Patient H.M. (7 page)

Dickens judged the asylum “admirably conducted” and cracked a joke when he learned that one of the inmates he met heard “voices in the air.”

“Well!” thought I. “It would be well if we could shut up a few false prophets of these later times, who have professed to do the same; and I should like to try the experiment on a Mormonist or two to begin with.”

Dickens was not the asylum's only admirer. One of the institution's later superintendents, writing of those early years, stated that “there apparently was no criticism of the hospital or the quality of care given to its patients,” though he did add the following caveat: “There were old wives' tales about the supposed occult happenings in the hospital, of course, but that is not uncommon for mental institutions. People have difficulty understanding the nuances of mental disorder, so fantasy often takes the place of fact in their minds and all too often in their conversations.” Another observer, a doctor who admired the gentle and largely hands-off “moral treatment” given to even the asylum's most hopeless cases, wrote that “it is only, as it were, twining fresh flowers on the graves of the dead, still it is a grateful sight to the humane, and a more certain indication of high civilization than the most refined taste in literature and the arts or the most fastidious of social etiquette.”

By the time my grandmother passed through the gates of the asylum, a hundred years after Dickens, things had changed, and the moral treatment that was at the heart of the institution's original mandate had transformed into something very different.

It was beautiful, that much remained the same.

The car drove through the gate and up the gently sloped driveway that led to the asylum's main building. If she was looking out the window, my grandmother would have seen carefully tended flowers and bushes and lawns glide by. Frederick Law Olmsted, America's greatest landscape architect, the man behind Central Park, had overhauled the grounds in the late 1800s, seeding it with a harmonious assortment of ginkgoes, sugar maples, black walnuts, sweet gums, copper beeches, and the only living pecan tree this far north. The vehicle rolled past elegant cottages and a few larger dormitories, then pulled to a stop in front of the oldest structure on the campus, the palatial administration building. If my grandmother was feeling well enough to exit the car without assistance, Pete Souza, a Portuguese-born sailor who had worked as the asylum's head porter for almost a decade, would have been there to grab her bags and show her inside, where a receptionist sat behind a desk, waiting to check her in. From there, Souza would have escorted her to her room, which was tastefully appointed. On her bedside table, a member of the housekeeping staff had probably left a copy of a slim magazine called
The Chatterbox
. There was an Easter Bunny on the cover, peeking out through a thicket of lilies. If she picked the magazine up and flipped it open, she would have found a notice on the opposite page advising her that the publication was “prepared fortnightly for the Guests of THE INSTITUTE OF LIVING.”

The name was new. One year earlier, the asylum's superintendent, Dr. C. Charles Burlingame, had successfully petitioned the Connecticut General Assembly to have it change the facility's name to the Institute of Living from the Neuro-Psychiatric Institute of the Hartford Retreat, which had itself replaced the original, the Hartford Retreat for the Insane, in 1931. Burlingame had also requested that in all future references to his institution the word
asylum
should be replaced with
mental hospital,
and that any use of the adjective
insane
should be replaced with the words
mentally ill.
Words, appearances: These things were important to Burlingame. As he once wrote, he strove to make the Institute of Living a “meticulously normal place.”

On the surface, he more than succeeded: When my grandmother flipped through the pages of
The Chatterbox,
she would have found pictures of a place that looked more like a country club than anything else. There was an outdoor swimming pool, a small putting green next to the Golf House, a volleyball court, even an indoor ten-pin bowling alley. She'd see advertisements for some of the goods available at Vauxhall Row, the asylum's own shopping mall: She could buy artisanal Ajello candles and Easter greeting cards at the Here-It-Is Shop, purchase a variety of different corsages—starting at ninety cents apiece—at the Vauxhall Row Flower Shop, or browse a selection of newly arrived bestsellers at Ye Royale Booke. She would find photographs of some of the guest-created handicrafts on display at “our little arts and crafts colony in Center Building,” a collection of “avocational shops”—Ye Glaziery, Ye Silver Smithy, Ye Bindery, and Costume à la Main—known collectively as Pomander Walk. (A pomander is a perfumed ball that can be suspended from a necklace. It was a popular fashion accessory in the eighteenth century, when doctors prescribed it to help ward off plague.) One of the asylum's annual reports stated that Pomander Walk strove “to create an entirely non-institutional atmosphere,” and that it was “designed to simulate an early English road, with the shop exteriors constructed of half-timbers in the Elizabethan manner.”

In the entire magazine there was no indication of what the Institute of Living really was, except for one place, on the fourth page, where the veil was drawn back a bit. There, a gentle admonition was printed next to a drawing of a bunny standing on its hind legs:
DON'T TELL YOUR TROUBLES
, it began, then continued: “Easter time is an excellent opportunity to reflect upon the trials of another, to whose sacrifice it is dedicated. Your doctors and nurses always are willing listeners but others may be spared by trying to emulate the spirit of selflessness that marks this season.” Keeping the guests from discussing their mental states with one another was a part of the institution's efforts to maintain its meticulously normal appearance, and some variation of this advice was contained in every issue of
The Chatterbox,
often in rhyming form, as in the previous issue, where the following lines ran under a cheery illustration of a horn-playing cherub:

T
O
O
UR
G
UEST

Welcome to our guest!

To you, we make this one request:

When your symptoms you would discuss,

Tell no other guest, but do tell us.

—THE DOCTORS AND NURSES

My grandmother violated the spirit of that dictate within hours of her arrival. That evening, instead of going to sleep, she removed all her clothes, pounded incessantly on the locked door of her room, and ranted in a loud voice. It was, at the very least, a disturbance to the neighboring guests. Attendants soon arrived. They helped her get dressed, took her outside, then escorted her across the campus to a building known as South One. There, that first night, she received her first glimpse of the dark reality that lurked beneath the asylum's placid surface.

S
outh One was a white-tiled, dimly lit, and sound-insulated room full of exposed plumbing and valves. There were five large tubs in the room, and it was quite likely that at least one of them was occupied by another of the 355 guests currently residing at the Institute of Living. The empty tubs had been scrubbed clean with yellow soap, and one of these tubs was now prepared for my grandmother. A nurse unlocked a control panel on the wall and used the valves and knobs behind it to fill the tub with water. Given my grandmother's behavior that evening, it is likely that the nurse chose to make the water very cold, as cold water, and its attendant hypothermia, was known to have sedative effects on mammals. Aides stripped off whatever clothes my grandmother still had on, coated her body with oil, then placed her in the tub. If she struggled, and there is no reason to believe she did not, attendants forced her down and strapped a large sheet of heavy fabric over the tub, leaving a small aperture for her head, trapping the rest of her body beneath.

It is not clear how long they kept her there. A treatment of “continuous hydrotherapy” at the Institute of Living typically ranged from hours to days to, in exceptional cases, weeks. If this session lasted a long time, a staff member would remove my grandmother every four hours and “relubricate” her before returning her to the tub. This was to prevent her skin from becoming excessively dry. Every twelve hours, she would receive an alcohol rub.

Eventually the staff decided she was calm enough to return to the residential area, where a clinician noted that she was, for the moment at least, much quieter and seemed to be enjoying herself playing the piano.

Guests at the Institute of Living underwent an extensive series of interviews over the course of their stays, during which psychiatrists probed their life stories for clues to their present conditions. Summations of these interviews were then typed up and placed in the patient's file. On the first page of my grandmother's clinical notes, under the heading “Personal History” and the subheading “Intellectual and Social Development,” a psychiatrist wrote the following:

A bright child and adult. Culturally, she is above the average, received high marks at school and at college, graduated from Vassar with a B average. She has an excellent mind, is a great reader of all types of literature, she majored in music and shows considerable ability, both with the piano and slightly on the cello. She has a true love of music, without any sentimental forced feelings towards arts, literature, or culture. Delinquency—none. Neither a model child or any immoral tendencies. Adult intellectual level—markedly above the average, but in a completely feminine fashion. A good mind, a logical mind, an extremely sensitive mind, especially towards the arts and music.

My grandmother had an unusually privileged upbringing. She grew up in Manchester, Connecticut, where her mother's side of the family owned a business—the Cheney Brothers Silk Manufacturing Company—that, during her teen years, was the largest producer of silk outside of China and one of the wealthiest corporations in the United States. Manchester was a company town—one in four residents worked for Cheney Brothers, and the company's campus, which sprawled over hundreds of acres and included its own hospital, school, and power utilities, was in many ways a city unto itself.

The company peaked when she was fifteen years old and then began a slow decline, brought on by the rise of rayon and other synthetic materials. No matter: She wasn't going to be tasked with saving the company. Women had never played important roles in the family business. Her mother had ten siblings; most of them lived on the Cheney Brothers compound, and my grandmother could have gauged the relative importance accorded the sexes with a quick glance at the comparative sizes of her aunts' and uncles' cottages and mansions, respectively.

She adored music, always. After graduating from Vassar in 1933, she moved to Vienna to study the piano and spent a gilded year in the city. She embarked on an affair with a married concert musician and found employment as a pianist in silent-movie theaters, improvising emotional soundtracks to the oversize characters flickering on the screens above her. But the year came to an end, and she boarded a ship back home to Connecticut. Shortly after her return, while she was riding in the passenger seat of a friend's Model T, a dashing young medical student jumped onto the running board and introduced himself as Bill Scoville.

The Cheney Brothers Silk Manufacturing Company declared bankruptcy in 1937, selling off, among other things, its private railroad. At the time of my grandmother's institutionalization, however, the company was experiencing a brief resurgence, having scored a contract to manufacture the silk parachutes used by most American aviators during World War II. But I imagine that the ups and downs of the silk industry were far from her mind as she sat at the piano in the residential hall, temporarily subdued by her hydrotherapy, perhaps playing from memory one of her beloved Chopin pieces.

It was a moment of respite, a brief interlude, before her next treatment began.

One morning during my grandmother's second week at the Institute of Living, attendants woke her at six
A.M.
and served her tea and toast before escorting her to the Pyretotherapy Room on the first floor of White Hall, a brick building on the eastern edge of the campus. The room was medium-size, and a mural of a desert oasis covered the walls, palm trees and sand dunes and birds silhouetted against a blue sky. Alongside one of the walls, pushed up against a painted dune, there was what appeared to be a copper coffin with a semicylindrical lid. A nurse opened the top of the device, revealing a thin mattress inside. Once my grandmother had disrobed, she lay down on the mattress, and a blanket was placed over her before the lid of the device closed. Her body, from her neck down, was entirely inside. Her head protruded from a hole at one end and rested on a pillow.

An infrared lamp inside the device radiated heat, while a machine called an inductotherm monitored the temperature, allowing staff members to adjust it as desired. A fan circulated hot air inside the device. A pan of water sat near the fan, maintaining high humidity to prevent excessive skin dryness. Every fifteen minutes, a nurse took my grandmother's temperature. Humans are warm-blooded and can generally maintain a uniform body temperature of approximately 98.6 degrees regardless of their environment. Eventually, however, when exposed to relentless heat, the body's thermostatic ability breaks down and its internal temperature begins to rise.

That first day, within the first two hours of treatment, the attendants managed to induce a fever of 102 degrees in my grandmother and then adjusted the inductotherm to maintain that approximate level of fever for the remainder of the session. Along with her temperature, they monitored my grandmother's pulse and respiration, looking for signs of acute distress. By the time they let her out of the cabinet, she had been inside for a total of eight hours. She was allowed to rest for an additional hour inside the Pyretotherapy Room and then was escorted back to her residence. The next morning attendants woke her at six
A.M.
again, and the process repeated itself, only this time they brought her temperature up to 103 degrees.

By the fourth day of treatment, they were able to induce a fever in my grandmother of somewhere between 105 and 106 degrees.

Pyretotherapy, or fever therapy, had been one of the treatments offered at the asylum for at least a decade, though the mechanisms by which the fevers were induced changed over the years. In the past, nurses would inject patients with a strain of malarial parasite, giving them a “benign malaria” that caused high fevers. The electropyrexia cabinet used on my grandmother was meant to achieve the same results, in a more modern, controllable way. It had been installed at the Institute of Living five years before her arrival, and an issue of the staff newsletter from around that time boasted that when compared to the biological method it “produces equally good results.”

Toward the end of her first full week of pyretotherapy, a clinician noted that although my grandmother was still delusional, rambling about “transmigration” and falsely identifying asylum guests and staff as “various different friends she has known in the past,” she was on the whole “quite pleasant” and “quieter.”

On the second page of the asylum's clinical notes about my grandmother, under the subheading “Mental Make-Up and Type of Personality,” a psychiatrist described her as “entirely unaggressive,” “extremely sensitive,” “gentle and kind,” and “utterly feminine.” The psychiatrist then spent some time discussing her relationship with my grandfather and judged it to be a healthy one: “The marriage actually has been extremely happy and congenial,” he wrote, “with the two being together constantly for 10 years, making many trips, skiing abroad, and sharing a book, art, etc. The husband has been happy in his marriage and at no time has ever considered or wished he was married to another.”

My grandfather would have agreed with this assessment. In a letter he wrote to his parents on January 29, two days after the breakdown, he wrote, “I have been so happily married, and am utterly heartbroken.”

My grandmother, on the other hand, had a different, more negative opinion of the marriage. According to her psychiatrist, this view was itself a symptom of her mental problems. “She is too idealistic,” he wrote, “demanding too much perfection in her husband.” My grandfather, the psychiatrist continued, “is truly devoted and loyal to her, but has upset her by mild promiscuity.” Her husband's infidelity, my grandmother's psychiatrist concluded, “has upset her to an exaggerated degree.”

The psychiatrist was clearly comfortable making certain basic judgments about my grandmother's backstory and modes of thought, but he did not pretend to understand the precise biological or psychological causes of her breakdown. Just as it had been a century prior, mental illness remained largely a mystery. As Charles Burlingame, the superintendent of the Institute of Living, put it, “psychoses can hardly be called disease entities, even now, but are regarded as manifestations of a disease process, concerning the real sources of which we can do little more than speculate at the present.” What had changed, however, was the asylum's attitude toward the treatment of these mysterious illnesses. Whereas in the institution's early days, treatments were conservative and minimalistic, they had by my grandmother's time become aggressive and prolific: In Burlingame's view, “in psychiatry there should be no conflict between the various therapies.” Each type of treatment, he argued, “has merit and should not be discarded,” and the best treatment plan for the asylum's guests was consequently almost always a multivalent one.

My grandmother had endured hydrotherapy and pyretotherapy. She was still not well. A third treatment was prescribed.

Some days she would wake up and they wouldn't give her any breakfast. Not even tea and toast. This had been going on for months now, about three times a week, and she had learned what it meant. She knew what was coming. Or she knew that something was coming, something she dreaded. It was a vague, indistinct dread, though, since what was coming always caused a short-term amnesia and she'd never quite remember it the next day.

The aide would escort her from her residence to the building called Butler One. They would follow a special route between the two buildings, one that minimized the exposure of my grandmother to other guests in case she caused a commotion. This was not because my grandmother was particularly volatile. The same instructions applied to any guest being escorted to Butler One. Conversation was also to be kept to a minimum. Burlingame stressed these points in an employment manual that was provided to the aide shortly after his hiring: “In escorting Guests, do not discuss the treatments; try to be reassuring, considerate, quiet and pleasant. Securing the Guests' co-operation aids the Guest in receiving the maximum benefit from the therapy.”

Once the aide and my grandmother arrived at Butler One, the aide would escort her inside to the Therapy Room.

“You will not,” the aide's manual read, “discuss anything which transpires in the Therapy Room with the Guest or anyone else, except members of the personnel to whom you are responsible in connection with the care of the Guest to whom you are assigned. Under no circumstances will you give any details to the Guests themselves.”

This is what transpired in the Therapy Room.

The aide brought my grandmother to a chair, then checked to make sure that she did not have any glasses or hairpins or jewelry on her person. Had she been wearing false teeth, which she was not, the aide would have removed those as well. Had she been wearing a girdle, the aide would have loosened it. Same with a belt. The nurse in charge in the Therapy Room double-checked the aide's work, then the aide guided my grandmother to one of the beds. My grandmother lay down on a loose sheet atop the mattress, and the aide carefully placed a foam-rubber pillow just above her shoulder blades. The aide requested that my grandmother place her arms by her side and extend her legs. The sheet was then wrapped around my grandmother, pinioning her legs and arms in place. Her head remained exposed. The aide placed a rubber gag in her mouth, then held down her shoulders while a second aide held down her hips. It was important that she be immobilized as much as possible, as the therapy she was about to experience caused muscular contractions so violent that unrestrained limbs had been known to thrash around so hard that their bones broke.

Once the nurse in charge had checked again to make sure all was in order, she brushed out of the way any strands of hair that may have fallen across my grandmother's forehead and then applied the electrodes to her skin.