Working In The Mental Hospital
I needed a summer job, and it being the 1950’s when jobs were plentiful, the university bulletin board provided me with a ready solution. The mental hospital in North Battleford was advertising for summer help and it sounded like a nice change. I had never been to northern Saskatchewan and the pay was pretty good with room and board included. Besides, I knew nothing about mental illness except that I sometimes wondered if I were losing my mind, or if it was just the other people with whom I associated. This could be a good chance for a reality check (or should I say ‘sanity’ check?).
On the train going to my new job I had the leisure time to read about the job I had accepted. It sounded easy enough and pleasant enough except for the section concerning it being a ‘hospital’ with the intrinsic expectation that there would be patient care such as feeding and goodness knows what else that I didn’t want to think about. I thought the rotating shift work schedule would be easy. University life had prepared me well for staying up late at night and sleeping during the day when required. The hospital was outside the small city of North Battleford, near the bank of the North Saskatchewan River. The hospital consisted of an isolated clump of brick buildings nestled among forest and small farm areas. One section of the main building was for male patients and the other for female. The doors were always kept securely locked with only the permanent staff having keys. There were a few trusted patients who also had keys to open the doors when necessary. Temporary employees such as I did not have keys. I was initially insulted to think they considered mentally ill patients to be more trustworthy than I. Eventually, I realized they might have a valid point for thinking that. After all, mental health is only one facet of a person’s character and personality. Life for the staff at the hospital was déjà vu of my first year residence at university complete with community dining hall and smallish rooms but with two single beds—an improvement over the university bunk beds. One difference was that because my roommate and I were on different shifts we were rarely awake at the same time and place and never got to know each other, except for saying hello and goodbye as we passed on our way to and from our shifts. Training consisted mostly of a sheet outlining the schedule of where and when to report for shifts. There was always at least one regular staff member on every ward so we learned the ropes as we went. When we were presented with an unfamiliar situation we would just ask one of the other staff members, or one of the more normal acting patients. This system usually worked well. In retrospect, I think the new assistants were probably scheduled to be on the easier wards first. The staff residence was 100 yards (more or less) from the patients’ hospital and was generally quiet at that distance. However, starting two or three days before a full moon there would be a gradual increase in the sound level until it become an unmistakable cacophony emanating from the hospital. On the actual day of the full moon the quietness returned. I was impressed with this verification of the forces of the moon on human life and behavior. Up to this time, I had been studying Physics and Math and had never taken a single Psychology course. I was told that each separate ward held a different kind of patient, determined by psychiatric evaluation: psychotic, severely neurotic, schizophrenic, legally insane, medical, etc. Try as I would, I found it impossible to identify the ‘class’ of mental problem from the appearance or actions of the ward members. Every ward seemed to have a wide variety of erratic behavioral patterns, obsessions, compulsions, speech characteristics and manner of social interaction (or lack thereof). Although I could accept the label, and understand how it was determined, I could not for the life of me see how the label helped in understanding the patient or his treatment. It was more like the biological classifications of butterflies—useful to identify them and talk about them, but providing no depth of information or understanding about them. Some twenty years after I left the hospital, I learned that, in fact, mental illnesses were distinguished by a classification of symptoms in the Diagnostic and Statistical Manual of Mental Disorders (DSM). In 1988 the DSM divided mental disorders into the following major categories: substance use disorders, schizophrenic disorders, paranoid disorders, affective disorders, anxiety disorders, somatoform (i.e., physical symptoms), and disorders of infancy, children and adolescence. Each of these categories was further divided into several subtypes with descriptive behaviors. One big problem with this method of classification is that it is totally circular. The group of observable behaviors determines the classification of the mental illness; the named mental illness is then used as the reason for the behaviors. For example, a person who had a split personality would be classed as ‘schizophrenic’. Then, if you asked why the person behaved as though he had two personalities, the answer would be, ‘because he is schizophrenic’. This did not seem to be very useful from the point of view of a person who was used to the laws of science, which could be used for the prediction of changes caused by altering the circumstances. Another big problem was that studies over the past decades indicated even professional psychiatrists are often not able to agree on the classification for a disturbed individual. The classification of their ‘illness’ seemed to me to be arbitrary and not very helpful. At the time when I was there (1950) a major distinction was made between ‘neurotic’ and ‘psychotic’ based on the severity of mental disturbance.
A common expression of the time summed it up as, “a neurotic builds castles in the air; a psychotic lives in them.”
Another way of expressing it might be, “a neurotic suffers inwardly from his day-to-day problems; a psychotic inflicts his mental disorientation on others in the environment.” This was an easy way to distinguish the severity of the illness, but not very enlightening. During the fifty years since I was there, the terms psychotic and neurotic have fallen out of favor and are no longer employed as official psychiatric categories, although they are still used in general conversation. When the patients filed through the courtyard on their way to the dining room many of them detoured out of their lineup to touch a spot on one of the stone walls. Many years of frequent touching had worn an indentation half an inch deep in the solid stone. I asked one of the permanent staff members what would happen if the person could not touch the wall. He suggested I should find out. So I waited until a relatively normal looking patient moved out of the line and headed toward the wall.
I intercepted him and said, “It’s OK. You don’t need to do that,” as I gently guided him back to the line.
I walked with him, carrying on a one-way discussion as we went into the building, got our meals and sat at a table with a few other patients.
We started eating and I thought to myself, “Well, I guess it isn’t such a big deal after all.”
Then I noticed he was getting very agitated and had stopped eating. Suddenly he got up and headed for the door. I caught up to him and held him gently but firmly, suggesting he was safe and it would be alright for him to come back to his meal. That was a bad idea. He became progressively more agitated until it soon became evident that he would get out of the room any way necessary, including over my protesting body. I watched him leave, thinking, “Now what do I do? I’ve really messed up this time.”
In less time than it took for me to get my brain in gear, he returned, sat down beside me and started carrying on a normal (for him) conversation. I didn’t need to ask him where he had gone or what he had done. There certainly would be no point in asking him why.
Later in my life, after I became a teacher, I came realize that one of the things teachers frequently say to errant students is, “Why did you do that?”
It makes good sense as a question until you realize that no one can ever answer it. The best one can do is to make up some plausible rationalization for what they did. No one really knows why he or she does something, any more than the mental patient did.
Have you ever noticed that when you are speaking, you don’t know what you are going to say until you hear yourself say it? No one really knows what he or she is going to say until they say it. So, who is it that is speaking through you? Maybe it is the effect of TV commercials? And, are you actually doing the thinking, or do the thoughts just appear in your head from somewhere and you merely claim ownership of them?
There were several well-educated and intelligent patients who had for some reason been forced to trade respectable and good paying jobs for a life of aimless wandering in the hospital. On their good days most of them could carry on lucid and coherent conversations on subjects of their choice. Most had trouble focusing on topics suggested to them. One of my earliest experiences was having a patient call me to the window and tell me to ‘look out there’. After a few minutes of his gesturing and describing ‘them’, it dawned on me that I was trying to see the patient’s hallucination.
I think the real clue came when he said, “They are hard to see because they are green and blend into the grass.”
I met a few patients who thought they were some famous person. And yes, there was one who believed he was Napoleon in spite of being over six feet tall (most people think of Napoleon as being a bit on the short side). On a tour of the female side of the hospital, I did see a case of catatonic schizophrenia. She was a girl in her mid-twenties, who spent her time sitting with her back to a wall, didn’t make eye contact, and never spoke. There was one patient, kept bedridden in a separate private room, who was in the late stages of syphilitic dementia. He had a large ulcerous open sore in his side. In order to be allowed into his room a face mask and full gown were required. I would also have liked a gas mask. One middle-aged fellow was there for being severely alcoholic. He was fun to talk with because he loved to give details of his life. Unfortunately, his brain had been thoroughly pickled from alcohol and Demerol for many years, making the accuracy of his stories subject to question. He would say things like: “The police picked me up at noon for being drunk. I wasn’t. I’d had a 26 of whiskey for breakfast and my friend and I, we killed a 24 of beer. I was feeling a bit nervous so I took a shot of Demerol just before they picked me up. I didn’t actually start drinking until after I talked to them.”
Most of his stories were variations on that theme.
I was frequently on the ward with a patient who liked to chat with me. One day he shyly brought up the topic of Mathematics. I admitted I had studied Math at university and he asked if I would like to see something he had been working on for the last many years. I said I’d be very interested. He scurried off and returned with a notebook filled with calculations of the roots of quadratic equations. He said he could give me the roots of almost any equation I suggested by looking it up in his hundreds of calculation tables.
I tried him with a few and checked his answer using the quadratic equation formula every Grade 12 student memorizes. Invariably, he was right. When he asked how I knew he was right, I showed him the formula and did a couple of examples for him. He promptly disappeared into his room and didn’t come out for three days. Then he came out and gave me some more equations to solve. I assume they were the toughest ones he could think up. He watched carefully as I solved them and then disappeared into his room for a couple more days.
He never spoke to me much about Mathematics after that except to show me some pages of his original geometric theorems based on the postulates of Euclidian Geometry. His was similar but totally different. I didn’t have much opportunity to study them, but they seemed logical, precise, and accurate. I cared enough to often wonder what would happen to all his notebooks when he died, but not enough to try to find out. Now I wish I had cared more. The easiest ward was the one with the criminally insane. You know, the convicted murderers. After the initial shock of finding yourself surrounded by a dozen individuals who had absolutely nothing to lose by killing you on impulse, it was a piece of cake. The majority of them were totally sane. They just had a good lawyer who kept them out of jail on an insanity plea. Most of my time was spend playing pool or cards with them and chatting. They called their favorite pool table game ‘golf’. It was nothing like the clubs-and-green outdoor golf, and not even what you would find by an Internet search with Google for ‘pool golf’. It consisted of one ball for each player plus the white cue ball. The goal of the game was to force the person following you to ‘scratch’ or to miss hitting his ball, by getting him ‘hooked’. A scratch or missing contact with your ball counted as one point against the shooter. It was an ideal game for them because any number of people could play, and the game never ended. Whoever had the lowest score was winning. They had nowhere to go and I had nothing else to do. What a perfect game for us! My least favorite was the hospital ward. I just knew I wouldn’t like looking after people who were old or sick or both and I was right. Whether or not they were mentally unbalanced was irrelevant except for looking after their assorted medications and making sure they didn’t fake taking the pills or trying to sneak extras for later use. But the hospital ward was the worst when you had it on the graveyard shift. One popular explanation for this term is that between midnight and eight in the morning everything is deadly quiet: no one is moving, one’s eyes won’t stay open, and the brain goes numb. It seemed to me that more patients died during the graveyard shift than during other shifts. My first action when taking over on the graveyard shift of the hospital ward was to assess each patient to determine if he seemed likely to live until the end of the night. And if not, try to figure out if there were some way to get him through at least to the end of my shift. If someone died on the shift, it was part of the attendant’s role to prepare the body and plug the body orifices. The first time this happened it was shocking to a person who had, prior to this time, never even seen a human corpse. I was most grateful to my supervisor who took pity on me and looked after the task for me every time as necessary. He saved me a lot of nightmares. One memorable person was a large, slightly overweight man about 60 years old who spent his time sitting motionless on the edge of his bed. His total food intake, twice a day, was a small glass of fruit juice and a piece of dry toast. I was told he had been living on this diet for several years in spite of it not being enough calories to keep a person alive, let alone maintaining an overweight body. I am reminded of the boy in India, Ram Bahadur Bomjan, who apparently lives on nothing but air and light. There is even a name for it. A ‘ breatharian’ is defined as a person who is nourished by light and has no need for food or drink. Shouldn’t it be called a ‘lightarian’? I have trouble believing the whole idea, but then, I’m a scientist type and not a philosopher type. There are a lot of things I don’t know. If you check ‘YouTube’ it will give you some interesting information. When I was a teenager, I was sent to spend a summer with my Uncle Harry who was a doctor in Calgary. It was interesting to go through the mountains, especially after living on the Prairies. He told me that he had seen patients die just because they decided not to live, even though there was no medical reason for their life to stop. I have also heard that it is not uncommon for a devoted spouse to die within a short time of the death of their partner. Maybe it is also possible for a person to stay alive through the exercise of will power, although I would expect there must be some definite limitations. This was in the mid-fifties when electroshock was routinely part of the regimen for severe depression. It is currently coming back into favour now, under the more descriptive name of ‘Electro Convulsive Therapy’. The patient was strapped to a sturdy table and had at least four attendants to hold his arms and legs firmly to control the convulsions. Left free, the violence of the convulsions could break a limb or the patient’s back. Electrodes were attached, one on each side of the patient’s head at the temple, and the electrical shock was adjusted so that he would lose consciousness and have convulsions lasting at least 15 seconds. There was often the side effect of recent memory loss. In some cases it was actually a good thing if the patient lost the memory of recent events that were contributing to his depression. It was not a pleasant treatment to administer or watch. I can only assume that it was less pleasant for the patient. The vast majority of the patients strongly, and physically, resisted the sessions. I never looked forward to assisting with the sessions and I never saw a patient who did either.
~ Being Original Is Not Always A Good Thing ~
Psychology 101 professor: “Your essay on a new method of classifying mental illness is plagiarism.”
Me: “I don’t use the concept of psychotic vs. neurotic. Have you ever seen any classification even remotely like this before?”
Me: “Then how do you know it is plagiarized?”
Professor: “Because we don’t expect first year students to write at this level.”
Me: (not mentioning I’d worked the previous summer in a mental hospital), “I’m in my final year, not my first year.”
Professor: “Then I’ll give you a mark of 50% for it.”
I accepted the mark.
Several years later I discovered that ‘plagiarism’ had been noted on my permanent university record.