In the end, I decided not to try to make a new arrangement, even if I could have found one that was a significant improvement. Instead, I did the best I could to back up Silvia and Julia in the valiant efforts they were making to navigate a system of heartbreaking and bureaucratized medical impersonality for which, one can only hope, even in the face of currently disturbing trends, a more effective and humane alternative is someday put in place.
—
In the final twelve months of my father’s life, as I saw him falling even further into the condition of an almost wholly passive, usually smiling, but totally dependent child, I looked for consolation and distraction once again by spending the late evening hours looking through the boxes of materials he had entrusted to me. In one of the cartons in which he’d filed copies of his correspondence and some printed papers from the years when he began his practice, I came upon a bold critique that he had written on the state of psychiatric education as he had observed it when he did his year of study at Johns Hopkins under Adolf Meyer.
The document, which he wrote only three years later, surprised me by the harshness of the language he had used in his evaluation of the teaching practices established by Meyer himself. (It surprised me all the more because, in the same package, there was a commanding portrait of Meyer, dedicated by the doctor “to my friend and pupil Dr. Harry Kozol,” which my father had valued enough to have had it beautifully framed and which he had hung on his office wall next to a portrait signed by Dr. Bleuler.) The critique was presented in the form of a letter solicited by a physician named John Whitehorn who had been selected to take over the directorship of Dr. Meyer’s clinic in the summer of 1941, when, as the letter indicates, Meyer was getting ready to retire.
“Dear John,” the letter began. “I am sending you the report I promised….I will direct your attention to the matter of the education of your medical students, about which I have not had much to say before. I shall take up the matters under different headings.”
Under the first heading, “A Criticism of the Course Given by Dr. Meyer,” my father had started off, unapologetically, “He overemphasized his own system and its various minutiae. This involved much memorization of his concepts of integration, psychobiology, etc. The students gained no perspective about psychiatry in general….” Whatever reference to the work of his contemporaries he presented at the morning meetings was “slight in nature and somewhat derogatory.” This, my father contended, had a “boomerang” effect in that, later, “many of these same students grew so intrigued by psychoanalytic and other exploratory concepts” that “they went off the deep end,” dismissing Dr. Meyer’s concepts altogether.
Under the heading of “Relationship of the Phipps Clinic to Other Divisions of the Johns Hopkins Hospital,” my father began, “The Phipps Clinic was in a psychological Siberia. There was very little intercourse between the psychiatric and medical divisions. This isolation was emphasized by the fact that it [the clinic] had its own medical internist, thus making it independent of the rest of the hospital. Not only was this insulting to the hospital, but it was also grossly unfair to the patients, because the quality of the medical consultation in the clinic itself was vastly inferior to what was available in the regular medical divisions of the hospital.”
In reference to “The Regular Wards,” my father said, “I do not think the patients got as thorough treatment as they ought to have received,” because of an absence of proper supervision. “There was virtually never an instance of [a member of the senior staff] sitting down with a patient and the intern for an hour or even half an hour of careful questioning. The essential point is that the interns need to get some personal clinical teaching…, rather than second-hand discussion in the morning conferences based on their descriptions of what they think they have elicited from the patient….
“Most of the training revolved around the morning meetings. Dr. Meyer would make sage comments after the intern read a long hand-written description of a patient’s case. These [the meetings] were sometimes quite ridiculous in that the battle would revolve around a diagnosis but did not affect the treatment of the patient one way or the other….
“Although the supporters of the old regime will undoubtedly hotly deny it,” he continued, “the interns gained virtually no experience in the handling of acute problems, such as combative deliria, wild manias, etc.”
The thoroughness of patient care was also compromised, my father wrote, by poor organization in assignment of the interns. “The newly admitted patient would receive a great deal of attention for a week or two until his work-up was complete. After that, he would be dropped almost like a hot cake because the intern would be busy with other new admissions or would be distracted by a number of time-wasters. Thus, the patients would have quite a letdown in their third or fourth weeks in the clinic. After that, their meetings with the interns were usually brief and few.”
Under the heading of “Laboratories,” he had written, “I have virtually no comment. I see little point in making much of the anatomy lab, because it was a personal indulgence of Dr. Meyer. He stressed anatomy [but] with very little conception of physiology….”
Under the heading of “Psychoneuroses,” he had written this: “The treatment and instruction in handling psychoneuroses has been one of the weakest points [in the clinic’s operation]. I suggested to Dr. Meyer that a special division for the treatment of psychoneuroses over a long period of time ought to be established, but to no avail. In this respect, I think the clinic has fallen down in its responsibilities to American psychiatry.”
In a final “Addendum re Psychoanalysis,” my father proposed that the clinic might anticipate, and thereby prevent, the later rejection of all Meyerian ideas on the part of interns who were being given no exposure to non-Meyerian positions if it were to find “a refugee of eminence” who had been immersed in the psychoanalytic schools of Europe. “Up here [i.e., in Boston],” he went on, “we have a very able fellow, unbelievably dynamic…,” whose experience included “the directorship of Freud’s outpatient department for a great many years.” After giving the name of the man he recommended, he added this description: Although “orthodox” in his beliefs, “he is not a stereotypical copy of Dr. Freud….He is always alert and contemplative” with “a rapier-like quickness of thinking, which is exceedingly stimulating….It might be a good idea to meet him and size him up yourself.”
The doctor to whom these proposals were addressed replied to my father in what I thought, given the severity of my father’s words, was a gracious note of thanks for “your very helpful and thoughtful letter.” I have no idea if my father’s recommendations had any consequence at all in policies established by the new director. I do know my father continued to maintain a close association with other doctors on the staff for many years to come.
—
In a larger and much later body of materials, dating from the 1960s, when he was evaluating criminal offenders who had been remanded to his care by the mental health department here in Massachusetts, I came upon another instance of my father’s willingness to incur the risk of causing some discomfort for his colleagues or immediate superiors. It may seem surprising that I hadn’t thought about this episode from so many years before until I was reminded of it now, because the story that unfolded from these documents had been of great importance to the public while it was taking place and remained a matter of contentious disagreement for several years thereafter.
The story began in 1962 and continued through 1963 and into 1964, when thirteen women, some of them elderly, one as old as eighty-five, were strangled in their homes in, or close to, Boston. Their bodies, according to a press account, were “strangely manipulated sexually,” their “swollen necks garishly decorated with large, looping bows.” A massive search was immediately begun for the single individual who, police believed, had probably carried out these strangulations on his own, but, as of 1965, no suspect had been found.
In that year, a patient at a large sta
te mental hospital and prison complex, to which my father’s treatment and evaluation center was attached, indicated to another patient that he was the one who had killed these women and, soon after, made a full confession to his lawyer, then to the state’s attorney. The credibility of his confession was, however, clouded by the fact that the man had a seemingly compulsive inclination to outrageous braggadocio and appeared to be possessed of a desire to inflate his own importance, even in this instance by confessing to a crime that carried the potential punishment of life imprisonment or execution. (Massachusetts still permitted executions at that time.)
As in other cases in which there were questions about a suspect’s psychiatric status, the court requested that my father help it to determine if the man in question had the mental competence to be brought to trial. My father subsequently interviewed the suspect, a former handyman and construction worker named Albert H. DeSalvo who already had a dossier of sexual assaults, none of which, however, had involved an act of murder.
The transcript of the interviews—which are dated March 14, 24, and 29, 1965—runs for 145 pages. Another psychiatrist sat in on the interviews, but his participation seems to have been minimal. In a cover letter submitted to the State Commissioner of Mental Health, my father noted that DeSalvo (whom he referred to as “the patient,” rather than “the suspect”) was “essentially responsive” to his questions but displayed the indications of “a state of shallow affect.”
In these interviews, my father asked DeSalvo to describe the murders, which he did in rather gruesome detail but with no perceptible emotion and often with a choice of words that seemed to indicate he looked upon these strangulations as unfortunate events that had “happened” to these women as opposed to acts he had himself committed.
In speaking of one of the women whom he claimed that he had murdered, for example, DeSalvo told my father, “She was the one with the pillow case.” My father noted the detachment of this phrasing from any indication that DeSalvo was connected somehow with the uses of that pillowcase. The pillowcase was “there.” But how did it get there?
“What do you mean by that?” my father asked.
Only when so prompted did DeSalvo introduce himself into that portion of the narrative. “I used the pillow case on her” and “tied a knot” [i.e., around her throat], he finally said.
In another instance, he remarked of a woman who, he said, was in her sixties, “She died, fractured skull and stabbed.”
“Who gave her the fractured skull?” my father asked.
“I did,” said DeSalvo.
Again, in the case of a woman who had been in bed when he claimed that he had “slipped the lock” to enter her apartment, he said that “she got out of bed…” and “something strange…I don’t know how to explain the feeling that came over me, looking at her….And she turned and she was getting up and all I remember is her lyin’ on the floor….Stocking was around her neck.”
My father had to ask him how the stocking got there, at which point DeSalvo said, “I put it there.”
In some cases, DeSalvo told my father, he could not remember someone he had killed, or had no knowledge of exactly what he’d done, until he read about it in the paper. Only then did he become aware (my father’s words) “that he had been the one who did the killing….” His repeated references to newspaper accounts, as my father noted, raised the possibility, admittedly a faint one, that DeSalvo, who appeared to him as being very shrewd, inventive, and intelligent, might be manufacturing portions of these stories out of the plenitude of details that the newspapers were running, although other portions of the narrative did not awaken this suspicion.
In any event, if DeSalvo was in fact the perpetrator of these strangulations, my father recognized “a notable experiential unreality” within the man’s perception of events he was describing. He remarked again upon the absence of emotion when DeSalvo spoke about the victims while at the same time conveying “an almost grandiose enjoyment of the fact that he was now the focus of great interest and consideration.” These impressions, reinforced by other indications of irrationality and “a nearly absolute insensibility as to the endangerment in which he’d placed himself” by his confessions, led my father to believe the man should not stand trial.
“Albert H. DeSalvo,” he wrote in his conclusions, “is suffering from a committable mental disease,” as defined by Massachusetts law, with “grossly defective judgment,” “lack of competence to comprehend his situation,” and inability “to make decisions which will best serve his interest….”
My father’s opinion was overruled, however, by others in the mental health department, who diagnosed DeSalvo as a schizophrenic but, at the same time, told the court that he was not insane and that he was capable of knowing right from wrong, a position that my father felt was legally and psychiatrically untenable.
The media, meanwhile, which already had adjudged DeSalvo to be guilty, was demanding he be brought to trial. The court at last decided that DeSalvo could be tried, not, however, for the thirteen strangulations but only for his earlier offenses, which, as I have noted, did not eventuate in homicide—a decision that my father viewed as “utterly illogical” and “inherently self-contradictory” and possibly tainted by political considerations.
The trial nonetheless went forward and resulted in an outcome that my father said was easily predictable. A jury that could not conceivably have been unbiased by exposure to the media—amazingly, the judge did not require that the jury be sequestered—found DeSalvo guilty on all charges. He was given a life sentence, taken from the hospital, and sent to a state prison, where no treatment was provided for his mental illness.
A year later, DeSalvo wrote a letter to my father from the penitentiary. The letter, which has never been made public but which my father had secured in a sealed envelope, was written by hand on sheets of blue-lined notebook paper and bears the date of January 1, 1968.
“Dear Dr. Kozol,” DeSalvo had begun. “I have tried in vain to do what I felt was right. But for some unknown reason I find I’m at a stand-still. I have thought of you many times and can’t understand why I never saw you again [i.e., after he was transferred from the hospital]. At least you showed me you were interested in me as a person and…I respect you very much for this.”
He went on to say he thought my father “understood” what he was feeling. “I wanted very much to talk with you alone,” he said, “and release everything inside me. I can’t explain why, all I know is I felt so at ease with you….
“It’s a shame you were not Medical Director”—a reference to the fact that another doctor, to whom my father was officially subordinate, was the one DeSalvo had to deal with for most of the period while he was under observation. If it had been otherwise, “all of what has happen[ed] could have been avoided. If you think about it you will realize what I mean.”
After saying again that, in his present situation, he found himself “unable to release what’s inside me,” the man who had allegedly strangled thirteen women ended politely, “I hope this letter finds you in good health. Have a happy New Year.”
In a postscript, crowded at the bottom of the page, he said he hoped my father would remember that he had “walked into the police station” on his own some years before and had asked for medical help. “And this,” he said, “is the results….I just don’t understand.” Five years later, still in prison, DeSalvo was murdered by another inmate. No other person ever went to trial for the strangulations.
In the folder that contained DeSalvo’s letter, I came upon a memo that my father wrote, in which he again took issue with the doctors who had testified that DeSalvo was a schizophrenic but nonetheless was not insane and was capable of knowing right from wrong.
“In light of the absence of emotion,” my father wrote, “and the sense of unreality that he conveyed in description of his crimes, the term schizophrenia would probably apply, because of the apparent fragmentation of his anima. But to attribute ethical perceptions
—the recognition of good or evil, right or wrong—to a man with this division in his soul is a very loose and unconvincing formulation….
“DeSalvo was not capable of knowing right from wrong if, by ‘knowing,’ we mean something more than recognizing, as a generality, that there exists a socially accepted set of values but, rather, knowing in a way that penetrates the essence of one’s being and can therefore countermand an impulse or compulsion to take actions that will do grave damage to another human being. Any other kind of knowledge is inert, an ineffectual abstraction. In order to know, we have to feel. Without that capability, our knowledge has no value and no meaning.”
—
The same assertiveness with which my father stated these beliefs, as well as the incrementally accelerating pace by which he made his argument and his agility in seizing on exactly the right words to encapsulate his meanings, remained the hallmarks of his writing for the rest of his career. Admittedly, along with his assertiveness, there was also that persistent inclination, when he took issue with another doctor, to express his disagreement in a manner that approached the adversarial. My mother used to worry that it wasn’t in his interest to antagonize so many of his colleagues. “But this,” she said, “was part and parcel of his personality. His mother, I don’t need to tell you, could be hard on other people too. He didn’t like it when I said this, but he was more like her than he knew.”
He did, on occasion, return to something he had stated strongly and attempt to modify its absoluteness, although, on the question of DeSalvo’s legal disposition, he never did alter his opinion. Around the time DeSalvo died in prison, my father said, “He was in every likelihood the one who carried out all thirteen strangulations. But if the courts were going to convict him, they ought to have done it for the crimes in question—the crimes that they were actually avenging. Instead, they took their vengeance indirectly….
The Theft of Memory Page 16
