Personal Accounts: My Experiences as a Psychiatric Patient in the 1960s
In 1969, a turbulent decade was coming to an end. For me, that turbulence came in the form of having to deal with a serious mental illness when the system for treating mental illness was changing as much as the rest of society was. During that decade I spent more than 40 months in nine different psychiatric hospitals, most of them state institutions. I had 13 separate stays at these hospitals. At the close of the decade I walked into a community mental health outpatient clinic for the first time and never returned to a state hospital.
I had my first manic episode in 1958, when I was entering my senior year at Denison University. I left school and was hospitalized at a community hospital for about two weeks. I received shock treatments and returned to school, hoping that my symptoms were a one-time occurrence. I managed to graduate, but pursuing my goal of an advanced degree in theology proved to be frustrating. My recurrent symptoms landed me in several different hospitals in four states, depending on where I was working or studying at the time.
Grace New Haven hospital, a private hospital where I spent several weeks in 1960, was the first of my hospital experiences in New England. Although little active treatment was provided, I did receive some group therapy, and both the treatment and the environment proved to be better than most of my subsequent experiences.
In 1961 I spent eight months at Massachusetts Mental Health Center in Boston. I received about three sessions of psychotherapy with a psychiatrist every week. However, I was bored, having little to occupy my time. I was allowed out to walk around the block, and, if my family had sent me any money, I would buy a cup of coffee and a pastry.
For the most part the only therapy I received during my 40 months of hospitalization was drug therapy with Thorazine (chlorpromazine). Danvers State Hospital in Massachusetts, which hosted me for three months in 1963, was typical in that I received no treatment other than medication. Just a steady diet of institutional food, chlorpromazine, and boredom. The admission ward at Danvers was extremely crowded and chaotic, but the specialty unit to which I was later transferred was a bit more comfortable.
Discharge planning and follow-up treatment were notably absent from most of my hospitalization experiences in the 1960s. The process of transfer from one hospital to another was difficult and painful. In hospitals in Connecticut, Massachusetts, New York, and Pennsylvania I had no knowledge of any discharge planning and was not linked with community services when I was discharged.
In 1965 I found myself in a Howard Johnson's restaurant in New York's Times Square, where I ordered a large meal and several drinks. At the end of the meal I revealed that I had no money. Being somewhat manic, I thought this was funny, but the restaurant manager did not. Soon the police showed up and took me, involuntarily, to the infamous Bellevue Hospital. Bellevue was a nightmare—extremely crowded, with many patients' beds in the hallways. The conflicts among the patients were never-ending. My treatment consisted of my old standby, chlorpromazine, with Stelazine (trifluoperazine) added. The trifluoperazine made me extremely agitated, so I spent most of my time at Bellevue pacing the floors.
After several months the Bellevue doctors transferred me to Central Islip State Hospital on Long Island, a much calmer environment. At Central Islip some of the patients provided shaving services to the other patients. These patients were unskilled or used bad razors—or both—so I endured a lot of bleeding from the many nicks and cuts they unintentionally inflicted. Even though I was not alcoholic, I went to the Alcoholics Anonymous meetings on the ward with some other patients for the free coffee and donuts that were provided.
While I was at Central Islip, my brother tried to get me transferred back to Pittsburgh. He encountered great difficulties with the New York and Pennsylvania bureaucracies, but finally the hospital flew me back to Pittsburgh with an attendant, and I was admitted back to Mayview State Hospital, my home away from home (I had four stays there during the 1960s).
A year later, in the midst of another unsuccessful attempt at graduate school, I had several brief stays (each less than a month) at the City Hospital in Hartford, Connecticut. There on the psychiatric ward I received drug therapy and nothing else. When I stabilized they sent me back to school. After several episodes of this pattern, a friend took me to see an Episcopal priest, who took me to Norwich State Hospital.
The Norwich Hospital environment was decent, and I was fairly comfortable there. Compared with other hospitals, Norwich had more group therapy, art therapy, and activities such as holiday parties. After two months, I was discharged from Norwich under the assumption that I would return to the seminary. Instead, however, I caught a bus back to Pittsburgh, where I managed to get a bed in a rooming house and a job with juvenile probation.
I was relatively successful in the juvenile probation job. About a year into the job a family doctor prescribed Valium (diazepam) for stress, and that turned out to be rather helpful. It is notable that even after all those hospitalizations I was not seeing any kind of mental health practitioner in the community. After nearly two years I finally quit the job because of stress. A few months later, in 1969, I had an anxiety attack and drove myself to Mayview. This was to be my fourth and final stay at that hospital.
My first stay at Mayview had been the worst experience of my life. This experience began with a brief hospitalization at a local community hospital in 1961, followed by an abrupt transfer to Mayview, where I remained for six months. The hospital used an assembly-line technique to administer electroconvulsive therapy (ECT). I could see many people in front of me getting treatment and going through convulsions. I saw about five of these treatments before actually getting to the gurney myself. I was told to put my head down so that the electrodes could be attached. I knew that once I put my head down, which I dutifully did, the electrodes would touch my forehead and I would be convulsed and knocked out by the shock. When I came back to consciousness, I was given coffee and something to eat and was then sent back to the ward. During this stay at Mayview I received 20 ECT treatments, two per week. After the shock treatments I was given chlorpromazine and forced to work in the bakery without pay. I thought that after 23 years of life my world had come to a bizarre and shocking end.
Upon waking from ECT, I always felt depleted. Once the treatments were over, the chlorpromazine made me feel like a zombie. This first stay at Mayview was the most horrendous experience of my life. There were some social activities, such as dancing and singing, but I found them bizarre and refused to participate. I did engage in occupational therapy, mainly crafts. Mostly, however, I just sat around and gained weight because of inactivity and the side effects of my medication. When I finally got on an open ward, I enjoyed walking on the hospital grounds and going to the hospital store.
After I left the hospital, I continued to feel like a zombie until the psychiatrist, at my only follow-up appointment, discontinued my chlorpromazine (and did not replace it with anything else). Only after the chlorpromazine wore off did I feel human again; only then could I start to think clearly.
My second stay at Mayview, in 1964, also came after a brief hospitalization at the previously mentioned community hospital. This stay at Mayview was not as bad as the first one. However, I was forced to carry soiled laundry from building to building, my payment being a candy bar at the end of the day. I believe I had the option of not working, but I was afraid that if I refused to work I would lose my chance to be discharged from the hospital. My treatment was strictly chlorpromazine and custodial care.
My third stay at Mayview was the one after I was transferred from Central Islip. This time I was allowed to work at the Little Store, a small snack shop and restaurant on the hospital grounds. This was a great improvement over the laundry and the bakery, and this stay at Mayview was consequently much more pleasant. Nevertheless, I still received no active treatment and no follow-up treatment.
When I admitted myself to Mayview for my fourth and final stay in 1969, the hospital did not want to admit me. But I refused to go home, and they finally let me in. This experience at Mayview was briefer and better than my previous three stays. The environment had improved, and the patients were treated more respectfully.
So my first stay at Mayview State Hospital was the worst, and my last was the best. Still, other than ECT and drug treatment, there was little else to help me work toward recovery. Upon my final discharge, however, a nurse put me in touch with the outpatient clinic at Western Psychiatric Institute and Clinic. There, in 1969, I started weekly psychotherapy that lasted five years. I resumed taking diazepam and in general fared much better than I had in the previous decade. Of course, I still had the misdiagnosis of schizophrenia. It was only much later, in 1982, that I was finally given a diagnosis of bipolar illness—the diagnosis I consider to be the correct one.
In the 40 months I was hospitalized in the 1960s, I experienced the absence of what is now commonplace—active treatment, discharge planning, and connections to community-based treatment. The treatment I received was for the wrong diagnosis, and consisted mainly of powerful doses of a single antipsychotic drug. The treatment included many inhumane elements, including overcrowded conditions, forced work, and a lineup for ECT.
We have come a long way since then. Today the opportunities for recovery are much better. There are more integrated and holistic approaches, more rehabilitation, and less toxic medications, and more attention is given to wellness and community integration. Now I have better information about my illness and what I need to do to cope with it, and I am an active participant in my own recovery. Consequently, I spend less time in the hospital and more time in the community; I spend less time dealing with my illness and more time working on the rest of my life.
Mr. Carney lives in Pittsburgh. Send correspondence to him at Carson Towers, 2117 East Carson Street, Apartment G10, Pittsburgh, Pennsylvania 15203. Jeffrey L. Geller, M.D., M.P.H., is editor of this column.
