Which is just about what happens. The following day, before noon, Barahal phones. “Come on over. I’ve got a fax to show you.”
Barahal is sunning himself on his front lawn when I drive up. He shoves his sunglasses to his forehead, pulls on his shirt, and hands me the fax.
“The director turns out to be former student of mine,” he says. “I explained what you were doing, how interested I was in your work, that you were next of kin. We had a nice talk, catching up, and—” he pauses, relishing the punch line “—it didn’t hurt that I had given her an A!” He laughs, heartily.
The fax contains a copy of Annie’s master card file from the Detroit Psychological Clinic, recording the results of five intelligence and aptitude tests. I’m wary of putting too much stock in IQ figures, but Annie took the tests often enough to provide both a baseline and a comparison over time. I’m no expert on these tests, but I understand the basic concept: IQ is a calculation, not a measurement—the test results would yield an estimate of Annie’s “mental” age, which would be divided by her actual age and multiplied by 100 to produce the IQ, or intelligence quotient.
The Detroit Psychological Clinic didn’t just administer these tests—it pioneered its own. In the 1920s, clinic experts developed several, including ones aimed at measuring manual and mechanical ability. (The Detroit Tests of Learning Aptitude, now in their fourth edition, are still widely used by psychologists, although no longer by the Detroit public schools.) By the 1930s, the clinic had earned a national reputation as a leader in the field, and it drew visitors from around the country and the world. Seeing itself as more than a placement service, the clinic decided to keep and archive the thousands of test results that it was compiling, a veritable gold mine of data for researchers. Annie’s records went into the master card file in July 1953.
On her first IQ test in October 1926, six months past her seventh birthday, she registered a mental age of 5.6, giving her an IQ of 73, or “borderline,” between what was then known as mild retardation (69) and the low end of normal (80). On each successive test, her mental age rose, but not at the same pace as her chronological age, so her IQ kept dropping. In November 1930, it slipped slightly to 67, and while that was within the test’s margin of error, school officials decided to move her into a special education class for retarded children; in May 1937, she reached her low point—56, still considered mild retardation but trending toward moderate (below 50).
I’m surprised at the decline in Annie’s score. “Wouldn’t IQ remain relatively stable?” I ask Barahal.
“Not necessarily,” he says. “It’s not a precise thing. A lot of factors—depression, for example—could account for Annie doing worse as she got closer to being an adult.”
I scan the mental ages, looking for the alarmingly low result that Howard Peirce cited in his court affidavit, five years and eleven months in November 1937, which translates to the intelligence level of a first-grader for a young woman six months away from her nineteenth birthday. On the IQ scale, that works out to 32, considered then and now as severe retardation.
I can’t find any such result.
The master card shows that Annie took three of the Detroit Tests for Learning Aptitude in November 1937—for intelligence, manual ability, and mechanical aptitude—and on all three, her mental age fell somewhere between nine and ten years old, significantly below her chronological age of eighteen, but significantly better than five years, eleven months.
Academically, that put Annie somewhere in the fourth grade, and as any elementary school teacher would say, a fourth-grader’s sophistication level is a big leap over that of a first-grader. Which might explain Annie’s insight that “she would never be able to live a normal life such as other girls.”
{ FOURTEEN }
One of the Thousands
Overcrowded: female patients at Eloise, 1947 (courtesy of the Walter P. Reuther Library, Wayne State University)
The cars slowed as they made their approach along Michigan Avenue, and fingers emerged from the rolled-down windows, gesturing at Eloise’s buildings behind the fences. Often the fingers belonged to parents, and the parents were saying to their befuddled kids, there, that’s where the crazy people go, that’s where you might end up if you don’t behave. If the gawkers arrived at the right moment on some evenings, they might see several small figures clinging to the iron fences, pulling at them, yelling to the startled passengers in the passing cars.
That was a favorite prank of Betty Zimmerman and other children of Eloise employees who lived on the hospital grounds in the late 1930s and early 1940s, when Annie’s stay at Eloise turned permanent. “We didn’t want them to be disappointed,” Zimmerman recounted in a 2007 talk, referring to the gaping motorists. “I’m pretty sure our parents never knew.”
Zimmerman’s parents were both working at the hospital, her dad as a psychiatrist, her mom as a secretary, when Betty was born in 1926. She describes her childhood there as entirely “normal”—riding bikes on the paved paths, playing hide-and-seek, ice skating on the frozen pond across Michigan Avenue. True, most “normal” children in search of an afternoon snack couldn’t hang around an open cafeteria window in hopes of catching a sympathetic server’s eye, and most children’s Christmases didn’t include the annual lighting of a huge tree facing Michigan Avenue while a patients’ choir sang carols in the frosty night air. But, she stressed, everyone has a neighborhood, and “this was ours.”
What was Annie’s neighborhood like, inside the hospital? How did this young woman spend her days? Did she pursue those “normal” activities that had once interested her, such as sewing in the classes offered by the recreational therapy department? Did her previous desire for independence lead her to look for work in the kitchen or the laundry, along with other patients who could handle such responsibility? Did the hospital see her artificial leg as a bar to such jobs? Or was she too bewildered, too depressed, or too overwhelmed by her plight to engage in the world around her?
When Annie arrived, Eloise was just three years into its first attempts at group therapy, a small program that Ira Altshuler had created to reach those patients who had “lost the ability to behave adequately,” as Altshuler put it. Individual therapy would be better, Altshuler wrote at the time, but the size of Eloise’s mentally ill population—approaching four thousand—made it impossibly expensive to offer one-on-one sessions to every patient. The groups met right on the wards, part of Altshuler’s strategy for disrupting the deadening atmosphere he saw there: “The daily sessions…not only disperse gloom and monotony but they also destroy the ghastly habit of inertia so prevalent in hospital wards, inertia which tends to wither the few social threads saved during the psychotic process.”
Would Annie have been selected for one of Altshuler’s groups? Or did her combination of infirmities, as Ed Missavage had suggested, put her firmly into the category of custodial patient, regarded as neither treatable nor curable, one of the many patients destined to live out her days at the institution, a Biddy Hughes of the twentieth century? And then there’s this question: How would her destiny have changed if she had been born near the end of the twentieth century, rather than near the beginning?
Before journeying back to the 1940s for his educated guess at what happened to Annie once she settled in at Eloise, Ed Missavage wants a full briefing. He’s wearing a camouflage-patterned shirt and pants, his favorite attire these days; I can’t remember the last time I saw him in anything else. The Army-style garb and Missavage’s gruff demeanor makes me feel like I’m a junior field researcher, reporting to my superior on my latest findings. Missavage’s bushy eyebrows knit in dismay at my failure to lay hands on more of Annie’s hospital records, but he grins broadly at my discoveries about Annie’s earlier life, especially the interviews with Millie Brodie and Marty Moss. “Now you’re getting somewhere, Stevie.” Stevie. Mom would be appalled.
“Let’s say that Annie became your patient,” I say. “What would you do first?”
&
nbsp; He digs around in the mountain of paper that resides on his kitchen table, temporarily displacing Supercat, a long-haired feline who regards the pile as his personal habitat. Missavage finally locates the buried treasure he is looking for, a well-thumbed book called Outlines for Psychiatric Examinations, issued to him upon his arrival at Eloise in 1948. The slim volume—essentially the forerunner of today’s DSM, the Diagnostic and Statistical Manual—came out of the New York State Psychiatric Institute and Hospital in 1921, and as the preface states, “was compiled mainly for use of physicians in psychiatric hospitals.” But within a decade, as psychiatry developed a substantial presence beyond the nation’s mental institutions, medical students and private psychiatrists began relying on the 158-page guide’s step-by-step description for examining a patient and collecting the sort of comprehensive family history that Mona Evans did for her Routine History.
“First,” Missavage says, “a physical exam. But any invasive tests or treatment would have to wait until her legal status was settled and we had a permanent order of commitment. We’d do an extensive interview, with her and her family, and observe her carefully—her responses, her affect, how disturbed she appeared.”
His copy of Outlines is heavily annotated—on-the-job notes of a young psychiatrist learning his craft as he assessed the expressions, actions, movements, and moods of the patients under his charge. Flipping to the pages on schizophrenia, Missavage gives me a brief tutorial on the disorder and its different manifestations, as they were seen back then. “We were very pessimistic about schizophrenia in the 1940s,” he said. “We didn’t have very good options. Very few patients responded to shock treatment,” either insulin-induced or electric.
“Would Annie have been a candidate for either?” I ask.
A shake of his head. “Unlikely. Shock treatments were for the manic-depressives and highly disturbed schizophrenics, and from what I’ve seen of her case, she wasn’t highly disturbed,” he says. “The longer she was there, the more her chances went down. We tended to try it on newer patients.”
I nod, but secretly, I’m relieved. From what I’ve heard and read about these treatments, they were anything but pleasant.
“So what kind of treatment would she get?”
“Not much,” he says. “When medications came along in the mid-1950s, she might have been a candidate for one of those.” At some point, the Northville records show, Annie did join the thousands of mental patients prescribed one of the new antipsychotic drugs; as a result, she suffered from parkinsonism—tremors or other loss of control over movement—a known side effect from the long-term use of those early medications.
“What about a job?” I say. “There were patients working in the laundry, the kitchen, the cannery. Would she be offered any of those?”
Missavage’s wonderfully expressive eyebrows telegraph his skepticism. “Not with her leg. I can’t imagine anyone would think she could handle that. She would probably be on a dysambulatory ward.”
“Dysambulatory?” I haven’t heard that word, a Missavage invention. “What do you mean?”
“Wards for people who couldn’t get around very well.”
Shock treatments for schizophrenia debuted in the 1930s as more members of the medical world gravitated to the neurological view that there must be a physical cause for mental illness, and therefore, a physical, or “somatic,” cure. I had read Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness, by University of Michigan professor Elliot Valenstein, which recounts how the search for somatic solutions led many U.S. mental hospitals to embrace a series of radical treatments—lobotomies and the various shock therapies (insulin, drug, electricity)—that came out of European laboratories during the 1930s. (Lobotomy, a word that makes us recoil now, won a Nobel Prize for Portuguese neurologist António Egas Moniz in 1949.)
Some in the psychiatric community did express doubts about insulin shock, but overwhelmed by the rising numbers of patients diagnosed with schizophrenia, they were open to any promising treatment. In 1936, one psychiatrist wrote to William Alanson White, the superintendent of St. Elizabeth’s Hospital in Washington, “schizophrenia is so hopeless that anything that holds out hope should be tried.”
Eloise raced to the forefront, making plans for a limited insulin shock program two years after the treatment’s debut in the United States. It was hard to resist: Time magazine wrote, in January 1937, that “the presence in Manhattan last week of a young Vienna psychiatrist, who cures such disoriented wits by means of insulin, created great stir among doctors, great hopes among relatives of schizophrenics.” Dr. Manfred Sakel’s insulin shock treatment had created these great hopes, Time observed, “because U. S. doctors have been able to discover no rational, generally accepted cause for schizophrenia. And they have been generally unable to bring about cures.” Time’s canonization of Sakel as the man who “cures” schizophrenia proved premature; insulin shock and the other convulsive treatments never panned out as panaceas.
Eloise shelved its shock treatment programs during the war years, unable to find or afford the large number of nurses and doctors to monitor the patients. In February 1947, when Gruber sought approval to resume insulin shock treatments, he told the hospital board that it would require three additional psychiatrists, ten additional nurses, and fifteen more attendants just for a limited program. The board approved a $60,000 budget. In 1948, seventy-four Eloise patients received insulin shock; in 1949, only fifty-eight.
“I did my first insulin shock in 1948,” Missavage says, grimacing at the memory. “Fourteen women on D2. I was so glad when it was over. It was physically demanding for the staff as well as the patients. We had to arrive at 6 A.M., five mornings a week, for more than a month. We’d give them a walloping dose of insulin, and then you had to be hypervigilant while the patients were in the comas. Twice, we nearly lost patients who didn’t respond at first to the big slug of sugar we gave them to bring them back. Panic would not be too strong a word for what I felt until they finally came out of it.”
Electric shock became Eloise’s preferred option. The convulsion came quickly, and if done correctly, produced no coma—although broken jaws, from the force of the convulsion, were a risk. Eloise administered 6,617 electric shock treatments to 333 psychiatric patients in 1947, and increased that in 1948 to 7,617 shocks for 474 patients, about 12 percent of the hospital’s population. The results were hard to judge; manic-depressive patients seemed to show more improvement than schizophrenics, but over the long term, that improvement didn’t hold up.
And then there were lobotomies. Eloise’s annual reports, which describe in detail its work with shock treatments, are silent about this discredited procedure, which was tried in many mental hospitals in the late 1940s. “Did Eloise do lobotomies?” I had asked Missavage at an earlier interview.
“We did, for about three or four years, as I recall,” he said.
“Why were they stopped?”
“Too many bad results,” he said. “Patients urinating on themselves, no evidence of improvement in their illness. We didn’t do many, and we abandoned it pretty quickly.”
“Would Annie have been a candidate for that?” It seemed unlikely, given everything I knew, but I had to ask.
“I can’t imagine why,” he said. “No one thought a lobotomy would help someone with mental retardation.”
By 1943, Eloise had too many Annies, too many long-term custodial patients, too many patients, period. The rate of new admissions had slowed slightly since the initial boom of the 1920s and 1930s, but the impulse toward institutionalization remained as strong as ever. I reviewed a dozen other Probate Court cases from the month that Annie went to Eloise, and found no other physician’s statement comparable to the one from Howard Peirce, who had inserted “not” in front of “actually insane” after examining Annie.
Whether this continuing boom in admissions represented a new enlightenment about the nature of psychiatric disorders o
r overzealousness by well-meaning professionals with an expansive view of society’s obligations—or perhaps a bit of both—it had an obvious consequence: severe overcrowding, and not just at Eloise. The state mental hospitals had hit their limit, too. How could it be otherwise? Michigan’s long-held policy toward its mental “defectives” (mirrored in other states) contained an inherent contradiction that led, inexorably, undeniably, mathematically, to a perpetual crisis.
On the one hand, the state had declared as long ago as the 1880s that it had a moral duty and legal responsibility to provide care for its insane and feeble-minded, a commitment restated in 1937 when the legislature overhauled the state’s insanity laws. The standard of “treatment and care” would last until the 1960s, when legal battles led to a new criterion for involuntary commitment: whether the patient posed a danger to himself or others. So every year, more people went to mental hospitals, and every year, more stayed than left. It was only a matter of time before the number of patients exceeded the number of beds—unless, of course, the state was willing to commit itself to a never-ending expansion of its system or change its approach to institutionalization.
From time to time, a public cry went up about the conditions and capacity of the state’s facilities. A 1934 survey, ominously titled “Present State of Emergency in Michigan in the State Care of the Insane,” reported overcrowding levels of about 16 percent at the six hospitals for the insane (not including Eloise); there were 1,642 more patients than the official number of beds. That was bad enough, but as the report correctly noted, it was nothing new. For years, Michigan’s legislature, like others around the country, had been under nearly constant pressure to spend more on its mentally ill and feeble-minded. While these discussions frequently revolved around issues of morality and humaneness, economics often dictated the outcome, and Michigan was no exception.
Annie's Ghosts Page 24
