I hate to speak indelicately about a delicate subject, but many books and films about mental illness resemble one another to the point of seeming formulaic. Maybe that’s a testament to their accuracy; they all document a similar experience. Reflecting on One Flew Over the Cuckoo’s Nest, Girl Interrupted and I Never Promised You a Rose Garden, the following list represents what I have come to expect from mental illness literature:1) A surprisingly-relatable protagonist who describes his/her disease in the first person, in surprisingly-relatable terms.2) A tour of a hospital inpatient psych ward, with introductions to various other patients, who inevitably range from mildly- sometimes comically- off-kilter to profoundly debilitated, some of whom act as cautionary tales about how badly things can end.3) Usually a “good” doctor/nurse/attendant, who shows the positive side of the healthcare system, and a “bad” doctor/etc who illustrates the negative.4) Some sort of resolution or therapeutic breakthrough which allows the story to end with a sense of a completed plotThat list looks callous, but it’s also about right. Bitter Medicine breaks from this pattern, and actually brings something new to the table. It is a nonfictional account of Oliver (“Liv” ) Martini’s struggle with schizophrenia from 1986-2010 (the publication date). Although Oliver himself provides illustrations, the text is entirely authored by his younger brother, Clem, who doesn’t always understand what Oliver is experiencing, but makes an earnest attempt to document it objectively. He’s a devoted brother who goes to great lengths to support Liv, but is frequently unsure what he should do. When Liv first experiences paranoia -imagining he is being followed by masked figures- it is painful for Clem to ask him to seek help. Ten years prior, their youngest brother Ben had similar delusions, but he committed suicide before he could get any substantial treatment. That experience left the Martini family with a lot of guilt, fear and uncertainty, which understandably surfaces in this story several times. Most of the narration follows Liv in and out of therapy, and details his difficulty finding work when he isn’t hospitalized. Little is said about the psych wards he frequently checks into. Much more attention is paid to the side effects of his medications (muscle spasms, poor balance, slurred speech, blackouts, weight gain). Those are real-life issues that other books never seem to touch on, but they can be a great concern to long-term psych patients. Another real-life issue is how Liv’s disease affects the family. Clem doesn’t sugarcoat the fact that Liv’s condition probably pushed his parents’ already-problematic marriage beyond its limits. He doesn’t blame Liv for the disease, but he does show the enormous demands schizophrenia makes on family members of the afflicted. Living with Oliver through trials with ineffective therapies, or trials of medications with intolerable side effects, through periods of unemployment… these all require a lot of cooperation, communication and understanding. Lacking those skills was a proximal cause of his parents’ divorce. That’s a tough message to deliver diplomatically, but it sounds credible coming from Clem. Instead of being bitter about it, though, Clem also cites ways his family benefited from the experience. Now that’s something new. Liv and his father had always been distant, but the disease did somehow bring them together. The father was the most outwardly shaken by Ben’s suicide, and when Oliver was diagnosed with schizophrenia, his father reached out in a way that surprised everybody. Likewise, there are instances where the brothers come together in ways they otherwise wouldn’t have. This isn’t being Pollyanna; Clem admits the disease takes more than it gives, but insists there are silver linings to be found, if you’re looking for them. That’s an unusual perspective for this kind of book.It’s also refreshing that there aren’t really any white-hat or black-hat doctor figures in this story. In fact, the doctors are hardly mentioned at all. There is however, a long discussion about how under funded/undermanned hospital-based and community psychiatric services are, and how many of the mentally ill are consequentially homeless or in prison. I was surprised to hear this, since the Martinis are living in Canada, where I assumed social services and community-based outpatient therapy was better. Apparently not.The last third of the book follows Oliver’s attempts -eventually successful- to qualify for a trial regimen of a then-new drug (clozapine), which he responds to remarkably well. At the end, the Martini family sees Oliver spontaneously smiling for the first time in twenty-five years. The smile is a much-needed sign of encouragement to a family desperately in need of one, but it isn’t a Hollywood resolution like I put on my list above. Clem makes it clear that schizophrenia is never cured and gone forever.If this subject holds interest for you, I highly recommend this book. There is a realism here which I have not seen surpassed in this genre.