Finding Sanity

by Greg de Moore

  The freshness and clarity of the outside air is at odds with the dank and stifling gloom deep within the abandoned buildings. Inside, the echo of one’s tread on the stone stairway is sharp; and the clank of each closing lock has a ring of ominous finality. Decrepit beauty abounds in these century-old buildings, even as the walls decay and paint flakes. This is a place calcified in time. Pigeons roost by the hundreds in the alcoves.

  Outside, if you stand still for a moment, it is not hard to imagine the hospital in its heyday in the 1930s: the covered walkways, now empty, rattling and humming like a main street with workers pushing trolleys filled with laundry or meals from the kitchen; at the change of a twelve-hour shift, a pullulating mass of workers streaming down the hill, an equal number plying their way up the hill to the hospital. This crush of employees—earning a living and working in the hospital for the insane—breathed life into the economy of Beechworth.

  Older nurses can still remember the terrific din of humanity in the asylum. The raucous and rowdy noise of around a thousand captive souls floated down the hill to the town, day and night.

  Death was common in the asylum, especially in the colder months. Winter was an unforgiving time, and the shadows were deep and long; the chill air silently carried away dozens of patients each year. It was often a junior attendant or nurse who’d cart the dead from the ward to the mortuary. To do so in the dark of night was a rite of passage for new staff; the common initiation ritual was for older staff to spring out of the blackness to terrify the new nurse to see if he or she were made of stern-enough stuff.

  The old hospital mortuary now stands in solitude. Painted white, it looks more like a public toilet block from a distance. By peering through a window, the slab where the dead rested is still visible. In a final insult to the faded grandeur of the old hospital, the depredation of vandals has taken its toll and graffiti daubs the once-beautiful stone walls, this defacement reflecting a different type of disturbed mind. Near the porter’s gate, at the old entrance at the top of the hill, there is a flyer on the ground advertising ghost tours at night in the asylum: cheap thrills, no doubt, and a way to make a living for someone in the 21st century.

  Myths and stories about the hospital still linger in the pubs and homes down the hill, and the Beechworth townsfolk still regale visitors with a repertoire of tales. Mrs Zwar was the young daughter of Dr Naylor, the psychiatrist superintendent of the asylum in the 1920s. She vividly remembered that one of the asylum doctors believed a full moon caused madness. The cautious doctor could be seen on bright nights on his nocturnal strolls between the hospital wards, umbrella aloft, shielding his cranium from the mind-damaging lunar beams.

  This story, perhaps apocryphal, nonetheless hints at the medieval mindset of asylum life in late 1936, when 24-year-old John Cade having spent just a few months studying psychiatry, turned up for his first day within the stone walls of Beechworth.

  John was warmly greeted by nurses who remembered his father and ‘the young boy’ from his time there in the early 1920s. Allocated a doctor’s cottage, he settled in and spent his first night as a fully fledged asylum doctor.

  ‘My first introduction to my new patients took place early on the morning after my arrival, as I was in the midst of a bath.’

  From somewhere came the sharp-edged call: ‘Do you keep a cat?’ John answered in the negative.

  ‘Then do you keep a dog?’ As Bonzo the Fourth, John’s canine companion, had accompanied him, he answered honestly.

  ‘Can’t stand cats or dogs. I’m leaving,’ came the reprimand.

  John, not certain where the questioner was located and curious about who they were, stepped out of the bath, dried himself, and assumed his ‘professional dignity’. Rather than leaving, the interlocutor—‘a thin misanthropic, elderly apparition with two front teeth missing’—was still present. ‘She had evidently assumed, very conditionally, the position of housekeeper.’ This was John’s introduction to Mrs Arkins, his first Beechworth patient; she spent the better part of the day nosing about his cottage, making his bed and doing a little sweeping. Within no time his pyjamas were dashed off to the laundry, so he slept in his tennis shirt, and a general chaos engulfed his household.

  Then there was the comical Ethel, who accosted John each morning as he struck out from his cottage across the asylum grounds to the locked wards:

  A gorgeous creature . . . like a coy bird of paradise . . . Ethel is seventy, short, uraemic, romantic, painted and panting. It starts something like this: ‘Oh, dear doctor, you’re so tall, so handsome, I knew your darling father (so kind to me, don’t you know). My back is aching so, you will give me some more of that ginger mixture darling Dr Trembath ordered for me, won’t you.’

  A resplendent Ethel wore lips as scarlet as the reddest rose with cheeks to match, and charcoal eyeliner; she was an apparition to stop John in his tracks. Ethel, like a swaying temptress, danced ‘coyly about me and would certainly embrace me but for the guardianship of the matron and the nurse in charge of the ward. She is terribly jealous and has retired to her room temporarily since I have announced that I have decided to extract the two remaining front teeth of her rival’, a certain Mrs Cole.

  John settled into this rural retreat of the deranged—a world full of Ethels—and gulped in whatever goodness and knowledge he could find. As for the institution, John was less than impressed. ‘The whole place is constructed on the idea that mentally afflicted people are infinitely more dangerous than criminals, with no regard for their comfort.’ Some patients remained in the asylum, imprisoned, for decades.

  John immediately caused a stir when he announced to the matron that he would like to do ward rounds and (heaven forbid) speak to the patients. Hospital staff were not accustomed to such unorthodox and undoctorly habits; indeed, the matron retorted—with what we imagine was an impatient air—John would only be required to attend ward rounds when she alerted him to a problem. John listened to this advice and then ignored it in a spirit of quiet insurrection: young Dr Cade set about seeing patients each day. And if this was a surprise to the sleepy attendants at Beechworth, well, they were in a veritable tizz when the young doctor physically examined his charges and dared open up their medical records to write his daily observations. At the time it was common for doctors’ notes on patients to be brief or non-existent, other than for the initial interview or during episodes of acute ill-health. By providing a daily assessment, John and other staff members were better placed to observe and manage early signs of physical or mental deterioration or improvement. From the very start Dr Cade Jnr, unlike his father, was a revolutionary.

  When John entered the locked wards of Beechworth, the first thing he noted was an acrid aroma—faeces smeared by patients into keyholes, and the unholy triad of stale urine, tobacco and floor polish. This swirling mix rose like fumes from the stinking bilge of a ship. Many patients looked downtrodden—socks scrunched around ankles and coats shabbily slipping from shoulders were a common sight; frumpy dresses were the rule. As one retired female nurse remarked when recalling this dull plumage: ‘All the girls’ clothing was made in the sewing room . . . the girls had blue and white striped dresses . . . it was awful. They had no underpants.’ Toilet paper was a luxury; newspaper a convenient alternative. Seeking beauty, and just a bit of humanity, female patients crushed geranium petals as rouge for their cheeks, and sometimes styled their hair with cooking fat when soap was absent.

  Outside the wards some patients perched on steps, others loped about, shuffling through the loose dirt like street sweepers. These abandoned individuals were the discarded detritus of Australian life. Visitors, and there were not many, gawked at their oddities. There were, of course, the usual assortment of asylum inmates—the melancholics rocking to a rhythm unheard; the paranoid patients plotting yet another revenge; the manics—frenetic and incoherent; the docile—vitality drained—ossified into an existence like the bluestone they sat on; and the occasional catatonic patient, stiff and seemingly uncomp
rehending, like an Easter Island statue.

  Many nurses were remarkably caring; some were not. Taunting patients to provoke them was an awful game played by a few pernicious nurses to disrupt the boredom of a long day in the asylum. The staff anointed patients as either ‘good’ or ‘difficult’. It was a functional, if crude, bifurcation. ‘Good’ patients, John recalled, ‘were encouraged to assist in the wards by polishing and scrubbing floors, making beds, washing foul clothes and bed linen, and helping in the kitchen and dining room’. The ‘good’ patients helped crank the asylum to life every morning. ‘Difficult’ patients were another matter altogether. Aggressive types might be isolated in wooden cubicles several metres long and several metres wide; with a single split door like a horse stall. A sliding shutter opened in the top half to enable the attendant to view the patient.

  Physical restraint was common, some patients trussed up like poultry and released only at feeding times. There was a repertoire of canvas restraints, which read like a department store catalogue—camisoles, vests, dresses and jackets, designed for men and women. All coarse and stiff like steel, appearing to be unfit for humans but used nonetheless.

  Some patients openly masturbated; offending hands were placed into canvas muffs, which in turn were sewn tightly onto a canvas vest, wrapping the arms around the waist and rendering them immoveable. Not quite clapped in leg-irons, but not that different. Only an act of God, or a nursing attendant, could offer liberation.

  All manner of patients were thrown into mental hospitals like Beechworth. Most were obviously sick, others were troublesome, and some just misunderstood. The deluded, the depressed, the alcoholic, the epileptic, the head-injured, the backward and the psychopathic were, like a potpourri of problems, mixed together and sent ‘up the hill’. Indeed, the classification of mental illness was crude for much of the nineteenth and early twentieth century.

  On the other side of the world, in Germany, a brilliant psychiatrist Emil Kraepelin wrote a mental health masterpiece that became the bedrock of modern psychiatric classification. The English translation of Kraepelin’s work was published in two volumes, the first in 1919 and the second in 1921. In the second volume of his magnum opus he delineated from the morass of madness a specific mental illness called ‘manic-depressive insanity’. It is also called manic-depressive illness, or just simply manic depression. Although the old term manic depression is still occasionally used, in the 21st century it goes by the modern label ‘bipolar disorder’. And it remains an extraordinary and intriguing illness. Most people have some vague idea of how bipolar disorder expresses itself—that is, a mental illness where people have ‘highs’ and ‘lows’. For our story, its description is crucial, so we need to know more about manic depression. Typically, manic depression begins in late adolescence or early adulthood—at the prime of life. And it runs in isolated attacks: sometimes the person suffers from mania, at another time, depression. It is an illness that has some remarkable features. One of these is that between episodes of illness, that is, between episodes of mania and depression, a person can remain perfectly well, as well and as normal as the most sane person on earth. And they can remain well in between episodes for years at a time.

  When a sufferer becomes manic, the essential features are an exaltation of mood, rapid and pressured speech, delusions of wealth and grandeur, excitability, often expansive ideas to change the world, and an increased sexual drive. In the most profound states of mania the body and mind are completely lost to delusional excitement. The original descriptions by Kraepelin, taken from the late nineteenth and early twentieth century, remain unsurpassed:

  His surroundings appear to the patient to be changed; he sees St Augustine, Joseph with the shepherd’s crook . . . God, the Virgin Mary. Statues salute him by nodding; the moon falls down from the sky; the trumpets of the day of judgment are sounding. He hears the voice of Jesus, speaks with God and the poor souls, is called by God dear son. There are voices in his ears; the creaking of the floor, the sound of the bells take on the form of words. The patient has telepathic connection with an aristocratic fiancée, feels the electric current in the walls, feels himself hypnotised; transference of thought takes place . . .

  He cannot be silent for long; he talks and screams in a loud voice, makes a noise, bellows, howls, whistles, is overhasty in speech, strings together disconnected sentences, words, syllables, mixes up different languages, preaches with solemn intonation and passionate gestures, abruptly falling from high-sounding bombast to humorous homeliness, threats, whining, and obscenity, or suddenly coming to an end in unrestrained laughter . . .

  The patients make all sorts of plans, wish to train as singers, to write a comedy . . . they start senseless businesses, buy houses, clothes, hats, give large orders, make debts; they wish to set up an observatory, to go to America . . . kiss strange ladies on the streets, frequent public houses, commit all possible acts of debauchery . . . While they appear in company as jovial fellows, give large tips, stand treat, they quarrel with their superiors, neglect their duty, give up their situations for trifling causes, leave public-houses without paying.

  Of course it takes little imagination to translate the above escapades into the modern day. Instead of a nineteenth-century public house, think of a manic patient in an RSL club playing poker machines until all their money is exhausted; or emptying a credit card in a single night in a casino; or putting a down-payment on a fifty-million-dollar waterfront property in Sydney; or setting up an on-line business to sell secret cures for the problem of global warming; or placing a deposit on a third Porsche; or betting over the internet from one’s bed 24 hours a day; or slapping on a GoPro helmet to film oneself jumping from a third-storey apartment, believing one can fly; or driving 160 kilometres per hour in a suburban street; or communicating with NASA to control the orbit of the planets. This is manic behaviour in the 21st century.

  Such manic behaviour might last days or weeks or months. And in some cases, especially in the early twentieth century when there was no treatment, it could last as long as several years. Invariably these manic patients were admitted to asylums like Beechworth. Then, over time, if they managed to survive, the mania burnt itself out, and the person might become perfectly normal, waking from this furious delirium. When they looked about them, they had done great destruction to themselves and their families.

  Sometimes patients remained well for months, even years. But almost inevitably another episode would grip them. Sometimes this was another manic episode, but it was just as likely to be an episode of depression.

  In this deep and stagnant melancholia, thoughts slowed into viscous dribbles, barely budging, and a mood could plummet into the most profound state of despair; for most of us, the despair is not imaginable.

  It is to Kraepelin again we turn and a snippet this time will do, because his description is almost unbearable to read to its end:

  The torment of the states of depression . . . engenders almost in all, at least from time to time, weariness of life, only too frequently also a great desire to put an end to life at any price . . . The patients, therefore, often try to starve themselves, to hang themselves, to cut their arteries; they beg that they may be burned, buried alive, driven out into the woods and there allowed to die.

  Early death was common in untreated manic depression, suicide rates high.

  Lives were lived out in this never-ending cycle of reckless exaltation and miserable lows. Patients might have dozens of admissions to asylums.

  In 1936 the cause of manic depression was utterly mysterious. Some held that there might be a physical disorder ticking away in the body that brought it on; others assumed that something in the person’s upbringing was at fault. Whatever one’s belief, it remained the case that little could be done to treat it. Indeed, in the whole of psychiatry, there was not a single medication that specifically treated any mental illness. Of course there were pills and potions, like a mad-hatter’s apothecary, which sometimes soothed, even knocked out pa
tients for a while. But when patients woke from this drugged slumber they awoke as mad as before. The only ally doctors and nurses had was time.

  4

  During his time at Beechworth, John kept up a steady stream of letters to Jean in Melbourne. At first, the formality of the era overwhelmed intimacy and he started letters with a prim ‘Dear Nurse Charles’, written with all the passion of a job application; but in no time the stiffness was overthrown by romantic desires. Soon his letters were addressed to his ‘Dear Jinnie’. In early 1937 John left Beechworth and returned to Melbourne; he and Jean made a decision to marry.

  John and Jean were wed on 1 November 1937 at Melbourne’s premier Catholic cathedral, St Patrick’s. Family oral history has it that John had little money for an engagement ring and was too poor to invite guests. Instead, their meagre reception took place at the house his parents occupied on the grounds of Mont Park Hospital for the Insane, not, we imagine, the venue his bride might have envisioned when agreeing to a betrothal. Just a single photo exists of this reception, but in brilliant sunshine it captures a post-nuptial moment of bliss as John wraps a loving arm around the waist of his new bride. That they are on the grounds of a hospital for the insane seems inconsequential to them both.

  The next phase of the story, it seems, has been repeated many times over the generations; children and grandchildren are able to recite the events at will. After his near-death from pneumonia, John had ditched his fashionable motorbike and purchased a Dodge coupé. The car was one of those flashy American jobs with exquisite maroon upholstery and the capacity to be a sporty two-seater. Jean and John tossed their few worldly possessions into the boot of the car, put the hood down and roared eastward out of Melbourne to Lakes Entrance, where they stayed at the evocatively named Robin Hood Inn, and then motored up the eastern seaboard of Australia to Sydney. And from there, as their honeymoon ended, they drove directly to Beechworth Asylum where a fully furnished doctor’s cottage awaited them.