by M. J. Cates
“Well, if you’re at the Phipps,” he said to her on her first day, “you must be a very intelligent young woman. We get nothing but the best from the Phipps. Room all right, dear?”
“Yes, it’s fine.” Dear?
“Should be comfortable enough. The nurses eat better than the rest of us, for some reason—I keep meaning to look into it. Have you been inside a state asylum before?”
“No, I haven’t.”
“Well, let’s just say we’re not the Phipps.”
He ransacked his desk for a set of keys and, when he finally found them, held them aloft like a trophy. With his wild hair and his baggy suit he didn’t seem like a doctor at all.
He took her on a tour of the wards, keys jangling with every step. A and C Cottages were not much different from the wards of a general hospital, but D Cottage was a different matter.
“Have to move quickly,” he said, as he unlocked a door, “otherwise I’ll never get out.”
He introduced Imogen to the ward psychiatrist and the floor nurse but she didn’t take in their names because of the cacophony of the patients, some wandering here and there, talking, gesticulating, sometimes shouting. Others stood stock-still, muttering, or simply staring.
“Obviously an area visitors don’t see,” Zachary said. “If they did, families would never allow anyone to be admitted and we’d end up with them roaming the streets.”
Imogen nodded, and tried to look unruffled.
Two patients were sitting in corners by themselves, rocking violently back and forth. A wild-eyed man paced from one side of the day room to the other, making agitated gestures, then suddenly stopped to stare at the ceiling or floor. Many slumped in chairs, clutching books or magazines, unopened, on their laps.
As Zachary pointed out various aspects of the facilities, a handful of patients rose from their seats and shuffled around him, tugging at his sleeve.
“Doctor? Dr. Zachary? May I speak with you?”
But he breezed on by, pointing and chatting the whole time, as if the patients were so many leaves, blowing around him.
Imogen was glad he did not ask her any questions. She doubted she would have been able to reply—not just because of the noise, but because of the smell. The ward was clean, its surfaces shining, but the floors were old and wooden and all the carbolic in the world was not going to wash away the smell of urine.
“Well, how did that strike you?” he said when they were outside again. “Still sure you want to be a psychiatrist?”
“Oh, yes,” Imogen managed. “Quite sure.”
She breathed in deep lungfuls of fresh air, as they headed back to the main building.
Dr. Zachary pointed to B Cottage. “Our violent ward. We don’t put interns through that.”
“Do you have laboratories on the grounds?”
“Oh, yes—we do all our blood work in-house.” He looked at her. “Or did you mean experimental labs?”
“Yes. Experimental.”
“The asylum is not a research facility. We house the mentally ill. Some of them get better, but not a lot. Rest and quiet may be enough for those in A or C, but the patients you just saw are not going home. The minute some clinic or hospital sends us a cure, we’ll use it, but until then we’re what the unkinder critics like to call a ‘warehouse.’ Personally, I think it’s no small thing to keep psychotic people safe and comfortable—it’s a kindness society has not always provided.”
* * *
—
Although the asylum’s nurses and psychiatrists were friendly, Imogen missed Donna. She spent her evenings in her room, studying German and reading Freud and wondering if she might be able to apply his thinking to psychotic patients—a prospect for which Freud himself expressed little enthusiasm—and writing long letters to her friend.
“I don’t know what I expected,” she wrote. “I suppose I thought I could look into the eyes of a mad person and see the injured, suffering person hiding in there and coax her out. But mad eyes are so opaque—like windows onto nothing. At times it makes me question the whole idea of psychiatry. From what I see on the back wards here, the patients’ best friends are the attendants. They’re almost completely untrained, but some of them are marvellous, even with the most paranoid.”
She told Donna about a legendary attendant named Molly Myers. She was a short, tubby little woman, who never had a harsh word for anybody, no matter the provocation. Patients were constantly asking to be transferred to her ward, because she was so kind and so good-natured—but firm and consistent. She teased the patients in a way no handbook would ever recommend. Imogen heard her say, more than once, “So-and-so, my dear, you’re as mad as t’ree hatters today, but I loves ya.”
“I suppose,” she wrote to Donna, “the Irish accent helps.”
One Monday morning, Molly was absent. Patient after patient came up to Imogen, asking, “Where’s Molly? When is Molly coming back? I have to see Molly!” In the course of a few days, their worry rose to near panic. The ward psychiatrist finally relented and told them the reason why Molly was gone. One of her daughters had caught diphtheria and died—just ten years old.
A wave of sorrow washed over them, and even the more agitated lapsed into silence for a time.
Imogen was there when Molly returned to the ward. As she was signing in and checking the logbook, the patients gravitated toward her from all corners of the room like ducklings toward the mumma duck.
“I don’t think they even said anything,” Imogen wrote. “They just drifted over, one by one, and touched her arm or shoulder. And the tears just streamed down her face. Eventually, of course, she wiped her eyes and blew her nose and then said, ‘Yer all nuts, the lot a ya, but yer good folks and I loves ya to pieces.’ ”
Donna’s letters in return were full of Phipps gossip. Ganz had appointed Ruth Fein, a senior nurse whose single available emotion seemed to be self-pity, to his Mental Hygiene Initiative—unqualified, Donna noted, but at least it was keeping her away from the patients. And Lila Quinn was growing more waspish by the hour. The woman was a positive fount of turmoil, completely unemployable anywhere else, and remained at the Phipps solely because Ganz could not resist birds with broken wings. The good Doktor had a bigger saviour complex than all the other psychiatrists put together. She also wrote about her own growing passion for Freud.
Imogen was beginning to consider Freud the Einstein of psychology. Although she couldn’t see a way to cure the severely schizophrenic with his insights, she thought there might be a chance on the middle wards. “That’s my trouble,” she wrote to Donna. “I want to be brilliant in the lab and a saviour in the wards!”
There was a patient in C Cottage named Sylvia, who was about thirty-seven. She had been in the asylum for six months, her third admission. According to the intake report, she was a high school teacher who had stopped looking after herself, stopped writing to her family, stopped seeing friends. When she stopped showing up at the school they sent someone looking for her and found her dirty, highly agitated, and delusional.
As Imogen was leaving the ward one day, Sylvia was being led away by a nurse for hydrotherapy. With her bombed-out eyes and grey skin, she seemed as frail as a ninety-year-old. This, Imogen knew, was the toll her inner voices were taking.
Molly Myers, who was also observing, said, “She fights her demons, that one. All day long, and all night too if you ask the night nurse. And it just takes it out of her. Some o’ these poor souls aren’t able to fight, God knows, and some just breaks under the struggle. But not Sylvia. She’ll fight ’em till the day they die—or she do.”
Imogen went to Dr. Zachary and asked if she could try treating Sylvia with psychoanalysis.
Zachary closed Sylvia’s file and folded his hands on top of it.
“All afire with Dr. Freud, are you, dear?”
“Well, not for every patient.” Dear yourself, she wanted to scream.
He tapped the file with a stubby finger. “Why this patient in particular?”
Partly it was because Sylvia just looked more normal than the other patients. She had none of the facial distortions or tics that were so common on the ward. Except for the exhaustion, she looked like someone Imogen might know in the outside world. But she didn’t say that.
“I think Sylvia’s a reasonable candidate because she has days where she can be lucid for an hour or two.”
Zachary shook his head. “Not enough.”
“I know. But most days, Sylvia is aware of her condition. She’s unique in that respect. Even when she’s quite florid, she seems to know there’s something wrong with her—that she hasn’t always been like this.”
“She doesn’t blame electricity? Or the Marconi company?”
“No. She says, ‘I know there’s something going on inside of me, something that needs fixing.’ She’s motivated and she has this modicum of insight—I think she’d be a good candidate.”
Zachary winced a little. “We don’t want to confuse her even more, do we, dear. What would be your approach?”
“Dream analysis and free association, to begin with. I’d go gently.”
“You’d have to. Won’t do to force self-knowledge on people too weak to bear it.”
“I’ll proceed at her pace, not mine, Doctor.”
“Very well. Tell the ward psychiatrist you’ve cleared it with me.”
The ward psychiatrist actually laughed at me, she wrote to Donna a few days later. I mean literally. I don’t understand that attitude. Or maybe I do. These asylum psychiatrists are bitter men—they can‘t advance because, stuck out here in the country, there’s nowhere to advance to. They’re cut off from all the new developments, and I think they’re in a kind of despair.
* * *
—
She met with Sylvia three times a week. Even maintaining eye contact was beyond her patient at first.
“Can you tell me why you find it so difficult to look at me?” Imogen asked. This elicited a tight shake of the head.
It was only on her fourth session—and it felt like a major triumph—that Sylvia found the courage to answer.
“It’s him…my voice,” she said haltingly. “The loudest one. Meanest one. He’s screaming in my ear—even right now, right this minute—that you are a witch. You’re evil. You’re here to poison my mind.”
“Are you able to tell yourself it’s not real? That what it says is not true?”
“He says the same about you. Your every word. Lies.”
Session after session Sylvia resisted dream analysis. She would tell Imogen she had had the most horrible nightmare but refuse to tell her anything more.
“Did it involve someone near and dear?”
“I can’t say.”
“Was it full of action—or was it more like a mood?”
“Please, Doctor. I can’t say.”
“Why can’t you, Sylvia?”
“I can’t. Please, I just can’t.”
Sylvia received any probing question, no matter how gently phrased, as if it were a sabre thrust, cowering, folding herself up tighter in her chair. She could not talk about her childhood, her parents, her siblings—even in the most general terms. When Imogen asked, “Tell me about your father,” Sylvia wrapped her arms around herself and rocked back and forth.
Free association proved slightly more successful—at least in bringing repressed material to the surface. But the moment Sylvia recognized it for what it was, her eyes would dim and she would curl up again. Over the course of two months, Imogen believed she saw some improvement but nothing that could remotely be considered a breakthrough.
I should have known better, she wrote to Donna. I was so naive—not because it’s hopeless but because there’s simply not enough time. Two months is barely enough time for normal people to get to know each other. She’s had no time to adapt to the process, and it was bound to fail. If Dr. Zachary were better informed he would have never let me make the attempt—Dr. Ganz wouldn’t have. I don’t think I did her any harm, but I feel totally humiliated. I can’t bear the smirks of the staff psychiatrists and I can’t wait to slink back to the Phipps.
Donna wrote back to her by return post.
Of course you didn’t do her any harm.
Dr. Ganz won’t let anybody try anything that isn’t mandated by the principles of his “psychobiology,” which—you notice—are nowhere written down.
You have nothing to slink about.
Come back immediately.
6
After her experience at Byberry, the Phipps seemed to Imogen a temple of reason. Beyond its walls, the world was at war—even the United States was now officially a belligerent, though so far no troops had actually been sent overseas. But inside the Phipps, a psychiatrist could walk the corridors unruffled by the screams, the tears, the sudden mad pronouncements of its inmates, because reason was as unthreatened here as the oaken doors and marble floors.
Just as the smells and oppression of Byberry seemed to reflect the moribund nature of old medical thinking, the beauty and openness of the Phipps seemed a reflection of Dr. Ganz’s common-sense approach to everything. The high, wide windows, bright with sunlight, mirrored his endless curiosity about the human mind and the myriad ways it might go wrong. The breezy roof gardens, the patio, the gazebo, the cheerful fountain—in short, all that open air—were at one with his openness to fresh ideas, new avenues of research, all the various possibilities for eventual, if elusive, cures. His patience and compassion were as quiet and contemplative as the wooden cloister, a place surely constructed to encourage the calm of quiet reflection.
In contrast to the despair of Byberry, Dr. Ganz managed to infuse his clinic with a crisp sense of optimism. “Treatment, research, and teaching,” he often said, “these are the three aims of the Phipps.” If Imogen made an error of judgment that perhaps provoked tantrums in a patient and the wrath of the patient’s family, Ganz would say, “It’s all right. You have learned something today, have you not? You have tried a treatment, it has had a certain outcome, yielded certain data. You know more now; you are a better physician, and you will never stop learning.”
The greatest demand he made of his residents, and he was unrelenting in it, was for detailed patient histories. At Byberry Imogen had seen for herself the “histories” that accompanied a patient from another institution. They were never longer than a single page and consisted of little more than a synopsis of the presenting problem.
“All mental illness,” Ganz drummed into them, “is a reaction.” Indeed, sometimes he seemed almost to be saying there might not be any disease involved, at least not in the traditional sense. “Even a schizophrenic does not entirely ‘lose his reason,’ as we are so fond of saying. If you believe the Democratic Party is plotting to murder you, it is not so unreasonable to stay all day in a darkened room. The premise is false, but the response itself cannot be said to be irrational.”
Imogen found this idea did much to increase her tolerance for patient ramblings. She could assume incorrect premises lurked behind the mad verbiage and thus see it as less mad than ineffective, that the patient’s reason, however vestigial, could be nursed back to health. All of Ganz’s ideas encouraged optimism that, despite the absence of any actual cure, a physician could do much.
“Something in this patient’s life,” he would insist, “has made her respond in this way. Your task is to find out what has made her react the way she has. If you do not discover a specific inciting event, what you may discover is a series of events or sets of circumstances that help to explain why such a reaction might occur. If you have this in hand, believe me, the patient will recognize that you understand her better than anyone ever has, and you are a long way toward gaining her trust, her faith that you can help her learn more efficient ways of responding.”
Imogen hoped that this was so—it had to be so—because what Ganz meant by a complete history was an exhaustive history. In a matter of days, you would know more about a patient than you knew about any member of
your own family.
When she was eventually allowed to take the occasional male patient, Ganz assigned her one James “Jimmy” Worth. Jimmy had been working on his Ph.D. in mathematics at Johns Hopkins when he began to suffer from delusions, the most detailed of which involved a colony of mathematicians who lived on the dark side of the moon and were planning to take him there as soon as he was “ready.” He was a good-looking young man, and also one of the brightest mathematicians Hopkins had ever produced. He had never shown any previous sign of schizophrenia, and it was thought this episode was most likely a transient event brought on by the stress of graduate work. A few weeks of hot baths and cold packs, along with deep, regular sleep, appeared to have set him aright, and Imogen worked with him for only three weeks before he was discharged. Even so, he took a strong liking to her and promised to come back and show her his thesis the moment it was accepted.
Her next serious therapeutic involvement was with Millie Nielsen, a twenty-nine-year-old salesgirl at Hutzler’s department store, who had tried to kill herself by jumping into the Baltimore harbour in the middle of the night. She was unable to swim, and might well have drowned had she not been saved by an alert seaman on a Swedish freighter.
In the months leading up to her plunge into the harbour, Millie’s behaviour had become increasingly bizarre. She had alienated her fellow sales clerks by repeatedly accusing them of plotting against her, and more recently she had become convinced the trolley tracks were speaking to her, commanding her to do terrible things.
Imogen spent hours with Millie’s father, her mother being deceased, collecting the minute details upon which Dr. Ganz insisted. As a resident, she was expected to carry actual protocols with headings and subheadings beginning with birth itself and read them out: Special circumstances surrounding? Instrumental delivery? Premature? First, second, third of how many children? Twin?
