Thursday, September 28, 2017

One Size Does Not Fit All

A couple of nights ago I had the pleasure of re-visiting Sacred Heart University, my undergraduate alma mater (B.A. in English, '99), for the screening of a documentary film entitled Dorothea's Tears: The State of Mental Health Care in America by School of Communication and Media Arts graduates Keith Maciog, a Newtown resident, and Geer Teng. This beautifully filmed production that comes from the Vision Project, presided by Richard Falco, Coordinator of Multimedia Journalism at SHU, documents former Fairfield Hills/Fairfield State Hospital employees, state officials, Sandy Hook parents and therapy professionals.

The film's implicit argument is that closure of state mental hospital facilities such as Fairfield Hills has contributed to the rise of violent incidents over the years such as Virginia Tech and Sandy Hook and the rise of severely mentally ill people being sent to jails or ending up dead on the streets because none of the promised funding for community-based outpatient services was ever given.

There's some truth to this. 

Bills were signed but adequate funding for programs following deinstitutionalization was never really given. You can't completely shut down a system without fully planning for or supporting a sustainable replacement mechanism(s).

Yet while institutionalization was indeed an answer for some individuals, it certainly was not for all. Back in those days, some people were placed in mental hospitals who didn’t need to be there and, as discussed in previous posts, you could be hospitalized just for being anxious or for being LGBT (seen as "sex perversion"), amongst other reasons. Hospitalization could happen as easily as with a physician’s recommendation for a thirty-day observation (and a husband’s signature if you were a woman, of course). Most often, but not always, once you were admitted, the chances of your leaving the hospital after thirty days were pretty slim. You most often were transferred to another ward.

The film failed to comment on this fact along with the conditions of overcrowding in these places (except for a statistic flashing across the screen in the opening) and how that overcrowding contributed to such things as lack of basic linens and other necessities, to overworked and cantankerous (and sometimes abusive) staff, and other issues.

Since film and literature focus so much on the negative aspects of state mental hospital care, I was appreciative of this documentary's attempt to demonstrate its strengths. However, I just didn't see strong enough evidence presented. For instance, I would have liked to have seen an interview with a former patient who was helped by the system and what being released from the hospital's care after its closing meant for that individual.

As noted in previous blog entries, despite the flaws inherent in institutionalized mental health care when reflecting on its history, there indeed were people who genuinely wanted to and did help patients under their care and there were cases in which people required the round-the-clock care the hospital provided. Those are the people deinstitutionalization failed.

The film caused me to reflect on a larger issue: that no matter what mechanism has been or is currently in place, there's been a tendency toward a "one size fits all" approach. It used to be institutionalization. Today it's primarily medications.

I'm not saying that we still don't need the two solutions mentioned above for certain individuals. We do. There are those who require hospital-like care because their cases are severe; they require daily assistance from trained professionals with different combinations of therapies. But there are also those who can function in society with the right medications and/or talk therapy techniques. Each individual's case is different. The problem isn't so much deinstitutionalization as it is the lack of time, energy, and support that goes into treating a person according to their individual needs and situation.  

Finding the human and fiduciary resources to serve people in such a capacity presents a challenge, but I hope mental health care providers and patients will advocate for it because it is clear that we need a better approach altogether. Institutions and drugs work for some, but they have failed others. What kind of care can we imagine to treat each unique individual? How will we support it?

There's no definitive solution, but I hope we'll come up with some.

Monday, November 23, 2015

"Dignity makes all the difference"

For all we read about women's experiences in state mental hospitals between the 1930s and 1950s, it's nice to come across a story about a place where women could live removed from the constraints, misuses, and abuses of male-dominated and male-profiting treatment, even if this story begins in the 1920s.

The Atlantic just ran this article about Rockhaven Sanitarium, founded in 1923 in Glendale, CA, by Agnes Richards. It was here where women suffering from minor psychological conditions could find compassionate care in an idyllic all-female environment, their humanity and dignity upheld until Rockhaven's closure in 2006.

Since Rockhaven ran during our era of focus, it is worthy of highlighting on this blog.

I wonder what mental health care would look like in the United States for all genders today if we actually invested funds to adopt a model like Richards'? It may not be a panacea, and one size surely doesn't fit all, but the idea of compassionate care rather than Big Pharma-driven outpatient treatment or hospitals that are facing reductions in staff due to budget cuts seems a more palatable and humane alternative.

Monday, August 4, 2014

Physical "Innovations" in Treatment of Mental Illnessses circa 1957

It's been awhile, but those lazy days of summer have been interfering! I assure you that I have not forgotten the reasons this blog was started.

To that end, I have found a program from the BBC (circa 1957) that gives an interesting look into the types of physical interventions and "innovations" administered by mental health specialists during the era. It takes a look at more benign possibilities for the administration of electroshock therapy (ECT), insulin shock therapy, etc.

The question I ask is: was science trying to be more humane? Might other approaches have benefited patients, and if so, what might they have been?

We only know what treatments existed and what exist now. What possibilities might exist for the future? That is the crucial question.

This video, an original segment from the BBC, is in three installments (there's a fourth on You Tube, but it gave me trouble). I'd love to know viewers' thoughts. I'd also like to know what viewers might think the implications of these treatments for women might be. 

Monday, May 19, 2014

The Rape of the Mind

** WARNING: Some footage in this video is a bit graphic. Viewer discretion is advised.**
The lobotomy.  A psychosurgical procedure that involved cutting into a patient’s brain in order to rid her or him of mental illness, or at least to decrease the symptoms.
Before the advent of psychotropic drugs in the 1950s, mental illness was still grossly misunderstood, and state hospital admissions were rapidly increasing in the 1930s and 1940s. Psychiatry experimented with new methods to contain symptoms including insulin shock therapy, deep sleep, cold wraps, continuous baths, and electroconvulsive therapy (still in use today).
The lobotomy, which seemed to promise a more solid fix than the previously mentioned therapies, is perhaps one of the most barbaric and bizarre methods we’ve seen emerge within the 20th Century.  
The footage in the video above will show part of a transorbital (i.e. the "ice pick") lobotomy performed on a female patient, who is first subdued for the procedure by electroshock. It will make you sick to your stomach. (At least I hope it will.)
Here’s what infuriates me more than what this patient and others like her experienced: a 1949 report written by psychiatrists from the former Fairfield State Hospital on their experiments with lobotomies performed on-site indicated that a ratio of 78 women to 29 men received frontal lobotomies at Fairfield that year. 78 to 29! That’s close to 63% of the total 107 patients (if I did my math right--I'll admit I'm not good with turning ratios to percentages).
Yes, you can argue that more women than men suffer from mental illness, but today we have a better sense of the factors that play into that, and we know it's not because women belong to an inferior or defective sex.
Yet back in those days, if you were a woman who was dissatisfied with the gendered roles and expectations society dictated, you were considered crazy. If you were lesbian or bisexual you were definitely crazy. And if you were a woman being involuntarily committed, there were two ways in which that could happen. One was through probate court. The second, and more subtle and frightening way, was when a physician signed a certificate, often encouraged by a family member or spouse. You’d go in for observation at the reception ward and if you showed no improvement or any signs of non-conformity, you were transferred to another ward for longer-term care. Of the large population of women who received lobotomies, I'm not sure what their actual cases were. I'm not sure if they were mostly schizophrenic, if they might have had other conditions, or if some were among the population who simply didn't fit the norms of mid-20th century society.  
Whether it was performed on women or men, however, we do know that the lobotomy most often left the patient incapacitated. And for an indication of how greatly incapacitated, we need only to look at Rose Kennedy’s story. After her lobotomy at 23, she couldn’t walk or speak coherently and was rendered as dependent as a toddler. The lobotomy was nothing short of a raping of the mind, perhaps even the spirit. (I recommend Howard Dully's memoir, My Lobotomy, as one survivor's story of triumph.)
Let’s never forget or repeat history.

Sunday, March 2, 2014

Polyanna-ish Propaganda?

Okay, so this seems like a harmless video about mental health services in the 1950s. But is it really?

The answer is debatable.  

I show this clip not to say that institutionalization was all bad in and of itself. Some women would not have been able to function in society, and the state mental hospital was an "asylum" in the true sense of the word--a safe space and possibly a place to pave a road to recovery. However, there were others for whom hospitalization was not necessary and those are the women in whom I'm primarily interested in this blog: the woman who was hospitalized because of her lesbian or bisexual sexual orientation and expression, or because she expressed sentiments that kept her from being a doormat, or because she was an immigrant and found navigating a new language and culture difficult.

While the main focus of the video is not on women, I would still love to know some general thoughts. Is it propaganda or does it reflect a bygone era whose sincere intent was to help people rehabilitate?

I'll let you decide. But whichever way, please tell me your thoughts.

Wednesday, February 12, 2014

Put to Sleep

When I first came across this article, I drew in a breath. Just when you thought women didn't suffer enough horrors at the hands of patriarchal psychiatrists--what with lobotomies, insulin shock therapy, ECT, "sex therapy," and the like-- I discovered a "new" technique: putting women to sleep for weeks at a time.

I can't even imagine what this must have been like for the women who underwent this treatment, and I won't even try to articulate my response to it. I'll let the article, which details what occurred at Royal Waterloo Hospital in the UK, speak for itself:

Saturday, December 28, 2013

Dignity is for the Dogs

When I first saw this photograph, taken in an Ohio hospital sometime between the 1930s and 1940s, I thought, "That's interesting. I didn’t know they let dogs inside hospital dayrooms to keep the ladies company? How nice!" My curiosity piqued, I took a closer look. My eyes widened in disbelief as I realized the form occupying the floor underneath the bench wasn't a dog at all. It was a human female, an elderly one at that, even though the hollow pockets of her reclining sinews mimicked the form of a Labrador retriever. Ashamed of the mistake my eyes had made, my mind raced with questions: What was this woman doing on the floor? Where were her clothes? What was her name? Why were the women seated above her barefoot and in flimsy gowns? 

Of course, anyone might challenge that this photograph was taken in an acute ward with mostly incontinent geriatric patients, a type of ward in which it was easier to leave patients undressed than it was to change soiled garment after soiled garment. One might also argue that such wards were significantly understaffed and overcrowded, so what would one expect, especially for the time? True, true. But leaving a woman, regardless of her condition, to lie on the floor without dignity like a zoo exhibit? Was I just being too melodramatic in my reaction to the photo?

The saddest part about viewing this frozen fragment of time and space captured and exposed some 70+ years ago was that in the exact moment when I had mistaken this woman for a dog, I (as the viewer of the photograph) had robbed her of her humanity—the same humanity she had been robbed of by the voyeuristic camera and the hands of the staff who had left her in such state when she could have easily been my grandmother, or yours.

This photograph speaks to the less-than-human ways in which the elderly, the mentally ill, and women have been and still are regarded and treated by society-at-large. How many of us turn to look at something or someone more pleasing to the eye, something or someone more dignified and less "beneath us"? And yet we pride ourselves on what we do to give others back their humanity—when dignity is not a right to give, but something innate and already possessed. 

While my eyes once again trace the seated women’s feet, swollen like the numerous inflatable lawn ornaments I’ve seen in front of homes this holiday season, part of me wants to step through this little portal and hand them each a pair of slippers (or at the very least those little slipper socks hospitals do give nowadays). But an even bigger part of me wants to crawl down on that floor underneath the bench and share a blanket, for, in the words of the late Nelson Mandela, "Our human compassion binds us to the one to the other—not in pity or patronizingly, but as human beings who have learnt how to turn our common suffering into hope for the future.”