This was previously published in several other
venues, and is posted here in May, which is designated “National Mental Health
Month”
Up From Bedlam
“Bedlam” is the name of a London
suburb where, in 1247, compassionate monks established a place for the care of
people with mental disorders. The “care” provided for the unfortunate wretches
sounds more like torture. Some “patients” were chained to the walls, some in
iron cages, others wandered free to act out their delusions, hallucinations,
and violent self-destructive behavior. But Bedlam was progress. It was a first,
a new concept, a place intended for some kind of protection and care for
mentally ill persons.
About 1948 I accepted an invitation to visit the Missouri State
Hospital for the Insane.
It was the most mind-searing, gut-wrenching, spirit-gagging experience of my
young life.
About 25 men lethargically pushed dirty mops in a continuous circle across a
warped and splintered wooden floor. Their eyes were vacant, their faces
expressionless. Some of them were drooling, one man‘s sexual arousal was
obvious but ignored, now and then one of them would laugh mirthlessly at some
secret inner-minded humor. The one stubble-faced attendant, in filthy white
clothes, chain smoked and lounged impassively as his custodial charges marched
their purposeless, endless treadmill of mindless desperation. They were more
suggestive of inmates than patients.
The ambience in the female area was different only in gender. There was no
circular floor mopping, but each of the patients was supposedly occupied in
some useful activity. One skinny, pale-faced type approached me with an
explicit sexual proposition stated loudly in colorful street vernacular. In the
laundry room a cheerful, heavily perspiring fortyish woman stuffed grungy gray
bed clothes into a tub of tepid water which matched the color of the sheets. I
thought she was an employee.
In times past psychiatric hospitals were sometimes referred to as “Snake Pits”.
That is defamatory to snakes. I got a dose of reality that day which has never
left me.
Move forward a decade.
With a newly minted doctoral degree in my hand, I reported to the Kansas City Psychiatric Receiving
Center for clinical
training. The ambience was strikingly different from the ones I just described.
The common room was bright, cheerfully furnished, no gender segregation for
most patients. There were a few semi-zombieized patients who were being moved
“up” from more restricted levels of care, but most of them were sort of doing
their own thing. A few women were knitting with blunt brittle plastic “needles“
which they had to check in and out when they wanted to use them, a few were
playing cards or checkers, one man was doing a chess solo. A couple of patients
were pacing, driven by inner demons, but disruptive behavior was infrequent.
Two female nurses and two or three male Psych Techs were actively involved with
the patients, distributing meds, answering questions, or just chatting.
Psychiatrist John
O’Hearne gave me an orientation tour;
the solo chess player came over to talk. His name was Don.
About 40 years old, clean-shaven, neatly dressed, with an educated vocabulary
and an easy manner. Dr.
O’Hearne told me he was a high
school principal. When I asked about his diagnosis, John
said cryptically, “Wait a few days”. About a week later Don
was in a “rubber room”, stark naked and filthy from his own feces, talking in
staccato gibberish about his plans for world reform. A year later he was still
in the hospital, having his cyclic battles with his inner demons. Terrible
waste! As other medications became available I hope he was able to resume
somewhere some semblance of his former life.
Now move ahead thirty more years, another city, another hospital, another man.
A clinical psychologist, a professional with four university degrees, he was in
the grip of a major depression.
Even doctors get sick. (his symptoms appeared in adolescence, but no one
recognized them). At 2 o’clock one morning he was sitting at his desk, ripping
pages from his typewriter because he couldn’t write a coherent paragraph. The
next morning his wife and his secretary each took him by an arm, walked him
firmly to the car, and delivered him to a psychiatric hospital.
The first night he crawled on his hands and knees in the bathroom, afraid the
staff would find some pills he had spilled, pills with which he had been
medicating himself and smuggled in. The treatment he received was excellent,
highly professional, effective. After a month in the hospital, 6 months off
work recovering at home, medication (which he will gratefully take for the rest
of his life) monitored by a very good psychiatrist, an understanding,
supportive boss, and a wife who is a shoo-in for sainthood, he is back doing
his thing, doing well.
I was that man.
That was 27 years ago, a third of my
total lifetime. That was the birth of 5 great-grandchildren ago. That was a
quarter of a million miles of travel in 20 countries ago. 27 busy, active,
years I would have missed had there not been some caring, competent people to
pick me up when I crashed, some skilled professionals and some incredible
pharmaceuticals. Years I would have missed if some people had not been
struggling for 700 years to bring mental health care up from Bedlam.
Had I been born a few centuries, a few generations earlier, I would certainly
have worn Bedlam’s chains, or mopped a floor, or shared Don’s
cyclic nightmare in the rubber room.
Mental illness has always afflicted human beings. Many of its victims made
significant contributions of great benefit to society.
Martin Luther was about a quart low on Lithium
when he had hallucinations so severe he threw an inkwell at the Devil. Abraham Lincoln
suffered from awful depressions that occasionally led to thoughts of suicide. Vincent Van
Gogh cut off his own ear. Michelangelo, Isaac Newton, Charles Dickens, Ernest Hemingway, Winston Churchill, Mike Wallace;
all certifiably mentally ill. Have you seen the movie, A Beautiful Mind, about Nobel laureate John Nash,
whose quantum leaps in mathematics were accomplished despite his rampaging
schizophrenia?
Progress is being made. Bedlam is history. Psychiatry and psychology have made
remarkable gains in understanding and treatment. But there is a long way to
go. Mental illness is still stigmatized. Public attitudes are way behind the
realities of modern treatment.
We are not crazy, or insane, we are sick.
Sick like you who have diabetes or migraine headaches or ulcers or problems
with any other part of your physical equipment that doesn’t work like it
should. You take medicine routinely so you can function effectively. So do we.
But we are treated differently than other sick persons.
Insurance companies usually pay a percentage of the cost of mental health care.
Not long ago my primary care physician wanted me to have a series of tests. My wife and I are fortunate to have excellent health insurance coverage, which is simply too expensive for many people. Probably most people.The
hospital and physicians bills looked like a page out of the national debt, but
didn’t cost us a nickel out-of-pocket. But on my quarterly check-up visit to my
friendly shrink, the same insurance company pays only 50% of the cost, which is
about the price of a tank of gas or a meal for two at a mediocre restaurant. Go
figure.
This year, about 168,000 Coloradans are, or will become, mentally ill.
(That’s a terrible term, but I don’t know what else to call it). Disorders of
their body chemistry, which are known, understood, and treatable by methods
which exist in this state. About 40% will be unable to get treatment. The
majority of these will get worse, their illness progressing until they are
disabled or homeless. A few will commit suicide.
And it’s all so unnecessary. But so are a lot of sad things in life. Whining
doesn’t help, or complaining, or thinking there is nothing to be done. There is
plenty to be done. Some of it you can do. And what we do will make a
difference. We must simply keep whacking away at this particular piece of
“outrageous fortune”.
I am very glad some people, long ago, thought there had to be something better
than Bedlam.
© 2012
Jack Wilson
