With this young lady, as with many other similar patients, the psychiatrist is confronted with the family’s serious questions: What are we to do now? What would you do if you were in our place? These are questions for which I have found no satisfactory answer. Such a girl causes more harm to herself and to others than the average patient with schizophrenia and a more tragic sorrow to those who love her. It can scarcely be said that she is safer outside an institution than the average patient who hears imaginary voices or that she can more satisfactorily be cared for at home.
When a physician is asked such questions week after week by honest people who for years have struggled futilely with such problems, he becomes at length rather firm in the conviction that any agency capable of taking an initial step to change this situation should be aroused from its scrupulous inattention.
7. Arnold
This patient had recently left the hospital (A.W.O.L.) while out on pass. The following letters arrived from him after a few days:
Baltimore,
April 4th, 19-- Saturday,
2 P.M.
Dear Friend:
Physically I am a very sick man. Have had fever since last Friday. Cold all the time. Very dirty. No bath since I left. Clothes wet all the time. Four meals since I left. Chest hurts severely. Can’t give up. Have tried to contact my people by phone and telegram several times but am ostracized. —Hurts—Really hurts. —but they do not understand—Have never understood. No use for details regarding what is past. Will you give me just one chance please. You must. If you receive this by Monday noon will you wire me some funds at the Western Union. Use my father’s first name, Stephen, for reference. If I were not sick I would not ask this. Can’t beg, can’t steal; so am in the devil of a shape.
Please do not try to have me detained. If you would have sent Jack [a parole patient] to the hotel last Sunday I would not have tried what I have undertaken, as I have too much respect for you and a few others to break my word.
Have I registered? Will your response be O.K.? A chance! One chance!
As ever your friend,
Arnold
* * *
New York
April 10th, 19-- Friday A.M.
Dear Friend:
Man’s limitations are many. I must say that it is hard, very hard, for me not to give up, but I am still trying to carry on. Frankly I was afraid and still am. It has rained ever since I left the Hospital and I believe every drop touched Arnold. Have enjoyed a fever since Tuesday morning. I will not give up. If you could see me at present you would wonder how it was possible for this condition to become mine. I am the worst looking tramp on the road.
My regret about my departure concerns you, Miss Green [nurse] and Mr. Drayton [a physically ill patient]. Doctor, you and McDaniel [a physician on the hospital staff] must make him a well man.
Respects to all my boys [fellow patients] and to any of Ward A men [dopers] who want to leave, tell them to be sure and think.
Would you stake me to a start of a few dollars? If so, write me at Hollywood Cafe, New York City. Place money order in envelope. Whatever amount is O.K. I don’t think you want to be bothered with me any more so I won’t suspect a trap.
Closing with my utmost respects to one of the finest characters I ever met:
I am, the young brigand from the South,
Arnold
These letters were addressed to a physician at the hospital who had taken a special interest in the patient’s case, trying over a period of many months to help him achieve some sort of adjustment.
For a while a measure of faint hope was entertained that he might be able to get along with freedom to walk about the grounds. He had been in and out of the hospital for seven years, spending most of his time on a closed ward with delusional and dilapidated schizophrenic patients. Struck by the man’s friendliness and his frankness to admit himself in the wrong, his physician, despite the usual rules of dealing with such behavior, made an exception of his case, restoring his ground parole time after time when it was lost by failure to adjust. The experiment had been more or less innocent, since the patient did little harm to himself or others beyond cashing a few bad checks for small amounts, cheating unsuccessfully in dice games, stealing a bicycle for which he had no use, and behaving uproariously after a few drinks and getting into jail, whence he was brought back each time safe and apparently repentant.
An effort was made to see if this rational and intelligent man, even though he failed seven times, seventy times, and seven times seventy times, might at last achieve a positive reaction to indefatigable forgiveness and succeed in finding some way to exist without supervision as incessant as that required by a traditional madman. Little or no hope was held that he might leave the hospital and live as a normal man; but something would have been gained if, still sheltered. in a psychiatric hospital, he could enjoy the freedom of the grounds and an occasional pass into town.
Be it noted that during seven years of psychiatric study and observation he had never shown any sign technically regarded as indicating a psychosis. That is to say, he was always entirely rational in conversation, alert, above average in intelligence by psychometric tests, free from delusions and hallucinations, and completely lacking in the slightest evidence of “deterioration.” Nor had he ever shown retardation, a true depression of the cyclothymic type, increased psychomotor activity, flight of ideas, or any other condition which it is permissible to class as psychosis. He had been free also from any symptom characteristic of a psychoneurosis.
During his long and frequent periods within closed wards, he was superficially agreeable to his physicians most of the time but extremely fretful about his confinement. He spoke eloquently of having learned his lesson and always pressed his request for parole or discharge with good logic. Once after making an especially convincing plea for freedom and with the possibility of parole within the next few days, he succeeded during the night in obtaining whiskey by lowering on a cord an empty Coca-Cola bottle which he had obtained and which some confederate filled for him. He at once proceeded to get rather high in the dead of night to the great astonishment of the attendants, who had regarded him as a “sane” man but who were now at a loss to understand his senseless guffaws, sudden maudlin outcries, and impulsive lurches about the ward. Not realizing that he could possibly have obtained liquor, they feared for a moment that he must have developed an ordinary psychosis. On being approached he cursed, sobbed feebly, and was brought back to bed, passing intestinal gas with frequent loud and unpleasant effects, grinning almost triumphantly at the nurse who had hurried to him at each detonation.
The next morning he admitted the drinking after being confronted with the Coca-Cola bottle to which the string was still attached. He was at first superficially penitent but soon could be seen to show pleasure at his cleverness, which he seemed to feel afforded just cause for a bit of gloating. He seemed to have no deep sense of regret and could not understand why the episode delayed his parole. Indeed, he became definitely vexed and talked incessantly for a day or two about his failure to get a square deal.
This patient, entirely sane by orthodox psychiatric standards, having spent the better part of seven years closely confined among other men who, to him as to any layman, were unmistakable lunatics if otherwise agreeable company, was given another series of chances to win his freedom.
The opinion has often been expressed that the psychopath, who in some ways seems to behave like a badly spoiled child, might he helped if he could be put in a controlled situation and allowed to feel the unpleasant consequences of his mistakes or misdeeds regularly, as he commits them.
With this patient such a policy was pursued and the effort was protracted to remarkable lengths. Such a plan of treatment or reeducation perhaps may accomplish a good deal with some patients of this type. With Arnold it yielded no discernible fruits. His parole was restored time after time. He expressed a clear understanding that he was obligated not to leave the hospital grounds. Each time,
in accordance with his past behavior, he would promptly disappear. After a few hours, several days, or perhaps a week, the police would call to say they had him in custody. Back on his ward he seemed properly regretful and immediately expressed confidence in himself, explaining that the last misadventure had served as the lesson he needed. He was soon allowed to go out on the grounds again. Two or three small acts of defrauding, the temporary misappropriation of an automobile (which he would usually abandon after his whim for a ride had been fulfilled), or some other succession of deeds incompatible with parole status always brought him back under strict supervision. After a short time he was given still another trial.
He spoke fulsomely of the handsome treatment he was receiving, protested an earnest affection for his physician, and swore staunchly that he would justify this faith shown in him. Always he seemed entirely sure that his difficulties were a thing of the past. Unlike the patient whose behavior is distorted by compulsion in the ordinary sense, he showed no evidence of a struggle, no awareness of anything that gave him doubt about his future success in achieving what he planned.
This alert, intelligent man remained always free from confusion, from any indication of powerful impulses or yearnings, froth all conscious influences that might account for his spectacular failure to gain freedom. He expressed eloquently very natural desires to live an unrestricted life outside his familiar wards where he was locked in with very psychotic men. He mentioned no force or conflict, in many long interviews, that might make it difficult for him to conduct himself in a way that would bring him release from hospitalization. He denied experiencing the slightest pleasure from alcoholic beverages. And, indeed, he always seemed miserable, melancholy, and quite unlike his usual buoyant self when he had partaken of drink.
He did sometimes, as a matter of fact, continue ten days or two weeks without mishap. At his own request he was detailed to help the attendants on the infirmary ward, which he did ably, faithfully, and apparently with interest. A merry, rather witty person, he freely admitted that he had made a fool of himself and a mess of his life, but he always maintained that he would never again break his word, which he had given not to drink, not to stay out beyond the limits of a pass, and not to violate any other hospital regulations. He was usually friendly and courteous to his physician and to other personnel and went out of his way to be attentive to physically ill patients, apparently taking mild pleasure in any kindness he could do them.
He continued to request a pass to go downtown, but seldom insistently, often smiling or laughing with apparent relish as he admitted that his past performances did not justify the further confidence he begged. It was an academic point, apparently, this admitting of fault or guilt. It seemed more an expression of being polite and proper than anything indicative of comprehension about cause and effect. But he made these gestures attractively. His characteristic approach was tentative and with what looked like a dash of humor at his own expense.
One Sunday morning he was given a pass after he had made a special point that he wanted to attend church. Arnold did not return. Some of the hospital attendants on their way home that night found him several miles out in the country staggering about in the rain on a lonely road, his trousers hanging down about his heels, seriously impeding his progress and tripping him from time to time into the ditch, where he rolled and thrashed, hallooing wildly or cursing in aimless violence. Soaking wet, covered with mud and vomitus, he was brought back to the hospital.
The next morning he faced his physician with a hangdog expression through which a merry glance soon darted. Smiling, he lightly damned himself for the worst sort of fellow imaginable and swore good-humoredly that he had learned his lesson. Within a week parole was restored and shortly thereafter he celebrated his freedom by somehow obtaining whiskey without leaving the grounds and hobbling into the recreation building, where a dance was in progress, a picture of agitated dejection. He stumbled about in purposeless lunges, eyes rolling, mouth open, and drooling saliva, then collapsed sensationally on the floor before attendants could seize him.
These episodes are entirely typical of his last few months in the hospital. During this time a limited degree of freedom was restored to him within a few days after each episode and each time he failed as promptly and as spectacularly as in the incidents described previously. Altogether he was arrested some dozen or more times during this short period, nearly always within a few hours after leaving the hospital grounds.
He had frequent superficially serious talks with his physician in which he expressed despair over his situation, remorse for his all but incredible record as a failure, and a quick, cheerful confidence in his future. What might be called a thin and bright surface of sincerity which is hard to indicate without paradox seemed to distinguish him from his fellows who are also described in this book. This quality, not in the simplest sense false, seemed not only consistent but almost complete. It was, however, too bodiless to hold any true resolution or remorse or to be useful to him in gaining worthwhile insight. It seems likely that his sincerity, though not a literal fraud, was so thin as to be, for practical purposes, merely an academic abstraction. He was often in high spirits, communicative, boyish, and rather winning. Though fretting and complaining continually about his confinement and apparently unable to understand adequately why this was advisable, he seemed to find mild interest and trivial pleasure in small matters. He could give no explanation of why he committed acts that demanded his remaining in a psychiatric hospital. He always fell back on the plea that he would never do so again. When drinking, he was often noisy, always unhappy and distraught, silly, and tearful.
His physician’s enthusiasm to rehabilitate him by a siege of patience slowly waned as failures accumulated. Finally on Easter Sunday he engagingly made another plea for a bit of freedom. If he could only have a pass for a few hours, to go to church for Easter services! His request was granted. Marvelously, he returned on time without indication of having sought disaster and exultant at his success. On the strength of this performance he was allowed to remain out in the sunshine on the grounds during the afternoon. At nightfall he could not be found. The two letters at the beginning of his story tell the rest.
All this, however, is but the merest glimpse of the man. The account as related to this point is a word, and no more, in the man’s history. Seven years ago, when admitted for the first time, he had already spent some ten or twelve years in and out of jails and mental hospitals, scarcely ever passing a week of his life without attention from the police.
Small swindles, with property owned by another given as collateral for a loan, bad checks, wrecking an automobile which he had bought on credit and for which he made no effort to pay, surreptitiously selling a half dozen of his uncle’s cows and blowing the cash—in these and scores of other but similar activities he kept the local law enforcement agencies extended. He seemed always so frank and honest, so thoroughly without malice, that often those damaged by him withdrew their charges to give him another chance.
Sometimes by pleading grave illness or other disaster and emergency in the family, he would, in his father’s name, borrow $50.00 or $100.00, which he squandered before the misrepresentation was detected. Once, feeling himself in need of funds to make a trip, he rented to a stranger rooms in the house of a neighbor, cleverly timing his transactions so he could show the accommodations, close the deal, and obtain payment in advance during a period when the lady owning the property was downtown shopping.
The money he obtained and promptly wasted was seldom, if ever, sought for any appreciable need or to satisfy impulses that seemed more than mild and transient caprice. The frequent trips he made were all but purposeless. Whether he went to a nearby town or a large, distant city, he sought no job or other opportunity, found no adventure in the ordinary meaning of the word.
He often hung about street corners, went to a movie, loitered in a park, or spent hours in a poolroom or cheap hotel lobby chatting about trivialities, and then, finding his
environment tedious, he would return home. Meanwhile, his parents, whom he never informed of plans for travel, suffered no little anxiety and grief wondering whether he was dead or alive and if they might see him again.
He did not write to his family while on these expeditions. If jailed for pawning a tire he had stolen from someone’s car, pressed too unpleasantly for bills he had run up, or faced with trial for fraud (after selling nonexistent commodities for which he successfully misrepresented himself as salesman), he usually telephoned his parents and spoke convincingly of the ill fortune which had overtaken him and of his innocence of willful wrongdoing. They regularly sped to his aid and, usually with appreciable expense to themselves and with humiliation, succeeded in obtaining his release. Otherwise he simply turned up one fine day, nonchalant, gracious in his apologies, but apparently unaware of having caused any valid distress to those he always maintained he dearly and deeply loved.
On turning to drink he sought low company and often ended by wandering off. Sometimes days passed before he was discovered lying in forlorn swamps or wallowing drunkenly about remote cornfields. Not dozens of times but scores of times his friends and relatives had to search him out and bring him, inert or struggling farcically to no end, back home, where he was washed, reclothed, and nursed to sobriety. He had done no work at all since a brief gesture of helping his father in the store for a few months after he quit junior college in the town of his nativity at 17 years of age. He had no real friends and seemed to want none, though he was superficially sociable and mingled easily with both sexes. He had frequently sought the favors of prostitutes but had never showed a lasting or a wholehearted interest in any woman.
The Mask of Sanity Page 9