonely sadness and the kinds of deprivations that defined Naomi’s history—and the cognitive dissonance when those wrongs were not acknowledged, the sense that reality could not be trusted. Yet psychiatry approaches these sets of troubles in the same way, adopting a position of neutrality that can feel violent. What can a psychiatrist say, Elliott asks, to “an alienated Sisyphus as he pushes the boulder up the mountain? That he would push the boulder more enthusiastically, more creatively, more insightfully, if he were on Prozac?”