by Samuel Shem
About the Book
Welcome to Mount Misery psychiatric hospital, home of the crazed, the suicidal, the Machiavellian and the wicked. And that’s just the doctors. For Dr Roy Basch, proudly starting his residency there, it is a bewildering and nightmarish experience. The different disciplines appear to compete with one another to find the best ways to reduce the patients to gibbering wrecks. As Basch immerses himself in the system, he discovers that the process of treating the patients has less to do with making them better and more with maintaining the flow of insurance company money. Basch believes that he can find meaning here, but in a world which has lost its head, he soon finds that survival, not meaning, is the most valuable lesson he will learn.
Mount Misery is hilarious, provocative and terrifying. Filled with biting irony and a wonderful sense of the absurd, it is an absorbing and authentic report from within the crumbling fortress of psychiatry and tells you everything you’ll never learn in therapy. And it’s a hell of a sight funnier too.
Contents
Cover
About the Book
Title Page
Dedication
Epigraph
Emerson
Chapter One
Chapter Two
Chapter Three
Chapter Four
Chapter Five
Chapter Six
Toshiba
Chapter Seven
Chapter Eight
Chapter Nine
Thoreau
Chapter Ten
Chapter Eleven
Chapter Twelve
Chapter Thirteen
The Heidelbergs
Heidelberg West
Chapter Fourteen
Chapter Fifteen
Chapter Sixteen
Chapter Seventeen
Heidelberg East
Chapter Eighteen
Chapter Nineteen
Chapter Twenty
Chapter Twenty-One
Canyon De Chelly
Chapter Twenty-Two
About the Author
Also by Samuel Shem
Copyright
MOUNT MISERY
Samuel Shem
For Janet and Katie and Rose
Thanks to Judith Abbott, Joy Harris, Les Havens,
Ben Heineman, Chris Robb, and Daniel Zitin.
‘It was how the sun came shining into his room:
To be without a description of to be,
For a moment on rising, at the edge of the bed, to be,
To have the ant of the self changed to an ox
With its organic boomings, to be changed
From a doctor into an ox, before standing up,
To know that the change and that the ox-like struggle
Come from the strength that is the strength of the sun,
Whether it comes directly or from the sun.
It was how he was free. It was how his freedom came.’
—WALLACE STEVENS
The Latest Freed Man
EMERSON
‘Terror acts powerfully upon the body, through the medium of the mind, and should be employed in the cure of madness.’
—BENJAMIN RUSH, M.D.
‘The Father of American Psychiatry’
1818
One
WASPS, I’D DISCOVERED in my month of being a shrink, are notoriously hard to read. Their body language borders on mute, and their language itself is oblique, like those masters of obliqueness the English who, I had learned in my three years at Oxford, when they say ‘Yes, actually’ mean ‘No,’ and when they say ‘No, actually,’ may mean anything.
Now, try as I might, coming at him from various different interviewing angles, much as my father the dentist would come at a recalcitrant tooth, Cherokee Putnam remained a mystery. It was six-thirty in the morning. I was bone-tired, having been on call at the hospital all night long. Cherokee had appeared at the admissions unit without calling in advance, and had paged the Doctor on Call – me. He said he wasn’t at all sure he needed admission, but he hadn’t been able to sleep and had to talk to someone ‘about a delicate matter,’ in confidence. The closest I had come to reading any feeling in him was when he told me how, at a dinner party at home recently, he’d gotten so furious at his wife Lily that he’d actually done the unheard of: picked up his linen napkin and thrown it down onto the tablecloth beside his plate.
To my probings, he denied that he was depressed. He denied suicide attempts, suicide gestures, suicidal ideation, and showed no signs of being crazy. He seemed like just the kind of guy the word ‘normal’ was made for.
He looked normal enough. He was my age – thirty-two – my height and build – six-three and slightly fallen from slender. But while I was a lapsed Jew, he was a cornered WASP, in buttoned-down pink shirt and pressed khaki pants, with an excellent blade nose and blue eyes, a charming mole on one boyish cheek, and strawberry-blond hair combed back and parted off center. Tan and handsome, he looked like the young Robert Redford. He was rich, the father of two young girls – Hope and Kissy – and he admitted sheepishly to being a lawyer. A Yale graduate, he’d made a small fortune working for Disney in California, before coming back to his roots in New England eighteen months before.
‘But you kill yourself at Disney,’ he said. ‘There’s a saying out there, “If you don’t come in on Saturday, don’t bother to come in on Sunday.”’
His wife Lily was also from New England. He’d spent ‘a million two’ to buy a foothill and a horse farm nearby. He and his wife were into horses, she into show-jumping, he into polo. After a year of leisure he was now trying to figure out what to do next with his life.
‘Is that what’s troubling you?’ I asked.
‘No, no, not at all,’ he said, ‘but once in a while I wake up at three in the morning comparing myself to other people, successful people. I turn to my wife and say, “I’m a failure.” That used to get her right up, but now she’s so used to it she barely wakes up. She just murmurs, “Take a Halcyon and go back to sleep.” Lily’s heard it too many times.’
‘So there are problems in the marriage?’
‘Oh no, no. Things are fine, actually. The normal disagreements, mostly around her being so neat, and me, well, y’see how neat I seem?’
‘Very nice, um hm.’
‘Very. But in private I’m pretty messy. Nothing big, just socks on the floor, nothing hung up. She’s very neat. We had a big tiff last week, when the help was off – I emptied the dishwasher and just threw the silverware into the drawer. Lily nests the spoons! Just the other day I said, “Please, I beg you – give me the dignity of living like a pig.”’ I laughed. He smiled, barely. ‘Lily’s a stunning woman. If she were here, you couldn’t take your eyes off her. She did the whole debutante thing, cotillion, the works. Even after two kids, dynamite body. Incredible, really. You should see her on a horse.’
‘It must be a great feeling,’ I said, stifling a yawn – thinking, Enough of this bullshit, how can I get rid of him and get some sleep? – ‘to wake up early in the morning and go for a horseback ride with your wife.’
‘She’s never there early in the morning.’
‘Why not?’
‘Lily’s in psychoanalysis. Actually … her doctor is on the staff here. That’s why I came here. A Dr Dove. Do you know him?’
‘I do.’
‘She sees him every morning at six a.m.’ He glanced at his watch, one of those mariner’s, with nineteen dials. ‘She’s there right now.’ His eyes met mine and then skittered away, as men’s eyes do when they are about to try to make contact. ‘Look, I half think I’m crazy for thinking this, and as a lawyer I will deny that I ever said it to you, but … well … I think … no, it’s crazy.’
‘Go on.’
�
�I think … think that my wife is having an affair with Dr Dove.’
My mind recoiled. Talk about pigs. Schlomo Dove was one of the most unattractive and unappealing men I’d ever met. He was a man who, in the parlance of these times, would have to be referred to as ‘Beautifully Challenged.’ A fiftyish, short – five-five, maybe – fat Jewish man with thick, curly chestnut hair coming down over his brow like a helmet, tiny eyes sunken into slitty sockets, snaggly teeth still hoping for braces, and a nose that didn’t look happy, he seemed to take pleasure in flaunting his homeliness, wearing suits that were rumpled and ties that were stained and loose around his neck like a series of slack, secondhand nooses. Despite this, or perhaps because of it – in the counterphobic way that some people, afraid of heights, become bridge painters – Schlomo was a performer. The fat little guy was always in your face, always dancing up to you bigger than life, in academic seminars or private supervisory sessions always rising up onto his tippytoes like a bingeing ballerina to present some goofy Freudian stuff in the voice and gesture of a Borscht Belt comic, self-mocking in the extreme. Schlomo had a large private practice, and also was well known as one of a small number of psychiatrists you went to for a consultation to get yourself matched up with just the right therapist. He was an eminent psychoanalyst, on top of the Freudian pile in the institute down in the city, and Director of the Misery Outpatient Clinic, which lay at the swampy, reed-clogged end of a sausage-shaped lake that roughly split the hospital’s campus.
Eminent, yes; appealing, no. How could any woman, especially a gorgeous WASP Ice Princess, go for Schlomo Dove?
So looking at Cherokee, I thought, No problem, this guy’s crazy. Yet one thing I’d learned in my life so far, especially this past year traveling around the world as a doctor: as in human achievement, where no matter what you do there is always someone who has done it more, so in human degradation, there is always someone hurtling on down past you, down past what you can even imagine. And so I said only, ‘Really?’
‘Yeah. It’s been over a year now that she’s been in therapy with him. We came back East, it was our dream. To take time off, together, to be with our kids, after the phoniness of Hollywood. Everything was in place. And then she feels a little down, you know, and goes to him for a consultation.’ He sighed. ‘She sees him every weekday morning, sometimes on Saturday, occasionally on Sunday too. Our sex life has dried up. But she looks more and more sexy. Not only to me, but to my friends too. Buys sexy underwear. Lotta color, lace, you know?’ I nodded, my mind rolling into fantasies of lace and color and my girlfriend, Berry, and thanking God that one perk of being a shrink is that you hear some pretty hot sexy stuff. ‘It’s not like her. Not since the kids. And she cut her hair short, like a boy. Really strange, that. Her long hair was her pride. Not like her at all.’
‘Have you asked her about this?’
‘I’ve got no solid evidence. I ask her what goes on in therapy, but she says that Dr Dove says it’s confidential.’
‘But it’s driving you crazy. You might just—’
‘You think I’m crazy?’
There was a hint of crazy in this, given the reality of Schlomo, but just a hint. ‘No, no, you are not crazy.’
‘Oh. Good. You believe that he’s … you know, screwing her in therapy?’
‘I believe that you believe it.’
‘I don’t, totally, I mean. But you say I’m not crazy?’
‘Suspicious yes, crazy no.’
‘Not even, maybe … I don’t know … a little paranoid?’
‘Have you ever seen Dr Dove?’
‘No, why?’
‘Look,’ I said, ‘you don’t know the truth. You’ve got nothing to go on.’
‘And it’s driving me crazy! Do I need hospitalization?’
‘No.’
‘Can I come talk to you?’
‘To start therapy?’
He grimaced, as if I’d just suggested we try a few root canals. ‘I wish you wouldn’t call it that. Father – none of my people – believe in psychiatry. “Stand tall,” they always say, if there’s any trouble, “stand tall, and call your lawyer.” Therapy’s for … others.’
‘Too “messy,” eh?’
He blinked, as if in strong light. He sighed. ‘You got me. Shit.’
‘I’d be glad to see you.’
He paused. I felt him struggle with it. Then he loosened his tie and through gritted teeth said, ‘Fuck ’em. Let’s make an appointment.’
We set up an appointment for the next week. He stood, crunched my hand, and walked out as gracefully as, well, as a horse. I liked him and felt for him, and if I could get him to come to therapy, I could help him. Schlomo? Do I tell him about this? Better talk to my supervisor, Ike White, first.
My on-call night was over. I walked over to the administration building, the Farben, handed in my beeper, and walked on past the grand front stairway with its rosewood banister that curled up overhead to the right and left. On the landing two antique Chinese vases filled with silk flowers framed a landscape painting of fields and cows and a proud, lone tree. My feet sank into the carpet as if I were in slippers. As I opened the front door and went from air-conditioning to reality, the damp heat hit me like the fat palm of a Turkish masseur slapping me around in a steam bath in Istanbul. Squinting in the russet morning, I stood on the front steps, perched on the crest of a high hill overlooking the city. Feet on granite, head between soaring pillars, I felt like I was standing in the doorway of a bank.
Mount Misery was the name of this hill, and of the hospital built upon it. The hill had been christened first, in the early eighteenth century, by a band of hardy Puritan farmers tormented by the nor’easters that would whip the rough rock for four days at a time. The hospital had been founded later, in 1812, by a group of civic-minded Yankees who, having built a hospital in the city to treat diseases of the body, decided they wanted a matching set, and built one far out in the countryside, in the shadow of the mountains, for diseases of the mind. Their keeping the name Misery showed a measure of obvious delight, that perverse delight which comes with ironic resignation. By the late nineteenth century there were many of these elegant fanlike mental institutions, some of which still survive: Austin Riggs, McLean, the Brattleboro Retreat, Shepard Pratt, and Chestnut Lodge. The principle in the construction of asylums was denial: ‘Out of mind, out of sight.’ Misery had been protected from suburban sprawl by its natural boundaries: the high hill, several ominous ravines, and the swamp at the end of the lake. Its dozen or so separate buildings were surrounded by eighty acres of fields, woods, and streams, all rimmed by a high, iron-spiked fence.
Mount Misery soon became a teaching hospital affiliated with what was nicknamed ‘the BMS’ – the ‘Best Medical School’ in the world. Throughout its history Misery had been in the forefront of the latest red-hot treatment for mental illness. At first this consisted of shackles, purges, bleedings, and teaching proper table manners. Now Misery offered all the different treatments of late-twentieth-century psychiatry. Traditionally it had been the hospital of the unstable wealthy – it was at one time fashionable to be able to announce that one had ‘a son at Harvard, a father buried in Mount Auburn Cemetery, and a mad cousin in Misery.’ These days it attracted not only the wealthy, but also the insured. While welfare cases were rare, each of us new first-year residents in psychiatry would spend some time at Candlewood State Hospital, the state facility down the hill and across the swamp. At Misery there were artists, poets, folk singers, writers, and a steady stream of those tender young men and women cracked by the most ruthlessly prestigious colleges in America. Creative, interesting people who, it was said, made ‘great cases.’ The unofficial hospital motto was, ‘There’s Sanity in Misery.’
It was almost the end of July. The morning was already hot and humid, the dawn cool seeping out under the night’s umbrella in smaller and smaller droplets, heating up, sizzling off, gone. To the north, mountains cooled their peaks with clouds. Before me, lining
the roads and coalescing in peaceful woods, were oaks, maples, and, with their clusters of lilylike flowers, catalpas. To my right was the red-brick colonial of Toshiba, the Admissions Unit, with the windowless research wing sticking out of it just above ground level like a stainless steel prosthetic foot. High up on the hill to my left above a ravine nicknamed ‘Loopy Lovers Leap,’ peeking out from a clearing in the pine forest like eyes from a hiding place in a scary fairy tale, were the twin spiked towers of the two buildings named the Heidelbergs – replicas of the famous Bridge Towers that were the gateway to the real Heidelberg, ‘Birthplace of German Romanticism.’ Heidelberg West was the Misery Center for Psychopharmacology, the drug treatment of mental illness. Heidelberg East, just across the ravine, was Alcohol and Drug Recovery. An incessant, busy stream rushed down from the ravine, pooled in the sausage-shaped lake, and oozed off to swampy stuff where, amidst the cattails and skunk cabbage and forlorn willows, was the squat ivy-covered building that housed Schlomo’s Outpatient Clinic. Farther down the hill, alongside the road leading to the wrought-iron gate and granite gatehouse, across the broad swath of the orphaned eighth fairway of the once-grand Misery Links, rose the towering Greek Revival structure of Thoreau, the Freudian Family Unit, its bubble skylight a cyclops eye staring back in transcendental defiance past me, up at the spiked, certain, drug-centered Heidelbergs. Far to my left, past the lake and out of sight in the deep woods, was Emerson, my current home base, which housed Depression, Borderline, and Psychosis, one on each of its three floors. Here and there on the lush green lawns an immense copper beech spread its branches like a hoop skirt sequined with metal.
I took off my suit jacket, turned left, and wandered along the narrow, twisting, and hilly main road that skirted the lake and crossed the stream on a narrow stone bridge. The ivied buildings could have been a college campus. What could have been students strolled peacefully along, none looking like patients. I had yet to learn how to tell the patients from the staff on sight.
I was one of five first-year residents in a three-year training program to become psychiatrists. This, our first year, was tightly structured. Every eight weeks or so we would move from one rotation to another, on a computer-generated schedule that we had been handed on our first day in Misery. Each of these Misery rotations was to teach us how to treat inpatients, those poor souls locked up in the various wards. Each rotation was with a group of patients with a particular diagnosis, each group housed in a different building – depressives on the first floor of Emerson, borderlines on Emerson 2, drug addicts on Heidelberg East, and so on. Each of the first-year residents did the exact same rotations, in different order, every couple of months moving on in a kind of equal-opportunity psychiatric musical chairs, with exactly enough chairs for all. I was a month into my first rotation, on Emerson. Next I would move to Toshiba, then to Thoreau, and, for the final part of the first year, to each of the Heidelbergs. In addition, all year long each of us was assigned to a different Outpatient Clinic Team, and would follow our very own patients as outpatients – not admitted to the hospital – in psychotherapy throughout the course of the year. And of course each of us first-year residents would be on call every fourth night, as the DOC – the Doctor on Call – the only doctor available to the 350 inpatients all night long.