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.
Reading Recommendations
- 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 Quiver Of Quotes 
I’ve delayed responding to this because I have too much to say! Apologies therefore, for the essay which follows and which is really off-topic in terms of language and the written word.
Firstly, thanks for a great ‘balancing’ post, and one which offers such food for thought. How easy it is for any of us to regard such institutions with disdain when we ourselves have had no experience of them. Their images are frequently built upon film and literature and we think of them either as places of fear and horror or as staffed by eccentrics bent on their own agendas. It’s refreshing to hear of accounts that redress this skewed portrayal.
As it happens, I’ve had a number experiences – though not as a lunatic/inmate/patient/client. (The succession of labels we in the uk at least, have used to refer to people placed in the care of asylums/institutions/hospitals/clinics for mental health conditions. (More labels.)
Maybe 20 years ago, a mother from the school I helped to run was ‘committed’ after attempting to kill her 2 youngest children and then herself. Thankfully she failed on all counts. But she was taken for trial and held in a secure mental health ward for some years before it was confirmed that she was suffering from post natal depression and was also bipolar. I remember still the way she was discussed: the horror that she could have done such a thing, the total lack of sympathy, the condemnation. I was struck by the excuses made by other parents: “She kept herself to herself; how could we have known.”
Years later I saw her, leaving one of the secure wards. She looked well and happy and gave the nurse with her a warm hug before setting out. I saw her because I now lived next to the cluster of dilapidated huts – wards – where she was treated. I, at that time, had a flat in what had, until the 1960s, been the local lunatic asylum. It had lain dormant and decaying until the late 1990s when it was converted. As you point out, these buildings (this one was Victorian) were frequently beautiful pieces of architecture and this one had once enjoyed extensive grounds and a stunning view. I now had the luxury, the view, the grounds; she and her fellow sufferers had makeshift wards surrounded by tarmac.
Scroll forward 15 years and my own daughter was suffering from severe PND. There was no danger to her baby but she herself was delusional and acutely suicidal. It took 11 months before we finally got her condition recognised and a further huge effort to get her admitted to a clinic which specialised in the condition and allowed her to keep her child with her. (Many women here are separated from their child whilst being treated, sometimes of course, by necessity.) My daughter, in her ‘saner’ moments, pleaded to be seen as mad; for practitioners to see her for what she was at that time. Admission to the clinic was a terrifying experience for her but it was a wonderful place and she and I both credit it with saving her life and with enabling her to become the stable, balanced young woman she is today, and a wonderful mother of two happy sons. When the initial terror subsided, she saw it very much as a place of love and refuge.
On the flip side, my son’s former girlfriend has an ongoing battle with her mental health. Twice whilst they were together and once since, she has had psychotic breakdowns and has had to be sectioned. The wards she was placed in were sad, sorry places with minimal care and even less understanding. Each time, she was kept for the legally required period (very short) and released with medication and minimal aftercare. Left to fend for herself essentially – until the next episode.
I suppose my point here is that I see exactly what you have been describing in recent posts, including that for some, admission is a welcome release and a place of caring and safety. In many respects, it seems, little has changed over the past century: mental health care remains a lottery and can be influenced on an individual basis by those who are fighting to support the sufferer. What has changed, in my opinion, is the increasingly open forum in which mental health is now discussed and the sympathy with which it is increasingly accepted. Now it seems, when a tragedy occurs, people are saddened by learning that the sufferer had been unable to speak out rather than using it as an excuse for why they themselves passed by on the other side.
Phew! A subject close to my heart! Thanks for this series of posts – and apologies again for hijacking the thread with my rambling!
LikeLiked by 1 person
A wonderful, heartfelt reply — I’m not sure anything I can say could give such a complete, balanced, and detailed view. You’ve said it all. Please do not feel bad about the length of your reply or the details or anything, really, I just hope that others who come around to the blog post above, will scroll down, read what you wrote, and think about your words before judging “mental healthcare” either way. It really is a gamble, depending on where the “patient” is referred to and whom they meet on their path to (hopefully) recovery. Other public services are a gamble too, I suppose, but it’s the instances when the person is most vulnerable that can end up being a matter of life and death, and that should be addressed as a priority.
Thank you for sharing your story, that’s very kind, and it contributes to the increasingly open forum on mental health.
LikeLiked by 1 person
Yes! I love the idea of asylums in the most literal sense…..as a place of refuge. Such a tragedy that it can’t be that way today. In addition to those that need long term or permanent care in an institution, how wonderful for those who need shorter term care for less serious mental health issues to have a place to go to rest and recuperate and get treatment…someplace AWAY. Sometimes just being “away” can be a huge asset to people’s recovery. I hate that there is such a stigma attached to “Institutions” these days.
LikeLiked by 1 person
I agree! I was glad that I got to research this topic for the blog, and through it to understand the problems and stigma surrounding mental institutions. It’s like with children, or the old, or the ill, these are people that would benefit most from a safe environment, from respite and care. We’ve got a lot to learn about caring for our own!
Thanks for speaking up, saying what you feel on the topic.
LikeLiked by 1 person
Reblogged this on O LADO ESCURO DA LUA.
LikeLiked by 2 people
Reblogged this on HemmingPlay and commented:
“…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.”
LikeLiked by 2 people
Good to have this balancing of different views. When I was a school girl in the 1960s in England mental institutions did not intrude into “normal” life, but things were changing. A visitor to our school attempted to show us how ignorant we were by pointing out that few members of the public ever stepped inside such an institution. She asked for a show of hands of those who had been inside one. All hands went up and she was totally thrown. The explanation was that we had a Religious Education teacher who made sure every school year had a “trip” to the local institution. This teacher admirably tried to open our eyes to how mental health was treated; I should add a balancing memory though – she was not averse to slapping girls in her classes if they annoyed her.
LikeLiked by 2 people
If the events causing the balancing memory weren’t too frequent, I suppose you were lucky to have had such a broad-minded teacher … If I may ask: what were your overall impressions of the institution? (Positive, negative, mixed or is it hard to tell, as much has changed since?)
LikeLike