I associate neurologist and author Oliver Sacks with serene-laughter. Don’t ask me to define the term. The best I can say is: look at the image of him that appears on the cover of his book Musicophilia.
I read his book The Man Who Mistook His Wife for a Hat a long time ago, so I do not remember whether he employed magnificent figures of speech, or merely decent ones. But I do remember that his case-studies were not oppressive, despite the seriousness of the conditions he described. The New York Times called him the poet laureate of medicine for a reason.
After two heavy books, Kesey’s One Flew Over the Cuckoo’s Nest and Bly’s Ten Days in a Mad-House, I decided to find a fresh, uplifting voice on a similar topic. I settled for Asylum : Inside the Closed World of State Mental Hospitals, by photographer and architect Christopher Payne, and with an introduction by—you guessed it!—Oliver Sacks. It was published as an essay in the New York Review of Books, under the title The Lost Virtues of the Asylum.
You see where the title is going.
Ideally, I would quote the introductory paragraphs here, then dissect their arguments below, but the post would become too cumbersome. Instead, I urge you to read the first few paragraphs of the NYR page to feel the power of his argument, before having me ruin its effect.
Now, line by line, here is how Oliver Sacks disarms my dreadfully prejudiced and darkly forming opinion of mental institutions—the same opinion I have been imposing on you this week.
We tend to think of mental hospitals as snake pits, hells of chaos and misery, squalor and brutality.
My response: yes, I agree! This is his opening salvo and by using we he is establishing that both he and I, the reader, have a common ground and that we are likely to share concerns. The tend implies doubt, or perhaps prejudice. I’m already half-primed to hear a but.
Most of them, now, are shuttered and abandoned—and we think with a shiver of the terror of those who once found themselves confined in such places.
Definitely. My previous post about the fear of being mistakenly, irrevocably judged insane, was written earlier, so how could I not agree. He reaffirms commonality with the we, and has moved from a detached tend to think to a more primal shiver of terror—an appeal to the emotions.
So it is salutary to hear the voice of an inmate, one Anna Agnew, judged insane in 1878 (such decisions, in those days, were made by a judge, not a physician) and “put away” in the Indiana Hospital for the Insane.
The correlative conjunction So implies that what Sacks says next is a result of our previously agreed statements; so it is salutary warns me that this is actually the but I was waiting for, the contrast (because there is nothing salutary about the vision of mental institutions so far). Indeed, he is saying that it is salutary to hear from the inmates themselves, rather than hastily making the judgements of the first two sentences.
Anna was admitted to the hospital after she made increasingly distraught attempts to kill herself and tried to kill one of her children with laudanum.
He gives Anna’s circumstances: the most dire and extreme, therefore drawing out my emotional response, involving me with the voice he is about to invoke.
She felt profound relief when the institution closed protectively around her, and most especially by having her madness recognized.
Finally, he states his point by summarising her stance. I’m already involved with her as a character, and I can believe that her internal darkness would be much worse outside the institution than inside it.
As she later wrote:
And now he’s ready to quote her.
Before I had been an inmate of the asylum a week, I felt a greater degree of contentment than I had felt for a year previous. Not that I was reconciled to life, but because my unhappy condition of mind was understood, and I was treated accordingly. Besides, I was surrounded by others in like bewildered, discontented mental states in whose miseries…I found myself becoming interested, my sympathies becoming aroused…. And at the same time, I too, was treated as an insane woman, a kindness not hitherto shown to me.
How different her point of view is from that of the characters in Cuckoo’s Nest! No cynicism, no hyperbole. Being treated as insane was a relief. Hearing this other point of view makes all the difference, especially since she does not “sound” insane in the way we “tend to think” insane voices sound. But this is not enough, Sacks continues to quote her.
Dr. Hester being the first person kind enough to say to me in answer to my question, “Am I insane?” “Yes, madam, and very insane too!”… “But,” he continued, “we intend to benefit you all we can and our particular hope for you is the restraint of this place.”…I heard him [say] once, in reprimanding a negligent attendant: “I stand pledged to the State of Indiana to protect these unfortunates. I am the father, son, brother and husband of over three hundred women…and I’ll see that they are well taken care of!”
How different her words sound from that of Nellie Bly! The doctor is actually in command, setting negligent attendants straight, pledging himself to be all that a man could be to the women under his care.
The rest of Sacks’s article is just as good, and indeed, salutary—he reminds us that the old term lunatic asylum meant sanctuary, and that even the worst hospitals in the 1950s had pockets of human decency. (He balances his view by warning against romanticising madness or madhouses, as there is an immeasurably deep sadness about mental illness.)
The essay by Christopher Payne gives a historical overview of mental hospitals in America: from their idealistic beginnings in 1840s, as self-sufficient institutions with food, clothing, heat and entertainment produced on the premises, and as technological marvels of their time, offering modern amenities and possessing striking similarities to great resort hotels of the era, to their decline after the peak in the mid 1950s when psychotropic drugs were developed, laws were changed, and the flux of the times heralded a (premature?) obsolescence. Payne’s photographs were taken in the past decade or so, and they show yards and wards and hallways and details of specialised spaces, in various peeling, moss-covered states of disrepair. However, his collection gives a complete picture in it’s own way, as Payne explains in the Afterword.
Almost every hospital had something special to offer: an extraordinarily well-made building that had been abandoned for years, or, perhaps, a locked room whose contents were an unintended time capsule. It was no longer possible to find one hospital with all its parts intact, but by juxtaposing a photograph of a theatre from one hospital, a morgue from another, a bowling alley from a third, and so on, an entire model hospital could be recreated.
What I found most remarkable, is that these institutions seemed to have a kind of dignity associated to them—something I would not say is the case today.
Sadly, few Americans realise that these institutions were once monuments to civic pride, build with noble intentions by leading architects and physicians who envisioned the asylums as places of refuge, therapy, and healing.
Amen to that.
- My other two companion posts, Hiding Behind Hyperbole on Kesey’s One Flew Over the Cuckoo’s Nest and To Be Sane Amongst the Insane on Bly’s Ten Days in a Mad-House.
- Asylum : Inside the Closed World of State Mental Hospitals, Photographs by Christopher Payne and Introduction by Oliver Sacks.
- The Man Who Mistook His Wife for a Hat, Oliver Sacks. You’ll have fond memories of the book.
- Love’s Executioner: & Other Tales of Psychotherapy, Irvin D. Yalom. Some mighty riveting tales. A lot of reviews class the book as non-fiction. This is misleading. Indeed, here is the author speaking in the Afterword: As I started writing, I had no idea where a story would lead or what shape it would take. I felt myself almost a bystander as I watched it develop organically. This means Yalom’s stories are fictional. He does say the book was meant to be a collection of teaching stories aimed … at the young psychotherapists and all other people, including patients, interested psychotherapy, but this doesn’t change that his book is fiction in every but the widest, most didactic of senses. Please, reviewers, at least mention such facts.