Memories of life in a "mental institute"

I've been reading a truly fascinating book: The Lives They  Left Behind: Suitcases From a State Hospital Attic, by Darby Penney and Peter Stastny. I mentioned it a few blogs ago - I found it in the used book room of the Teton Library in Jackson where it caught my eye. I was drawn to it because the summer of 1952, when I was nineteen years old, I worked as an attendant at the State Mental Institute, in Independence, Iowa; and then, only three years later, at age 22, I took "Clinical Training" as a ministerial student at the Danville State Hospital in Pennnsylvania. Both were very similar in nature to the Willard State Hospital in Seneca, NY, on which this book is based. Willard was closed in 1995 after 126 years of operation. At that time, some 426 old suitcases, containing the belongings of former patients, were found in an attic of one of the buildings about to be demolished. They were rescued from the landfill  by Craig Williams, Curator of the New York State Museum who had them shipped to the Museum. There they were evaluated and catalogued. Eventually, the authors, Penney (a social worker and activist for patient's rights) and Stastny (a psychiatrist who is very self-critical of his profession), selected, initially, 27 suitcases, and then narrowed them down to ten, and then proceeded to research as thoroughly as humanly possible, the lives of the ten persons whose belongings were in those suitcases. They became detectives, archeologists, genealogists, historians and more. The result is absolutely gripping, at least to me.

In the book we meet:

• Lawrence Marek, who worked for more than 30 years as the institution’s unpaid gravedigger until he died in 1968 at the age of 90.
• Rodrigo Lagon, a young Filipino immigrant who worked as a house servant in Buffalo, NY until he was committed at the request of his employer in 1917.
• Therese Lehner/Sister Marie Ursuline, who at age 20, was ejected from her Dominican convent in a leadership dispute (she sided with the former prioress, so was kicked out of the convent along with that prioress), but who was never granted a dispensation from her vows, even though the church no longer allowed her to wear a habit or present herself as a nun.
• Ethel Smalls, who after divorcing her alcoholic, abusive husband, and while grieving the death of her father, was committed at the request of her landlady when, instead of meekly allowing herself to be evicted, Mrs. Smalls decided to take to her bed and not get up.
• Margaret Dunleavy, a former TB nurse, who was committed to Willard on the advice of her physician after she admitted to feeling persecuted by the administrators at the hospital where she worked.
• Herman Graham, an epileptic who was transferred from the inpatient care center at Craig Colony to Willard after his portrait photography business unraveled and his behavior became increasingly difficult for Craig Colony staff members to control.
• Dmytre Zarchuk, a WWII refugee who was committed after his wife died of a miscarriage and he began visiting the White House repeatedly in an attempt to convince Margaret Truman, President Truman’s daughter, to marry him.   
•  Frank Coles, an African-American WWII veteran who after receiving a medical discharge from the Army, lost his mother, his job, his girlfriend and his temper in rapid succession, and was committed after he was arrested for kicking a restaurant’s trash can in response to being served dinner on a chipped plate.
• Madeleine Cartier, a former French literature teacher who was committed to Willard after her emotionally turbulent nature and belief in spiritualism began interfering with her ability to keep jobs and housing.
• Irma Medina, who became extremely paranoid after she made a public claim that her former employer, the Roger & Gallet perfumery, was being used as an illegal distillery to manufacture whiskey during the Prohibition. 

Each of these life stories is compassionately told. They are all sad, some tragic, some heart-wrenching. Several of these persons were committed to Willard against their will and lived there for decades and died there in anonymity. The authors emphasize that these ten persons, rescued from oblivion, must stand in for the tens of thousands of other patients at Willard whose names and lives we will never know. They were selected on no scientific basis. They are not a representative sample. But they spoke to the authors and they spoke to me and reminded me of patients I knew those summers of 1952 and 1955, whose names are lost to me (though I think that back home in my files are possibly a case study or two that I did of patients I worked with in 1955).

That summer of 1952, when I was nineteen, was one of the most formative summers of my life. I worked initially as one of a few attendants on a ward of about 70 "senile" men. It was one huge room, with the beds in long rows, occupied by old men who for the most part were bed-ridden, who were often incontinent, some unable to feed themselves, many unable to communicate. I emptied their bedpans, often had to clean them up, bathe them, feed them. Many, as I recall, had been victims of the influenza epidemic of 1918 which had permanently damaged their brains. A few had been bed-ridden for so long, they had serious bedsores, which I had to medicate and bandage. Some tended to "wander" and had to be restrained - their wrists and ankles tied to the bed frame with gauze! This was quite something for a nineteen- year-old kid to witness and do.

But that was just the beginning. From  there I was transferred to wards where they performed electro-shock therapy and  insulin shock therapy. The book describes both these therapies in brutal detail. Insulin shock was a bit more benign. The patient was given a dose of insulin, enough to put them, eventually,  into a coma. I had to monitor them and look for signs of impending coma, at which point I would "bring them out" with a glass of orange juice that had a cup of Caro Syrup in it.

I also remember the fear many of the patients had of electro-shock therapy. They had to be coerced to come to the room where it was administered. Fortunately I did not have to do that. My job was to hold them down during the application of the shock because it caused violent convulsions. Holding the patient down during the convulsion helped prevent damage to his or her back or neck. The patient usually had no memory of the treatment, and often it erased a large portion of their memory. EST was particularly effective in the treatment of depression.  A woman in my father's church became severely depressed, went to Independence, had shock therapy, and recovered completely. Unfortunately it was also used in other cases, mostly to make patients more "manageable." I was appalled by some things I saw or heard about. But I was not yet an activist. I did not protest. Mostly I was curious, I wanted to find out what was really happening. I was aware that there were two kinds of attendants. One type was kind; another type was cruel. Many attendants were "professional" attendants. They moved from hospital to hospital. They were hardened and cruel. On the other hand, at Independence that summer was a group of Quakers doing alternative service. I immediately saw in  them a kindred community.  We tried as much as possible to be kind and compassionate in our relations with patients.

The crowning experience that summer was when I was chosen to work in the Psychodrama department. 1952 was just before psychotropic drugs came on to the scene. There was no Valium or anything else in 1952. That meant there were all kinds of non-medical therapies: e.g., occupational therapy, music therapy, color therapy, hydrotherapy, and  - - psychodrama. Psychodrama had been developed by a visionary named J.L. Moreno at St. Elizabeth's hospital in Washington, D.C. One of his students was a woman  named Eya Rudhyar. She had founded a department of psychodrama at Independence just before I came. She was married to Dane Rudhyar, a philosopher, musician and astrologer. He was and still is very famous in some circles. (The Rudhyars will get a separate post in this blog). Eya Rudhyar was a remarkable woman, and she took a shine to me. So I was invited to work with her. Psychodrama can take many forms. What I remember was a kind of spontaneous role-playing. We worked with patients who were about to be discharged. They were understandably anxious about what it would be like to go home. So we would act that out with them. A scene would be set - e.g., their home living room. The patient described every item in the room, and all the people likely to be there. The scene would be set and different ones of us would take roles.  The patient played himself, or herself. I might have played the role of a brother. Someone else, the patient's mother or father. Eya worked hard to elicit information from the patient that would make it as realistic as possible. Then we would "act it out."  The patient then might be asked to play the role of his father or sibling, and we would act it out again. I remember one time, the patient, a young man, was having trouble expressing his thoughts and feelings. Eya asked me to sit next to him and assume his posture, try as hard as I could to "become him," feel what he was feeling, and then say what I thought he might say. The patient could respond, disagree, agree - whatever - but it got him talking. What an amazing thing for a nineteen-year-old to be asked to do!

When I went back to college in the fall, I tried to use some of what I had learned in the Psychodrama department. I was the president of a Congregational College Fellowship, and could create programs. I didn't call it "psychodrama." I called it "sociodrama," which seemed less intimidating. I set up some role-playing situations relevant to a college student and tried to get people to act them out. As i recall, my fellow students were a bit skeptical.

Twenty years later, as Dean of Men at Lawrence University, I had better luck. I was working with a student who was alienated from his very demanding father who insisted his son become a lawyer like  he was. I created a simple role-playing exercise - I set an empty chair next to the student and invited him to pretend that his father was sitting in the chair and to tell him honestly what he was feeling about him. Then I asked him to move into the empty chair, become his father, and respond to what he had just heard his son say. This seemed to be really helpful to him and give him some insight into his father, and himself.

The Lives They Left Behind says nothing about there being a Psychodrama department at  Willard State Hospital. I think they were rare. I was lucky. But, sadly, I think many of the patients at IMHI had experiences very much like those at Willard. We want very much to believe that we've put those years well behind us. And in a way we have. We are not performing lobotomies any more (they still were in 1952 at IMHI). But Penney and Statsny are skeptical that things are really that much better today in the way we deal with mental illness. I'll save that issue for a later post.

The Main building of the Independence Mental Health Institute

The Main building at Danville State Hospital, Pennsylvania

Both these buildings are "Kirkbride" buildings - a design originated by T. S. Kirkbride --

"The Kirkbride Plan refers to a system of mental asylum design advocated by Philadelphia psychiatrist Thomas Story Kirkbride (1809–1883) in the mid-19th century. The asylums built in the Kirkbride design, often referred to as Kirkbride Buildings, were constructed from the mid-to-late-19th century in the United States." They were designed to let in more light, to be more spacious and humane.