by Darby Penney and Peter Stastny; New York, Bellevue Literary Press, 2008, 205 pages, $14.95
Dr. Geller, who is the book review editor, is professor of psychiatry and director of public-sector psychiatry at University of Massachusetts Medical School, Worcester.
Penney and Stastny, authors of The Lives They Left Behind, deserve great credit not only for saving "suitcases from a state hospital attic" from being destroyed but also for bringing to life the patients whose property was excavated. However, I was dismayed that they did not trust the patients to speak for themselves. Instead, the authors, by grafting their views onto the patients' lives, have undermined the memories they worked so hard to preserve.
First, the authors inflame the reader with ideological rhetoric. For example, they equate the patient to a "prisoner of the mental health system." They claim to be able to pick out a group of psychiatric patients by their "medication shuffle." They state that psychiatry was and is "largely in the business of stripping patients of their quotidian identities." Further, they claim that psychiatric diagnoses neither previously nor currently "provide a basis for successful treatment and recovery." Also, hallucinations, paranoia, and major depression are described as responses to stress and diversity and not as "indications of a chemical alteration in the brain." Biological psychiatry is put forward as a model to explain "so-called schizophrenia" that "posits a brain-based process that injects toxins into itself … a sprouting of malignant neurons." The authors explain that psychiatry has "generally been complicit" in violence and loss, driving women mad throughout history.
Second, the authors put forth a revisionist history. The following pronouncements do not comport with historical fact: American psychiatric hospitals of the 19th century were built to accommodate thousands of patients; this is contrary to Thomas Kirkbride's design, whose model was most followed. Another claim: for over 100 years, Willard State Hospital sustained itself "by the labor of its mostly unwilling charges"; however, the authors' own accounts dispute this. Next, they claim that the end of unpaid patient labor in 1973 was a major factor in deinstitutionalization; however, it is common knowledge that deinstitutionalization was well under way a decade earlier. They indicate that male psychiatrists in the 19th century were "all too willing to oblige" husbands who sought to "institutionalize their troublesome spouses." Yet Superintendent Andrew McFarland tried desperately to rid himself and his hospital of Elizabeth Parsons Ware Packard (1). Although the book describes Willard Hospital as unique in admitting individuals with neurosyphilis and elderly persons because there were no other institutions to do so, all state hospitals for the first half of the 20th century admitted such persons (2).
More revisionist history: the authors perpetuate the view that a diagnosis of schizophrenia "virtually guaranteed lifelong institutionalization" even in the 1950s. Psychiatric Services is replete with articles from its 1950s editions that dispute this portrayal (3). Also, the authors claim that although 19th century psychiatry touted recreation as therapeutic, this was just pretense—its true purpose being "to lighten the workload of attendants and administrators." Nineteenth century psychiatrists wrote much to the contrary, however (4). According to the authors, "before the introduction of 'modern' psychiatric drugs in the 1950s, there was little offered in the way of mental health treatment." This is simply not so (2,3,4). Further, they claim that neuroleptic drugs such as chlorpromazine did not actually improve people's mental or emotional state; again, there is evidence to dispute this (5).
Third, the authors actually do what they claim not to have done: they create "a posthumous pasting together" of lives that is an "exercise in puzzlegamesmanship."
Let us take one of the suitcased lives:
Rodrigo Lagon drafted a letter to his uncle in 1921, two years after his admission to Willard State Hospital. His letter opens with, "I am pleased to inform you I am still living at Willard State Hospital" and closes with a postscript, "I have no definite knowledge yet when I shall obtain my freedom." The authors conclude that Mr. Lagon did not feel he was hospitalized for treatment at that time. How could they know? That Mr. Lagon went on from there to be hospitalized another 60 years is outrageous—on that we concur. But what was Rodrigo Lagon's experience? Opening the suitcases allows the authors to bounce their views off the saved possessions of the lives of Willard State Hospital's former patients but fails to allow Mr. Lagon and the others—so often voiceless—to speak for themselves. Did Penney and Stastny think that we, the readers, would not hear them?
The authors say "the suitcase owners' responses to decades of hospitalization ranged from resignation to resistance, from despair to hope that they might someday be released." They go to great lengths, on an admirable endeavor, to portray the richness of the lives of people who shared mostly that they passed through the portals of Willard State Hospital. Why transform their reactions to Willard State Hospital into such a flattened range of responses? What about gratitude, fury, safety, fear, familiarity, ambivalence, comfort, a sense of belonging, and freedom from homelessness, starvation, and routinely untreated physical ailments?
Or did the authors not trust the doctors, whose records are cited extensively? Much to my surprise, these physicians, whose caseloads could number in the hundreds, recorded patients' perspectives—the good, the bad, and the ugly—infrequently (preposterously so by any contemporary standard) but with a texture that today is in the process of being obliterated by the electronic medical record.
Finally, Rinzler's photographs are excellent. I am sorry I missed the traveling exhibit. I believe it would have left me sad about these patients' lives. The book left me sad about what has been done with their life remains.
The reviewer reports no competing interests.
1.Curwen J: Proceedings of the Association of Medical Superintendents. American Journal of Insanity 29:137–263, 18722.Grob GN: Mental Illness and American Society, 1875–1940. Princeton, NJ, Princeton University Press, 19833.Geller J: The last half-century of psychiatric services as reflected in Psychiatric Services. Psychiatric Services 51:41–67, 20004.Butler JS: The individualized treatment of the insane. Alienist and Neurologist 7:435–460, 18865.Bird EG, Goss JD, Denber HCB: Preliminary clinical reports: chlorpromazine in the treatment of mental illness: a study of 750 patients. American Journal of Psychiatry 111:930, 1955