Library Collections: Document: Full Text

Out Of Sight, Out Of Mind

Creator: Frank L. Wright, Jr. (author)
Date: 1947
Publisher: National Mental Health Foundation, Inc.
Source: Available at selected libraries
Figures From This Artifact: Figure 2  Figure 3  Figure 4  Figure 5  Figure 6  Figure 7  Figure 8  Figure 9  Figure 10  Figure 11  Figure 12  Figure 13  Figure 14  Figure 15  Figure 16  Figure 17

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Copyrighted and published by the National Mental Health Association, no part of this document may be reproduced without written consent.




We Americans cannot justly be proud of the way we have dealt with our nation's most important health problem. Mental disorders affect more of us than cancer, tuberculosis and infantile paralysis combined. Severe mental illness fills forty-five percent of all hospital beds in the country with its victims. Yet most of us have been sadly unaware of its extent, falsely confident that adequate care is generally available, and blindly indifferent to its disastrous effects, both social and economic, upon our national life.


Mr. Wright's forceful book cannot fail to shock us, to awaken us, to impel us to action. It is not pleasant reading, for it deals realistically with exceptionally unpleasant facts. Nevertheless, Americans should read it, for unless these facts are faced frankly, and the problem solved satisfactorily, many thousands of mentally handicapped persons will continue to be "out of sight, out of mind."


No one should doubt the authenticity of this book. As chairman of the National Mental Health Foundation, I am acquainted personally with many of the problems upon which Mr. Wright seeks to focus public attention and concern. I am convinced that the picture his book presents is a true one, and that the persons, places and events described, though necessarily disguised, are real and undistorted.






With considerable humility and trepidation, I agreed to undertake the responsibility of writing this book. At my hand was the greatest wealth of factual material about conditions in mental hospitals that had ever been gathered in one place. At my back were hundreds of people who had submitted their experiences in mental hospitals to the National Mental Health Foundation, in the hope and faith that their reports would ultimately benefit mental patients. In my heart were thousands of mental patients and their families, many of whom I had come to know personally, whose anguish and bafflement knew no bounds. And in my mind were the millions of Americans who know so little, and therefore care so little, about those forgotten thousands who are in our mental hospitals.


I saw my task as that of acquainting uninformed millions with forgotten thousands through the eyes of concerned hundreds. In short, I wrote this book in an effort to bring mental patients and their problems into the light so that everyone could see and know them -- so that they would no longer be Out of Sight, Out of Mind.


I have finished that task now, and you are about to be introduced to mental patients and mental hospitals within these pages. You will find herein a number of graphic incidents, each a short-short story or character sketch unto itself, each undeniably true and accurate, each representing hundreds of similar incidents that are occurring all over this country today, and each giving you some new insight into the problems of mental patients and mental hospitals. All of these incidents have been selected from over two thousand documented, first-hand, on-the-scene reports of actual experiences in the files of the National Mental Health Foundation.


You will be unable to identify any persons or places in this book. If you are at all familiar with mental hospitals, you may recognize the prototypes of many old friends, for there are hundreds of doctors, nurses, attendants and patients who might well be the principles in the incidents included. But no one person, no one place, no one event can be definitely identified by anyone. Names of persons and places, as well as certain identifying details, have been altered for purposes of publication, just as faces of patients have been blacked out in the photographs. Nevertheless, I hope you will know that it is real flesh and blood which you are meeting in these pages.


To acknowledge even a fraction of those who have contributed to the writing of this book would take many pages and make very dull reading. I can only mention those conscientious objectors who served without pay in our nation's mental hospitals during the war and those citizens who supported and encouraged them. Except for these two groups, this book would never have been conceived and could never have materialized. I am confident that all of these, plus the many others who have participated in the development of this book, will be amply rewarded if these pages can in any way benefit those thousands who face the prospect of life in a mental hospital.


FRANK L. WRIGHT, JR. Baltimore, Maryland. April, 1947


Opening A Long-closed Door


"One dark night in October, I took a short-cut through the asylum grounds in order to reach my home as quickly as possible. I had gone through the grounds often when I was in a hurry, but I never went again after that night.


"Just as I drew near the big, gabled building -- near enough to hear the shrieks and groans and crazy laughter that came from the darkened hallways -- a great hulk of a man, clothed only in pajamas, stepped out from the shadows. He took one look and started for me, one hairy hand outstretched. Visions of Dracula, Frankenstein and The Monster assailed me from every side, and stories of the madmen of every generation raced through my mind. I turned and plunged blindly into the woods behind the asylum.

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"I ran blindly, frantically. Branches cut across my face, brambles tore at my legs, grass entangled my feet. My breath came in short gasps. The insane monster followed me close behind -- drew nearer, ever nearer -- and drove me to exert my last ounce of strength.


"Twice I fell; twice I recovered and ran on, barely ahead of that hairy hand. Just when I thought I was about to reach the gate that would release me towards home, I ran headlong into a high brick wall. I had lost my direction. I was a mile from the nearest building. I was stranded and alone in the very deepest part of the woods behind the asylum -- with a madman crashing through the brush a few yards behind me. I clawed desperately at the brick wall and struggled to reach its top. Bleeding and tortured for breath, I fell back whimpering, burying my face in my arms. I could do no more.


"The madman drew up beside me. I felt his hot breath. I knew just how his fang-like teeth would feel as they pierced my neck. His hairy hand groped forward and tapped my arm. He spoke. His voice was harsh -- terrifying.


"'YOU'RE IT,' he said, 'now it's your turn to chase me!'"


The speaker's voice had risen to a crescendo on "You're it." The moment's silence which followed was broken by thirty-two relieved sighs from thirty-two young throats. Then there were gales of laughter.


This story, told to a group of ten-year-old boys at a Hallowe'en party in 1926, no doubt made a lasting impact on their minds. For many of them, it must have been their first conscious impression of an "insane" or "crazy" person -- a person who is mentally ill. Since then, those boys have been bombarded with many others. From the newspapers, they have gained the impression that all mental patients are "sex maniacs" or "dangerous lunatics." From the movies has come the suggestion that all patients are either amnesia victims or defiant, homicidal paranoids. Family and friends have passed on to them the idea that mental patients are horrible creatures, something less than human, to be avoided at all costs.


In a way, the boys who heard the above story were fortunate. The "raving maniac" who only wanted to play tag is a much more accurate characterization of a mental patient than can be had from the papers, the movies or most uninformed people. Even this characterization is woefully inadequate, of course.


Nearly all of those boys who heard the story twenty years ago are still getting along with an inadequate, infantile understanding of mental patients. They still refer to sick people as "insane" or "crazy." Like most American citizens, they are still ignorant of the nation's number-one health problem.


For mental illness is our greatest health problem! It is eating away at our national vitality and strength, sapping the very life blood from our veins, and endangering all our hopes and aspirations. Still we remain complacent and uninformed.


Figures alone cannot record the toll which mental illness takes in this country, but facts and authoritative estimates indicate that mental illness:


-- fills forty-five percent of all the hospital beds in the country with its more than 600,000 incapacitated victims.


-- sends over 175,000 persons to the hospital each year.


-- costs us $300,000,000 a year for direct care.


-- costs us over a billion dollars a year in lost earning power.


-- causes inestimable loss through unhappiness, misery, broken homes, shattered careers and inefficient people.


In spite of these facts, we are still playing ostrich. We are still hiding our heads in the sand and refusing to look this great national problem in the face. The six hundred thousand citizens who reside in our mental hospitals today are truly "out of sight, out of mind." This book is the story of these forgotten thousands.


One of the boys who heard the Hallowe'en story twenty years ago is partly responsible for the writing of this book. He did not remain ignorant. For two years he worked in a mental hospital. He came to know intimately several hundred so-called "crazy" people, and he discovered that they are just like other people. He found that each patient in a mental hospital has emotions and ideas, likes and dislikes, hopes and fears. He found that each one is an individual personality, humorous or pathetic, mischievous or helpful, loving or hateful.


He also discovered that many mental patients live in conditions and under circumstances unlike those endured by any other group of people in the country. He began to wonder if those conditions alone were not enough to drive almost any person "out of his mind." He wrote a report about some of the things he personally witnessed. That report is the basis of one of the sixty-three factual, eyewitness accounts of life in mental hospitals which compose the following chapters.


Over two thousand similar reports were used in the preparation of this book. Every person depicted is a real person; every place described is a real place; every event recorded actually occurred -- and they all took place in mental hospitals in the United States within the last five years, 1942-46.

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In the following chapters you will be given a glimpse of mental patients and the conditions in which they live. The picture will not be beautiful, but it will be interesting and accurate. You will be taken behind the impressive facades of imposing institutions, and there you will meet doctors, nurses, attendants and patients face to face. After reading these pages, the forgotten thousands in our mental hospitals will no longer be "out of sight." You will have seen them. Neither will they be "out of mind." You will have known them and known their problems.


A gate which has long been closed to you and to most ordinary citizens swings open beyond this page.


It's People That Count


"No building ever cured a patient. Neither medicine, psychiatry, hydrotherapy, occupational therapy, dietetics, drugs, electricity, music, dramatics, surgery, psychoanalysis, religion nor psychiatric social work ever cured a patient. Recoveries occur only when such techniques are applied directly and continuously to individual patients by trained people. People, not things or theories, cure patients."


Commissioner of Mental Hygiene,
State of Maryland.




"To attendants: You perhaps more than anyone else, can help patients get well. You are with them constantly -- days to the doctors' hours. The little things you do, week by week, day by day, hour by hour, minute by minute, can make or break them. Of all the members of the hospital staff, you are closest to the patients. You can support the work of doctors and nurses, or cancel it. Yours is the important, cornerstone job in the hospital."


In The Attendant's Guide
Published by The Commonwealth Fund.


Picture, if you can, a ward where two hundred and forty mental patients are locked in one room from morning until night. No patient is ever permitted to leave the ward unless accompanied by an attendant.


Most of these patients are forty-five years old or more. They're vegetative. They eat, they sleep, they void. Then they eat, sleep and void all over again. The only variation in this program is twice a week when someone shaves them and bathes them. Many of them can't dress themselves or help keep themselves decently covered. They never stand up when they can sit down. They never sit down when they can lie down. Most of them look as it they wouldn't even lie down if they could find a less demanding way of existing.


Now, into this atmosphere, inject a boy in his early twenties. He gets no greeting, no introduction, no explanation. The door is opened and he is pushed into the ward. He finds a seat or stands up in a comer. He looks around him and sees hopeless despondency. His ears are assaulted by the vocal discord of two hundred disordered minds. His nose -- well, you can't picture that.


You're the attendant on the ward. It's your duty to help this beardless boy who is gazing off into space. But you know nothing about him -- not even his name.


He has been pushed into the ward in much the same manner as a stray steer would be pushed into a cattle pen on a railroad siding. The expression on his face seems to say, "Where am I, and where do I go from here?"


"Hello, fellow."


No response.


"Where do you hail from?"




"Where is your home town?"




"No foolin'? That's only about half a mile from where I live. Whereabouts in Bellville?"


"Spruce Street."


"That's between the river and the furniture factory."


"That's right."


And so, stealing time from the other two hundred and forty patients, you establish contact with the boy. You find out how old he is, how long he has been in the hospital, how many brothers and sisters he has, whether he is married, has any children, or lives at home with his father and mother. This is not accomplished in one sitting, but in odd moments stolen from the other routine duties attendants have to perform -- chiefly locking and unlocking doors.


Finally you learn his name is Tony, and you say, "Tony, I guess you'll be glad to get out of here, won't you?" to which he replies, "Gosh, mister, you can say that again! I thought I was comin' here to get a rest and quiet my nerves. Why, this place would drive a guy nuts!"


You know this is true, for there are times when it almost drives you nuts. But you can't admit this -- not to this boy. And you know there is a definite routine through which this boy must go before he can hope even to go home on a trial visit. So you suggest to him that there is a method by which he can get transferred from this ward almost immediately -- a way to get out in God's open space where he can get relief from the clatter and bang of the overcrowded ward.


You tell him that in the morning, when the ward doctor makes his rounds, he should say, "Doctor, may I speak to you for a moment?" And when the doctor stops, he should say to him, "Please, sir, can I get work on an outside detail?" You explain to the boy that this will, in all probability, get him a job on an outside detail: trimming hedges, cutting grass, or something along that order, where he won't be required to do any great amount of arduous labor, but where he will be expected to respect the discipline of the attendant in charge of the detail.

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You explain to him that faithfulness on this detail will, in time, get him the privilege of going "to staff" to ask for a "parole" or privilege card. This privilege card will permit him to roam the grounds and go to the recreation hall or the store. Also, it will "earn" him a pack of cigarettes or a bar of candy about every other day. You add that the goal is neither the privilege card nor the cigarettes, but escape from the perpetual din of this ward, and the establishment of a record of good conduct. Then his family can request a trial visit for him -- a visit home, where he can actually REST amid his loved ones.


You know that if this boy will follow the procedure you have outlined, you will have snatched a soul back from hell in the nick of time. For if this boy remains on this ward, amid this senile decay, you know from past experience that you will see him deteriorate from day to day before your very eyes. You have witnessed it scores of times before.


A day or two later you miss Tony. You hope and pray that he has done as you suggested, and you keep your fingers crossed. Ten days to two weeks later, as you are leaving the ward to return to quarters, a familiar voice hails you:


"Hi! Jim! Wait a minute. I want you to meet my folks!" You meet a father and mother with strangely moist eyes. Their English, by its peculiar inflection, betrays their European origin. The baby sister, who has hold of Tony's arm, is clearly typical of young America, from the flower in her hair to the pumps through which peek her enameled toes. On Tony's other side stands his brother, Giuseppe, erect and very proud of the World War II service button in the left lapel of his coat. They chorus in unison, "you goin' to take care of my Tony?"


Heck, you can't do anything for him. You can only explain the procedure he must go through. "Has he told you what I suggested to him?" "Yes," they all agree. "Well, then, it's up to you people to get behind him and encourage him to carry out that program as fast as he can."


The mother wants to know how long it will take. You confess that you don't know. "Tony is only one of twenty-two hundred patients. We are short on doctors. We are short on nurses. We are short on attendants. We are short on everything. It seems almost impossible to get around to all the individual cases needing special attention." But you assure them, "If he will stick to it, and you will come up to visit him every time you get a chance, he may be home before you know it. In the meantime -- well, he'll get good food and plenty of fresh air." And you promise that you will keep your eye on Tony and see that he toes the mark.


One day, a little while later, as you go into the store, somebody grabs your arm and there's Tony with that infectious grin on his face that you couldn't wipe off with a mop, whispering into your ear as though he is afraid to trust God himself with his good news, so low that you have to strain every nerve to hear: "Jim. I'm going home Sunday. My Dad and Mother are coming to take me home."


To which you reply, "Hey, fellow, good enough! But watch your step when you get out and see that you don't get into any mischief. In fact, after you have been home a while, see if you can't get a job lined up. If you can, come back with your Dad and Mother and report that fact, and maybe they will extend your visit. Who knows, maybe you'll never have to come back." With that, you stroll over to the soda fountain and have a coke with Tony to celebrate his good luck.


You walk away, elated. But your elation is short lived; you think of the hundreds of other Tonys in this place for whom you can't possibly "steal" enough time for the individual attention you know they need.


But you go back to the ward resolved to do the best you can in an impossible situation.


(Based on report 1142)




"During the period of July 1, 1944, through June 30, 1945, the employment situation has remained critical, and has shown little or no improvement over the previous year. With 660 established positions, we have had an average of 467 employees and an average of 193 vacancies for the year. Through the twelve months' period we employed 324 persons and 340 persons resigned. Sixteen persons were dismissed during the year for the following reasons:


8 -- excessive alcoholism
5 -- services unsatisfactory
3 -- emotionally unstable"


-- From the annual report of a large mid-western hospital.


"Eight Dismissed: Excessive Alcoholism."


"Hey, Joe! Did you hear that Nelson is back?"


"No! You can't mean it! Surely they wouldn't hire him again!"


But that's just what they had done. Joe found out for sure when he went to take over his ward for the day shift. Even as he came near the door, he could tell that the night man hadn't changed many beds during the long twelve-hour shift. The odor was unbearable.


Inside, half the patients were up and half of them still in bed. A dozen or more were walking up and down the ward completely naked. Water and feces were all over the hall. And Big John, with a wet towel, was lording it over a cowering group of fellow-patients in the dormitory.

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Joe sighed, hitched up his pants, and took off his white coat as he strode into the office. There was Nelson, slouched in the chair, sound asleep.


"Come on. Get out! You're off duty -- officially now." Nelson didn't stir. So Joe shook him and finally roused him enough to send him off duty. Joe had to go along most of the way, because Nelson couldn't get his key in the locks. He was that drunk.


Nelson had been employed at that hospital before -- that's why Joe couldn't believe he was back. Nelson had been fired a few months earlier, and had worked at another hospital in the meantime. He had been dismissed from the other hospital because of bad eyesight.


With the help of a powerful magnifying glass. Nelson just managed to scratch out a night report that passed for writing. He admitted that he couldn't read the labels on medicine bottles -- yet he was allowed to give hypodermic shots of morphine and other drugs to patients. At a distance of twenty feet, he couldn't recognize people he knew well.


Nelson was still employed at the hospital six months later when Joe gave up in disgust and left.


(Based on report 450)


"Five Dismissed: Services Unsatisfactory."


Visitors' day was something of an occasion on all the wards at Pineyville. The patients who had visitors got a good feed from their families, and they usually brought enough back to the ward to share with their fellow-sufferers.


It was little wonder that all the patients looked forward to visitors' day with as much anticipation as Bowman.


Bowman was charge attendant on Ward 90, and he reigned supreme there. Not a patient on the ward would stand up to Bowman for even a minute. They all cowered in corners, or ran to do his bidding when he spoke. To hear Bowman tell it, all the doctors took orders from him, and all the nurses asked him to their rooms at night. The patients acted as if he controlled the universe as well as the hospital.


But on visitors' day, Bowman was a different sort of a fellow. He'd come to work without the smell of whiskey on his breath, and he would spend most of the day fixing up the patients who were certain to have visits. Then, during visiting hours, he'd be seen flitting about from table to table, talking pleasantly and in confidential tones to the mothers and dads and wives and sisters of his patients.


All the relatives thought Mr. Bowman was a fine attendant, and they were glad to know that he would take good care of their son or husband or brother. Bowman always got across the idea that he would take care of the patient all right, but that first-class care would take some extra money to buy better food and clothes than the hospital provided. And that way he often collected from thirty to fifty dollars a week from the relatives to buy cigarettes and candy and food and clothes for the patients.


Bowman would bow the last visitor out the door, and then a change would come over his face. He'd pocket Mrs. Klein's ten-dollar bill, kick her beloved son upstairs, get him out of his "visiting" clothes, and yell, "Start mopping the floor, you son of a ---. Don't think you get your cigarettes for nothing." And so it would go for another week.


Bowman made cigarettes out of state-furnished tobacco, brewed coffee from cans he "lifted" from the kitchen, and held back on the meat at the patients' meals so that he could make sandwiches for his "customers." He bought two-for-a-nickel cigars for old Peter, whose wife had said she wanted him to have a fifty-cent Havana every night after supper. And even then he made every patient work for what he was given, and constantly reminded patients how much they owed him for all the "privileges" he allowed them. By the same methods he always kept a couple of patient stooges on hand to discipline other patients. Then, when too many patients went to the infirmary with broken ribs from Ward 90, Bowman would put the blame on one of his stooges and have him transferred to the violent ward.


Rumor had it that the rational patients on Ward 90 prayed every night that one of the stooges who had been "sold down the river" would be transferred back to Ward 90. But Steve quit praying that when he saw, one day, the brass knuckles, the blackjack, and the weighted hose that Bowman kept handy in the office.


(Based on report 434)


"Three Dismissed -- Emotionally Unstable."


Dwight didn't feel too comfortable about his work in building F. It wasn't that the patients bothered him -- they were pretty badly deteriorated and needed a lot of care. But the charge attendant, Joe, seemed to resent having Dwight around.


Joe had been in charge of Building F at nights, all by himself, for more than a year. But there was no doubt that there was work enough for two men; a hundred and fifty patients, about half of them incontinent, make plenty of work. So Dwight kept doing the best he could without any cooperation or instruction.


One job which Joe always took care of was showering the patients. And more than once, Dwight had found the door to the shower room locked from the inside while Joe was giving a bath. Dwight also noticed that Joe often took patients with him into the office and locked the door.

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Suddenly, after a few weeks, Joe's attitude toward Dwight seemed to change. Joe became friendly and invited Dwight into the ward office for a chat every once in a while. But Dwight soon suspected that Joe was leading up to obscene advances. He began refusing Joe's invitations and Joe became resentful again.


One night Dwight went to first supper -- night attendants broke their twelve-hour shift with a meal about midnight -- leaving Joe on the ward alone. But when Dwight reached the outside door, he found it was raining, so he returned to the ward to get his coat. As he went into the big dormitory, he saw charge attendant Joe bending over the bed of a deteriorated patient. His suspicions were confirmed -- Joe was a homosexual.


(Based on report 502)




"While the ward physician is not directly responsible for the ward routine which is carried on by the nursing and attendant personnel, yet his attitude toward his patients will determine more than any other factor the attitude of the nursing personnel toward the patient."


-- GEORGE W. MORROW, M.D., Superintendent, Kankakee State Hospital, Illinois.


"Bright morning, Mr. Pisky, isn't it?"


Mr. Pisky looked up from the bowl of unsweetened cereal he was eating, and blinked at the attendant standing there. A little smile broke on Pisky's face. "Yeah, bright! More cereal?" he asked.


"Sure enough. I'll bring it right over." And the attendant went away smiling, to try to scrape just a little more pasty oats out of the tin.


Those were the first words Pisky had spoken in two weeks. During most of that time he had been so depressed that he had to be told to eat every mouthful. This morning he had gotten out of bed by himself and had dressed himself. (That is, he had done everything but button his shirt -- all its buttons were torn off, and he had let another patient tie it together with a string.) Now he was actually asking for food, and eating it as if he enjoyed it.


As soon as the attendant and his sixty-three patients were back on the ward, Pisky presented himself again. "Say, do you s'pose I could have my glasses and something to read?"


"Sure, you can have this magazine to read. But we'll have to ask the doctor for your glasses. The doc should be along before long, so you watch for him. Okay?"


"Hokay!" said Mr. Pisky.


Pisky had been around long enough -- he had been in the hospital fifteen years -- to know that the doctor didn't spend much time going through the ward. He took up his vigil right at the door of the ward and watched carefully for the doctor's appearance.


The attendant was down at the other end of the ward when Dr. Klemm swept in on his daily dash through the wards. One hour -- ten wards -- seven hundred patients -- not much time.


Pisky stepped up timidly behind the doctor and touched his shoulder: "Please sir ... ."


Dr. Klemm whirled around, pushed Pisky roughly onto a bench and cursed him roundly. "You -- -- -- -- ! Who do you think you are, putting your hand on me?"


Pisky quivered on the bench a moment, slid to the floor and ran for the toilet, where he crouched in a corner, crying.


Dr. Klemm strode out the door at the other end of the ward, muttering: "If I ever get fired or want to leave this hospital, I'll beat hell out of that patient before I go."


(Based on report 283)


Visitors' day was always the most disagreeable day in the week for Miss Ingles. The sight of so many confused and disappointed relatives depressed her, and the shabby way the doctors treated them -- that nearly always made her mad. The worst of it was that Miss Ingles, receptionist and secretary for the four doctors who shared the second-floor office in the Administration Building, usually had to handle the difficult situations the doctors got her into.


She looked at the wall clock and saw that it was already after three o'clock -- still Dr. Grant and Dr. Morrison had not come. Then she looked at the row of mothers and fathers, wives and husbands, brothers and sisters who sat patiently, waiting to see the men who had control over their loved ones. In the big, open office room. Dr. Bander and Dr. Fitch sat at their desks.


Dr. Bander, a seventy-three-year-old woman who had returned to duty only because of the war-caused doctor shortage, had quickly disposed of her visitors. She was so abrupt and impatient with them that they seldom asked to see her. and never stayed longer than necessary. Now she sat glaring at the waiting relatives and listening to Dr. Fitch's interview. Every once in a while she would purse her lips and grunt, "Humph! All nonsense!"


Dr. Fitch was too old for duty, too, but -- except for the fact that he couldn't remember names and was very set in his ways -- he seemed to be doing all right. Every time Dr. Bander made a remark, he stopped talking, clenched his teeth, and then went on.


At last Miss Ingles decided she would have to do something about the waiting relatives. She called Dr. Grant's apartment by telephone. He answered immediately.

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"Dr. Grant, there are four visitors in the office to see you."


"Oh, is that so? I won't be able to see them in person today. Is there anything special?"


Miss Ingles knew the rest of the conversation by heart -- it was almost always the same. The visitors would get the "run-around" and she was the one who had to give it to them. I think most of them are just routine."


'Well, you try to take care of them. If any of them insist on talking with me, put them on the phone. I really can't come down just now."


All right. Dr. Grant. Mrs. Edwards wants to ask about taking her son home for a trial visit, so I'll put her on soon."


Miss Ingles knew what to expect from Dr. Morrison, too. When she told him there were visitors waiting, he said with real concern: "Oh, I forgot today was visitors' day. I'll be right down." He really had forgotten -- he forgot almost everything unless his wife was on hand to remind him.


In just a few minutes. Dr. Morrison came into the office. He was a small, jovial man of sixty-five, a victim of high blood pressure and dizzy spells. He smiled vaguely in the direction of the visitors, mumbled that he was sorry about the wait, and went to his desk.


"You're first, Mrs. Kauffman," Miss Ingles nodded to a gray-haired mother whose son had been under Dr. Morrison'a care for two years. The boy had recently had electro-shock treatments, and was well on his way to recovery.


Mrs. Kauffman went right to the point. "Dr. Morrison, you said on the phone this morning that I could take James home for the weekend this afternoon. But the nurse tells me she has no order to let him go out for a visit. Can he come?"


Dr. Morrison made an effort not to look as blank as his mind was. "Oh, your son. James -- what was the name?"


"James Kauffman."


"Oh, yes. Excuse me and I'll check up on it."


He went to the telephone on Miss Ingle's desk and called his wife, who was in charge of the hospital pharmacy. "Molly. There's a Mrs. Kauffman here who wants to take her son, James, home for the weekend. I can't remember the boy, but probably you do."


"Certainly. You asked me about him this morning, and we decided he should go on the visit."


"Hm! I forgot to make a note of it, I guess. Well -- thanks, Molly."


He phoned the male supervisor, giving orders for James Kauffman to go on a weekend visit. Then he asked Miss Ingles to get the case histories of other patients he might have to discuss with visitors. "My memory doesn't seem to be very good today," he explained apologetically.


When Miss Ingles returned with the case histories, Dr. Morrison was discussing politics and the O.P.A. with Mr. Herman, whose wife was a chronic case. As the afternoon wore on, the conversation touched on the army discharge system, the National League pennant race, the rubber shortage and the relative merits of American and foreign women. The five o'clock chimes on the tower clock reminded Dr. Morrison it was time to go off duty.


He stood up and shook hands with Mr. Herman, and then strode over to the three visitors still awaiting him. He asked each one whom they were calling about, and assured each, in slightly different words, that he thought he might have a full report on the case in another few weeks.


Just as Dr. Morrison was about to leave, Mr. Herman came back into the office.


"By the way," he said, "I forgot what I came for. Here's ten dollars I want deposited for my wife in the patients' store. That ought to keep her in ice cream cones for a while."


"I'll take care of it," Dr. Morrison assured him, slipping the bill into his pocket. He turned to say goodnight to Miss Ingles.


She held out her hand. "Don't you want me to take care of that ten dollars?" she asked.


Dr. Morrison looked puzzled a moment. "Oh, yes," he said, "Will you? I might forget."


(Based on report 748)




"In the nursing of patients who are mentally ill, every bit of personality counts, every bit of intelligence counts, every bit of insight as to what is going on in the patient's mind counts. The psychiatrist directs the way; it is the nurse who leads the patient back to health."


In Nursing Mental Diseases,
Published by the Macmillan Co.


"Miss Branscome! Are you washing out that sink yourself?"


"Certainly I am, Bristol. I want to do my share in keeping the ward clean."


"My! It certainly is a pleasure to have a nurse like you on duty for a change. That Miss Felder never did a hand's turn. Of course, I expected to do all the cleaning, but she wouldn't even take care of the patients."


"Now, Bristol, don't be unfair to Miss Felder. I'm sure she gave the best treatment possible." Actually, Miss Branscome, new nurse on North Infirmary, knew that the ghastly bed sores on some of the patients could have resulted only from gross neglect. But attendants should not criticize nurses.


"Unfair!" exclaimed Miss Bristol. "I can't be unfair to her. Many's the time I've seen her fail to apply a bandage the doctor ordered -- and then tell the doctor, when he asked, that the patient kept tearing it off. Many's the time she filled in the temperature chart for sick patients without even going near them. And I won't soon forget the way she kept patients under sedation without a doctor's order."

Page 8:


"You had better just forget about it, Bristol. It won't help to complain now."


"I guess that's right. But I'm glad she's gone. You know why she got transferred to night duty?"


Miss Branscome, who was a very strict nurse, didn't approve of discussing such things with attendants. But she was curious to know why her predecessor had been removed to night duty so suddenly. "I imagined it was a routine shift. What was it?"


"Dr. Forbes caught her withholding insulin from one of the patients on the shock list. She refused to give the patient her shot four days in a row -- just because the patient refused to wash windows without getting extra cigarettes for it."


(Based on reports 783 and 945)


"Nurse, that new patient says she doesn't feel well; and she does look pretty bad."


"Spencer, straighten up your cap -- your uniform never is just right."


"Yes, Miss Bond."


"And don't worry so much about the patients. There's nothing the matter with that new one; she just wants attention." In other words, go back to your duty as watchdog and turnkey and forget about how the patients feel; after all, you're just a dumb attendant.


Spencer went back to her duties, but she didn't stop worrying about that new patient. When Spencer went to help the patient into the dining room for supper, she found her hot as a bed of fresh cinders and her skin dry as a bone. An attempt to get the patient to her feet brought forth an agonized, cry of pain. "My stomach," groaned the patient.


Spencer went down to the nurses' office again, and was relieved to find that Mrs. Whitmore had replaced Miss Bond. Mrs. Whitmore was a motherly sort of person with a kindly heart under her starched nurse's cap and uniform.


"Mrs. Whitmore, I wonder if you'll give me a little help with the new patient from Ward 40?"


"What's the matter with her?"


"That's just the trouble; I don't know," and then Miss Spencer went on to explain how she had found the patient and what her condition was.


Before Miss Spencer had finished, Mrs. Whitmore thrust out a vaseline-smeared thermometer and barked, "Go take her temperature."


Spencer was back in a few minutes. "Will you check this, please, Mrs. Whitmore? I read it as just over a hundred and four degrees."


Mrs. Whitmore gave one glance at the thermometer and went into action. "Get a wheel chair and make a stretcher out of it. Get a couple of blankets. Get someone to help you, and be careful how you move her. Bring her here. I'll get the doctor."


Spencer did all she was told, quickly and with care. Now we've got a nurse who's on the ball, thought Spencer, and it's a pleasure to work with that kind of a nurse.


During the next twenty-four hours, eight other women were wheeled off the ward in the same condition. The doctor said it was dysentery, or diarrhea, or something like that. But Miss Spencer kept thinking that it might have been an inflamed appendix in that first patient -- all the symptoms were there. And if it had been, then what price the remark of the careless nurse who had said, "Don't worry so much about the patients?"


(Based on report 1139)




"There is no one upon whom the patient's welfare is more dependent than the nurse or attendant who is with him hour after hour during the day."


-- ANTON T. BOISEN, Chaplain,
Elgin, Illinois, State Hospital.


"Sure, I know how to treat these patients. I've had experience with them."


That was Anderson's reply to O'Toole, the charge attendant on Ward E. But O'Toole didn't think that experience was too valuable a recommendation. Baker and Landon, the last two men who had been sent to O'Toole, had been "experienced" too. But they had turned out to be dyed-in-the-wool "bughousers." "Floaters," some people called them, and O'Toole called them "drunken bums."


They came and went from one hospital to another; they never stayed at one place more than a few months. Their attitude seemed to be: "We'll run this bughouse like a bughouse ought to be run. If we happen to bang a patient up now and then, or if we let some of the 'nuts' die in their beds, who cares? We know the hospital will let us slip out quietly, and we can always get a job at some other hospital." And so they took out their own dissatisfactions on the patients, and got a kick out of cracking the whip over helpless inmates.


O'Toole looked at Anderson. The new man hardly looked like a "bughouser," but the hospital didn't get a chance to hire much else these days. So O'Toole asked, "How do you treat them?"


"Give 'em the old soft soap. That's the best thing I've ever found."


O'Toole thought that sounded pretty good. You could talk these old patients on Ward E into most anything, if you were patient enough and used the right approach. He had thought of his methods in higher terms than "soft-soaping," but he guessed the old slang expression covered the situation pretty well. So he said, "Okay, Anderson, I guess we'll get along." And then he started Anderson off into his job.


Everything went pretty well the first three days. Anderson wasn't much of a worker, but he seemed willing enough. O'Toole was sorry, but not particularly alarmed, when Anderson appeared on the fourth day with alcohol on his breath. After all, he thought, at least three-quarters of the attendants drank to excess. It was too much to hope that Anderson would fall into that other quarter.

Page 9:


That evening O'Toole noticed that Anderson was herding the patients into the bedrooms with some kind of weapon. He saw Anderson swing the weapon into a patient's bare back, and he called out, "Hey, what are you doing there, Anderson?"


"Giving these slow bastards the soft-soap treatment," Anderson replied.


"Well, cut it out. We don't go for rough stuff on this ward."


"You don't have to worry about this. See? I've got a square of soap in the toe of the sock. You can beat the hell out of these numbskulls with it, and it won't leave a mark anywhere. Watch." Anderson wound up and swung his soap-sock directly into the abdomen of the unsuspecting patient nearest him.


But by then O'Toole was on hand. He took the sock away and told Anderson to get off the ward. Anderson looked at him, disbelieving for a moment. Then he scowled: "Why you stinkin' prissy-pants, you! You let these patients run the ward, and then you try to order me off it."


"I run this ward," said O'Toole, "and I run it for the patients -- not for you. Now go down and turn in your keys while I call the supervisor."


Anderson sneered and walked off the ward. O'Toole reported the incident and went on putting the patients to bed.


Two days later, O'Toole was moved to another ward, where he worked entirely alone. Ward E was placed in charge of a man who was known throughout the hospital for his tough, brutal treatment of patients.


"Well," the supervisor explained, "we certainly couldn't have someone on that ward who couldn't get along with anyone else in the hospital!"


(Based on report 273)


As soon as Lucy came on duty in the morning, she hunted up a sturdy push-broom. From then on, every time she sat down, she had the broom within reach, leaning against her chair.


The patients could think of only two possible explanations for their new attendant's strange attachment to the broom: either she was very particular about the housekeeping on the ward, or she was afraid to be alone with the patients without a weapon.


As the day passed, however, both of these explanations fell into discard. In the first place, Lucy didn't pay any attention to the ward cleaning. Instead, she became totally absorbed in a game of solitaire, and made no comment when the working patients finished up the mopping and waxing. Also, she was completely unconcerned about anything the patients did. Their coming and going, their talk and chatter, failed to distract her in the least from her cards.


Then the patients found the answer to the riddle. The rattle of a key being fitted into the ward door was heard, and Lucy jumped to her feet and began to push the broom vigorously in a big circle around her chair. When she saw that the newcomer was only a trusted patient delivering laundry, she resumed her seat and the card game.


The patients smiled. Their new attendant would never be caught loafing.


(Based on report 765)




"A reasonably well adjusted employee, interested in his work, who sees its purpose, and knows the results, is worth a dozen who are merely carrying keys and collecting checks. To be successful, the hospital personnel program will clearly entail careful selection and placement."


Commissioner of Mental Diseases,
State of Ohio.


The clock on top of the Main Building chimed ten o'clock as Fred White made his way up the steps to the Nursing Office. As he looked about at the brown and tan walls and the massive furniture, he wasn't sure that his psychology professor had done him a favor by recommending that he work in a mental hospital for the summer. But, thought Fred, if I can get the job, I'll stick it out for three months.


"Can I help you?" The young girl behind the reception desk smiled up at him.


"Yes, if you will, please. I want to apply for a job as an attendant."


"Oh, fine!" The receptionist beamed at the prospect. "Will you fill out duplicate copies of this application, please?" Fred sat down and filled out the questionnaire: Name, address, work experience, circle last year of school attended, sign your name. Nothing more. Same thing on the other sheet.


"I think these are filled in properly."


"All right. Come in and meet Miss Green. She's the Director of Nursing."


The receptionist moved toward a little office off the corridor. She smoothed her dress, patted her hair, took a deep breath, and plunged in.


"Miss Green, this is Mr. White, applying for a job as an attendant," she said, handing over the application papers and excusing herself.


Miss Green glanced at the papers a moment. "Ever had any experience in this kind of work?"


"No, I haven't."


Miss Green looked Fred over critically. "Well, we can use you. Tell that girl who brought you in here to show you the way to North Building. You'll work there."


Fred murmured a tentative "Thank you" and retreated to the receptionist. "Friendly old girl, isn't she?" he asked sarcastically. "She told me to ask you how to get to North Building."


Fortified with his directions -- and nothing else -- Fred thanked the receptionist and started for North Building. He rather lingered over the smile the girl had given him. He had a feeling that it might be the last smile he would see for some time.

Page 10:


When Fred wandered rather hesitantly into the office of North supervisor, the nurse behind the desk (in his three months at the hospital, Fred rarely saw a nurse except behind a desk) looked at him as if she'd just eaten a green persimmon.


"I suppose you're the new attendant."


Fred hated to be the cause of such a pained expression, but he answered, "Yes, ma'am."


"Sign your name on this sheet and take the number 69 set of keys off the board. Now, keys are the most important thing for you to take care of. You're responsible for set 69 whenever your name is signed here. When you leave the building hang your keys up on the board and sign your name in the column where it says 'out.' Is that clear?"


"Yes," Fred answered, thinking that his psychology professor would be surprised to know that he was spending the summer taking care of a set of keys.


"We expect our attendants to pay strict attention to the rules. If you don't, you'll be out of a job. You'll find the rules posted on Ward 86, where you are to work. The attendant on the ward will tell you everything else."


Fred felt that the interview was over, but he decided to ask at least one little question. It seemed fairly important to him. "And how do I get to Ward 86?"


The nurse heaved a sigh of exasperation, shook her head hopelessly, and gritted her teeth. "Take your number one key, go to the third floor, and keep going back in the building until you come to a door with an 86 on it."


She didn't look up again, so Fred started out on the search for Ward 86.


The first door on the third floor was marked 80. He entered and walked down the long corridor. There were a few old men sitting in the chairs along the corridor, and they watched him pass. Fred's steps echoed back and forth in the corridor, and he was reminded of those scenes in the movies where the prisoner marches through the passage to the gallows.


The door marked 82 let him into a ward where everybody wore ill-fitting bathrobes and nearly everybody had some kind of bandage on his head or arm or leg. Pretty little student nurses were scurrying here and there with basins and bedpans, thermometers and charts. Booming, buzzing confusion, thought Fred.


Door 84 swung in on a terrific hub-bub: chattering, singing, polishing blocks going up and down, all sorts of costumes, all sorts of postures. The place is like a madhouse, thought Fred. He stopped short and looked quickly from left to right. Madhouse? Madhouse? Fred went warily on down the corridor, watching carefully out of the corners of his eyes. He rather wanted to run the other way, but he opened the door that was numbered 86.


Fortunately he saw the white coat of the attendant as soon as he entered the ward. He went over and introduced himself as the new attendant.


"Well, so they're sending me some help at last! Make yourself at home."


Fred wasn't sure he wanted to feel at home here, but he asked the attendant where the rules were posted.


"Oh, I don't know," the attendant answered. "You just do what I say and we'll get along all right. You never worked in a bughouse before?"


Fred wasn't sure it was a question, but he answered, "No, this is my first time."


"Well, if you ever want to take a nap, use that chair over there -- I use this one," instructed the attendant. "And don't pay any attention to what the patients say. They're all plumb nutty and don't know what they're talking about. What's gonna be your day off?"


Day off? He had been on the ward two minutes, and the attendant wanted to know when he would have a day off. Frankly, Fred thought, I wish I had taken the whole summer off.


"I don't know yet," he answered.


The attendant looked as if he thought Fred had overlooked the only really important thing about the work. "Well, you can sort that laundry if you want to," he told Fred. "I'm going on my hours-off now."


The clock on top of Main Building chimed eleven o'clock as Fred realized that he was a full-fledged, attendant in complete charge of eighty-one psychotic patients on Ward 86. He was sure that if he could have set time back an hour, he would never have climbed the steps to the nursing office.


(Based on reports 278 and 404)


When Jim came to the hospital to work, he arrived about noon. He was immediately given a former patient to act as his guide and was taken to the cafeteria for his dinner. Then he was given a physical examination. The doctor seemed to enjoy giving the physical. "It's nice to give an exam to a normal person for a change," he said.


From the doctor's office, the former patient took Jim over to the attic (fourth floor) of a building which housed patients on the lower floors. Jim was shown a large room with eight beds in it and was told that he would live there. He learned that an uncertain taxi was the only way of going the four miles to the nearest town ($1.50 each way), and that there were no social or recreational activities for employees on the grounds -- except some pool tables, which were always busy. The former patient left Jim with the warning that he was to report at seven the next morning.

Page 11:


Jim was at the supervisor's office the next day at seven o'clock sharp. The supervisor gave Jim a routine five-minute lecture on what attendants at the hospital were not allowed to do -- don't smoke on duty, don't gamble with patients, don't lose your keys, don't accept tips, and a dozen other don'ts. Then one positive suggestion -- stand up, drop whatever you're doing and stand at attention whenever a nurse or doctor comes on the ward. "With the staff we have now, you won't be bothered with that very often," the supervisor concluded.


Then Jim was taken to the ward door, given a bunch of keys, and told this was where he was to work. Jim went in and looked around. There was a group of old men sitting around the room. About half of them were dressed. Another attendant was sitting at a table playing cards with one of the patients. He did not speak to Jim or greet him in any way; he just gave him a surly glance and went on winning the patient's pennies, and smoking.


Jim had no instructions about what he was to do, so he stood around with his back against the wall wondering how crazy the patients were and what might happen to him. One spry old patient sensed the situation and came up offering to beat his "green ears to a pulp." Jim paled slightly, the patient cackled heartily, and Jim went on standing against the wall, and wondering.


About eleven-thirty, the other attendant knocked his pipe out on the floor and yelled, "You can go to dinner now."


Jim has had lots of tough arguments to settle with his conscience in his day, but he still claims that the hardest thing he ever did was to persuade himself to return to that ward after dinner.


(Based on reports 408, 409, and 437)




"In mental hospitals, as elsewhere, the employee's satisfaction in his job depends to a large degree on prevailing practices of personnel management. If his work assignments are indefinite or confused, if constructive initiative on his part is ignored or actively discouraged, the effect on the employee's morale is often catastrophic. Each employee should be told exactly what is expected of him, and should be helped to understand the function and importance of his particular role in the hospital's total program."


Administrative Director,
Pennsylvania Hospital,
Philadelphia, Pa.


"Well, Don, I'm leaving this outfit." Jack was standing over his bag, packing his clothes, when his room-mate came in.


"Can't say that I blame you much," Don answered. "I've been working around this hospital for almost ten years, and I've wanted to leave nearly every day of it. But I haven't packed my bag yet. What's starting you off?"


"It's nothing special," Jack replied, "just more of the same old thing."


"Was 'Old Ramrod' on a rampage today?"


"Not much worse than usual. I don't mind being the bottom man on the totem pole. But when the guys on top start kicking the patients in the teeth and acting holy about it, then I quit."


"Yeah? Go on and tell me about it while you pack."


"It's not just that we eat that lousy stew over in the cafeteria while the doctors and nurses get served classy chops in their dining room. And I certainly don't give a hang that we're not allowed to speak to the nurses except in line of duty. I can almost stand it that we have to ask the 'Old Hen' when we want to stay out after eleven p. m. But darned if I can take it when they obviously don't give a hoot about the patients.


"Take today, for instance. You know that special diaper I worked out to keep old Louis from removing his catheter? Well, Dr. Graves saw that outfit this morning and ordered it removed immediately."


"No foolin'!"


"Yeah. It had been working perfectly for three weeks, and now we've had to put Louis back into a straitjacket again, to keep him from bothering the thing. You know his bladder is so bad he has to have one in there all the time."




"I suppose I should have expected something like this. When I first suggested using a diaper. Miss Lodge told me I'd better not do it even though it did sound like a good idea. 'The doctor will condemn you for your presumption,' she said. 'You just do what the doctors say, and forget about anything else.' But when I could save the patient a lot of pain and keep him out of a jacket at the same time, I went ahead anyway. Well, Graves noticed it today -- after three weeks of use -- and I got bawled out for not minding my own business. Which seemed to mean waxing floors and keeping the ward clean."


"'Well, sure. Graves is a little unreasonable, but --"


"But, phooey! It's the same way about everything. Did you ever see Dr. Bancroft on the rare occasions he's in his office? He's like a paunchy potentate holding court up there. All his little lieutenants come running in and out: plumber, gardener, farmer, carpenter, chauffeur, doctors and nurses. They all come in to get their daily orders from Bancroft.


You know I can't even get toilet paper on my ward unless he signs the order. The way everybody flits around to do his bidding, you sort of expect to see them salute, click their heels, and say 'Heil, Bancroft!'

Page 12:


"But did you ever see him when the state examiners come around? Then it's just the opposite. The paunchy potentate bows and scrapes to the state officials, shows them how low he's keeping the budget, and sends them away saying 'Bancroft makes a good hospital superintendent.' Gad, I wish they could see that stinkin' hole where my hundred and seventy patients live -- or die, rather!


"I don't wonder that most fellows who stay around here long get to saying 'Why worry' and 'Who cares.' Everybody from the garbage collector to the staff surgeon feels the same way."


"I'd go along with you, Jack, only -- "


"Yeah, I know, Don. It's the patients who pay. And you've got a soft spot in your heart for the poor devils. Well -- so long, and good luck."


(Based, on reports 267, 272 and 278)


Messes of Brick -- Masses of Men


"Too long the hospitals for mental diseases have been hospitals in name only, and. it is time that the administrators and psychiatrists, as well as others, connected directly or indirectly with these institutions make additional effort to improve existing conditions. Too long we have depended on the veneer covering the crumbling walls of our structures to give us the appearance of being the real article." (October 6, 1941.)


Delaware State Hospital.




"Certain technical things help to create the desired atmosphere of confidence and reassurance in the hospital and assist in rebuilding mentally sick patients. There is always a degree of exhaustion, both physical and mental, which must be counteracted by external measures such as ultra-comfortable beds, attractive and well-ventilated rooms, easy access to toilet facilities, and appetizing, nourishing food." (1)

(1) From The Human Mind, by Karl A. Menninger, M.D, published by Alfred A. Knopf, Inc.




The tree-lined drive and the Colonial-type buildings reassured Walter considerably. Ever since the doctor at the admission hospital in the city had told him he was going to be transferred to a state hospital, Walter had been dreading what he might find there. But now, as he arrived, it looked quite nice. The rolling lawns, the spacious verandas, the spreading trees -- everything looked calm, peaceful, serene.


The car stopped in front of the main building, and the attendant who was transferring Walter said, "Well, here we are." They got out and went into a blue-tinted waiting room. Comfortable leather chairs, bright pictures and a rug on the floor made Walter feel at home. He had lost all his fear by the time the doctor had come in, talked to him, and put him in charge of an attendant.


Walter said goodbye to the old attendant and accompanied the new one through a short sunny hall to a locked door, marked Ward C. The attendant inserted his key, opened the door wide and waited for Walter to enter the ward.


Walter gasped and started back. Stale air, laden with a collection of repulsive odors, assailed his nostrils. His eyes looked into a long, dark hallway in which half-dressed men wandered up and down, muttering to themselves.


The attendant's hand pressed insistently on Walter's back. He moved across the threshold, and the door shut on the sunny hall. Walter had arrived.


Walter went through the rest of the admission procedures automatically, without speaking or thinking. He only observed. He found that the walls were dark gray, unbroken by pictures or decoration, except for rough patterns of lighter gray here and there where the plaster had fallen. The only furniture consisted of dark brown benches and one table. The part of the smell that didn't come directly from the two hundred unbathed, poorly clothed men came from the wooden floor. The seams and pores had opened up over the years so that everything that touched it -- spoiled food, dirty laundry, human waste -- left a little of itself behind.


He also found that the ward bathroom contained three toilet stools (all without covers or seats), one tub (no showers), and one deep sink. The sink served variously as urinal, drinking fountain, wash tub for bedpans, mop rinser, and dishpan for food plates.


Having made these observations and having taken his bath (which made him feel dirtier) and put on hospital clothes (which made him feel more undressed), Walter turned his attention to his fellow patients. He found it difficult to think of them as people. They seemed more like animals: a big herd of them penned up in one corral, milling about and making queer noises, unmindful of others except for an occasional push or snarl.


As these thoughts were going through Walter's mind, two attendants passed by making plans for taking the patients upstairs to dinner. One attendant said: "You go on ahead. I'll drive the critters up."


Walter let out a bawl that sounded just like a steer on the way to the slaughter-house. The attendants looked at each other and shook their heads. Walter had arrived.


(Based on reports 141 and 976)


"Graber, I understand some of these patients haven't been outdoors for months."

Page 13:


"That's right. Dr. Campbell," Attendant Graber replied. "In fact, some of the old women in wheel chairs have never been outside this building since it was opened two years ago."


Dr. Campbell frowned. She had just recently taken over the Women's Senile building, after being in charge of the Admission Ward for several years. The senile building was new and quite well equipped. But in some respects, it was worse than the older buildings. The fact that there was no way to get patients outdoors except by taking them down a flight of stairs was one of the worst features.


"I wish the architects who build mental hospitals had to live in them a while. Imagine constructing a building for old, decrepit patients without a ground level entrance!"


"That's not the worst. Dr. Campbell," Miss Graber suggested. "Do you know how these block floors are supposed to be kept?"


"No, I don't."


"The directions say they should never be wet. You're supposed to wipe them with a damp cloth and wax them frequently. We have a fat chance of doing that with these old women spitting and urinating all over the place!"


(Based on reports 107 and 142)


Mr. Frazer lay in his bed telling himself that he must get up and go to the toilet, he must keep his bed dry, he must try to get back on Ward 62. For three nights he had slept on Ward 70, but he had to get away from it. Only one sheet on his bed, coarse blankets which were dirty from many nights on other patients, the smell of urine and feces, men urinating on the radiators, rats and cockroaches -- he must get back to Ward 62! The attendant had told him it wag easy enough -- just keep his bed dry for a week.


Yes, that was easy enough. At least, it had been during all of Mr. Frazer's last seventy-six years. But for the last month or so, it had been difficult. This cold weather, and sleeping in a dormitory with twenty other men, and being put to bed right after supper, and the distance -- oh, the distance!


Mr. Frazer winced as he recalled that long journey from his back hall room on Ward 62 to the toilet. He remembered every detail of it. How he would awaken in the night, and start building up his courage. How he would finally throw back the covers and shudder as the cold air struck his body. How he would struggle out of bed and, clothed only in his light undershirt, begin the long journey. Ten steps to the door . . . turn right, and thirty steps . . . right again, and seventy-two steps . . . left, and seventy-two more . . . right for twenty-six steps, and turn in to the toilet. At last! Then back again, cold and exhausted. Then repeat, three times, each night.


If only he could have had a urinal near his bed. Or a robe to put on for the journey. Then he might never have undergone the ignominy of that first hot urinal bath, followed by many more, and now a bed in a room where all the patients wet their beds every night, where it was expected of them.


Suddenly the lights flashed on in the dormitory room where Mr. Frazer lay thinking. "All out for the toilet," called the attendant. He went along the closely packed beds and got each patient up in turn. "Whew, what a mess!" he muttered as he routed out the patient next to Mr. Frazer. "Hey, Bill, take this one to the shower room for a scrubbing," he called to his patient-helper.


Mr. Frazer got out of bed and felt the sheets. They were dry. "Good boy," said the attendant. "Go on down and unload now." Mr. Frazer joined the parade of naked, misshapen old men. Some stopped in dark corners of the corridor along the way, but fifteen men crowded into the toilet to use the two stools and two lavatories.


On his way back to bed, Mr. Frazer noticed the attendant and his helper were hanging urine soaked sheets on the radiators to dry. "We haven't enough sheets for the first change tonight, Bill," the attendant was saying, "so I guess we'll be using these again in a couple of hours."


Mr. Frazer stifled a tendency toward nausea and went on to his dormitory. He had some trouble finding his bed, so he counted again -- seventh bed from the door -- but somebody was in it. He yanked the blanket down and struck the patient. "Get out of my bed," he hissed. The other patient hurried out and climbed into the next open bed.


Mr. Frazer looked down at his sheet, and the heart flowed out of him. Right in the middle of his sheet was a big blob of human excrement. He ripped off the sheet and threw it on the water-soaked floor. He climbed into bed between the uncovered mattress and the coarse blanket, determined to make his bed the filthiest in the whole dormitory.


(Based on reports 101, 648, and 676)


Gus wanted to smoke a cigarette. He took the package of his favorite brand, which his wife had brought him yesterday. Then he imagined how it would feel to inhale the blue smoke, then let it slowly drift out of his mouth, then take a deep breath of fresh air, and inhale again. Smoking was a great pleasure for Gus -- or at least it had been until he was put on Ward 10.


On Ward 10, smoking had lost some of its appeal. It wasn't that he enjoyed smoking less, it was just that he had to go through so much to get a smoke. And even then, a cigarette never tasted right because there was no fresh air to contrast it with.

Page 14:


Wearily, Gus got up off the floor where he had been sitting. He scowled at the other hundred and eighty-five men in the big day-room, and estimated that the toilet shouldn't be too crowded just now. He crossed the room, stepped over the man lying in the doorway, and entered the hazy, smoke-filled toilet. One of the five stools in the ten-foot-square room was unoccupied. Gee, he thought, for once I didn't have to wait.


He looked around the room -- at the fellow-patients sitting, lying and standing about; at the puddles on the floor; at the pipe leaking in the corner; at the plugged-up, overflowing urinal. As he watched, the wizened old man they called "the weasel" darted into the room, scooped up a wad of discharged chewing tobacco out of the filled urinal, squeezed it, and popped it into his mouth. When Gus thought no one was watching, he slipped a cigarette from the package in his pocket and sat mouthing it.


Just then the white-coated attendant came in. Gus could never see a white coat and stay quiet; a white coat inevitably called forth a violent harangue. He leaped to his feet shouting and gesticulating.


"There's a hundred and eighty-five patients on this ward. Eight? We're supposed to use this toilet three times a day. Right? There's five stools in this toilet. Right? That means each stool gets used a hundred and seventeen times. Right? At five minutes each time, them stools is busy ten hours a day. Right? Now, why in the hell ain't there a union?" And in a different voice entirely, "Give me a light. Mister."


The attendant held up a match. "You're a demon with the figures, Gus. But don't let me catch you outside the toilet with that cigarette."


Gus drew breath for another harangue, but the white-coat had disappeared. Gus pulled on his cigarette; the only taste he got was of the sodden, stale, stinking room. He climbed up on the sill of the only window in the room, put his lips to the dirty screen, took a deep breath, exhaled. Then he turned to the room and drew deeply on his cigarette. Eyes closed, lips pursed, head thrown back, he let the blue smoke drift slowly from his mouth. "Bliss -- it's wonderful, he said, shaking his head ecstatically. His benign glance lowered to the fellow-creature at his feet. "Even in this God-forsaken place," he added.


(Based on reports 677 and 721)


Fire protection was the one thing that was stressed when a new attendant came to work in Building J. And well it might be, for the building was known to be a fire-trap, and it was rumored that it had been condemned four years ago. Be that as it may, the building still housed seven hundred of the state's mental patients, and attendants were told to take special precautions to prevent fires.


Mrs. Tolan read the rules and regulations carefully when she started to work in Building J. The fire hazard struck her especially, since she was to work Ward 6, on the third floor. There were two hundred and fifty-three patients on that ward, and the only exits were locked stairways at either end of the building, and a special fire escape -- also reached through a locked door. She was duly impressed with the fact that she alone carried keys to open any of these three exits -- patients could not get out except with her help.


The first morning on Ward 6 passed quickly for Mrs. Tolan, and it was soon time for her to go to lunch. But it didn't seem right to just go off and leave two hundred and fifty-three patients locked on the ward. She called the supervisor's office.


"Do you lock the doors on Ward 6 when you go to lunch?" Mrs. Tolan asked.


"Certainly! Never leave the ward without locking all the doors."


"But -- then the patients can't get out."


"That is exactly the idea, Mrs. Tolan. The patients aren't supposed to get out."


"Oh, I know. But I meant in case of fire."


"Oh, that! Well, don't worry about that. There are three hours a day and an hour each night when 'six' is left unattended. No one relieves you; just go on off duty when the time comes."


"All right, but it seems funny."


"Don't worry about it. If fire breaks out on the ward when you're not on duty, you won't be held responsible for it." Mrs. Tolan replaced the receiver on the hook.


"Well, that's nice," she thought. "I suppose that should put my mind at ease."


(Based on report 113)


Mental hospitals were not unknown to Mr. Graves. He had read several articles and books about them, and he had seen several of them from the outside. When he visited one on the inside, he decided there was real value in the old saying, "Don't judge a book by its cover." After his visit, he wrote the following description:


"I had read about conditions in the days when the mentally ill were regarded as persons possessed of devils, thrown into dungeons, shackled hand and foot with iron bands, left to rot in their own filth. It was almost impossible to believe that such conditions had ever existed. Now I know that such conditions exist HERE -- NOW. Our present treatment of the mentally ill is nothing short of barbaric. Let me tell you about my visit to one of America's 'modern' mental hospitals.

Page 15:


"I entered a dimly lighted doorway. A faint nausea came over me as the stench of human filth and moldy walls rolled toward me. My escort saw that I was getting sick. 'You soon get used to the smell,' he explained.


"We walked into the dining room. The long rows of crude wooden tables and benches reminded me of bleak prison scenes. The tables had no covering. Particles of food from previous meals were strewn about on the floor. The walls were covered with a thick coat of grime and dirt.


"My escort led me into the next room. 'Here's where they sleep,' he said, pointing to the beds which filled every inch of available space. There was barely enough room to squeeze through between the beds. As we walked down the isle a young chap looked up. Strapped to the bed with leather cuffs around his hands and feet, he had managed to free his left arm and was tearing the hair stuffing out of his mattress and eating it. No one seemed to mind. An old man strapped to a bed nearby had torn off his clothing and was lying in filth.


" 'This is the good side of the ward,' my escort remarked. 'Now I'll show you the other side.' He opened the door to another room. I stood frozen at what I saw. Here were two hundred and fifty men -- all of them completely naked -- standing about the walls of the most dismal room I have ever seen. There was no furniture of any kind. Patients squatted on the damp floor or perched on the window seats. Some of them huddled together in corners like wild animals. Others wandered about the room picking up bits of filth and playing with it. Near my feet was a little old man trying to shine my shoes. He had stepped in some of the human excrement and it was oozing out between his toes.


"A patient was eating some food from a tray which had been placed on the floor beside a urinal into which a patient had recently defecated. A sign above one of the urinals read:


'For diarrhea patients only!'"


(Based on report 2021)




"Buildings must be well equipped and provide enough space for good psychiatric care. But no mental hospital is adequate unless its physical facilities include provision for some of the niceties of life for both patients and employees."


Executive Secretary,
National Mental Health Foundation.


"Come into the office, Bill. I want you to empty your pockets again."


Bill reluctantly entered the nurse's office, but he didn't begin to empty his pockets of their bulging load. "Why can't I keep these things. Miss Logan? I need them all."


"Surely you don't need all that junk. Bill. And anyway, I can't have you going around looking like a loaded moving van." Miss Logan smiled at Bill. He did all the scrubbing and dirty work on the ward, and it was only because of Bill's work that she was able to keep the ward looking neat and clean. But why, oh why, did he insist on collecting so many things in his pockets! "Come on, empty out."


Bill sighed and began to remove the usual collection. A small piece of soap, a hand towel, some carefully folded toilet paper, four stub pencils, some paper, three envelopes, string, a bag of tobacco, cigarette papers, two paper-bound books, a comic magazine, yesterday's paper, a tooth brush, some shoe-polish, half a package of life-savers, four gum drops, three rags, a letter from his wife, a postcard from his son, twelve white buttons, eleven darker buttons, a box-top marked off into a checker-board, a folding drinking cup -- on and on it went.


Miss Logan shook her head. "Bill, why do you keep all that stuff in your pockets?" she asked.


Bill's answer was indirect. "Do you know why Blind Charlie is the envy of the ward?"


"No, Why?" Why anyone should envy that poor, blind patient was hard to understand.


"You know that plywood box he keeps under his chair?"


"Yes, I've noticed it."


"Well, it's padlocked. And Charlie carries the key around his neck. And he keeps anything he wants in there. So he always has soap when he wants to wash, and paper when he goes to the toilet, and a cup when he wants a drink. I guess that box is about the finest thing on this ward."


"Yes, I guess it is pretty fine, Bill."


Miss Logan recalled some words she had stressed in her class for student nurses, only yesterday: Psychotic patients need to take an interest in objects and things outside themselves; encourage them to take responsibility as much as possible.


In spite of such principles, only Blind Charlie, alone among these eighty-five patients, had a place to keep his belongings, a chance to own anything.


"Bill, you put that stuff on the shelf next to the linens." Miss Logan directed. "Hereafter, that will be your shelf. You can keep anything you want there."


"All right. That will be fine! But I'll be a terrible nuisance, always wanting something from inside the office, Miss Logan."


"It's the best we can do for now, Bill. Someday, maybe, we can have lockers or cupboards built so everyone can have a place of his own."


"Gee! That really would be something! Imagine, actually having a place of your own to keep your things!"

Page 16:


(Based on reports 681 and 706)


"In some ways it's like a stock-yard -- and other ways, it's not," mused Tex. He was sitting on guard outside the patients' exercise yard, looking through the high, iron fence into the small enclosed area where seven hundred patients obtained their only experience of outdoor life.


A gust of breeze swept across the dry, barren yard and tossed dust in Tex's eyes. It also brought a foul odor from that corner of the yard where patients answered nature's call. Masses of men milled about, walking to and fro in the enclosure; others lay exposed in the hot sun; a few wallowed in the corner of filth and mud; others huddled together under two small shelter porches. A babble of meaningless sounds and an undercurrent of fear and restlessness reached out to Tex. "Yes," he thought, "in some ways it is certainly like a stockyard."


Bit in other ways it wasn't. Tex had never seen a stockyard without a drinking trough. The hospital yard was as devoid of drinking fountains as it was of toilets. And as Tex began to single out individuals and watch them, he found a variety of interest among the mass of men that was lacking in any stockyard.


There at his usual post stood the "preacher," weaving back and forth, gesticulating and clasping hands, holding forth endlessly (in an unintelligible gibberish) to an immense crowd -- which paid no heed. The "athlete" weaved in and out of the crowd, unnoticed, as he did his road work and his shadow boxing. Pacing up and down on the walk, spouting unheeded venom at the President and the nation, was the political blasphemer. A "soldier" trudged wearily round and round the yard with his knapsack (a cleverly folded handkerchief) dangling at his side and his heart set on heroism. The "magician" snatched a rare and beautiful bird out of the air and exhibited it to the unseeing multitude; the "ballet dancer," completing a hesitant pirouette, bowed graciously before an unappreciative audience. The "worshipper" fell on his knees and made the sign of the cross at every turn, and the "evangelist" pushed through the crowd shouting in a sing-song chant, "What you need today is a personal Lord and Savior."


"No," mused Tex, "it's not like a stockyard. I guess it's like nothing else on earth, except ..."


Tex didn't let himself complete the thought. He had been captured in the Battle of the Bulge in Belgium, and he tried never to let himself think of those long, hard months he had spent in the Nazi prisoners' camp.


(Based on report 1101)


The three years that Mr. and Mrs. Rose had been apart during the war had pretty well messed up their family life. Their home and furnishings had all been sold, and Mr. Rose wasn't sure he could start in earning their living again right away. So it seemed like a good idea when they decided to go out to the state hospital to work for a year or so. Room and board would be provided, and even the small salary of sixty dollars a month would amount to a little something with two of them working. Besides, they'd be lending a hand during the shortage of hospital workers, and they might really enjoy the work.


At the hospital, the Roses talked to Mrs. Kennett, the nursing supervisor, one of the two registered nurses employed by the 1700-patient hospital. Mrs. Kennett seemed pleased at the prospect of getting two new employees. She made it quite clear how badly the hospital needed attendants, and what a big help an intelligent man and woman would be. She indicated that she thought married couples were especially valuable in caring for mental patients. The Roses were quite pleased with the prospect.


Mrs. Kennett took them over to their living quarters. "This is the female disturbed building, and our quarters for married couples are in the attic," said Mrs. Kennett. She led the way through a foul-smelling ward which reminded Mrs. Rose of the lion house at the zoo. "You have to go through this one ward to reach the steps," explained Mrs. Kennett, "but from then on, you go right up to the living quarters."


They went right up. Mr. Rose, who used to do such things in the army to keep his mind occupied, counted the steps -- there were just ninety-two of them. Mrs. Kennett opened the door at the top of the steps, and the Roses stepped into a dingy little hall. There were four straight chairs and a folding card table in the hall. The December, 1941, issue of Screenland and last week's comic strip lay open on the table. Six rooms opened off the hall.


"There are three other married couples living up here, but you can have your choice of room 4 or 5," announced Mrs. Kennett. Each room contained two iron beds, two straight chairs, two dormer windows, one chest of drawers, one rag rug and a bare electric light bulb. One room also had a table which Mr. Rose estimated measured ten inches by two feet. But they chose the other room because its windows' looked out on a cornfield instead of down into the "bull pen" where disturbed female patients paced back and forth all day long.

Page 17:


"You share the bathroom with the other couples," explained Mrs. Kennett as she showed the way to the little bathroom at the end of the hall. One stool, one tub, one wash-stand, eight people, four men, four women, figured Mr. Rose. Only a twelve-inch mirror, thought Mrs. Rose, and that toilet tissue looks awfully coarse.


It was noon by the time Mrs. Kennett gave the Roses a set of keys to their room. "If you're ready for dinner, I'll show you where you eat." So they went back down the stairs -- Mr. Rose got ninety-three this time because he counted the floor as a step coming down. The sun and fresh air seemed good, thought Mrs. Rose. It was like walking out of a cave, Mr. Rose felt.


"At this hospital, the men and women eat separately," Mrs. Kennett explained. "You eat in that red brick building over there, Mr. Rose. I'm going by the female cafeteria, so you can come along with me, Mrs. Rose."


The Roses looked at each other questioningly. "Well, we'll talk it over after lunch," said Mr. Rose. And he headed for the red brick building, where stew, bread, and custard were waiting for him.


(Based on report 433)




"Adequate and readily available supplies are essential to the proper functioning of a mental hospital. Since we are handicapped by lack of personnel, we should make certain that, the inanimate objects which contribute to patient welfare are available in quantity and quality."


-- PHIL STEER, Editor,
The Psychiatric Aid.


"Margaret, you can open twenty-four cans of peas, if you will," said Miss Ridgely, the new dietitian at the state hospital. She was rapidly discovering that nothing was done here in the way it had been done back at the city hospital where she had been working. But working with the patients was really quite interesting. And using canned foods in such large quantities certainly reduced the work.


Margaret lined up twenty-four quart cans of peas on the table. Then she reached in the drawer and took out a hammer and chisel.


Miss Ridgely drew in her breath. Had Margaret misunderstood? What was she going to do?


The hammer knocked the chisel deftly into the first can top. Margaret twisted it, withdrew, put a smaller hole on the other edge, and went on to the next.


Miss Ridgely went over to Margaret. "Is that the way you always open cans?"


"Yes, ma'am."


"Why don't you use a can opener?"


"There ain't no can opener." The chisel bit into another can.


Miss Ridgely looked and looked, and asked and asked. She did find a can opener -- a 10-cent model, rusted and bent. It had been bought a couple of years before by a patient who liked soda pop and needed a bottle opener.


(Based on report 623)


Dr. Kirkman, the assistant superintendent, walked around the big, barn-like room. He was counting patients.


Then he called the attendant on the ward to him. "Murphy," he said, "you have two hundred and forty-seven Patients on this ward, and only thirty-seven of them have any clothes on. Why is that,"


"Well, sir, a few of them are so destructive that I can't keep clothes on them at all."


"Yes, yes. But that doesn't account for there being over two hundred naked men on this ward."


"No, sir. The truth of the matter is, we just don't have any clothes to put on them."


"Not enough clothes? Hmm! Show me your clothes room.."


Murphy led the way to the clothes room, opened it, and nodded to the empty shelves.


Dr. Kirkman stepped over and counted the entire supply:


ten pairs of shorts and seven shirts. For two hundred and forty-seven patients.


"I save those to dress the men for visitors," Murphy explained. "I never know when the laundry will come in."


"I daresay you don't. It's a crime, though."


"Yes, sir! And, like all crime, it certainly doesn't pay!"


Dr. Kirkman then went over to the male infirmary. There he checked the bedding supply and found that there were forty-two beds with two sheets, two hundred and seventy-nine with one, and nineteen with none -- three hundred and sixty-three sheets for three hundred and forty beds.


Again he called the attendant. "Stone, do you have any sheets in the linen room?"


"Not a one, sir. I'm afraid the night man won't be changing any beds tonight."


"I've been counting things today. You need three hundred more sheets."


"That's right. But if you're counting things, come along. I'll show you something interesting to count."


Stone led the way back to the crowded dormitory of the infirmary. "Now, get ready to count again," he said. He whipped the sheet down off one mattress, and the bedbugs ran for cover en masse. "One of the patients claims he has counted three hundred and seventy-one bugs on one mattress. I don't know about that. But I do know the night man on this ward gets eaten up just sitting in the office."


"I guess I've had enough statistics for today!"


"I imagine so. This is some bug-house."


(Based on reports 259, 265, and 272)


Harris looked sadly at the order blank which had just come back from the hospital supply department. Three items received out of fourteen ordered. He hadn't really expected to get any sheets or towels or clothes or even tobacco for his patients -- but he certainly had hoped the order for an insecticide sprayer would be filled. Six straight weeks he had entered that order -- six straight weeks it had come back marked "None."

Page 18:


The situation was critical. Just yesterday he had counted twenty-two bedbugs on one bed -- that was the bed in which Cordusky was tied down every night so that he couldn't move. The night man was complaining about not being able to keep the patients in bed. And no wonder. Even the night man himself had been bitten as he sat in his chair reading. But you just couldn't get rid of bedbugs without some kind of sprayer.


The next day -- Harris' day off -- he found a solution. He went up to visit his friend, Roberta, who worked in the hog barns. There in the corner of the office, Harris saw eight or ten used sprayers. "Say, do you suppose I could get one of those old sprayers?" he asked Roberts.


"Sure. Take all you want. We get new ones every few weeks and aren't using these old ones anyway."


"Gee, swell. Now if I could only get the superintendent to supply me with the kind of cleaners you have here in the cow barn, I'd really be able to give my patients first-class care!"


(Based on report 715)


"Now this, students, is one of the finest, most complete hydrotherapy rooms in the state."


The student nurses, who were making a tour of the state hospital, looked around approvingly at the gleaming white tuba and showers, steam boxes, and sprays.


"Everything necessary to give any kind of approved water or temperature treatment is in this one department," the nursing instructor continued. Then she went on to describe the use of continuous tubs, the sitz bath, the needle spray, and an endless number of other modern treatment aids.


Several of the students had sensed the warm personality of the jolly old ward nurse who was assisting with the tour, and had been listening to her stories with much interest. When the description of the equipment ended, the girls began to wander around the room, and the old nurse remarked to a few of them:


"There's only one thing the matter with this room."


"What's that?" a couple of students asked.


"It hasn't been used for over two years."


"Not used! Why not?"


"Well, it's like that beautiful seven-hundred dollar anesthetic machine you saw upstairs in the operating room. That machine has never been used since it came in -- for the simple reason that none of the doctors know how to use it, and none of them will learn."


The old nurse smiled gently. "You know -- old dogs and new tricks? Well, this hydro room is the same story. Any decent nurse and a few attendants could run this room. They'd do a wonderful thing for the poor patients we keep locked up twenty-four hours a day. But we're so short-handed we have to put every nurse and attendant on the wards."


"Having the tubs open would lighten the work on the wards, wouldn't it?" one student asked.


"Oh, yes! It would probably save enough trouble that we could spare the people to run it. But you know how it is -- it's easier to stay in an old rut than climb out for a view of where you're going."


Again the old nurse smiled at the young students. "Maybe one of you will come back and run this department when you graduate."


Several of the girls thought maybe they would.


(Based on reports 780 and 793)




"Working on the theory that the institution has the double function of medical practice and business management, a few states have tried the experiment of placing a medical director in charge of the treatment of patients and a business manager in control of the economic side of the organization. This is an administrative absurdity." (2)

(2) Reprinted from Administrative Psychiatry by William A. Bryan, M.D., by permission of W. W. Norton & Company, Inc., copyright 1936, by the publishers.




"Attendant! It's freezing in here. Can't you put some more heat on? At least get out some blankets and cover the patients up." Dr. Lord was making his nightly rounds, and he was concerned about the early cold snap.


"I'm sorry, doctor. I've been trying to get some blankets ever since it turned so cold last week; but they tell me I can't have blankets until after September fifteenth. The heat doesn't go on until then either."


"That's foolish. I know there are hundreds of blankets stored in the supply building. I've seen them myself."


"But the Business Manager says they aren't to be used until after September fifteenth."


"Well, this is no business matter. This is a medical problem. We'll have pneumonia all over the hospital if this keeps up."


"We sure will, doctor."


Dr. Lord strode to the telephone. "Operator. Ring Dr. Bloom on an emergency call, please." He explained the situation to Dr. Bloom, but Bloom said he couldn't do anything about it.


"But, Dr. Bloom, these old patients are going to get pneumonia. Dozens of them already have bad colds. You know very well that half of them who get it will die of it."


"That's right, Lord. But, as Medical Director of the hospital, I can't do a thing about it. Stanhope admits that winter has come early this year, but he claims that his budgets and quotas run by the calendar, not by the thermometer."

Page 19:


"I'll bet there's heat in our staff cottages, isn't there?"


"Oh, sure. Mrs. Stanhope is susceptible to colds."


"Then there's really nothing we can do?"


"I'm afraid not, Lord. Stanhope can turn down my orders for medicines, therapeutic equipment, bandages, or anything else. If his budget reads 'no,' then I can't do a thing."


"Well, sorry to have bothered you. Good night."


Dr. Lord replaced the receiver. "What a system!" he muttered. Then he addressed the attendant. "Let's take all the clothes we can scrape togther -sic- and put them on the oldest bed patients. I don't know what we'll do on the women's side -- they've been short of clothes for months. Politics and puppets! What a system!"


(Based on reports 776 and 255)




"Where there is much pretension, much has been borrowed."




Ward 20 was in an uproar when Bruce came on duty after his morning off. Never had he seen such activity. A crew of worker patients was waxing the floor, using two big cans of paste wax -- the kind Bruce had been ordering regularly for two months without results. The smell of pine disinfectant came from the shower room . . . the exterminators were busy in the dormitory . . . patients who hadn't worn a stitch of clothing for weeks were parading around in new brown coveralls . . . beds which had been without sheets for months were being made up with two sheets, a pillow case, a blanket, and a bedspread (Bruce had never seen a bedspread on Ward 20 in the last four months) . . . the carpenter was replacing window-lights that had been kicked out six weeks ago. And to cap the climax, Miss Vollmer came sailing around the corner at the head of a cavalcade of potted flowers and plants, and framed pictures.


Heavenly days! The place is being made over, thought Bruce, as he watched Miss Vollmer direct the placing of the plants and the hanging of the pictures. She looked a little harried, but triumphant, as she turned her attention to Bruce. "Get on a fresh white coat," she ordered, "and please keep these patients in line until after the visit. The state inspectors will be here at two o'clock sharp, and we want everything to be ready. I'll send the workers back after the plants, the pictures, the bedspreads, and the other extra things at four o'clock. You can help them store these things away again."


"Yes, ma'am." So this was the cause of all the fuss, Bruce thought. Wax he could have made last for weeks, sheets enough for two weeks at the normal rate, clothes he had been pleading for for -sic- months, and more workers than he had been able to get in a year of asking -- all expended in one great rush. And why? So that the very people who alone could improve conditions wouldn't see things as they really were. Bruce rubbed a smudge off the floor and quoted:


"Who knows what hidden sorrows lurk
Behind yon cloistered walls?"


(Based on report 279)


An amazed glance passed between Nurse White and Attendant Livingston, as Dr. Phelps continued to walk around the ward and ask questions about the treatment and the patients.


They were amazed, not that the doctor was asking questions, but that he should be on the ward at all. For five months, Mrs. White and Mr. Livingston had been in sole charge of the insulin shock ward. During that time, they had been visited just once before by a staff physician. (The superintendent of the hospital had come to the ward to ask Livingston to play a violin solo before the local Rotary Club.)


The look of amazement changed to one of amused understanding when the hospital superintendent cruised into the ward with three state officials in tow. "Now this is our insulin shock ward," the superintendent explained, bobbing his head buoyantly to Dr. Phelps, Mrs. White and Mr. Livingston. "We accomplish some miracles of medicine in this room -- cure some very difficult cases," he continued. "We treat only ten patients at a time, but everyone who needs it gets this treatment."


The three officials and their escort went out into the hall, but the superintendent's voice could be overheard on the ward: "We always have a doctor in charge of insulin shock treatment."


Mrs. White smiled at Dr. Phelps. "Do you put on a false mustache and dark glasses now, and go cover another ward?" she asked.


Dr. Phelps left silently by another door.


(Based on report 803)


Some Things Just Aren't Done


"There are seven factors necessary to adequate psychiatric care: (1) prompt treatment, (2) decent surroundings, (3) good food, (4) good medical and surgical care, (5) good psychiatry, (6) adequate facilities for occupation and recreation, and (7) integration of the hospital with the community."


Medical Director,
National Committee for Mental Hygiene.




"Careless medical practice should never be tolerated by the mental hospital administration . . . Failure to investigate the somatic side of the problem is careless psychiatric practice." (3)

(3) ibid.




"Aren't you going to remove the gallbladder?" asked the young doctor assisting at the operation.

Page 20:


"We'll just wipe it out and leave a drain in it. That's best," replied the senior surgeon who performed most of the operations at the state hospital.


The young doctor -- McMasters by name -- showed his amazement even through his operating mask. He knew that for at least twenty years it had been standard procedure to remove inflamed gallbladders. He knew that removal was the only thing to do in this case. But he also knew that his suggestions held no weight against the clumsy confidence of Dr. Spellman, the senior surgeon.


Still, he could not hold his tongue when he saw that Dr. Spellman was going to close the incision with just one row of wire sutures -- it needed to have at least three different closures if it was to heal. "The peritoneum is ready for closing," Dr. McMasters suggested.


But Dr. Spellman disregarded the suggestion and quickly dosed all of the layers of the abdominal wall with the single row of stitches. "Finished," he announced.


That night, the inevitable happened. A few stitches broke through the tissue, and the wound reopened. At three a. m., the night nurse found the patient with his intestines spilled out of the abdominal wall and the wound wide open. Knowing that such a catastrophe required immediate re-stitching, she called Dr. Spellman at his apartment on the grounds, and reported what had happened. Dr. Spelhnan gave directions that a heavy dressing be drawn tight with adhesive tape to hold the intestines in. "I'll stop in to see the patient in the morning at eight-thirty," he concluded, and hung up.


When Dr. Spellman "stopped in" at eight-thirty, the patient was dead.


Dr. McMasters and Dr. Spellman met again over the patient's open abdomen at the autopsy. Signs of negligence were plainly evident.


"Well, after all, what could you expect?" Dr. Spellman commented. "He was just a poor dope."


Dr. McMasters turned on his heel and left the room. He had heard it said before, but now he believed it. Some doctors, instead of being in the Hippocratic tradition, were most certainly in the 'hypocritic' tradition.


(Based on report 772)


Marian was transferred to Ward 11 on a stretcher late one afternoon and put right to bed. The next morning, in spite of her complaints, she was gotten up into a wheel chair. It was a standing rule on Ward 11 that no patients were allowed to stay in bed except by doctor's order. Marian spent all her days in a wheelchair and was put back to bed at night.


Five weeks later, the attendants were informed that Marian had been transferred to Ward 11 with a broken hip.


Alberta was more fortunate. Her fractured leg was put in a heavy cast before she was placed on Ward 11. It hurt her a great deal, however, and she kept asking to see the doctor.


Four days later the doctor came to check on Alberta and found that the circulation had been cut off in the leg at that time. The doctor doesn't think he will have to amputate.


(Based on reports 766 and 769)


Patient Dubinsky, who usually walked up and down the ward from morning until night, lay on a bench in the toilet, moaning and groaning. His mental condition was such that he never spoke, so he could not describe the pains that assailed him. But Oliver, the attendant, investigated and found that Dubinsky had a continuous rectal discharge of blood and other matter. Obviously, Dubinsky was seriously ill.


Oliver took the patient to the infirmary that afternoon and was lucky to arrive just when Dr. Best was making his daily "rounds." Oliver explained the case. Dr. Best looked at the patient from across the hall and said, "Nurse, give that patient a rectal suppository when you get a chance." That afternoon, Dubinsky was returned to the ward, where he lay on a bench in the toilet, moaning, groaning and discharging.


The following day, Oliver reported the condition to the building supervisor. He suggested that the discharge had such a terrible odor and was so abnormal that he wondered if it might not be the lining of the intestines. The supervisor didn't look at the patient at all, merely ordered: "Give him some mineral oil, and we'll put him on the list for a colonic irrigation later in the week."


On the third day, Oliver decided he would try once more to get something done. He took Dubinsky to the infirmary again. Again nothing positive was done, and the patient was sent back to the ward. That night, the night attendant supported Oliver's hand by writing in the report: "Patient Dubinsky breathing heavily and passing blood through bowels."


On the fourth day of Dubinsky's illness, Oliver finally got results -- at least, he got permission to transfer Dubinsky to the infirmary for observation and treatment. It may be presumed that Dr. Best read the nurse's notes on Dubinsky each day thereafter. It is certain that the doctor never examined Dubinsky personally and never gave any orders for his treatment.


The nurse (who thought Dubinsky might have cancer or tuberculosis of the intestines) was not surprised. She had become accustomed to Dr. Best's methods of examination and prescription by guess -- at a distance of ten feet. She had never seen him make a rectal examination, touch a festering sore, open the lids of a running eye, or even dress a wound.

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Four weeks later, the whole unpleasantness came to an end when Dubinsky died. His illness was simply labelled "Diarrhea."


(Based on reports 773 and 790)


An ambulance from the nearby city swept up to the state hospital and unloaded a weak, helpless patient. Since the admission and commitment had been taken care of in town, the attendant on duty and a worker patient simply put the patient to bed, without even taking his temperature. Twelve hours later the patient died. An autopsy revealed the cause of death to be spinal meningitis, complicated by pneumonia.


Eight days later, George, the patient who had assisted in receiving this case, complained to Mr. Evans of a headache. Evans took George's temperature and found it to be 103.


"You'd better go in and lie down," Evans suggested. "I'll call the doctor, and we'll see what's wrong with you."


The doctor listened to Evans' telephoned report of the case and suggested, "Give him some aspirin and check his temperature every four hours." These directions were followed through the afternoon and until the night attendant came on duty.


"I'm afraid you won't have George to help you tonight, Lewis," Evans informed the night man.


"Gee, I'll miss him. What's the trouble?"


"He has a high temperature and seems pretty sick. I really think he ought to see a doctor, but I haven't been able to get one around here yet."


"Who's been on duty?" Lewis asked.


"Doctor Dutton, I guess."


"Oh, he's hard to get excited about anything. I reported a temperature of 105 to him one night and he said, "Call me when the patient expires!'"


"That's him, all right."


"Well, I'll keep trying anyway," Lewis said. "George is a good fellow, and he ought to get good care."


"Yes, since he had fever treatment he's come back to normal in a hurry. Well, I hope you get a doctor."


Lewis tried every half hour to reach the night supervisor in order to get a doctor. He was unable to get an answer at any time. About nine-thirty, the supervisor came to the ward, and Lewis made his report.


"If his temperature hasn't gone up, and if a doctor prescribed for him by phone, we won't bother the doctor again," the supervisor said. Lewis accepted the decision, but just before six a. m. he called the doctor directly and explained the situation.


Dr. Medor came to the ward immediately and diagnosed the case as meningitis.


George died five days later.


(Based on reports 832 and 1160)


The death of Mrs. Goodwin under circumstances remarkably similar to three other recent deaths finally brought reform to Gladstone Hospital.


The facts in the case were simple enough. Mrs. Goodwin had been in the hospital for many years, and on the infirmary ward for several months. During the last months, she had coughed a great deal, lost weight, had a disagreeable discharge from mouth and nose, and had a continuously elevated temperature, rising higher in the afternoon and evening. She slept and lived in a big dormitory with fourteen other sick patients. She grew steadily weaker, died, and her death was recorded as "death from arteriosclerosis," until an autopsy showed her lungs to have been almost entirely consumed by tuberculosis.


Then Dr. Camp got busy on the case. He pointed out that there had been no attempt to discover tubercular suspects for five years; that known cases were confined on wards with uninfected persons; that dishes used by tuberculosis patients were all separated or specially disinfected. When he found that patients from other wards were being brought to the T.B. ward to spend the night because of crowded conditions, Dr. Camp threatened an investigation and got action.


In the following weeks, twenty-one cases of active tuberculosis were discovered among the patients on eight of the women's wards. These were put together on a special ward where strict isolation practice was instituted. The survey was continued, and new admissions to the hospital were given chest X-rays.


Dr. Camp was on the trail of a killer -- one which the state itself had harbored in its own institution. He refused to give up until he had the killer cornered and confined.


(Based on report 771)


"It ought to be a joy to get reports from a lab like this," remarked Dr. Flemming. He was a recent addition to the hospital staff, and Dr. Struboni was showing him around. The laboratory was small, but exceptionally well equipped.


"They've got the equipment all right. But I doubt if you'll have much use for their reports."


"Oh, I'll use them, all right. You men in psychiatry may not have much use for lab reports, but my work in the infirmary will call for plenty."


"You still may not have much use for the reports. The old hen that runs the place is likely to send up a diagnosis of gonorrhea on an eighty-year old woman who hasn't seen a man in ten years. She can't tell one germ from another."


Dr. Flemming laughed at the joke and continued with the tour of the hospital.


A few weeks later, he had occasion to call up the laboratory physician. Dr. Patterson. He found that tests on uncontrolled diabetics were being made only once a week, whereas he needed them at least every day to achieve control. Dr. Patterson just about raised the roof at his suggestion of such frequent tests. "Listen here, Dr. Flemming. Don't think a young upstart like you can come in here and tell me how to run this laboratory. We do blood chemistries once a week -- on Tuesdays -- and you'll have to get along with that."

Page 22:


"It's impossible to bring diabetics under control without more frequent tests. Dr. Patterson. I'll need -- "


He was interrupted by another tirade about how long she had been in charge of the laboratory, how it was the best in the state, and how he was just a young nobody, meddling in affairs that were none of his business.


When the neat lab reports came up. Dr. Flemming looked them over and decided he would talk to Dr. Patterson in person. He picked out a report on one diabetic and headed for the laboratory. Dr. Patterson seemed pleased by his visit and asked him to sit down.


"Dr. Patterson, I want to verify this report. It indicates that Patient Johnson showed a blood sugar level of 50 milligrams/percent, and a urine analysis of two percent sugar. Is that right,"


Of course it's right! Everything that comes out of this laboratory is right. This is the finest laboratory in the state, and I'm -- "


"I'm not questioning how fine the laboratory is, nor how well trained you are. I'm only questioning these figures."


"Well, you've plenty of nerve. These figures are -- "


"Perhaps you don't know. Dr. Patterson, that 50 milligrams/percent sugar is below the level of hypoglycemic shock. According to these figures, Johnson should be in coma. Actually, he's been active all week. Perhaps you don't know, either, that a patient with such a low sugar level couldn't possibly pass any sugar in his urine, let alone two percent concentration."


"Humph! Poppycock! Drivel!" sputtered Dr. Patterson, her face almost blue with rage.


"I thought possibly your standard solutions might have aged or become inaccurate somehow," Dr. Flemming suggested. He had decided he had better offer her some alibi for her trouble, or she might throw a fit any minute.


But she only became more angry. Her face became livid; she shook all over. "I'll have you know -- " she began, drawing to her full height.


But Dr. Flemming decided that she might throw something more weighty and destructive than a fit. So he went back to his patients to practice medicine without the aid of laboratory determinations.


(Based on report 774)




"The physician must remember that treatment of the neurotic patient begins at the first instant of contact. Hurry, carelessness, impatience, unwill-ingness to make case notes, not only deprive the physician of needed knowledge, but also prevent the establishment of proper relations with the patient, without which nothing constructive can be accomplished." (4)

(4) Reprinted from Fundamentals of Psychiatry, by Edward A, Strecker, M.D., by permission of J. B. Lippincott Company.


-- EDWARD A. STRECKER, M.D, Professor of Psychiatry University of Pennsylvania.


"Here comes 'Swifty,'" whispered the working patient who was helping Dave wash the mattresses on Ward C.


Dave dropped his sponge in the bucket, slipped on his white coat, and stood at attention while Dr. Chalmers made his daily "round."


Every day for the past seven months -- except Thursdays and Sundays when he was off duty -- Dr. Chalmers had walked rapidly through the hall, ignoring both attendants and pa-tients, leaving the ward less than a minute after he had entered it -- speaking to no one.


But this day was different. One of the occupational thera-pists had taken pity on the hundred and ten patients who spent all of every day locked up on Ward C. He had brought a portable phonograph to the ward, and now he had over half the patients marching gleefully around the day room in time to the music.


Surveying this scene as he entered the ward. Dr. Chalmers smirked a little, and shook his head. As he passed Dave on his way to the farther door, he shrugged his head in the direc-tion of the music:


"Almost like trying to put some life into a bunch of cadavers, isn't it? That O.T. man ought to waste his time some place else. Imagine! Dancing in a living graveyard!


(Based on reports 1220 and 1221)


Edna Breen was a lovable old creature. She had been in the hospital forty-one years, and she considered herself the hostess of Rimer Hall. Aunt Edna -- as everyone called her -- couldn't see very well, but she spent most of her days tatting and weaving with her old "grocery store" string. Nearly every-body in the hospital saved string for Edna, and she would change a ball of cheap string into a delicate, beautifully de-signed doily or pillow cover in almost no time at all.


"Here's a little old rag I made out of my spare time," she'd say, chuckling. And she'd give her latest piece of hand-work to a new nurse or attendant. Until you had a gift from Aunt Edna you just weren't "one of the folks" at Wardmore Hospital.


One day Aunt Edna's failing eyesight got her confused, and she collided with a window washer's ladder, which had been left in the middle of the hall. Her lip was cut quite deeply.


When the doctor came through on his daily rounds, the charge nurse suggested that the cut should have a stitch or two taken in it. The doctor didn't even look at the cut.


"Let's see, he said, "today is Wednesday -- ironing day; sewing day is Saturday."

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And that was all.


(Based on report 1221)


Willie was doubled up like a jack-knife and lying on the floor. He had been that way for over an hour, but the attend-ants on the ward had been trying to bathe a good share of the other two hundred and forty patients on the ward and hadn't noticed Willie.


When at last one of the attendants passed near Willie, he went over to him.


"What's the matter, fella?" he asked.


Willie's eyes rolled up in his pain-contracted face. "They got me, Thompson. I hurt my back in shock this morning, and haven't been able to sit up since."


Thompson knew that sprained backs did sometimes result from shock therapy, so he told Willie just to take it easy and went to report to the nurse.


"Miss Gordon, Mr. Willard says he hurt his back in shock this morning, and he's lying on the floor in the day-room."


"I'll ask the doctor to look at him when he makes rounds."


Thompson looked at his watch -- still an hour and a half until the ward doctor was scheduled to come. "The patient seems to be in quite a bit of pain."


"All right, the doctor will see to him."


"I thought maybe we could -- "


"Mr. Thompson! You know we can't do anything without doctor's orders. Go on and get the bathing done."


Rules, rules, rules, thought Thompson as he went back to Willie. Rules prevented him from putting Willie to bed. Rules even forbade his letting Willie lie on the floor of the day-room. Rules said he should be bathing patients in the shower room. Phooey on rules. At least he would let Willie lie in the corner.


"Take it easy, Willie," he said. "We'll fix you up in a jiffy."


Dr. Dunham spotted Willie lying on the floor the moment he entered the day-room. "Humph," he snorted, and strode across the room and kicked the bottom of one of Willie's feet. "Hey, what's the matter with you?"


Willie raised his head a little. "I hurt my back in shock this morning, sir. And I haven't been able to stand up straight since.


"Why don't you quit your faking?" the doctor asked, scornfully. "There's nothing the matter with you that a night with a woman wouldn't fix."


Willie did have a sprained back, and he spent many weeks in bed recovering from it.


(Based on report 1142)




"Nurses and attendants should be encouraged to keep some type of behavior notes on their patients. Appreciation should be expressed by the ward physician for notes containing pertinent information."


Kankakee State Hospital,


Patient Charles Thomas was in a catatonic stupor -- he couldn't move or eat or do anything at all by himself. He had to be fed through a tube, and needed all kinds of special attention. His attendants thought it would help the doctor if he could know whether or not Thomas had been having bowel movements, so they kept a careful record.


Once, when it had been over two weeks since Thomas' last movement, they made a note in the journal: "Pt. Thomas defecated today." The journal came back from the doctor with a cryptic addition: "Did you?"


The next entry the attendant made about Thomas' bowel movements included the note, "in case anyone is interested." The doctor wrote after it, "Nobody is."


(Based on report 1151)


Cleaning up the music room was a tedious but interesting task. The hospital had been without any musical activity for several years, and a lot of junk had collected in the meantime. Miss Moran made all sorts of interesting discoveries among the piles of music and boxes.


She drew out one box labeled, "Property of James Doerr -- Patient." Inside she found a large assortment of music, from Bach and Mendelssohn to Cohan and Berlin. But most interesting of all were several pieces of music written by James Doerr himself, as well as a number of original arrangements and orchestrations. Several printed programs and posters in the box showed that he had appeared with a troupe of entertainers in England and Scotland several years previously. Miss Moran made a mental note to look up James Doerr and to get him into her new music program if it was at all possible.


A week later, she had opportunity to refer to James Doerr's record. She found that the diagnosis of the investigating physician included this note: "Delusions of grandeur -- believes he has written songs; believes he has been to Europe where he played before important personages."


(Based on report 1125)


"Doctor Brady, can you tell me what has happened to my son since he has been here?"


"Yes, sir. I certainly can. I'll have my secretary bring in his complete ward record, and I'll go over it with you."


When Dr. Brady got the ward record, he found just three entries had been made during the patient's first five weeks in the hospital:


6-22-45 -- Received on Ward 4, given bath, put to bed.


7-15-45 -- Not much change in patient's condition; is quite resistive; spends most of his time in side room.


7-20-45 -- To diagnostic staff.


"Well, sir, your son has gone through the usual routine. Everything is fine. If anything at all goes wrong, I'll know about it immediately from these records. Everything of even the slightest importance is reported to me immediately."

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The father went away reassured -- until he actually saw his son, who displayed two black eyes and a nose that looked suspiciously as if it were broken. Both injuries were obviously at least three days old.


The truth about his son was this: He had been locked in a side room almost continuously since his admission five weeks before. He had been permitted to dress and take a short walk around the ward only three times in those five weeks. He had been forcibly placed in a camisole (strait-jacket) five times. He had been injured in a scuffle with an attendant while restrained in the camisole.


(Based an report 1129)




"Segregation if nowhere practiced as it should be . . There can be nothing more discouraging to a young borderline patient than his remaining for months on the same service with a host of demented incontinents."


Speaking for a committee of Medical Doctors in mental hospitals.


A worn-out horseshoe, a stale egg, a box of wet matches, and a broken button, all collected into one box -- that's what Al thought of every time he returned to his ward. Certainly the hundred and ten patients on Ward F had little in common.


Al looked around the day-room and noted the differences:


In age, from eighteen to eighty; in health, from the blind and halt to the alert and burly; in action, from the depressed and immovable to the disturbed and aggressive; in morality, from the sodomist to the "Christer;" in classification, from dementia praecox to senile. One thing only they had in common: they were unwanted on all the other wards of the institution.


For Al himself, this wasn't so bad. The variety made the work interesting. And anyway, he could walk away from the ward in the evening, knowing he didn't "belong." But for Tommy, Al thought it must be terrible.


Tommy had been like any number of these others just two weeks ago. Then his electric shock treatments had begun to bring results. Yesterday he had returned from his shock with his mind as clear as a bell. "What am I doing in here with all these crazy guys?" he had asked.


The puzzled look had not yet left his face. He was walking around the day room now, trying to figure it out. Chris, with whom he had shared sexual perversions during his worst illness, was following him, reminding Tommy of what he had done, and encouraging him to do it again. Finally, Tommy came up to Al. "My God!" he asked, "Am I as crazy as these guys try to make me think I am?"


"You're all right now. Tommy. You've been sick, that's all."


"Can't I get out of this hog-pen, then?" he asked.


Al hoped that he could, but he couldn't do anything about it. "You'll have to ask Dr. Gribb when he comes in "


Tommy watched carefully until the doctor came. Unfortunately it was not Dr. Gribb, who was giving Tommy his shock therapy, but Dr. Benton, the assistant superintendent.


"When am I going to get out of here and go home doctor?" he asked.


"Why? What difference does it make when you get out? You have nothing to do anyway."


"But, doctor, I have a wife and two nice children at home. I want to be with them."


"Aw, what are you so excited about? She's probably forgotten all about you by now and is running around with some other man."


Tommy turned and walked away. Dr. Benton chuckled, and went on with his duties. Al was pleased to see that the puzzled expression was still on Tommy's face. Later, Tommy came up to Al, looking a little sheepish and ashamed. "I guess I can see the doctor when I go for treatment tomorrow," he said.


"Yeah, that's the best thing."


"You know, I guess I'm not so very well yet," Tommy said, shaking his head. "I took that crazy loon to be a doctor!"


(Based on reports 985, 1121 and 1124)




"Idleness in institutions is bad. . . . Often the measure of an institution lies in what it gives its inmate population to do. . . . The important thing is that every person participate in some way in the program, and that work be selected primarily for its benefit to the inmate and only secondarily for its benefit to the institution."


in Milwaukee Journal.


"Miss Adams, that new girl you sent down to me is terrible. I just can't have her working on my ward at all."


"Why, I've heard very favorable reports about Miss Levin's work! What's wrong with her?"


"She's always making trouble for me. You'll have to transfer her to another ward."


Miss Adams, supervisor of the women's side of the hospital, had listened to many complaints from Mrs. Beaver. Mrs. Beaver had been an attendant at the hospital for fifteen years, and she ruled her ward with an iron hand. She was a stickler for neatness and order; nothing was ever out of place on her ward, and very few people could work with her successfully.


"What kind of trouble has she been making for you?" Miss Adams asked, wanting to get to the bottom of the matter.


"She's always making a mess. Last week she brought a dozen magazines on the ward and gave them to the patients. Of course, they were all over the floor and tables in a minute."

Page 25:


"That wasn't hard to clean up, was it?"


"It caused plenty of mess. And the patients have been pestering me ever since for something to read. Another time she made a ball out of old rags and had the patients playing with it in the yard. If I hadn't taken it and burned it up, she'd have had the whole ward yelling and screaming down there every day."


"I think I see what you mean. Anything else?"


"Yes, there is. I just got back from my hours off duty and found a terrible commotion on the ward. That crazy girl had those patients singing and marching around the room. Old Crazy Kate was dancing and clowning at the head of the procession. Well, that was enough for me. I came straight to you."


Miss Adams thought she saw a good opening here to try to tell Mrs. Beaver something she ought to know, but she didn't know just how to begin. "Mrs. Beaver," she asked, has anyone been hurt since Miss Levin has been on your Ward?"


''No, no one hurt. But she had Marie wiping up the day-room floor the other day when there were worker-patients right there to do it. You know you can't trust that Marie."


"It seems to me that all the things you have reported so far have been good for the patients."


"Humph! Good for the patients! She's not doing them any good. She lets them play around and walk all over the ward. Then I have a time getting them quiet and making them work. Leave her on there another week, and my patients won't be worth a darn!"


"A little relaxation won't hurt the patients any."


"Humph! If that's the kind of hospital you're trying to run, you can count me out. We used to have a real hospital when -- "


"That will do." Miss Adams was tired of hearing about the exploits of her strait-laced predecessor. She was also tired of Mrs. Beaver, and she knew very well that Mrs. Beaver would never leave the state hospital as long as she could draw a pay check from it. "Miss Levin will get along with your patients very well. Now you go back and get along with Miss Levin. If you can't, we'll try to find another ward for you."


Mrs. Beaver was speechless. She reached the door of the outer office before she found her tongue. "Prissy-pants!" She hissed. "Me being told off by a prissy-pants!"


(Based on reports 913, 937, 993 and 1065)


Blind Mary was clapping her hands on every third or fourth beat of the music. Blackie was singing the words of "Darktown Strutters Ball," not knowing nor caring that the tune was "China Boy," and old Laura, who usually just sat and grumbled, was going through an elaborate waltz step in ragtime. Never had there been so much gaiety on the shut-in ward in Davis Building. Everybody was enjoying the afternoon.


The center of the fun was an old pump organ which had been gathering dust in the Davis Building attic for several years. Lois and Irene, two attendants on the ward who could play the piano, had dusted it off, repaired the pump-pedals, and brought it to the ward.


Their first concert had been in full swing for almost half an hour, when Miss Lang, the building supervisor, came to the ward and told Lots and Irene they would have to put the old organ back in the attic right away.


"Why?" asked Lois. "It wasn't doing anybody any good up there, and here it brings a lot of pleasure."


"Maybe so," Miss Lang said, "but it belongs to the recreational therapy department and can't be used on the medical wards."


"This is recreational therapy," Irene protested.


"Only employees of the recreational therapy department are permitted to use the department's equipment. Now take that thing back where you found it."


So the organ is back in the attic gathering dust. And Blind Mary, Blackie, Old Laura, and fifty-seven other shut-in patients are wondering when they can have another concert. And the recreational therapy department continues to complain that its activities have been curtailed this year because of lack of employees. And Lois and Irene are getting more and more disgusted that hospital rules and jealousies and short-sightedness keep the patients from getting the care they deserve.


(Based on report 278)


"I see some more plaster fell down last night, Mr. Allman."


Miss Whitmore, the supervisor, was making her morning rounds of Old East.


"Yes, ma'am. It didn't hit anybody, though."


"We were lucky this time."


"I was meaning to speak to you about that plastering, Miss Whitmore. We've been needing it done for over a year now, and nobody ever patches it up."


"I know. The maintenance men are very busy."


"That's right, ma'am. But I found out last night that old Roy Smith was an expert plasterer before he came in here. He says he ain't been asked in all them five years what work he done. He's sure he could patch up this ward good as new."


'"Well, I don't suppose that could be done, but -- "


"Another thing. Miss Whitmore. We've been humping along with a toilet out of fix for months, and them showers don't hardly run any more. Well, Abe Jones is a plumber -- at least he was on the outside -- and he's been pestering me to let him fix 'em."

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Miss Whitmore smiled. Mr. Allman was a good-hearted old fellow who would do almost anything for his patients. He always had some new idea. And after all, why couldn't patients be used to do needed jobs for which they were qualified? The hospital had them shoveling coal, cleaning stables, farming, and doing all sorts of unskilled work, whether they wanted to or not. Miss Whitmore knew that a former church organist spent every day peeling vegetables in the scullery.


"Mr. Allman," she said, "maybe you've got an idea there. At least I'll speak to Miss Roaeman about it."


Unfortunately, Miss Roseman, director of occupational therapy, chose to regard the suggestion as a criticism of her department. She suggested that if Miss Whitmore would pay a little more attention to her nursing, and worry less about occupations for the patients, everyone might be a little happier.


Miss Whitmore could think of at least four people who wouldn't be any happier -- Mr. Allman, Roy Smith, Abe Jones, and the organist -- but she knew that keeping your nose strictly in your own business was considered good hospital practice. So the next morning she told Mr. Allman, "Sorry, but it seems that doing what needs to be done isn't in the current definition of occupational therapy. You'll have to keep the boys idle and let the ward go to pot for want of repairs."


(Based on reports 1035 and 1066)




"The fact that physical illness and mental illness are in many instances so closely related means that good nutrition plays an important part in. the treatment and rehabilitation of the mentally ill."


Chief Dietitian,
Ohio State Department of Welfare.


In December, 1945, an analysis of the diet served in a large state mental hospital in the center of the midwestern corn belt showed daily food intake to be 1,881.21 calories per person. At the same time, a little farther north, participants in a starvation diet experiment were continuing to lose weight on a daily food intake of 2,000 calories. And a report of the National Research Council listed the minimum food requirement for an institutional dietary program at 2800 calories per person per day. In other words, healthy young men were starving on 6% more food than was being fed to the patients in a state mental hospital, and the state was providing only 67% of the recommended "minimum food requirement."


(Based on reports 1242 and 2022)


Promptly at ten o'clock every morning, food for over four thousand patients is taken out of the huge vats and ovens in the central kitchen and loaded on poorly insulated food trucks. Four hours later the trucks return with empty containers. What happens to that food in the four-hour interim is of no concern to the dietitian who plans the menus, hires the cooks, supervises the preparation -- and draws a comfortable salary. But you sometimes wonder if she wouldn't be disturbed if she knew what happened.


Take those ten trucks laden with food for a thousand, for instance, which are heading for the Hilltop House. Each truck has six two-and-a-half-gallon containers on top and two eighteen-gallon tubs underneath. Two trucks contain vegetable-barley soup; four contain beef stew made with beef, carrots, onions, and potatoes; one carries cole slaw; one vanilla custard; one bread; the tenth is empty, but goes along for the ride because it usually takes ten trucks to carry the Hilltop food.


The trucks are wheeled down a ramp to a sub-basement, and loaded onto an underground cable car. The half-mile climb to Hilltop is accomplished in ten minutes. The trucks are wheeled into the huge dining room one at a time, the others being left unattended. Roaches, rats and sometimes curious maintenance men investigate "what's for dinner today."


When all the trucks are in the dining room, a worker patient unloads them, setting each container on the floor. He puts two of the smaller containers of soup and four of the stew aside for the worker patients. Then he scoops most of the meat and vegetables out of two larger containers of stew, adding his gleanings to the stew he has set aside for the worker patients. Believing that the soup won't go around, he rune a bucket of water from the tap and adds a few quarts to each container. He stretches the stew in similar fashion. Then he makes up the trucks for serving, with two containers of soup, three of stew, and one of pudding in each truck. The larger containers remain uncovered on the floor.


Soon another patient comes, takes the bread and distributes a stack to each table. A spoon and cup are already at each place, having been put there immediately after breakfast. Returning, he asks, "What about the cole slaw?" He is told to "put it on the table." So he picks up a container and walks among the tables, leaving a little heap of cole slaw in the center of each. Later another patient comes out from a side room with metal pitchers of tea and sets one on each table. Several of them leak.


About eleven-fifteen, a disturbance is heard outside the door, and a moment later, four hundred and fifty men burst in the door and run for their seats. Attendants and worker-patients take a food truck and go between the tables, filling soup bowls and dropping them on the tables. Returning, plates of stew are served. One more trip to serve custard, and then all dishes are collected on the return. Each attendant serves a hundred and thirty to two hundred patients, with the help of two worker-patients. Nevertheless, the dining room is emptied in thirty minutes.

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Then the dishes are washed quickly, the tables are brushed off, the food trucks are refilled from the large containers, cups and spoons are set again at each place, heaps of cole slaw and bread and pitchers of tea are again placed on each table. Finding the tea running low, the patient in charge of beverages takes a pitcher of coffee left over from breakfast, adds two pitchers of water and a can of condensed milk, and serves four tables with it.


At twelve-thirty another disturbance -- this one in higher key -- is heard outside the door. When the door is opened, five hundred and sixty women overflow into every nook and cranny of the dining room. The serving process is repeated, only this time there are fewer attendants and more worker-patients, more mouths to feed and less room to do it in. Nevertheless, the dining room is emptied in just half an hour. Dinner is over.


The worker-patients clean up the debris, wash the food trucks and wheel them out to the cable-car. Dishes are washed and tables reset. A hose is used to clean the floor. The food trucks are returned to the kitchen. Supper will be loaded on them about an hour later.


The dietitian sits in her sunlit office and gazes with satisfaction at her neatly printed menu. She smooths out her stiffly starched white uniform as she reads it over again:


Vegetable-barley Soup
Beef stew, with onions, potatoes, and carrots. Cole slaw
Vanilla pudding with cream
Bread -- Coffee, tea, or milk


She knows that all the cream and milk were sent to the nurses' dining room, but she doesn't bother to change a minor detail like that. As the food trucks return, she signs her initials on the blank under the menu, where it says:


"Served as planned....................."


(Based on reports 538 and 576)


An anticipatory glint of competition came into McClintock's eyes as he watched the hands of the clock move toward twelve o'clock. His muscles tensed, he crouched on the edge of his seat as the hands moved closer together. He quivered with expectancy as a white-coated figure came out of a room down the hall and moved to the exit door. The clock hands closed together, and McClintock was suddenly electrified into action by the call re-echoing down the corridor: "Soup's on!"


Now, McClintock was an old bicycle racer. He spent most of his time sitting disinterestedly on the ward, but three times a day -- at seven, twelve and five -- he came to life and relived his days of glory on the track. Expertly he jockeyed for position among the scurrying patients. Soon he drew abreast of the white coat, where he held his position unchallenged until the white coat stopped at the steam table. That was the signal for the last drive down the stretch. McClintock opened up a wide lead over his nearest competitor before he slid into his seat at the table, breathing hard but grinning triumphantly.


The race, however, was not over -- it was hardly begun. McClintock seized a sloppy tray containing one boiled potato, with its peeling and a bit of the earth that nurtured it still intact; two slices of bread; a watery mass of boiled cabbage; a serving of corn starch pudding annointed with cabbage juice; and a cup of weak tea. McClintock snatched a spoon from his nearest neighbor -- that fellow always lapped up his food without aid of spoon or fingers anyway. Then he began to scoop in the food.


Two minutes passed. McClintock saw that the attendant was returning to remove the trays -- this was evidently to be a three-and-a-half-minute dinner instead of the usual four-minute job. McClintock gave up the spoon, leaned over into his tray and sucked up the watery cabbage. As the tray was being removed, he scooped out a helping of the pudding in his left hand and grabbed the bread in his right. The pudding had disappeared when the hall reverberated with the call: "All out!"


The patients filed by the white coat in single file. Just before McClintock went by, he crammed the two slices of bread into his mouth -- he knew it was against the rules to carry anything out of the dining room in his hands or pockets.


Once beyond the white coat, he took one slice of bread out of his mouth and began to munch the other one. Fellow patients jostled him mercilessly on the return trip to the ward. McClintock didn't care. The light of battle had left his eyes. Back on the ward, McClintock sat disconsolately on the chair opposite the clock. Not until the hands reached five o'clock would life again hold any charm for the mighty McClintock, cycler supreme.


(Based on reports 537 and 540)


"Don't let it worry you, son. In an institution as big as this, we're bound to have several cases of diarrhea. It won't kill anybody."


"Maybe not, doctor. But there isn't any reason why three-fourths of the patients on my ward should be in such a run-down condition. I know the milk is contaminated."


"You're imagining things. What makes you think so?"


"I've tested it. Three out of every five days the milk which comes to this ward is contaminated -- with human intestinal bacillus."

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"Say, boy, you're letting this work get you down. Will I have to commit you as a patient?"


"I think not. I majored in bacteriology at the State University, and I've continued to do a little testing since I've been working here. Incidently, I cultured the dishwater in the dining room, and the findings were the same."


"More human intestinal bacillus?"


"That's right."


"But that can't happen unless human waste enters directly into the milk and the dish-water."


"That's right."


"You say three-quarters of your patients have diarrhea now?"


"Yes. And those who don't have it are the ones who drink little or no milk."


"But this is ridiculous! This hospital is not serving milk that is contaminated by human waste."


"It's ridiculous -- and scandalous. But it's true."


"It can't be."


"Would you like to find out for sure? Would you recognize a human bacillus if you saw one?"


"No. Anyway, like I said, the poor devils won't die from it. And you'd better spend a little more time working on the ward and a little less making bacteria cultures. You're here to take care of the wards, not to go chasing up trouble."


(Based on reports 610, 611 and 612)


Insult to Injury


"If we can love: this is the touchstone. This is the key to all the therapeutic program of the modern psychiatric hospital; it dominates the behavior of its staff from director down to gardner. To our patient who cannot love, we must say by our actions that we do love him. 'You, can be angry here if you must be; we know you have been wronged. We know too, that your anger will arouse our anger and that you will be wronged again and disappointed again and rejected again and driven mad once more. But we are not angry -- and you won't be, either, after a while. We are your friends; those about you are all friends; you can relax your defenses and your tensions. As you -- and we -- come to understand your life better, the warmth of love will begin to replace your present anguish and you will find yourself getting well.'"


Psychiatrist and Author,
Topeka, Kansas.




"The personnel of mental hospitals are, on the whole, gentle and kindly people. . . . Abuses are rare exceptions. Indeed it is astonishing, in view of the dangers to which mental hospital attendants are continually exposed, that instances of physical violence are not more common."


In Mental Illness: A Guide for the Family,
Published by The Commonwealth Fund.


Mr. Miller glanced over the dining room and found everything in order. He beat a spoon against the bottom of a metal tray and called. "First meal! All in for first meal!"


A motley crew of patients began to file into the room, find seats and eat their soup. Some were blind, some crippled; several had both arms and hands bound in camisole restraints. Most knew exactly where they were to sit. When one made a mistake, Mr. Miller seized him by the nape of the neck and the seat of the pants and catapaulted him into the proper chair.


Two other attendants brought up the rear, riding herd on the patients. When all were seated. Miller spotted one patient in camisole who was not supposed to eat until second meal. He picked the patient up from the chair, kicked him in the buttocks, and sent him spinning out the door. "Dope! He'd eat six times a day if we let him," Miller explained.


Meantime the other attendants walked from one camisole patient to another, pouring the soup into their mouths as quickly as the patients could drink it. Miller was filling plates from the steam table. Suddenly his big serv-me spoon descended on Rossini's bald head with a thud. "Eat that soup, you goddam Jew!" he shouted. Every patient in the dining room hunched over farther and scooped food in faster.


Metal plates, containing beets, noodles and frankfurters, were at each place. Hemley was looking out the window dreaming of a mountain waterfall when Miller delivered a heavy blow on the back of his neck. "Eat that food! You hear me?" he shouted. Then in a less antagonistic tone, he spoke to one of the attendants. "Don't bother to try to feed Wilhelm; we'll skip his meals for a few days. He's been too troublesome lately."


Little saucers of applesauce were distributed, and then the attendants began to jerk patients out of their seats and send them to the door -- usually with a hearty shove or a slight kick. Miller yanked a blind paretic out of his chair and gave him a violent shove toward the door. The blind man ran headlong into the door jamb. "Whoops! My aim ain't so good today," laughed Miller.


In a remarkably short time the room was cleared, and the spoons and dishes were run through lukewarm water and replaced on the sloppy tables. Soup that had been setting in an open bucket for a little over an hour was in bowls on the table, and Miller banged a tray and bawled, "Second meal!"


Another group of disheveled, unkempt men shuffled into the room and began to down their soup. An attendant brought up the rear, dragging two reluctant patients. Miller spotted an empty seat. "Where's Hermitzky?" he asked.

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Then, remembering that he had just had a scuffle with Hermitzky and put him into camisole. Miller said. "I'll go get that Polack myself." While he was gone, the other attendants served the meal and fed the patients who couldn't feed themselves.


Miller brought Hermitzky in by brute force and sat him down in a chair. He offered a spoonful of soup, but Hermitzky turned his head away. "So, you won't eat, eh?


"Don't then!" Miller left the patient to gaze into the watery soup.


After a moment, Hermitzky got up and started to leave the dining room. Miller seized him by the camisole, turned him around and pushed him toward his chair. "Get back there and sit down!"


Muttering in his unintelligible gibberish and glowering at everything in sight, Hermitzky went half way toward his seat, hesitated, and started to turn back to the door. At that moment Miller hit the old man, whose arms were completely confined in the camisole, with a series of hard blows in the kidney area. The force of the blows threw Hermitzky forward with such violence that he lost his balance, and with no hands free to throw out in protection, he crashed into the steel radiator as he fell.


Hermitzky was unconscious a few moments, while Miller stood over him. When he moved again. Miller jerked him up onto his chair, wiped at the gash on his head with a paper napkin, and said: "I don't think that will be very noticeable by the time the supervisor comes through."


Meanwhile, the dinner routine had gone on as usual. For a time, the patients had been disturbed by such an atmosphere for their meals. But no more. Growing used to such scenes was a part of becoming adjusted to the hospital routine. Patients on Ward 62 had been around a long time. They were "adjusted."


(Based on report 969)


The blisters on Mr. Dunn's hands were so painful that he decided he'd better rest a day or two before going back to shoveling coal. He didn't want to give up his job on the coal pile -- anything was better than just sitting on the ward all day long. But he had been an accountant before he entered the hospital, and shoveling coal was hard work for him.


When the powerhouse foreman came to collect his worker-patients, Mr. Dunn said, "I would like to be excused temporarily from outside work, Mr. Grace."


"Come on, you loafer. We've got coal to unload today."


"But, my hands -- "


"Quit bellyaching," Mr. Grace ordered, as he pushed Dunn on through the door. Then he called to the ward attendant, "Okay, I've got my ten," and closed the door.


The rough handle of the shovel bit into Mr. Dunn's blistered hands. Tears of pain blurred his vision, but he kept working, slowly but constantly. This was occupational, he was sure -- could it be therapy?


He didn't even wince when he heard Grace shout:


"Dunn! Get a move on." He slowly urged his shovel under a pile of coal, gritted his teeth, gripped the handle, and lifted the shovelful into a wheelbarrow. He lowered the end of his shovel again, started to repeat the process. Then the flat of a shovel hit him heavily in the back, and he buckled under the blow.


Grace swung the shovel once more at Dunn's back and called for two other attendants to help him. The three of them drew Dunn to his feet, punched him a dozen times in the stomach and ribs, knocked him down again. Then they rushed him off to the violent ward.


The next day Dunn was sent to the medical ward and given an X-ray. Eighteen bruises were noted on the supervisor's report, and three ribs were listed as apparently broken.


Two days later, Mr. Dunn died. His post-mortem report reads: "Cause of death: Unknown."


(Based on report 1328)


"Where are you taking me? Get your hands off me! I ain't done nothing. Let me go!" Over and over, Andy protested to the big policemen riding on either side of him in the back seat of the patrol car. His wrists were locked in leather cuffs and fastened to a strap around his waist. The strap was fastened to one of the policemen. Andy didn't know where he was being taken, but he was sure someone meant to do him harm.


At Andy's continued protests, one of the policemen became angry. He punched Andy in the ribs and said, "Shut up, you fool. We're taking you to the hospital." Obviously, Andy figured, this was no way to go to a hospital, and the cops were lying to him.


When the car stopped in front of a big stone building out in the country, and a nurse and two men in white coats came out to the car, Andy wondered if the policeman had been right. "Here's a new one for you," one policeman said. The other detached himself from the strap around Andy's waist and said, "Better watch him. He talks tough."


The nurse, however, smiled reassuringly at Andy. "Welcome to the hospital, Mr. Andrews. Won't you come along with me?"


Andy followed the nurse, and the two white-coated attendants followed just behind. The nurse asked Andy to take a bath and laid out clean pajamas for him. Then she told the attendants to take off the cuffs and straps and get him ready to see the doctor. The doctor asked many personal questions, but he kept telling Andy he was going to help him. So Andy answered as best he could, telling especially about the gangsters who were after his money and his wife all of the time, and how he had stood guard over his wife day and night to keep her from harm. The doctor assured him that Mrs. Andrews was well taken care of now, and had called to say that she hoped Andy would sleep well and regain his strength at the hospital.

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Andy felt pretty good about things as he went along the corridor with one of the attendants. Then the attendant unlocked a door marked Ward C. "Here's a new admission for you, Finley."


A big, red-nosed attendant came out of a room down the hall. "Okay, Dodds. We'll take over."


"The cop who brought him in said he was pretty tough."


"Oh, did he now?" Finley looked Andy over with a speculative light in his eye. "You brought him to the right place. We've got a spot all picked out for him."


Finley urged Andy ahead of him down the hall. The farther Andy went, the more he sensed that something was wrong. The long hall was lined on both sides with heavy doors with little square wire-glass peek-windows in them. Andy didn't dare look into one.


Just opposite a little alcove on the left, Finley turned Andy into one of the little rooms. "Here's your hole," he said. Before he closed the door, he turned to the other attendants who were playing cards in the alcove. "Here's a new one, boys. And the cops who brought him in said he really put up a battle."


The "boys" turned around and looked at Andy. "We'll soften him up." "He's in the right place." "Maybe a little training, eh?" were some of their remarks. They resumed the card game. Finley locked the door and Andy looked around his room.


It was a small, bare room, about ten feet square. There was no bed or mattress in the room, just one coarse wool blanket. The one window was heavily barred. Andy sat down on the blanket and worried. The gangsters must have fooled him somehow; and yet, that doctor had sounded sincerely friendly. The problems tumbled over and over in his mind.


After a few hours, Andy became thirsty. He looked out the tiny window in the door and saw the attendants sitting there -- or were they guards? He knocked on the door and called, "I want a drink of water." No one moved. He banged on the door and yelled, "Please give me a drink."


One attendant half turned toward the door and shouted, "Make your own water!" The other attendants grinned and went on playing.


Before long Andy was not only thirsty -- he absolutely had to go to the toilet. He banged on the door, explained his situation, pleaded for release. He cajoled and threatened. Nobody paid any attention. Finally, Andy relieved himself on the floor.


An hour later, Mr. Finley and another attendant came into Andy's room. "So! You think you can mess up this room and get away with it, do you? Gimme those pajamas," Finley ordered.


Andy had carefully kept his pajamas from getting soiled. "My pajamas are all right. I'm sorry about -- "


A smarting slap landed on Andy's face. "Gimme them clothes, you filthy cur. You'll learn not to stall around when I tell you to do something."


Andy drew his arm back to return the slap. The other attendant grabbed Andy from the rear, crooked an arm around his neck, shutting off his breath, and planted a knee in his back, stretching him over backward. Finley pounded Andy's unprotected ribs and abdomen, brought his knee up forcefully into Andy's genitals, and slapped Andy's mouth when he screamed in pain. The other attendant dropped Andy on the floor and kicked him twice along the back.


"That ought to settle him for a while," the attendant remarked. Finley locked the door, and looked in at Andy, doubled over and shaking in the corner. "He knows now who's boss around here."


(Based on reports 941, 943 and 971)


The names of the two visitors were familiar to Don. He had heard the supervisor talk about them as two of the "fine attendants we used to have before the war." Therefore, he showed them around the ward freely.


They teased and laughed at several patients, and then they asked to see "Stinkie." Don finally understood that they wanted to see the little feeble-minded boy who was kept in constant seclusion on the ward. He was an incorrigible little rascal who liked to spit on attendants and throw his food around and make as much trouble as he could.


"Hello, you little bastard," one of the visitors said. "Can you still spit?" The patient demonstrated that he could. Then the two men took great delight in pointing to scars for which they were responsible. "Look, his hair still hasn't grown out where I conked him with a broom." "There's a remembrance from me he'll carry to his grave." And much more of the same.


As they left, they said, "Keep alive for us, Stinkie. As soon as the big money gives out at the war plant, we'll be back to play with you."


(Based on report 940)




"Let me emphasize that none of the good hospitals use strait-jackets or other forms of mechanical restraint, except in rare cases; nor do they resort to sedative drugs and seclusion except as a last resort . . . Force, which would excite and arouse even sane people, has given way to psychology and patient effort."


in Scribner's.


"Hilda, if you open your mouth just once more, you'll go right into the 'strip' room. I'm sick and tired of your godawful talking and singing."


Hilda, of course, could no more stop talking and singing than a woman with a sprained ankle can stop limping. It was a symptom of her illness. But Mrs. Gladwyn, the attendant, slammed her magazine down on the desk and said, "By God, I'll show you!"

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She unlocked a small, barred room which was entirely empty except for a young girl who lay naked on a torn piece of blanket in the corner. Mrs. Gladwyn seized the nude girl by the hair and gave a sudden pull.


"Come on. Goon-child. It's the bench for you tonight. We've got a customer for your room."


The girl got numbly to her feet and was led off without protest. Mrs. Gladwyn put a wristlet around the girl's wrist and tied her to a long wooden bench. The girl lay down on the bench to spend the night in the middle of the drafty ward hall.


Mrs. Gladwyn got a bath towel, wet it, rolled it, and sneaked up behind the singing, excited Hilda. Quickly she whipped the towel around Hilda's neck, pulled it tight, and began to twist. "Now, me proud wench! To the 'strip' room." Punctuating her words with jerks and twists on the towel, she half pushed, half dragged Hilda to the room just emptied. Once in the room, she gave one final, tighter twist, and let Hilda fall to the floor unconscious.


Mrs. Gladwyn removed Hilda's single garment, took the piece of blanket from the room, slammed and locked the door.


"Now," she said, "I guess we'll have some peace and quiet around here for a while."


(Based on report 976)


Gordon was not very well educated, but he liked to acquire knowledge. That was one reason why he enjoyed his work in the mental hospital. There was so much to learn that was entirely new and different. Yet nobody seemed to know very much -- at least, no one had tried to pass much knowledge on to Gordon.


A psychiatric word-book which he had found in the ward office was his only clue to the jargon of the hospital. Gordon pored over it nearly every night as he worked on Ward 11. Every new word he heard or read, he looked up in his word-book.


Dr. James had used a long, new word that night when he made his rounds, and Gordon looked for it now -- so far without success. He was pretty sure it began with "s," so he decided to go through all the words beginning with "s" and see if he could find it that way. He didn't find what he was looking for, but he did run across another word he had been curious about: "seclusion."


Every night in his ward report he headed one column "in seclusion," and then listed the names of the ten or twelve men who were locked in rooms at the back end of the ward. He read the definition of seclusion:


"Seclusion -- state or fact of being secluded, isolated; a place of isolation, retirement, aloofness or privacy -- prescribed to provide non-stimulating environment to patients."


Gordon was still pondering this definition when he took up his flashlight and made the round of the ward. As usual, he found quite a hub-bub at the back of the ward. Gordon flashed his light into the "seclusion room" where Jones, Finestein, McCarthy and Alcowiecz were kept locked up together. They were fighting again, and it looked as if Finestein was pretty badly hurt.


Gordon banged on the door, told them to quiet down watched Alcowiecz thumb his nose at him, and McCarthy make an obscene gesture, and moved on. He knew it was against regulations to open any of the locked rooms when he was on duty alone at night. He also knew that there was no place else to put the men, even if he did go in and try to separate them. He went back to the office and looked in the word-book again.


When he was writing his report that night, Gordon paused over the heading for the column "in seclusion." He was fundamentally honest, and he wanted his work to be accurate. He reread the definition and decided that it wasn't accurate to say that those men in the back room were in seclusion. There was nothing "isolated" or "private" about them. They were collected -- collected? That began to make sense.


Gordon wrote firmly at the head of the column:


"In Collusion:" And then he listed Jones, Finestein, McCarthy, Alcowiecz, and others.


(Based on report 1272)


Bradley and Stevens, the attendants on Ward D, were preparing a body for the morgue.


"Five days ago, this fellow was up and healthy," Slovene remarked to Bradley. Bradley was the charge attendant.


"Yep. He died pretty young."


"Aren't you worried at all about why he died?"


"Why should I be? We lose lots of patients this way up here."


"But this fellow was only twenty-five years old, and strong as an ox." He hesitated. "That record of sedation you gave him is clear enough evidence of why he died."


Stevens had noted that the patient had been given over 90 grains of sodium phenobarbital in a little more than a hundred hours -- and the record had not mentioned the usual overdose and the additional hyoscine he knew Bradley was in the habit of giving.


"That's nothing against me. The record only shows that I carried out doctor's orders."


It was true that the doctor had left a standing order for 3 grains of sodium phenobarbital every four hours, p.r.n. (when the occasion arises). That left it up to the attendant to give injections whenever he wanted to, so long as it wasn't more frequently than every four hours.

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"But what if the doc got sore at you sometime? Couldn't he put you in a hot spot then?" Stevens asked.


"I don't worry about that. The hospital takes care of things pretty well. They do their own autopsies. The coroner takes the hospital's word for everything. And they don't make any check on the amount of non-narcotic drugs we give. Anyway, the doc doesn't care about losing a few patients."


"How about yourself? Don't you feel bad about doing such a thing?"


"No, why should I? He was a hopeless case, always causing trouble. He's better off dead."


He seemed to be a pretty smart fellow. Why was he getting doped up, anyway?"


"He was suicidal. Lord, we didn't want him committing suicide on us, did we?"


"He's dead now."


"Yep. And there are two more who might just as well be dead." Bradley nodded toward two of the noisiest, most talkative patients on the ward.


Stevens looked at the two patients. "Do you have sedation orders on them?"


"Sure. I complained to the doc about the trouble they're causing, and he wrote out a 'p.r.n.' on them."


For months Stevens had been trying to get Bradley to change his attitude about giving sedation to patients. He was certain that at least a dozen young fellows had died unnecessarily on the ward, and that twice that many older men had been doped to death. He had tried to do something about it by talking to the doctor in charge, but had been discouraged. Now, suddenly, a new plan of approach occurred to him.


"You mean that in a couple of weeks both those patients will be helplessly on their backs, possibly dead?"


"I wouldn't say a couple of weeks. But a month or so ought to do it,"


"Well, look, Bradley. Let's try an experiment on them. Let's give them as little barbital as we can -- only give them a shot when we absolutely can't control them any other way. You think they'd be better off dead. I'm not so sure. Let's see where they'll be in a month's time."


Bradley agreed, partly because he thought it would prove his case, and partly because his conscience had grown uneasy under Stevens' constant questioning.


At the end of a month, one of the patients was still on Ward D, still a noisy trouble-maker. The other was on a front ward, with a good chance of going home soon, recovered.


Bradley was convinced. From that time on, he let a greater Power than himself determine who "might just as well be dead."


(Based on report 1284)




"Rules and regulations about treating patients kindly have no effect upon ward personnel, unless it is evident that the supervisor and superintendent support these rules wholeheartedly through their own actions and attitudes."


Legal Director,
National Mental Health Foundation.


Attendant Alden sat on the porch keeping guard. All the patients except Blozo were out in the enclosed yard. Blozo sat on a bench near Alden. A worker-patient began to sweep the porch. As he came near Blozo, Alden yelled:


"Blozo, get your lazy hulk off that bench. Let the man sweep." Blozo didn't move.


Alden seized the inch-wide restraining strap at his side, leaped on Blozo and beat him on the face and head, shouting, "Get up! Mind me, you -- !"


The patient still didn't move. Then Alden noticed that be was strapped to the bench and couldn't move.


"You fool, why didn't you tell me?"


"You put me here," said Blozo.


"Well, you didn't get anything you didn't deserve."


"I'll ask the doctor about that."


"You tell the doc about this and I'll beat you within an inch of your life."


Blozo knew that might be true. Nevertheless, he met the doctor at the door when he came in later that morning, and began to tell him what had happened and what threats had been made. Alden came up with his strap in his hand and said, "I told you you'd get it if you told the doc," and without a moment's hesitation, he began beating Blozo about the face and bead again.


The doctor, without a word, turned on his heel and stepped out the door.


Alden then stripped Blozo of his clothes, gave him an excessive dose of epsom salts, and strapped him in bed. Blozo lay there for a full day and night, naked and beaten in his own filth.


(Based on reports 1334 and 1342)


"If you can't keep that patient quiet, bring him in here. I'll shut him up."


"I can keep him in the chair, but I can't stop his noise."


"Come on! Bring him to the shower."


Dan, merely an assistant on the ward, followed the directions of the charge attendant. Mr. Sage grabbed the patient as soon as he entered the shower room and pushed him into a corner. "Take your clothes off," he ordered. "You're going to get the coldest shower you ever had."


The patient refused, and started to run out the door. Mr. Sage picked up a wooden-handled toilet plunger and struck the patient three blows on the head. The force of the last blow broke the plunger. He then kicked the patient in the groin, and pushed him to the floor. Dan stood by, stupefied by the performance.


The following day, the nurse noticed bruises on the patient's head and asked that an accident report be made out by both attendants on the ward. Mr. Sage told Dan to report that the patient had fallen against a radiator. But Dan reported the truth.

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As Dan was leaving the building that night, the supervisor stopped him in the office. "How does it happen that your report doesn't agree with Mr. Sage's report?" the Supervisor asked.


"I wrote what I saw -- what I think caused the bruises."


"Well, we can't have conflicting reports like that coming in. It puts me in quite an embarrassing position."


"I thought I was supposed to report the accident as it happened. That's what I did."


"Well, it's probably a good thing. Next time. Sage should know better than to hit a patient where the mark can be seen by a nurse."


(Based on reports 920 and 956)


"Good morning, Dr. Brant. I suppose you received the report I sent you yesterday."


The superintendent of the hospital looked blankly at Miss Walker. "Report? What report was that?"


"About those two attendants who attacked and injured a seventy-year-old man on my ward."


"Oh, yes. I got it, all right. Thank you."


"They didn't report up here today, so I suppose you discharged them."


"Well, no, I couldn't do that."


"No, Dr. Brant? I thought that was the penalty for abusive treatment."


"Well, it is -- but if I fired those fellows, I wouldn't get anybody to take their place -- unless it was some drunk in off the street. But I fixed it up all right. I had them transferred to a ward where the patients are strong enough to fight back."


(Based on report 2023)




"There is a type of psychological abuse of mental patients which may be more disastrous than any kind of physical abuse. By this I mean the tactless treatment of the patient, the refusal of small desires and requests, and the abuse of power that is necessarily conferred upon the individual who is in charge of a ward of mental patients." (5)

(5) ibid.




"Mistah Finney, has my newspapah come yet 'dis maw-nin'?"


Big John stood timidly outside the attendant's office. His sightless eyes rolled from side to side. His mighty body towered in the doorway. His big hands rested gently on the back of Peter's wheel-chair.


Big John and Peter were never seen apart. John -- big, black, powerful Negro -- was blind. Peter -- tiny, blonde, paralyzed Swede -- had no legs. Together, they were alive. But apart they were little more than dead -- John entombed in his world of darkness and misunderstanding, Peter in his world of immobility and persecution.


They had one real pleasure in every day -- the morning paper. Big John had a small pension from the government, and he had ordered a paper delivered to the ward for him each morning. As soon as it came -- the papers were always delivered promptly at eight o'clock -- John and Peter liked to retire to a sunny corner of the ward and spend the entire day over its columns. Peter would read every word and describe every illustration. Then Big John would ask questions, and the two friends would talk on and on about what was happening, what would probably happen tomorrow, and why things were turning out as they were.


Big John had asked for his paper three times already that morning. It was nearing noon now, and still he hadn't received it.


"Ah sure would like my papah, Mistah Finney," he said again.


"Get out of here, you blind ape!" shouted the attendant. "Can't you see I'm busy?"


Big John started to move away, but Peter's fingers held the wheel chair still. Peter could see that Mr. Finney was playing solitaire, and that the prized paper was lying on the table. "Give us that paper," he said.


"Why, you sawed-off little shrimp! I'll beat your two-bit brains out!" yelled Finney, leaping out of his chair.


But John had the wheel-chair under way now. Big tears rolled down his ebony cheeks.


"Don' hurt my li'l Pete. Don' hurt my li'l Pete," he pleaded as they fled to the other end of the ward. Peter's palsied arms shook in impotent rage as he guided the chair.


Big John patted Peter's arm. "Don' bothah, Pete. You jus' tell me 'bout Sweden once mo'."


(Based on report 685)


Often it took two weeks to accumulate enough clean clothes to provide a complete change for all the patients on Ward C. In such cases, the patients waited two weeks for a bath. But regardless of how long they waited, bath day when it arrived was a day to be feared.


Mr. Grupp prided himself on the speed with which he bathed and shaved the seventy patients on Ward C. He really had a system. Right after breakfast all the patients were stripped naked, and their clothes were thrown down the chute. Then they were forced to stand in the hall to wait their turn.


As soon as they reached the door to the shower room, they were run into the one shower, allowed to stand there a moment, and then pushed out and handed a towel. About twelve of the dirtiest patients were given a soaping in one tub -- the water remained unchanged, while all twelve were bathed -- and then allowed to rinse in the shower. Any hesitation in following the procedure exactly brought a stinging cuff from one of the worker-patients.


When the patient had about half dried himself, his towel was taken from him, and he was driven into the toilet room. There another patient slopped lather on his face. Then Mr. Grupp himself would take the patient in hand, set him down on the toilet stool, and scrape his face with a safety razor. (After every tenth shave he changed the blade.) The patient's cue that the shave was finished was a sharp slap at the base of his neck and the raucous yell, "Next." A moment was allowed him to rinse off the lather and blood before he was pushed out into the hall again. There he was given ill-fitting clothes. He had been cleaned and groomed for another week -- or more.

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Grupp usually gave the last patient a slap on the buttocks for good measure. Then he emerged from his toilet barber shop and sat down in his rocking chair. His henchmen gathered around him, and Grupp consulted his watch. "An hour and fifty-five minutes today, boys," he would report. "You guys are slowing down. We used to do the job in an hour and a half."


He distributed three cigarettes to each of the patients who had helped with "bath day" and told them to clean up the shower room and toilet. Then he would light his pipe and spread a newspaper on his knees. Except for interruptions for meals and to answer the phone, Grupp would spend the rest of the day in his chair.


(Based on reports 662 and 667)


"Clothes do make a difference," exclaimed Mitzi as she slipped a clean cotton dress over her head and pressed it against her bare skin.


"Huh!" grunted Margaret. "Better hold onto that dress then. No tellin' what you'll get in the morning."


"I just can't stand those rough old dresses. Not when they don't give you any slip or underwear. I thought I'd die last night when the attendant put that old blue denim on me."


"Look around you, girlie. Most of 'em on this ward wear blue denim."


Mitzi looked at her ward-mates. She had been transferred just yesterday and had been so upset she hadn't paid any attention. Now she noticed that of the hundred and forty women on the ward, a few were naked, a good many wore heavy denim dresses, and the rest wore faded cottons.


Mitzi shuddered. "Don't they ever give you slips and underclothes?"


"Oh, sure! When you have a visitor. You get shoes to go to the beauty shop, shoes and underwear to go to the doctor, and the whole works when you have company -- even stockings!"


"I'll sure be glad to have company," Mitzi replied.


The day was little different from other days on other wards. As there was only one attendant to handle the whole ward, the patients did most of the work. Mitzi had helped make beds on her former ward, but here the patients didn't take kindly to her offer of help. "Quit trying to horn in, girlie," she was told. So she sat and watched an old lady tear up her blue denim dress into narrow strips. Mitzi wished she had something to tear up, too -- at least, something to do. But she sat, and went to dinner; sat, and moved when a neighbor urinated on the floor; sat, and went with the other patients to supper at four-fifteen.


As the women were herded up the steps from supper, the big patient who had rebuffed Mitzi's offer of help in the morning met them at the head of the stairs. "Give me your dress," she boomed at each patient. Most of the women removed their dresses and handed them over meekly. When one hesitated, the big patient stooped down, whisked the dress off and gave her a stinging slap on the rear.


Mitzi watched Margaret stride up the stairs. She made an ugly face, said, "Don't touch this dress, you dried-up shrew. I'll tear ya' limb from limb," and stalked into the dayroom untouched.


Mitzi was pushed ever nearer to the top of the steps. At last she stopped before the domineering patient. "Please? I'd like to keep my dress if I may?" She asked it timidly. A few seconds later, Mitzi found herself in the center of a roomful of naked women, with a hot stinging sensation on her back and a red ball of fire in her brain. Confused and miserable, she sought a corner of the big room and slumped against the wall.


Margaret came over. "Gee, kid, I forgot all about you. You should have stuck to me."


''How long do we stay like this?" Mitzi asked tearfully.


"Until we go to bed. About eight-thirty. Then we get to cover up with a sheet."


"I hope I'll be -- dead before -- then," Mitzi wept.


"Aw, quit your bawlin', girlie. You got nothin' to be ashamed of -- like some of these creatures has."


"But -- but -- I -- "


"Skip it. Let's plan on gettin' you a garb for tomorrow."


"You mean -- I won't get my own dress back tomorrow?"


"There's one chance in a hundred and forty. And with that devil-dog dishin' 'em out, you ain't got the chance of a cat on a tin roof in a high wind."


"Oh-h-h," Mitzi moaned.


"She'll be lookin' for a nice filthy one to give you." Margaret smiled and nodded her head. "Yeah. I can see it now. She'll hand out one of them denim jobs, big as a barrel and stinkin' with sweat. Then you say, like you meant business, that you'll take a clean cotton dress, thank you."


Mitzi began to be interested. This would be a new role for her -- standing up to a big bully.


Margaret went on enthusiastically. "Well, while she's drawin' in her breath to blast ya' one -- she barks loud but she don't bite -- I'll slip up and whisk the dress off little Lil. Mmm, boy!"


"Who's Lil," asked Mitzi, while Margaret rocked back and forth in obvious satisfaction with her plan.


"Lil? Oh, she's that little prissy that's always trailin' the shrew, lickin' her boots and warmin' her bed. She always gets nice dresses to wear."


"And you'll give me her dress?"


"Yep. Right there in front of her!" Margaret's big body shook gleefully. "You stick to me, sister, and we'll have a lot of fun. You make the trouble, and I'll settle it. This is goin' to be great fun!"

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(Based on reports 1260 and 1261)


Forty-eight days had passed since the doctor had told him that he was ready to leave the hospital. "You're as good as home, Joe," he had said. "Your wife is ready to sign you out. You're perfectly well now. All you need to do is have your interview with the staff -- and out you go!"


He had counted the days since then -- all forty-eight of them. He had continued to work hard at his job (collecting laundry for Building F), but he did want to get home. The delay was getting him down. He was used to getting the run-around by doctors before he got a chance to see them, and he knew that doctors seldom gave a definite, straight-out answer to a patient's question. But he did think a doctor would keep his promise once he had made it.


Such thoughts as these tumbled around in Joe's mind while he waited patiently for someone to unlock the door. He had a big pile of laundry to deliver to the truck outside. In a few minutes, one of the doctors came in, and Joe started to push his laundry cart out while the door was still open. "Come back in here," the doctor ordered. "Get an attendant to open the door if you need to go out." He closed the door in Joe's face.


"Well, if that ain't a treatment! Here I am all ready to go home, and that saw-bones won't even let me out the door -- not even to do a job I've been doing every day for six months."


At last an attendant let Joe out. He deposited his load of laundry and then rang and waited at the same door to get back in. While he waited, the doctor who had just refused to let him out passed by the window. Joe saw him, rang the bell again, and knocked on the door. The doctor looked out the window, saw Joe, and passed on.


Joe shouted, "Damn the doctors!" and kicked at the door. One powerful kick went through the screen.


Instead of going home, Joe was sent back to the violent ward to begin the long journey upward again.


(Based on reports 1136 and 1137)




"Open ward patients often get lost in the hospital. They are assigned to industrial positions, become efficient workers, and frequently bog down into an apathetic acceptance of the situation . . . Emphasis on patient productivity as such should be minimized and replaced on the therapeutic effect which the patient may derive from such work." (6)

(6) ibid.




Attendant Bickle paced up and down by the open door of Ward 28. The routine of the ward was all messed up again. The gang of dairy workers hadn't come in yet, and the ward was supposed to go to supper in just five more minutes.


Bickle simply could not understand why the dairy workers didn't get back on time. He decided he would report it to the director of occupational therapy. The men left the ward at three-thirty every morning, stayed at the farm all day, and were supposed to get back at four-thirty in the afternoon. But as if thirteen hours of work wasn't enough, the dairy boss had taken to keeping them out until supper-time at five. Bickle decided he was going to insist that they get back at four-thirty, or else stay out until after supper. He couldn't be bothered with keeping the door open for them beyond the four-thirty deadline.


He was just about to close the door and let them go without supper when he saw the tired, drooping group of men coming across the field. He leaned out the door and yelled, "Come on, you birds! Make it snappy." Then he leaned inside the door and yelled, "Line up!"


Outside, the eight dairy workers moved their plodding feet a little faster. Inside, the patients stood up and formed a line at the far end of the hall. Every patient on the ward had put in a hard day's work. At the farm, the laundry, the greenhouse, the coal pile, the power-house -- they had all worked long and hard. And today, most of them had been given their "pay" -- one package of tobacco every third day.


As the dairy workers filed by Bickle on their way to the end of the line, each held up a package of ready-made cigarettes. "Extra!" they reported proudly.


Bickle slammed the door, made sure it was locked, pushed past the line, and unlocked the door at the other end of the hall. Down the steps, through the damp passageway and up into the cafeteria, the patients ran, pell-mell, first-come -- first-served.


In two minutes they were all seated; in five they would all be through eating. Bickle looked over the shoulder of one of the dairy workers. This man, he knew, had spent the day filling and moving ten-gallon cans of milk. Now he was gulping down all that was offered for the patients' supper: one bowl of corn-flakes, with just enough milk to dampen a few of the flakes at the bottom of the bowl.


(Based on reports 602 and 700)


Nora had made up her mind. That was quite remarkable in itself, for Nora seldom went so far as to make a decision on her own. She was a big, plodding woman who had earned the reputation of being "the best darn scrubwoman I ever seen," according to the hospital housekeeper. But no one had ever accused her of being a thinker.

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Yet the most remarkable thing was not that Nora had made up her mind. It was that Nora had decided to stop working. For as long as anybody could remember, Nora had spent every waking hour of every day padding around the women's infirmary in her old canvas slippers, scrubbing, changing beds, giving showers, cleaning and grooming from morning to night, untiring and untired; a kind of Rock of Gibraltar. Many waves of rage, hate, fear and loneliness had broken and spent themselves on Nora's ample bosom. There was room there for all, and patients soon learned that Nora was a safe port in any storm.


But for all of that, Nora was still "just a crazy patient" to the nurses and attendants whose work she did. True, she had been a "good" patient for the last seven years. But now, it appeared, she was becoming troublesome again.


"But, Nora, what on earth will you do with yourself?" asked Miss Ames.


"Ah thinks Ah'll jus' sleep for a few weeks."


"Now Nora, you can't just stay in bed. We don't allow laziness here."


"Yes, mum." Memories of seven years plowed slowly across the furrows of Nora's mind. Seven years, every day -- two days off in that time -- up at five in the morning, work until nine at night -- scrub, clean, do dirty work -- work, work, work -- no laziness here,


"Well, we can't let you stop work without any reason. You'll have to see the doctor."


See the doctor. Nora nodded her head slowly. She had seen a doctor every day for the last seven years. But she had never spoken to one. Could Miss Ames mean she would have to talk with the doctor?


"I'll send you down to see Dr. Bascome in the morning. Now get along to work."


Nora spent an unusually restless night. She knew that every time she turned her big body in her cot it shook the other nine beds which were placed end to end in her dormitory. But, for once, she was insensitive to others' hardships. Her own problems were all she could think about now. And the one thing she was sure about was that she had made up her mind to stop working.


That was still all she was sure about when she shuffled into Dr. Bascome's office the next morning. "Mrs. Nora Sillicoff," announced the bright young girl who ushered her in.


"Sit down, Mrs. Sillikoff," another young voice said.


Nora sat down.


The strangeness of hearing her last name made her want to see the man who said it. For the first time in years she, was conscious of her faded cotton dress, her short haircut, her canvas slippers. She slowly raised her eyes from the floor. Such a young boy smiling there! Her head began to nod. "Mohnin'," she said.


"Miss Ames tells me you want to stop working."


Nora nodded again.


"Maybe you'd like to have a vacation -- and a privilege card."


Nora looked incredulous. "You mean -- then Ah could sit? Outdoors? On the grass?"


Dr. Bascome's smile was pleasant. "Certainly -- if that's what you want. Now, tell me: why do you want to stop working?"


Nora's eyes slid down to her feet again; the furrows deepened on her brow. She wanted to answer this nice young man. She gathered all her thoughts and launched into the longest speech of her seven years in the hospital.


"Well," she said, "it ain't that the hours are long and the work is hard. It ain't that Ah don't get paid. Nor 'tain't that Ah have to beg for ever'thing Ah need." She paused and wrinkled her brow more deeply. "No, 'tain't that Ah get no time off. It ain't even them hussies I work for. It ain't -- "


Suddenly her eyes focussed on the canvas slippers she had been staring at. She looked up at Dr. Bascome with certainty in her eyes. "It's just that Ah've been workin' for seven years now, an' Ah ain't ever got to wear a pair of shoes."


Dr. Bascome smiled understandingly and began signing papers. "All right, Mrs. Sillicoff. You'll get your vacation. You'll get to sit in the grass, and you'll get a pair of shoes. Now come along and let me open the door for you. You have ground privileges from now on." For several minutes the doctor stood in the open doorway and watched Nora move down the sidewalk, kick off her old canvas slippers, and step off into the grass in her bare feet. Assurance of salvation seemed to well up in her as she flexed her toes in the grass.


"Seven years," murmured Dr. Bascome. "Seven years -- for a pair of shoes and some grass."


(Based on reports 693, 702 and 705)


Responsibility is Ours


"Unless reforms are to be mere lip-service, improved treatment of the mentally ill has to grow organically out of a new attitude society must take toward that cardinal problem. It is not the brutality and neglect which have occurred in the care of psychiatric patients, deplorable and detrimental as they may be; it is the feeling of isolation and solitude in which the mentally sick have lived for ages which constitutes the fundament of their plight."


Source unknown.


Inadequacy, Ugliness, Crowding. Incompetence, Perversion, Frustration. Neglect, Idleness, Callousness. Abuse, Mistreatment, Oppression. These have been the principal characters in the drama of the preceding chapters. They have always dominated the center of the stage.

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Perhaps you can remember only a few of the individual characters who have come and gone in these scenes. But can you forget the Inadequacy? The Incompetence? The Neglect? The Abuse? Can you now begin to know something of the atmosphere in which six hundred thousand of our fellow citizens are living at this moment? Have you now at least a vague intimation of the meaning of life in a mental hospital? The kind of life which one out of every twenty of us may expect to lead, sometime before we die? A life that is out of sight, out of mind?


Very probably you have come to understand that conditions within our mental hospitals are far worse than they ought to be, or need to be. With inadequate buildings, poorly planned and poorly equipped, mental patients are crowded together in such a way that adequate treatment and attention are impossible. There are far too few doctors, nurses and attendants to give needed care, and many of those few are incompetent or discouraged. Treatments that might cure sick minds are not used as often as they should be, and sick bodies, too, are often seriously neglected. Not even a minimum of food, clothing, shelter and cleanliness is always available to mental patients. And these unfortunate, pitiful human beings are still being locked up, beaten, punished, annoyed, offended -- even killed -- for no greater crime than simply becoming sick and showing the expected symptoms of their sickness.


If you have read the preceding chapters with alertness and sensitivity, you may have sensed yet another truth about mental hospitals -- that there are many fine people working in them, doing excellent work against impossible odds. The picture is not all dark. These shafts of light are there, and where they are, they illuminate the darkness. The contrast makes us more aware of the darkness and more certain that the light is both possible and desirable.


The final impact is clear -- inadequacy, incompetence, neglect and abuse are far too prevalent. Conditions in mental hospitals are insufferable; they can not be endured.


Confronted with the unrelenting impact of this certainty, many of us have a tendency to seek some escape. We want to explain the facts away, to justify them, to forget them, to avoid them. We do not want to face them.


Such a reaction is to be expected. Whenever modern man is confronted with undeniable evidence of man's inhumanity to man, he seeks to dodge the implications, to explain the evidence away. He is like a bird confined in a cage for the first time. Goaded by his condition, which he would escape, he flutters wildly, blindly, to find a way out.


Many of us, having read these incidents, will seek a means of escape, some way of assuring ourselves that "everything is all right." One of the handiest, most appealing escapes we try is denial. We exclaim, "It can't be true!"


Is It True?


A United States congressman from a midwestem state was presented with a few facts and pictures showing conditions in mental hospitals. After considering the materials for a moment he dropped them on his desk and said, "It isn't true. It just isn't true!" His informant replied, "It's true, all right, sir. For two years I have worked in these conditions, and I know whereof I speak." The congressman shook his head. "No," he said, "not in the United States. It just isn't true!"


Certainly every one of us wishes that the incidents reported earlier in these pages were not true. But wishing will not make it so. The fact is that they are true, in every particular. It was stated earlier, but will bear repitition here: Every person depicted is a real person; every place described is a real place; every event recorded actually occurred -- and they all took place in mental hospitals in the United States within the last five years, 1942-46.


Names of persons and places, as well as certain identifying details, have been altered for purposes of publication, just as faces of patients have been blacked out in the photographs; but all incidents are based on first-hand, "on-the-spot" reports. The originals of these reports, as well as thousands of others, are contained in an extensive collection of such materials in the possession of the National Mental Health Foundation. Each report contains all the pertinent details, is carefully documented, and is signed by the person or persons who observed the incident and contributed it to the collection.


Most of these reports have been contributed by three thousand conscientious objectors who were assigned to work in mental hospitals in lieu of military service during World War II. Coming from every region of the country and from almost every walk of life, these men worked in forty-six of the nation's three hundred and fifty public mental hospitals. They found conditions such that they were impelled to do something about them, even though they had nothing to gain personally, and much to lose, by their efforts. The National Mental Health Foundation itself is the result of their efforts and idealism. It has already become a powerful factor in informing an awakening public, not only about the plight of the mentally ill, but also about the vast problems of our national and individual mental health.

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The value and truthfulness of these reports is indicated in the Annual Report of the National Committee for Mental Hygiene for 1944. That report, made under the direction of Dr. George S. Stevenson, one of the nation's outstanding authorities on mental hospitals, stated:


"No one can deny that members of the Civilian Public Service Units -units of conscientious objectors working in hospitals- have first-hand knowledge of conditions in our mental hospitals. Since they know whereof they speak, their voices may well be hearkened to, and their influence in their communities may well break down the lethargy of the public in regard to present conditions in mental hospitals."


But not all the reports in the Foundation's collection, nor all the incidents presented in this book, have come from these conscientious objectors. Many doctors, nurses, attendants, former patients and other informed persona have added their reports and observations to the ever-growing collection.


From whatever source they have come, these reports have several things in common:


(1) They are accurate, first-hand reports, vouched for and signed by the observer.


(2) They have been submitted in a sincere effort to better the plight of mental patients in this country.


(3) They are to be used, not to point the finger of blame at one state, one hospital, one superintendent, one attendant, but rather to expose a general situation, and to show the public that the fault is ultimately its own. For this reason, names of persons and places and other identifiable details have been omitted or altered.


The validity and truthfulness of these reports, however, is not the only proof that these conditions exist, that they are true. Hardly a day goes by that some reliable newspaper somewhere does not report an incident or print a picture which shows conditions similar to those depicted in these pages. Albert Q. Maisels article in Life, May 6, 1946, and condensed in the July, 1946, Readers' Digest; Albert Deutsch's series of articles in the New York newspaper PM during the spring of 1946; and Mary Jane Ward's best-selling novel, The Snake Pit, provide undeniable evidence of intolerable conditions in mental hospitals. The official utterances of the American Psychiatric Association, the National Committee for Mental Hygiene, and the United States Public Health Service present the same facts, the same truth, in perhaps more prosaic but equally convincing form.


If anyone is still unconvinced -- if anyone still wants to escape the facts by asking "Is it true?" -- let him turn to the stable, undeniably accurate reports of the United States Bureau of the Census. There he will find statistical proof of facts which are best understood in terms of human misery, but which still lend themselves to quantitative analysis. Here are some facts from the year 1940, a pre-war year: (7)

(7) Patients in Mental Hospitals, 1940, United States Bureau of the Census, Government Printing Office, 1943.


Overcrowding -- State mental hospitals, on the average, had 10% more patients than they could normally accomodate. -sic-


Understaffing -- State mental hospitals, on the average, had one doctor (many of them not psychiatrists) for every 251 patients, and one nurse or attendant to care for every 28 patients (for three shifts).


Poverty -- State mental hospitals, on the average, operated on a budget of 82.1 cents per patient per day to buy all food, clothing and supplies, and to provide all medical care and personnel.


The accumulation of evidence is undeniable. The picture of mental hospitals presented herein is a true picture.


Is It Representative?


Granted that it is a true picture, perhaps it is a rare picture. Perhaps it exists in only a few backward states or in only a few backward hospitals. Perhaps incidents like those that have been described occur very rarely. Is it representative? Is it generally true?


A member of the Board of an eastern hospital, confronted with a general account of deplorable conditions in hospitals, immediately wrote a letter to the paper, assuring the citizens of his state that such conditions might exist in some places, but that they most certainly did not exist in their own state institutions. The editor of the paper received other letters guaranteeing that the conditions mentioned were actually quite characteristic of that state. A reporter was sent to visit the state hospitals and returned agreeing with the group of condemning letters.


We all wish this picture were not generally true. But the fact is that there is no hospital in any state where there is not room for improvement. In no case have we made a mental hospital live up to the best that we know.


This fact is confirmed conclusively by an informal survey of state hospitals recently conducted by the National Mental Health Foundation. A battery of thirty-two fact-finders was sent to each of forty-five mental hospitals throughout the country. The replies received indicated that:


95% were overcrowded, some by as much as 50%; patients of all kinds were thrown together on one ward in many of these hospitals.

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45% supplied insufficient quantities of bed sheets.


35% failed to provide adequate clothing.


None were highly selective in employing attendants, although the attendant "exercised effective responsibility" on the ward in every case, and was reported as giving medications in 95% of the replies.


Attendants' salaries ran as low as $45 per month, plus maintenance; nurses were paid as little as $50 per month; doctors, $150; hours were as long as wages were low.


In only 15% of the hospitals were doctors readily available for individual consultation with patients, and doctors spent more than half their time on "book work" in 60% of the cases.


Only 30% provided games and reading material on the wards.


Only 60% used hydrotherapy, and half of these had an untrained attendant in charge.


Tuberculosis patients were not properly isolated in at least 35% of the hospitals.


Food was unsanitary in 20%, poorly served in 50%.


90% used patients for work in a work-centered rather than a patient-centered manner.


30% acknowledged that doctors and nurses did not always maintain a therapeutic attitude toward their patients.


95% indicated that attendants, who have most contact with patients, often violated rules of good treatment and care.


From this survey, as well as innumerable surveys in the possession of the National Committee for Mental Hygiene, the United States Public Health Service, and the American Psychiatric Association, it is plainly evident that deplorable conditions not only exist, but exist generally throughout the country, in many different hospitals.


This fact is further supported by a list of the states from which the actual incidents reported previously in these pages were drawn. One or more of these incidents actually took place at a hospital in each of the following states: Connecticut, Delaware, Illinois, Indiana, Iowa, Maryland, Michigan, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, and Wisconsin. Some of the states listed are among the most progressive. There is every reason to believe that incidents similar in their effect on patients could have been selected from any state in the country. Those used have been selected for their clarity and ease of presentation. They are neither the best nor the worst cases on record.


(Some of the most flagrant examples of mistreatment were omitted because of the impossibility of making them seem plausible. Could anyone believe that a doctor would resort to Jew-baiting a poor refugee, offer to assist in suicide, or force a sick man to take an ice cold shower? Or could anyone believe that hospital patients would be forced to sleep on a wet tile floor with no mattress or covering but a piece of rubber sheeting? Only seeing is believing such things.)


Incidents similar to those reported in the first chapters of this book occur in every hospital in every state. They are not rare, unusual occurrences -- they happen daily. There is no mental hospital in the country that lives up to its possibilities, that stands in need of no improvements or changes.


An important corollary of this fact is that there is no hospital that is all bad, that has no redeeming features. Some hospitals are blessed with active and progressive medical staffs, but are hamstrung by "economy-conscious" politicians, or incompetent nurses and attendants. Others are equipped for all the latest therapies and treatment methods, but are burdened with unconcerned doctors or inadequate buildings. In some hospitals, the admission wards are consistently conducted on a high level, but the continued treatment wards grovel in degradation.


These variations exist in practically all hospitals. You may have noticed that there were usually redeeming factors in the incidents and cases in this book. There are always redeeming factors in every hospital. The proof of this is that our state mental hospitals discharge, as recovered or improved, thousands of patients every year. For this reason, at the same time that you acknowledge that conditions are intolerable and must be changed, you must also acknowledge the good work of the hospitals. You must encourage people in need of psychiatric treatment to seek it through early admission to a hospital.


The patient who is admitted to the hospital before his disturbance becomes chronic and ingrained is almost certain to find help. Doctors, nurses and attendants rally to the opportunity of cure; the best conditions and the best personnel gravitate to the patient with a chance. The redeeming features, even in the worst mental hospital, often make it a much more healthy place for the mentally ill than can be found elsewhere -- at home, in a "nursing home," or in a general hospital not equipped to care for mental patients.


This fact does not in any way deny that the conditions of which we have been speaking are representative of mental hospitals generally. The redeeming features, the shafts of light in the general darkness, are only the exceptions which prove the rules. They support the thesis that the conditions herein pictured are generally true, and representative of all hospitals everywhere, by proving that they are not universally true. The conclusion is undeniable; these conditions are representative.

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Can It Be Just the War?


There is one other way in which we might discredit the startling revelations of the preceding chapters. Perhaps we can blame conditions on the war. Maybe they are just signs of the times, or temporary situations which will soon right themselves.


A state administrator of welfare in an eastern state saw published pictures and reports of the poor conditions existing in the mental hospitals under her jurisdiction. She immediately wrote to the governor, sending copies of her letter to the papers, blaming the conditions on the war-time controls of the federal government. The papers found evidence in their files, and obtained statements from hospital superintendents, which proved that conditions had been just as bad before the war. It even was estimated that a slight improvement had been made during the war!


We may as well face the fact that this is one social disgrace we cannot lay at the doorstep of the war. Shortages and limitations have been increased by the war, but the conditions of which we have been speaking existed before the war and are now existing unabated after the war. In fact, there is considerable evidence to indicate that present conditions have reached a lower ebb than ever existed during the war.


In 1938, Inis Ward Jones wrote a factual article on "Man's Last Specter -- The Challenge of Mental Disease," for the December issue of Scribner's Magazine. Basing her statement on a survey made by the National Committee for Mental Hygiene, she said:


"This crowding exists in 70 per cent of our hospitals, a situation almost medieval in its horror and stupidity . . . Imagine one physician having to try to treat 400 mental cases! The minimum standard for nurses and attendants is one to 8 patients. This sometimes runs as low as one to 20. The rate for graduate nurses runs as low as one to 247 patients. And some hospitals actually have no graduate nurses! But how could it be otherwise when some hospitals receive only 20 to 40 cents a day per patient? The average for all is now 74 cents a day per patient -- for food, clothing, service, and medical care. This, while jailers get $1 a day for feeding prisoners . . .


"Then the need for equipment. Some of the complaints are insufficient surgical, X-ray, and hydro-therapeutic facilities, inability to make proper laboratory tests, an actual shortage of medicines, no new medical text-books or magazines, and want of materials for occupational therapy. . . . To make matters worse -- often desperate -- there is political interference. . . . There are still too many hospitals in which food leaves much to be desired, this on three counts: lack of special diets when they are imperative for health; want of balance; and monotony."


In 1941, Edith M. Stem used another National Committee for Mental Hygiene survey, and wrote an article for the August Survey Graphic on "Our Ailing Mental Hospitals." She says many of the same things, and adds:


"Hours in many state hospitals are from 12 to 16 a day, with no restful place to fall asleep afterwards. In one hospital, attendants' quarters are on the disturbed ward . . . The National Committee for Mental Hygiene's surveys of state hospitals are dotted with notations like 'falling plaster,' 'toilet leaking through the ceiling from the floor above,' 'fire hazards,' and 'floors so rotten they are dangerous.' . . . Patients in one hospital never enjoy a hot meal because food -- adequate enough in quality and quantity, the National Committee reports -- is put on the table twenty minutes before the dining room is opened. ... In too many states, still, the mentally ill are treated not like sick people but like criminals. They are tried by jury -- "just as if we called in the neighbors to diagnose meningitis," a young psychiatrist told me bitterly -- thrown into jail and taken, perhaps manacled, to the hospital by a sheriff."


Sounds familiar, doesn't it? These are exactly the conditions portrayed in the sketches which make up the earlier chapters of this book. They existed in 1935, 1941 and 1943, and they exist in 1947. We are forced to go along with the official statement of a professionally competent person who says:


"The nursing committee of the American Psychiatric Association believes that there may be danger in assuming that the war has been responsible for the poor conditions permeating psychiatric hospitals throughout the country. To adopt this thinking without careful reasoning, complacently expecting all to be well when the emergency passes, is but to delude ourselves and postpone the task which confronts us now and which it is our duty to attack with critical judgment and forceful determination." (Laura Fitzsimmons, R.N., Nursing Consultant of the American Psychiatric Association.)


Much as we would like to disbelieve, discredit or excuse the facts, we cannot do it. We are forced to believe that the conditions depicted in the earlier sketches are true, that they are generally true, and that they have been true for a long time. But we still want to escape, to avoid the impact of truth, to excuse ourselves from the arena of action.

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So What? Does It Matter?


The chairman of a prominent women's club had listened to a presentation of conditions in mental hospitals. When it was finished, she said: "Well, I suppose it really doesn't matter. After all, the patients are crazy, aren't they? They don't know what's happening to them, do they?" The speaker, who had spent many years caring for mental patients, smiled a bit grimly. "But they do know what's happening to them," he said. "They know only too well. They're not unlike you who are in this room. They feel and think, are hurt sometimes and pleased sometimes, just as deeply as any of you -- often more deeply. It really matters to them."


There are two valuable lessons in that simple reply which we all ought to take to heart. First, mental patients -- so-called "crazy" people -- are extremely sensitive. No one can work with them for any length of time and fail to become convinced that this is so. Regardless of their present condition, regardless of their immediate response, mental patients very often know exactly what is happening to them.


A nurse took care of a woman who was in a complete stupor, had not moved for weeks, and had to be fed through a tube. Many months later the woman was well and happy, ready to go home. She came to the nurse and said, "I want to thank you for covering up my naked body that night long ago. I was so ashamed. And you were the only one who cared about me!"


A well-built man finally snapped out of the childish, baby-state in which he had lived for several months. He had babbled incessantly, and had been completely out of reach of doctors and attendants. Now he was well again. On the ward he saw two of the attendants who had cared for him. "You're the man who fed me so patiently," he said to one. To the other, he said, "And you're the tough guy who beat me up every time you gave me a bath."


Textbooks of psychiatry have taught for years that many mental patients are sensitive and observant of what is going on around them. They do know what is happening to them.


The second valuable lesson we can learn from the speaker's remarks is that we -- the so-called "normal" people -- differ from the mental patient in degree, but not in kind. We all share their characteristics to some extent. We are like the old Quaker who had been crossed by the members of his Meeting. He said to his wife: "Everyone in the world seems queer except thee and me, and sometimes, even thee seems a little queer." He would have uttered a profound truth if he had included himself among those who are a little queer.


Since mental patients differ from the rest of us only in degree, and since they often know what is happening to them, and are sensitive to their environment, we must assume that it is as important for them to have good treatment and surroundings as it is for ourselves. We cannot escape the impact of the facts by supposing that it does not matter that mental hospitals are shamefully conducted. It does matter.


Why Bother? Isn't It a Hopeless Cause?


At the end of a discussion of the mentally ill in a church young people's meeting, a young man stood up. "The conditions for these mental patients are bad, all right," he admitted, "but I think we should concern ourselves with problems we can do something about. Once insane, always insane, they say. So why get so excited about it?" A young girl jumped to her feet: "That's not true! My Aunt Jane, who has taught Sunday School to nearly everyone in this room, was in a mental hospital for four and a half years. Now we all think she is the finest person in the church."


The girl was right. There are hundreds of thousands of well-balanced, healthy people living worthwhile lives in this country today who have been mentally ill. Not a few of them are living more useful, efficient lives now than they lived before their illness -- they have come out of the hospital with a degree of understanding and assurance they previously lacked.


Fifty years ago medical science knew very little about how to cure a sick mind. A few cases got well, many remained unchanged, and most gradually grew sicker. Since then psychiatry has made amazing strides.


Fever treatment, controlled "shock" therapy, psychoanalysis, brain surgery, drug therapy, directed occupational and activity therapies -- all these have been highly developed and have proven themselves to be aids in the "cure" of previously "incurable" cases. Many other methods of treatment are being used today with increasing success -- vitamin treatment, group re-education, drug-induced semi-consciousness and low-temperature sleep, among them.


If we would put everything we know about treating mental illness into general practice today, we could restore health to at least half of the hundred and twenty-five thousand patients who enter mental hospitals for the first time each year.


Unfortunately we do not practice generally what we know. This fact is clearly evidenced in the contrast between the authoritative quotations and the actual incidents presented in the earlier chapters. Instead of providing the care and treatment which would return these sick people to a useful, productive life, we allow conditions to exist which make them wards of the state for life.

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A striking example of the short-sightedness of our policy may be found among the psychiatric casualties of World War I. Each such casualty has cost us over $30,000 to date. It costs an estimated $10,000 to train a fully qualified psychiatrist. Therefore, if a trained psychiatrist could have restored just one psychiatric casualty to health, he would have paid for his education and saved the government an additional $20,000. Yet even today, the number of trained psychiatrists in this country is pitifully small in relation to the need we have for their services.


This short-sightedness carries over also into the field of research and experimentation. We do not yet know enough to cure all mental illness -- in that respect, mental illness is like cancer, heart disease and other serious physical illnesses. And we will never learn more unless we make research and experimentation possible. Psychiatry stands today on the brink of discoveries which may revolutionize our way of life -- may show us all how to live more efficient and happy lives -- but it must carry on its search on a shoestring. We are still following the example of a state legislature which refused to vote $10,000 for psychiatric research, but approved $200,000 for testing for Bangs' disease among cattle.


We know how to cure much mental illness. There is every reason to believe that we can learn to cure much more if we are given an opportunity. The old adage, "Once insane, always insane," is as dated as the first "horseless carriage." We cannot excuse our negligence with regard to mental hospitals by assuming that patients can't be helped. There is help. There is hope. We must be bothered by their plight.


Why Worry? Is It Really Important?


One of the most successful escapes from the impact of disagreeable facts is to dispose of them as unimportant, as of too little significance to engage our attention.


The community leaders in a southern city had been told that mentally ill patients were being housed in the jail, that the community was totally lacking in adequate facilities for their care and that even the nearby state hospital was little better than an 18th century asylum. The principal of a grade school wanted to know: "Do we have to get so upset about this matter? Surely not many people go insane. I don't see that it's such an important problem." The speaker replied: "Madam, Surgeon General Parran recently stated that mental illness is America's number one health problem. He told the truth!"


America's number one health problem? More important than all the other diseases and illnesses which beset us? Yes, that's what the foremost authority on health problems in the United States says about mental illness.


And well he might! As previously indicated, there are six hundred thousand persons in this country today who are hospitalized because of some serious mental disorder. At least forty-five percent of the patients in hospitals at any given time are there because of mental illness. We pay over $300,000,000 per year to take care of these sick people, and our national economy loses over a billion dollars in productive capacity because of their illness. Almost two million young men -- more than for any other cause -- were eliminated-from participation in our armed forces in World War II because of some minor or major mental-emotional disorder.


But these facts do not tell the story of the importance of mental illness. They only hint at it. The real story is to be found in the care-worn faces of millions of us little people, in our inefficient and unhappy lives, in our broken homes and shattered careers, in the delinquency of our children and the defeatism of our old folks. For while many of us are not mentally ill, neither are we mentally healthy. Our lack of mental health is eating deep into the fibre of our individual lives and of our whole civilization. Mental stability and emotional health are among the greatest needs of our day -- but we don't know how to attain them.


Perhaps you agree with all this. But, you ask, what does it have to do with the way we treat our mental patients? Just this: We can learn how to make the rest of us mentally healthy only by giving the best possible treatment and care to those of us who are mentally sick.


It is from the ill that we learn how to be healthy, just as it is from the problem child that we learn about the problems of normal children. Knowledge comes not by cutting off and forgetting those persons who deviate from our "normal" standards, but by taking them in and caring for them. Their serious disorders point to weaknesses in the rest of us. If we have skilled and sensitive observers on hand to treat and care for them, we can learn the lessons the ill have to teach. The plight of our mentally ill, therefore, ought to concern us all, not only because mental illness is our nation's number one health problem, but also because the seeds of prevention can be found and nurtured only among those who are diseased.

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The way in which we treat our mental patients is very important. We must be concerned.


It Couldn't Happen to Me!


One other avenue of escape still offers itself. We can seek refuge in our own immunity and isolation. We can assert: "It couldn't happen to me!"


The chaplain of a large state hospital told the members of a men's club about conditions in mental hospitals. At the end of the talk, the chairman remarked: "This is a tragic picture our guest has painted for us. Of course, such disaster does not befall men like you and me, but still -- " The city's most distinguished banker arose from his seat and interrupted the chairman. "Excuse me, sir," he said, "but I have been unusually moved by our speaker's remarks. I want to tell you something now which I have never spoken of before. Twenty years ago when I first came to this city, I had just spent two years as a patient in a mental hospital." Before the meeting adjourned, four other men had told of their own experiences "out of sight, out of mind."


No one can be certain that he is safe from the specter of mental illness. It lays its hand on rich and poor, high and low, young and old, men and women, intelligent and ignorant. No class or creed, no race or clan is beyond its reach. There is a chance that any one of us may sometime be brought face to face with the conditions reported in earlier chapters of this book.


In fact, the chance is not so very remote. At the present rate, the experts tell us, one out of every twenty persons who reach age fifteen in this country will have to spend a part of his or her life in a mental hospital. Just to make that figure mean something, recall how many members there are in your church or lodge or community. Or remember how many people you saw at the movie the other night. One hundred? The chances are that five of them will be patients in mental hospitals at some time before they die. Three hundred? Fifteen patients. One out of every twenty is a figure worth remembering. You could be the one!


But the prospect of coming face to face with the inside of a mental hospital is even closer than that. Besides yourself, there are your mother, father, brothers, sisters, sons, daughters, aunts, uncles, friends. We are told that one out of every five families will be affected by mental illness. One out of every five! How many families are there in your block?


These facts will not allow us to view conditions in mental hospitals disinterestedly, without concern. The threat of mental illness comes too close to home for that. We ourselves, our loved ones or our friends might well become the one out of twenty. Shall we be satisfied to allow ourselves or them to meet the situations described in this book? Certainly we cannot stand apart and say with any real assurance, "It couldn't happen to me."


There is no easy escape from the impact of conditions in mental hospitals. We would like to dodge, or to justify, or to evade. But our efforts are futile. The conditions reported in earlier sections of this book are true. They are important -- not only for those of us who are or will become mentally ill, but for every person in the country.


Throughout history the problem of the mentally ill has been dodged. We have continually avoided mental patients -- we have segregated them, ostracized them, turned our backs on them, tried to forget them. We have allowed intolerable conditions to exist for the mentally ill through our ignorance and indifference. We can no longer afford to disregard their needs, to turn a deaf ear to their call for help. We must come face to face with the facts.


In this country, over ninety-seven percent of all mental patients are cared for in government-operated hospitals -- city, county, state or federal. Therefore, you and I are the ones who pay the bills through our taxes; we are the ones who allow such conditions to exist through our legislators and representatives. Confronted with such facts, we the people of the United States cannot be indifferent. We may try to escape the facts, but when we face them we are impelled to give the sympathetic and understanding aid which we have given to other needy sections of mankind. And so we ask --


What Can We Do?


The most urgent needs of particular mental hospitals vary from one community to another, but there are some general things which every citizen can be doing -- now. Everyone can learn more, serve more, give more, and influence more.


Let's Learn More


There was a time, not so long ago, when we were as ignorant and uninformed about tuberculosis as we now are about mental illness. It was considered a disgrace to have "T.B." in the family, and the unlucky victims were hidden away while their disease became worse and more ingrained. Now we recognize tuberculosis as a serious disease; we provide quick and adequate treatment for it; and we are learning how to prevent it. Medical science alone did not accomplish this progress. An informed and cooperative citizenry was essential in controlling tuberculosis.

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Dispelling public ignorance is equally important in controlling mental disease. Therefore, let's learn more. Let's not be ignorant about what goes on behind those walls which keep six hundred thousand of our fellow-citizens out of sight, out of mind. Let's be conversant with the most recent medical knowledge about mental illness, its causes, treatment and prevention. Let's break down false ideas about mental illness and dispel the stigma attached to it.


The best learning always results from direct observation, from experience. Therefore, an important step in learning more about mental illness is to visit mental hospitals. A view of the outside of the buildings or an interview with the superintendent will be worthwhile, but not enough. In order to get the most information out of a visit to a mental hospital, you should visit the wards and talk with the patients, doctors, nurses and attendants. Even then, remember that you have seen the hospital only on "good behavior." A brief guide for such a visit is What to Look for in a Mental Hospital, available for five cents from the National Mental Health Foundation, 1520 Race Street, Philadelphia 2, Pennsylvania.


Special instructional visits to mental hospitals can often be arranged. Groups of students, ministers, social workers, and teachers make such visits to hospitals regularly. Any group of citizens might ask a nearby hospital to prepare an instructional visit in the course of which the types of mental illness and methods of treatment would be demonstrated and explained.


Visits to patients whom you know, discussions with families of mental patients, and all the ways of serving suggested in the next section are other means of learning through experience, of coming to understand the problem of mental illness through first-hand observation.


Reading and listening are additional methods by which we can learn more. Appendix II lists books for further reading. Some of these are as easy to read as the latest best-seller. In fact, several best-sellers (such as The Snake Pit, by Mary Jane Ward) are included in the list because they give accurate, interesting information about mental hospitals and mental patients.


Speakers who can bring interesting messages from those who are "out of sight, out of mind" can be found in every community. Mental hospitals themselves are the best sources, of course. Many doctors, social workers, and administrators consider it a privilege to talk to any interested group about the problems of the mentally ill. In addition, college professors, ministers, general practitioners, judges, and community workers often have valuable information to give about mental diseases. The reports of former patients and relatives of patients are often worth hearing also.


If there is a local mental health group in your community, it may have suggestions for speakers and reading material. Since most local groups carry on an educational program, joining one is an effective way of learning more about the problems of the mentally ill. Information about speakers in your own community and about local mental health organizations near you may be secured from the National Mental Health Foundation.


Let's Serve More


Knowledge is not enough. In fact, knowledge is useless until it is put to work. We must not only learn more about the problems of the mentally ill -- we must do more about them. There is enough needing to be done that all of us can find some way to be of assistance to the mentally ill, by serving more, giving more and influencing more.


Opportunities for service to the mentally ill are everywhere available. In the first place, there is scarcely a mental hospital in the country which has enough employees to give proper care to its patients. Most mental hospitals have immediate openings for doctors, nurses, attendants, social workers, therapists and farm and kitchen employees. Some of these positions require much training and experience; others require only a sympathetic willingness to serve and to learn.


In addition to these immediate openings, there is a long-range need for trained personnel -- a need which ought to challenge all young people looking for a career. In order to come up to standards of the American Psychiatric Association, mental hospitals in the United States need 5,500 more doctors, 14,000 more registered nurses, and 12,000 more trained attendants and practical nurses. Even these standards are not ideal; they are only adequate, and will certainly rise in coming years. For anyone interested in a medical vocation, the psychiatric field offers the greatest possible opportunity for service and advancement.


For those not interested in permanent work in mental hospitals, there are growing opportunities to serve the mentally ill in special, short-term work. The American Friends Service Committee, the Mennonite Central Committee, the Unitarian Service Committee, and the Brethrens Service Committee have established service units in several mental hospitals. Persons may enroll in these units for a few months, for a summer, or for a year. They receive the same pay as regular employees and work as attendants, recreational aides, or nurses' aides. Other church groups and several colleges and seminaries are considering opening similar units in the near future. In addition, the Council for Clinical Training of theological students operates comparable units for men and women preparing for the ministry.

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Most of us, however, will have to find our opportunities to serve the mentally ill in a voluntary capacity, not as regular employees. Possibilities for such volunteer services are unlimited, but they are undeveloped. In spite of the fact that mental patients need diversion much more than other hospital patients, and in spite of the fact that nearly half of the occupied hospital beds in the country are filled by mental patients, we provide many more voluntary services to general hospitals than to mental hospitals. The Red Cross Gray Ladies group which serves a mental hospital is still a rarity -- but such groups can be of great benefit to mental patients.


There are patients in mental hospitals who have never owned a magazine, never had a game to play, never had a visitor, never seen a person from "the outside" in several months or even several years. A filling station employee used an afternoon off to go through the wards of one hospital playing requests on his accordion -- it was the major topic of conversation among the patients for months afterwards. Literally thousands of mental patients are starving for little diversions which we could give them as easily as not. The rewards which would come to us in terms of smiling faces and heart-felt thanks would more than repay us for our efforts.


Some veterans' organizations, an occasional Sunday School class, a few Red Cross chapters and several specially organized citizens' groups have sponsored volunteer service programs among the mentally ill. These efforts have met with enthusiasm and success in almost every case. But they have not spread widely; they meet but a tiny fraction of the need.


Here are some things all of us can do: We can take our used magazines and books to the hospital; we can provide the patients with games and other recreational equipment; we can visit a lonely patient; we can offer to do whatever is recommended by the recreational or social service department of the nearest mental hospital. We can do this sort of thing alone if necessary. But we can do it best in a group. In a group we can give parties, show movies, stage musical or dramatic events, provide worship services and do all manner of helpful things, again on recommendation of the hospital authorities. The possibilities are so endless, the need is so great, that there is room. for everyone in this area of service. The ability to sit quietly and knit may be just as useful in entertaining a mental patient as the ability to dance a Highland Fling.


Not all opportunities for serving are inside hospitals, however. Patients who are discharged as recovered or greatly improved find that getting a job is a major hurdle, and that reassuming all the duties of normal life is a terrific obstacle. To face these problems without the support of sympathetic and understanding friends is often too much to stand -- it is literally enough to "drive a man crazy." And that's just what it does to far too many. Because family and friends often refuse to accept a former patient back into normal activities, many recovered patients remain in hospitals longer than necessary, or are needlessly returned for further treatment.


Assisting in rehabilitating former patients is, therefore, another area of service in which many of us can be active. Twelve states have a system of foster home care which serves as an intermediate step between institutional life and complete independence. A group of citizens in Northampton, Massachusetts, secures jobs and sponsors the release of deserving patients whose families have forsaken them. Here and there, farmers have found valuable farm hands among discharged patients. A few shops near hospitals make a policy of giving former patients a chance.


But these are exceptional cases. For the most part, mental patients meet a suspicious, antagonistic environment when they leave the hospital. As individuals and groups, we can help meet the need for foster homes, we can provide intermediate steps in the transition from hospital to home, we can act as sponsors or overseers for forsaken patients, we can help them find jobs and places to live.


At least, we can all change our own attitudes to make it easier for mental patients to go to the hospital, receive treatment and return home again. We accept without question medical decisions as to whether a former patient has recovered from a simple malady like measles. Why do we insist on judging complicated mental illnesses according to our prejudices and false notions? It is time to take a sensible, realistic attitude toward mental patients. Adopting such an attitude and spreading it among others is one of the most effective ways of serving the mentally ill.


These brief paragraphs do not begin to exhaust the possibilities for service to the mentally ill. They only suggest a few areas in which opportunities for service are immediately open to all of us. Regardless of how hard we try to "brighten the corner" where we are, however, we cannot possibly provide all the services that are needed. Dark corners will still exists -sic-.

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You and I can't conduct, ourselves, the research and experimentation needed to develop new and more effective cures for mental illness. We can't train the needed psychiatrists and other personnel. We can't provide rehabilitation facilities, out-patient clinics, and recreational activities for all the patients who need them. We can't possibly educate enough people to change the false notions of the entire nation. These tasks are too large for individual or small-group effort. A nationwide effort is needed. That takes money, so --


Let's Give More


Many authorities have summed up all the reasons why care for mental patients is so inadequate, in just one word -- poverty. Certainly a mere pittance is spent on research, education and prevention of mental illness as compared with the amounts spent on tuberculosis or infantile paralysis, for example. One recent study has presented figures to show that the general public contributes $94 per victim per year to voluntary agencies for infantile paralysis and $22 per victim per year for tuberculosis. A very generous estimate would indicate that less than 1/2 cent per victim per year is contributed for mental illness.


Confronted with these facts, we are likely to exclaim with Brigadier General William C. Menninger, former chief of psychiatric services in the Army Medical Corps: "Why is it that we become so responsive to a cause like poliomyelitis and ignore so completely a problem, one thousand times greater!" Why, indeed? Why do we give one fiftieth as much to fulfill a need a thousand times greater?


Now is no time for idle speculation about "why." Now is the time to establish a National Mental Health Fund appeal which will answer the need for giving more. Such a nationwide appeal should collect money to be used for research, experimentation, training of personnel, improvement of facilities and public education -- in short, for a broadside attack on every phase of the mental health problem. It should be collected cooperatively and distributed among those mental health groups most competent to perform services in various fields. Every existing organization which is performing a useful function ought to be strengthened through the fund, and many new organizations, particularly at the local level, ought to be established.


Nothing short of a voluntary national fund can do the job. The federal government entered the field with a $10,000,000 neuro-psychiatric bill in 1946. This bill, which had almost universal support, is a great aid in solving the problem, but it will fulfill only a fraction of the need. Even if the government doubles or triples this proposed $10,000,000 appropriation, there will still be a need for a voluntary fund. Until such a fund is established, we all can give more to local and national groups so that they can grow strong enough to initiate and support a national financial appeal.


The National Mental Health Foundation, the National Committee for Mental Hygiene, thirty-three voluntary state organizations for mental hygiene, the American Psychiatric Association, the American Association of Psychiatric Social Workers and other similar mental health organizations are bearing major responsibility for present mental health work. On meager budgets and using much volunteer or underpaid assistance, these groups have been working efficiently and effectively to bring the problems of the mentally ill to the public. Their work must be supported abundantly now in order to lay the groundwork for the major tasks which lie ahead.


To see that current work is carried on successfully and that foundations for future developments are laid properly, we must give more now. We must also be ready to support a National Mental Health Fund in the near future.


But learning more, serving more and giving more do not exhaust the things which aroused and informed citizens need to do to improve conditions for the mentally ill. Legislators, administrators, judges; newspaper editors, moviemakers, authors; hospital board members, local politicians and just common citizens -- all of these have so much to do with conditions in mental hospitals that we can not be content unless we are persuading all of these people to an increased concern and deeper appreciation of the mentally ill. Therefore --


Let's Influence More


Because treatment of the mentally ill is inextricably tied up with law and legislative procedure, improvements must often come through revision of legal measures. Such revision requires political influence. Perhaps it would be ideal if there were no more legal restrictions on the treatment of mental disease than there are on the treatment of physical disease. Then persons who needed treatment could be sent to the hospital by their own doctor, attended by him there, and released solely on the basis of health. This ideal is likely to be a long time in coming because of two major factors: (1) The traditional legal attitude toward insanity, which regards it more as a legal matter than as a medical matter, and which insists on complicated commitment procedures not unlike those used in sending criminals to jail; and (2) the high cost and long duration of mental care, which for many centuries has made it a problem for governmental rather than for private initiative.

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Through using our political influence, as individuals and as groups, we can bring about immediate changes in both these factors. Immediate changes cannot attain the ideal, but they can bring us much closer to it.


Certainly every state should make it possible for a person to be voluntarily admitted to a mental hospital for treatment -- that is, admitted on medical rather than on legal considerations. Even when it is necessary to commit a person involuntarily, competent medical authority should be relied upon, rather than the authority of untrained laymen. The barbarism of many of our commitment procedures must give way to more enlightened methods.


After commitment many patients still find themselves under the long arm of the law. They have every reason to think of themselves as criminals. They are often confined in a jail until there is an opening in the hospital; they are often transported to the hospital by a policeman, sometimes in handcuffs. Once inside the hospital, they too often find that the law which was so concerned about getting them into the hospital is little concerned about what happens to them while they are there. They find their civil rights restricted, their mail censored, their citizenship suspended, their freedom gone.


Then, at last, when they come to seek release from the hospital after they have recovered, they find that legal restrictions make it impossible for them to be discharged except in the custody of what amounts to a "parole" officer.


In short, the traditional legal attitude surrounds the mental hospital with forbidding, restrictive walls which make it hard to get in, hard to get out, and hard to live decently on the inside. But many of the abuses are the result of poorly framed laws, and, in this country, laws can be changed. In fact, laws will be changed if informed citizens use their political influence effectively. The traditional legal attitude toward insanity can be legislated out of existence. If we want to do something to improve the conditions reported earlier in this book, we can begin now to use our political influence toward this end.


At the game time, we need to use our political influence to see that facilities for care of the mentally ill are brought up to standard. We have already noted that ninety-seven percent of our mental patients are in hospitals owned and operated by city, county, state or federal governments -- which means they are tax-supported and voter-administered, in the last analysis. They are truly our institutions! We are allowing deplorable conditions to exist because we fail to use our influence. Responsibility for the incidents reported in the earlier chapters of this book rests on our shoulders.


A false economy has dominated mental hospital administration for hundreds of years. Cheap buildings, poor food, lack of medical care, inadequate and incompetent employees have been sanctioned so long as expenses were kept low. One state pays its hospital attendants $40 per month and pays its prison guards $125 per month. As a result of such policies, the hospital population has continued to grow, and thousands of potential "cures" have been overlooked.


A state which is interested in true economy ought to invest every possible cent in curative and preventive treatments for mental illness. It ought to provide adequate buildings and equipment for its mental patients; it ought to pay for and secure competent personnel to care for its patients; it ought to supply the best and most effective methods of treatment. It ought to have a non-political board of responsible citizens to make continuous evaluation of its mental hospitals; it ought to have out-patient clinics and follow-up care for convalescents; it ought to support psychiatric wards in general hospitals all over the state; it ought to use guidance clinics, the school system, the church and all other community agencies to promote mental health.


Such a program will cost money now. It will take time and effort to put it into effect. But in the long run it will save money, because it will reduce the number of patients needing care and reduce the length of time the average patient remains in the hospital. It will make productive citizens out of people who will be wards of the state for life under the current false economy. Our influence can make the difference -- if we make it politically effective.


There are other ways in which we can use our influence to improve conditions for mental patients. We can ask the newspapers, the radio and the screen to provide more accurate and informative treatment of mental patients and the problems of mental illness. We can protest scare headlines which proclaim "Sex Maniac Escapes State Hospital" whenever a harmless inmate wanders away. We can suggest sound, logical treatment of those rarer cases when potentially dangerous patients do escape. We can express our opinions to all the media of public information whenever they do injustice to the cause of mental health or to those who are laboring in the service of mental patients.

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In our personal relations with others we can encourage learning more, serving more, and giving more. Our influence can cause many informative programs on problems of mental health to be conducted by our clubs, churches, schools, and social agencies. Here again are endless possibilities for each of us to be actively working to improve conditions for mental patients through our influence.


In all these matters of influence, however, we will do our most effective work if we join forces with other like-minded people and work not only as individuals, but also as groups. There are mental health groups already formed in communities all over the country -- some are doing excellent work, others need new life and new stimulation. The National Mental Health Foundation can give you detailed information about any groups already organized in your community.


But thousands of communities have no such group. If this is the case in your community, you have an important and challenging opportunity to use your influence where it is needed most. If America's number one health problem is to be solved, it must be solved by local groups of citizens all over the country. Organizing such local groups is, therefore, one of the most effective contributions which can be made to improving the plight of those who are out of sight, out of mind. Your influence can be increased a hundred-fold through an effective mental health organization.




The last several pages have been devoted to answering the question which all readers of this book must have asked when confronted with the undeniable, shocking truth about conditions in mental hospitals -- "What can we do?" These suggestions are far from exhaustive, but they should be ample to give every reader some place to begin. We need to learn more, serve more, give more, and influence more, if we are to change these conditions.


There is still one narrow escape-gap which many of us will be tempted to try in our last effort to avoid doing something about these conditions. We can agree that all of the suggestions ought to be carried out, and that we ought to do these things. But as we express this agreement, we need to ask ourselves, "Who ought?" Very possibly you will answer:


"Why, we ought -- the people, the government, organizations like the National Mental Health Foundation -- they ought to do these things."


If that is your answer, then stop right there and plug up that one last escape. Think it over a little, and finally declare: "Who ought? I ought!" For that is where ultimate responsibility rests -- on you! You will need the support of others in groups and organizations. But organizations are nothing more than active and concerned individuals, working together toward a common end. We each must bear our share of responsibility.


It is your choice. Which shall we have? Shall we allow the conditions depicted in this book to continue to exist? Are you willing to reread those incidents, point to them, and say, "I allowed that to happen, and I'll let it happen again?" Or are you going to get busy learning more, serving more, giving more and influencing more, to see that changes for the better are made -- and made soon?


You are on trial before the bar of justice for gross neglect and indifference. You cannot plead irresponsibility, saying that you did not know. The only valid plea that you can enter is that you are working hard to see to it that such things shall never happen again.




The National Mental Health Foundation is an outgrowth of concern on the part of citizens who, shocked and chagrined by what they have learned about institutions for the mentally ill and the mentally deficient, have themselves set about to learn more, serve more, give more and influence more -- to the end that the atrocities which daily occur in mental institutions may be speedily reduced.


In present conditions in institutions, the members of the Foundation see not only a national disgrace but a threat to the national well-being. They know that such total neglect and such needless misery cannot coexist with a healthy and productive society. The demands of humanitarianism and self-preservation call upon us for an immediate and positive attack upon the problems of mental disease.


The Foundation strives for active participation by its members. Membership is open to all who are concerned about mental health and share the objectives of the Foundation. At the same time that a drive tor an expanded membership in the Foundation is underway, an effort is being made to encourage all persons to support local and state mental health organizations. It is felt that only through such local groups can the ultimate goal be achieved. Until citizenship responsibility is assumed for supporting mental health measures, improvements in the care of the mentally ill will be but superficial reform at best. It is essential that the present public apathy and misinformation be dispelled.

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With this need in mind, a nation-wide educational campaign was launched in May, 1946. Our Mental Hospitals . . . A National Disgrace (Life, May 6, 1946) was written to a large extent from materials gathered by the Foundation. Then followed an impressive list of pamphlets on mental illness and mental deficiency: Toward Mental Health (Public Affairs Pamphlet No. 120); Forgotten Children (The story of mental deficiency); From Folly ... To Fetters . . . To Freedom; If Your Child Is Slow; Will They Be Cured?; What To Look For in a Mental Hospital; Where Does Your State Stand?; and many others.


In the fall of 1946 a series of eight radio dramatizations were transcribed for nationwide use. These have proven an effective aid to local and state organizations which are conducting educational programs, and by April, 1947, had already been scheduled on more than a hundred and fifty broadcasting stations in this country and in Canada. Recordings of the programs are available tor training and educational purposes.


A monthly magazine, The Psychiatric Aid, is issued for attendants and other employees in mental hospitals and in training schools for the mentally deficient. An effort is being made to improve standards of ward care through making more adequate provisions for the training and compensation of institutional employees. Long overdue recognition for the valuable services rendered by staffs of mental institutions will, when given in a tangible way, result in much of the needed reform.


For those who work constantly with the patients, the Foundation has published an orientation to mental hospital work, the Handbook for Psychiatric Aides; for attendants in schools for the mentally deficient, a Handbook for Training School Attendants is being prepared.


The Legal Division of the Foundation is currently preparing briefs of the mental hygiene laws of the forty-eight states. When this project has been completed, the Division will prepare, in cooperation with medical and legal organizations, model provisions for reference and study in relation to future legislation. A service of consultation and recommendation with regard to legal provisions and administrative rules will be maintained.


The Education Division encourages and services summer and year-round college and church projects in mental institutions. This not only brings needed personnel to the institutions, but serves as an effective method of bringing the problems of the mentally handicapped before those who will be in a position to bring influence to bear for needed improvements. The Division maintains a field staff to assist in local community activities and to develop and extend the various educational services of the Foundation. Volunteer service to institutions is encouraged. Assistance is given, whenever possible, to institutions which are attempting to recruit personnel. Special research and educational projects are undertaken from time to time.


In a time of aroused national interest in the problems of mental disease and in the care of the mentally ill, it is essential to extend the services and influence of the Foundation. The history of the care and treatment of the mentally ill and mentally deficient is a spotted history, showing many advances, many regressions. Now, we believe, the substance, power and vision are all at hand to keep a wave of understanding and reform rolling; united efforts of all who share the concern will accomplish our objectives.


Executive Secretary,
National Mental Health Foundation,
1520 Race St., Philadelphia 2, Pa.
APRIL, 1947.






Roger N. Baldwin
Mary McLeod Bethune
Mrs. William H. Biester, Jr.
Dr. Jacob Billikopt
Anton T. Boisen
Earl D. Bond, M.D.
Mrs. Walter A. Craig
Mrs. LaFell Dickinson
Kermit Eby
Mordecai W. Johnson
Mrs. J. Barclay Jones
Rufus M. Jones
Al Paul Letton
Orie O. Miller
Arthur E. Morgan
A. Douglas Oliver
Clarence E. Pickett
Samuel Radbill
Owen J. Roberts
Louis W. Schneider
Dr. D. R. Sharpe
Walter W. Van Kirk
Mary Jane Ward
M. R. Zigler




James Lewald, M.D.,
District Training School,
Laurel, Maryland


William Draper Lewis,
The American Law Institute


Karl Menninger, M.D.,
Winter General Hospital,
Topeka, Kansas


Mrs. Elizabeth Ross,
Psychiatric Social Worker


Lauretta Bender, M.D.,
Associate Professor of Psychiatry,
New York University


Earl D. Bond, M.D.,
Administrative Director,
Philadelphia's Pennsylvania Hospital


R. H. Felix, M.D.,
General Chief,
Mental Hygiene Division,
U. S. Public Health Service


Charles A. Zeiler, M.D.,
Department of Mental Health,
State of Michigan




Chairman, Owen J. Roberts
Daniel Blain, M.D.
Pearl Buck
Mrs. LaFell Dickinson
Helen Gahagan Douglas
Dorothy Canfield Fisher
Dr. Harry Emerson Fosdick
Mrs. Louis Gimbel
Sheldon Glueck
William Green
Helen Hayes
Rev. John Haynes Holmes
Rufus M. Jones
Bishop W. A. Lawrence
Henry B. Luce
Thomas Mann
Adolf Meyer
Anne Morgan
Arthur Morgan
Felix Morley
Reinhold Niebuhr
J. R. Oppenheimer
Thomas Parran
James G. Patton
Claude Pepper
Clarence E. Pickett
Daniel A. Poling
Percy Priest
Walter P. Reuther
Mrs. Franklin D. Roosevelt
Lessing J. Rosenwald
Mrs. Harry S. Truman
Dr. Henry P. Van Dusen
Richard Walsh
Gregory Zilboorg

Page 50:


Join the National Mental Health Foundation


NATIONAL MENTAL HEALTH FOUNDATION 1520 Race Street, Philadelphia 2, Penna.




I want to participate in your program to preserve and improve mental health and achieve the highest possible standards of treatment and care for mentally handicapped persons. I am enclosing $1.00 annual dues for my membership in the National Mental Health Foundation.


I am enclosing $................ as an additional contribution to the work of the foundation.


(Checks and money orders should be made payable to "National Mental Health Foundation." All dues and contributions are exempt from federal income tax.)


Street and No.............
City, Zone and State...




Further understanding and information about mental hospitals and those who live and work in them can be gained by reading any of the popularly written books listed below:


A MIND THAT FOUND ITSELF, by Clifford W. Beers. (Double-day-Doran, 1944, 402 pp.) This is the story of three years the author spent in mental hospitals. This book was the spark-plug in founding the National Committee for Mental Hygiene, and the present edition contains also the story of the Committee's forty-year effort to improve conditions in mental hospitals.


PRIVATE WORLDS, by Phyllis Bottome. (Houghton-Mifflin Co, 1934, 342 pp.) An account of three psychiatrists who understand the "private worlds" of other people but are not immune to botching up their own lives, this is an exciting and intriguing book. Inextricably woven into the fabric of the story are accurate insights into the proceedings of a mental hospital.


THE OUTWARD ROOM, by Millen Brand. (Simon & Schuster, 1937, 309 pp.) Opening with an escape from a mental hospital, this book, by following the efforts of a sensitive girl to accept normal living again, creates an understanding of a patient's problems "on the outside."


BRAINSTORM, by Carbon Brown. (Farrar & Rhinehart, 1944, 302 pp.) Somewhat sensational in approach and background, this book nevertheless gives accurate pictures of mental hospital life.


THE DARK GLASS, by Joan Charles. (Harper Bros., 1944, 287 pp.) With genuine understanding of the working of the mind, this interesting novel conveys much of the atmosphere and feeling of a mental hospital.


THE MENTALLY ILL IN AMERICA, by Albert Deutsch. (Columbia University Press, 1946, 530 pp.) Scholarly and authoritative, this history of the care and treatment of mental patients pictures the degrading conditions which have existed since Colonial times.


RELUCTANTLY TOLD, by Jane Hillyer. (Macmillan, 1926, 205 pp.) A sensitive and introspective account of four years in a mental hospital, this autobiography gives a clear, sympathetic understanding of the inner struggles which patients constantly face in their efforts to regain control of their minds.


IF A MAN BE MAD, by Harold Maine. (Doubleday and Co, 1947, 435 pp.) As an alcoholic, Mr. Maine found himself a patient in several mental hospitals, one after another. Then, recovered, he took jobs as an attendant in several more. This thoughtful account of his hospital experiences neither pulls punches nor hits below the belt. It is exciting, rewarding reading.


THEY WALK IN DARKNESS, by Ellen Philtine. (Liveright Publishing Corp., 1943, 388 pp.) This novel, written primarily from the standpoint of hospital staff members, contributes much accurate information about mental hospitals against the background of an involved plot.


ASYLUM, by William B. Seabrook. (Harcourt, Brace & Co., 1935, 263 pp.) Written by a famous traveler and reporter, this autobiography reveals experiences and associations quite as interesting as the author encountered in his travels to faraway lands. It includes many excellent characterizations of patients.


THE SNAKE PIT, by Mary Jane Ward. (Random House, 1946, 278 pp.) This Book-of-the-Month Club selection is a totally accurate, graphically presented picture of life in "one of the better" state mental hospitals. Its sensitive, humorous presentation makes for light reading but leaves a lasting impression. It you can read only one book from this list, read this one.

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