From today's NYT.
March 25, 2008
From Forgotten Luggage, Stories of Mental Illness
By ABIGAIL ZUGER, M.D.
A trunk in a dusty attic holds a sleeveless peach-colored silk dress belted in creamy lace, a cane topped with a carved duck’s head, kid gloves, a riding habit, a few red leather date books and an eight-page typed essay analyzing Napoleon Bonaparte’s love life.
Trunks like it usually inspire dress-up games, memory exercises and writing class assignments, not works of medical history — although that discipline could often sorely use some human interest. This particular trunk is an exception: it belonged to a delicately featured Frenchwoman who walked into Bellevue Hospital in Manhattan one day in 1932 to engage the doctors in a dialogue on paranormal communication, and was committed to psychiatric wards for much of the rest of her life.
She wound up a long-term resident of Willard State Hospital, a gigantic institution in upstate New York that opened its doors to the incurable mentally ill in 1869 and closed in 1995, sending its last thousand or so patients out to smaller facilities. Left behind in an upstairs storeroom were hundreds of pieces of patients’ luggage.
Curators poking through were transfixed by the power and pathos of the contents, their ordinariness a sad contrast to the tangled aberrancy of the owners’ lives. After a decade of cataloging and research, a small subset of the material became the subject of an exhibition, and now a book.
One set of 18 pieces of luggage held the complete wardrobe and household goods of a successful midcareer nurse who became convinced her co-workers were conspiring against her. She reluctantly assented to temporary hospitalization at Willard and never left; increasingly incapacitated by paranoia and old age, she died there in her 80s.
One suitcase of small items (including a bronze model of the Washington Monument) belonged to an upstate carpenter whose obsession with Margaret Truman and repeated efforts to contact her for marriage earned him attention from the Secret Service, even within the walls of Willard. The government lost interest when he developed delusions of being Jesus Christ, although his family in Ukraine continued to write to his doctors for decades.
One dilapidated satchel of religious materials belonged to a German-born Dominican nun whose life slowly crumbled into a confusion her order wanted no part of. In the hospital, she was lewd and flirtatious, proposed marriage to a variety of men, spoke of giving birth to a dachshund and of her breakfast eggs hatching to chickens in her stomach. In her old age she announced she was 11 and happily waited to be sent home.
These patients stayed at Willard through the treatment vogues of the last century. Shock therapy was practiced, and the first psychotropic medications were given with enthusiasm. The hospital itself was a giant version of a therapeutic community, incorporating a working farm and workshops.
None of it appeared to make much difference to these inmates. As they aged, some of the worst psychoses burned out of their own accord, but few patients were in any condition to be repatriated to the real world. The book’s photographs are transfixing: vibrant young adults newly admitted to the hospital in the grips of wild confusion turn into slack-jawed, dull-eyed (but sometimes quite rational) old men and women.
The photographs, in fact, speak far louder and more clearly than the authors’ strident prose, for what could have been a uniquely affecting work proves to be almost unreadable.
Stories about the experience of illness are in vogue these days. Some seek to humanize medical science, while others (like those in the movie “Sicko” from Michael Moore) aim to change health policy with the brute force of anecdote.
The authors, Darby Penney and Dr. Peter Stastny, are in the second camp. Both are prominent patients’-rights advocates: Dr. Stastny is described on one advocacy Web site as a “dissident psychiatrist” and Ms. Penney as a “long-time activist.” Their platform is clearly stated in the book’s first pages: much mental illness is “understandable reaction to stress,” orthodox psychiatry often “stands in the way of healing” and even the most “distressed” patients will fare better outside institutions.
All may be legitimate subjects for debate, but basing a complex argument on fragmented and archaic case histories is problematic both for science and for style. A coherent scientific argument demands complete, current data, not reinterpreted glimpses of the past. Meanwhile, all the eerie, evocative power of the contents of the trunks is sucked right back up by these haranguing narrators, whose awkward prose thumps and screeches like a politician declaiming through a faulty microphone.
Readers with the stamina to tune them out will be rewarded with an unusual view onto the locked back wards of psychiatry, where that always controversial border between health and illness remains far more mobile and porous than most of us like to think.
The Frenchwoman in whose trunk Edwardian elegance mingled with modern scholarship was transferred among several psychiatric hospitals for her first few years in the system. Still deep in the grips of her obsession with the supernatural, she arrived at Willard State in 1939 at age 43. For decades, she would speak only to demand her release. She developed permanent Parkinsonian symptoms from the drugs she was given. She was discharged to a rooming house in a nearby community in her 80s (“There is no evidence of gross psychiatric symptomatology,” her last physician wrote) and died at 90. She never reclaimed her trunk.