Lowell was admitted to the Cincinnati hospital in early April 1954. His doctor wrote in Lowell’s chart that he was extremely elated, his speech was pressured, and he exhibited flight of ideas, which is characterized by a rapid flow of speech and a leapfrogging of loosely linked words and images. His thinking was meandering, indirect, circumstantial. He had been buying things, especially clothes, indiscriminately and had had both visual and auditory hallucinations. He was diagnosed with manic-depressive illness, heavily sedated, and prescribed a regimen of “relaxing baths” and psychotherapy. Lowell’s physician, Dr. Philip Piker, a professor at the College of Medicine, University of Cincinnati, used and studied electroconvulsive therapy extensively. When a combination of sedation, hydrotherapy, and psychotherapy failed to check Lowell’s mania, he was given nearly twenty electroshock treatments; they worked quickly and “quieted him down considerably.” He became temporarily depressed after the ECT, however, as he had at Baldpate Hospital.
The recovery from mania was incomplete. Within days of stopping the ECT Lowell became “more and more unruly, restless, strange, less and less serious about the illness.” He was “agitated and scattered.” There were a few signs of improvement, however. He was still manic, but for the first time in months, Hardwick wrote, “I enjoyed him…we laughed and everything was just as it used to be.” The electroshock treatment had brought him “to be partly his delightful self.” Still, there was “tremendous chaos beneath the superficial control.”
Hardwick wrote to Lowell’s cousin Harriet Winslow about the pleasure of seeing Lowell reemerge, however fitfully, into sanity. “His wit, subtlety, variety” had returned, she said, but “one of the great difficulties of this present breakdown was that he was in greater control than during the others.” Because of this he was still wreaking havoc. Addressing the particularly close relationship Lowell had with his cousin, as well as his inability to judge himself when ill, she continued: “I know how much he means to you and how deeply he cares for you. What is so heart-breaking about these breakdowns is that during them Bobby thinks he is exceeding himself, but actually is much less than his normal self. I can’t bear to find him dull, repetitive, aggressive, obvious—all the things he isn’t when well.” Hers is an excellent description of the gap between manic certainty and its reality.
Lowell was in a severe hypomanic, if not overtly manic state. Hypomania, mania’s less extreme relation, occupies hazy ground between mania and normal moods and behavior, can be hard to recognize and harder still to live with. It can exist in its own right or it can be a transitional state between mania and normal moods, or between mania and depression. It is, as Hardwick described it, a state “in which the patient has a lot of control, a lot of ability to function, while being at the same time extremely unwise, deranged.” Dr. Piker had told Hardwick that “such a state is the most difficult one in psychiatry—usually even the family thinks the patient is all right and friends nearly always resent any restraints being put upon a man who has so much of his powers left.” Hardwick added her own experience. “You are so afraid of accusing a person of being ill simply because he is acting in an inconvenient way.”
Hardwick’s discouragement with Lowell’s condition was palpable. “I do not see any future: this half-sane, half-mad condition is truly defeating to my spirit.” Sheer obstinacy, she said, kept her going. “Like a grim missionary I will save him if it kills him.” Given his irrationality and manic impulsiveness, she added, “he may be in Paris before I know it. But it will be over the corpse of one dead Hardwick, not because of love but because of my relentless pursuit of poor Cal’s sanity. I’m afraid I’ve become a sinister Goddess of Reason.”
Dr. Piker recommended that Lowell be transferred from Cincinnati to another hospital for “convalescence.” His condition was improved, but it was not possible to predict how much further treatment he would need. In a paternalistic aside not uncommon for medical practice in that era, he added, “I suppose that Mr. Lowell’s wife should be consulted concerning the next move.” Hardwick, for her part, was developing an understandably jaundiced view toward doctors. “One of the great troubles with psychiatrists,” she wrote to friends, “is that they do not have to take responsibility; they don’t advise or discourage nearly enough in my opinion, having all kinds of possible evasions ready at hand. They won’t do what a doctor does for a person with a bad heart, simply tell him the facts of life; on the contrary they sit back looking wise, letting you go to your doom.” The one exception, she said, had been the bluntly pessimistic Dr. Watson at Baldpate Hospital, who had warned her about the likely recurrence of Lowell’s illness. Delivering a bad prognosis, she said, “is not a pleasant thing to do, but it ought to be their duty.”
Lowell was transferred to an interim hospital for a week and then admitted to the Payne Whitney Clinic of the New York Hospital in New York toward the end of May 1954. His new psychiatrist, Dr. James Masterson, examined Lowell on admission and found him to be “neat, cooperative, extremely tense, anxious, preoccupied, and somewhat depressed.” His speech was “vague, rambling, halting, and indecisive.” When Lowell was asked to describe his mood, he said it was one of “nervous intensity.” He appeared to be in “a mixed phase with some evidence of depression which is covered over by superficial affect of elation.” Lowell had been preoccupied with suicide, wrote Dr. Masterson, but was not currently thinking seriously about killing himself. There were no delusions or hallucinations, no obsessions, compulsions, suspiciousness, or excessive difficulty in thinking. His remote and recent memory was good. When asked what he hoped for his future, Lowell said, “I intend to go on writing and teaching.” Lowell’s mania of the preceding months had cleared and left only the charring from its high-voltage path. He was depressed but not morbidly so.
Dr. Masterson asked Lowell about the circumstances leading up to his manic attack in Cincinnati. Lowell told him that he had arrived too late in Italy to be with his mother when she died and that he had brought her body by ship back to the United States. He reported that during the trip he had been “over-exuberant and light-headed,” overactive, slept too little, spoken too much, spoken too fast. He had found it difficult to control his behavior: “I felt like a drunk person with sober people.”
During his mother’s funeral, he told the psychiatrist, he had “maintained himself well,” but once back in Cincinnati he had again become elated, talked too much, and written too many letters. He had been “extremely over-active,” aggressive, out of control, and had made “savage verbal attacks at various social affairs.” He had announced to all who would listen that he was divorcing Hardwick and marrying his Italian lover; he had spent his money loosely and had taught “unrealistic seminars” far too fast. He had been delusional, had hallucinated, and now was suffering from a “terrible, unpleasant inner and outer distractibility.” He was living a nightmare.
Dr. Masterson diagnosed Lowell as having manic-depressive illness. There was no evidence Lowell had a personality disorder, he said, a clinical opinion of significance in light of Masterson’s later international recognition as a psychoanalyst and authority on personality disorders, specifically narcissism. He conceptualized Lowell’s psychiatric problems as a manifestation of a psychotic mood disorder, not as a disorder of personality or character. Lowell told Masterson that his illness was “something deep in my character.” The doctor disagreed.
Masterson described Lowell’s behavior during his first ten days in the hospital as “restless, preoccupied, aloof, indecisive, dependent on others, anxious, tense and depressed,” a clinical description not unlike the one given by Dr. Blitzer, who five years earlier had treated him at Payne Whitney. Then, two weeks into his hospitalization, Lowell switched into mania. He became “aggressive, over-talkative, over-active, elated, anxious, tense, hostile with much sexual talk and much rumination about a romance with Giovanna, and the need to divorce his wife.” He slept poorly, refused to cooperate with the nursing staff, was easily annoyed, impulsive, and excee
dingly irritable.
Lowell was transferred to a ward for more severely ill patients. He told the nursing staff and his doctor that he was Christ. His conversation was hard to follow; he spoke in “analogies” and was, at times, “incomprehensible.” He sparred with the nurses and doctors, chain-smoked in his room against hospital rules, spoke incessantly on the telephone, and “needled” other patients. He was tense, coiled, and defiant. He sang at the top of his voice in the lounge. Once, jealous of the attentions another patient was paying to a woman patient, he grabbed him by the feet and yanked him off a couch. He had profuse night sweats. He deliberately broke his glasses by dropping them from the window and drank great quantities of milk and buttermilk. He had dreams and daydreams in “bright colors,” during which he talked with Ezra Pound and walked through the bombed-out city ruins of Italy. In one particularly frightening dream he found himself alone with his dead mother; in another, he was called out to a firing squad. The bright colors of his dreams lay over dark waters.
Three weeks after Lowell switched into mania he was given chlorpromazine (Thorazine) for the first time, a new antipsychotic drug that had been found to be of striking benefit to patients with severe psychotic illnesses. The first psychiatric patient to be given chlorpromazine, two and a half years before it was prescribed for Lowell, had been acutely manic and had responded dramatically well to it. As did Lowell. Within twenty-four hours of his first injection he showed “a marked and dramatic improvement.” The overactivity, elation, pressured speech, flight of ideas, irritability, and sexual talk “disappeared.” His sleep improved markedly. “Thank heaven [chlorpromazine] seems to be working,” Hardwick observed. “The results are quite astounding. Cal is rational, the first time in five months.” Within a few years chlorpromazine would largely replace electroconvulsive therapy as the treatment of choice for mania and would be the primary reason for the decreasing number of patients institutionalized in state mental hospitals and asylums. It worked well in acute mania but, unlike lithium, which Lowell would be prescribed more than a decade later, chlorpromazine did not prove effective in preventing recurrence of his illness.
Lowell’s striking improvement was a relief, but it came at a cost. He suffered from the common side effects of chlorpromazine; he told his doctor that he felt “restless and weighed down” by the drug and had a “desire for more activity but [felt] less able to do it.” He felt “slow witted and helpless intellectually,” “as though I’m carrying 150 lbs. of concrete in a race.” When Lowell’s clinical condition improved, his medication was decreased and then stopped altogether.
As Lowell’s mania cleared he was better able to discuss other psychological issues with Dr. Masterson: his imperfect but cornerstone marriage; his tendency toward “vagueness and withdrawal”; his intense, at times contradictory needs for solitude and affection. Once Lowell’s mania resolved, he immediately retracted his plans to marry Giovanna and wrote to her to that effect. “I see more and more clearly that I will never be over my disturbance and back to my health and work again without Elizabeth,” he explained to her. Hardwick “understood my disease far better than I myself.” He had made a commitment to be in psychotherapy for several years: “I’ve really been quite sick and this time I want to get to the bottom of it all…I need [Hardwick’s] knowledge of me and encouragement to get well….She loves me, I love her.”
Blair Clark told Hardwick during this period that Lowell was committed to the idea of treatment and had been for some time: “He told me sitting in Venice and, I think, long before that in the Public Garden in Boston, that he knew he ought to take psychiatric treatment and that there was something in psychiatry which was both useful and interesting.”
Lowell made it clear to his doctor that above everything he wanted to preserve his marriage. He recognized that his attacks of mania “started with falling in love,” with a restless discontent and an irritable desire to slip the collar. When he was well, he said, he knew he had a “perfectly good marriage” and didn’t want it to end. It had “bare spots” but it was good: he and Hardwick had the same values, liked the same people, trusted each other, and were used to each other. “I can’t get well without Elizabeth,” he said. “She doesn’t go crazy.” She was earth to his fire, lived in a comforting reality not his own. He went “into a stupor” when practical matters came up; she didn’t. She loved him. He loved her.
Many of Lowell’s sessions with Dr. Masterson focused on his marriage and his parents, but always in the room was his shame about what he had done while he was manic, a shame attended by a mounting alarm that he would “go mad again.” As early as Lowell’s first day in the hospital, Dr. Masterson wrote that Lowell was “preoccupied” with his “fear of manic attacks and a desire to control them.” Lowell told the doctor, “Manic attacks terrify me”; it was “humiliating to be here because of mania.” He had had three attacks in five years, didn’t know when the madness would come back, and it was frightening beyond words. (John Haslam, apothecary to Bethlem Hospital, quoted Dr. Johnson for the epigraph to his 1809 textbook on madness and melancholy: “Of the uncertainties of our present state, the most dreadful and alarming is the uncertain continuance of reason.”)
But mania was complicated to Lowell, as it is to most who experience it; it had some attraction. Even if “having manic episodes control me [was] terrifying, I like to have these feelings but under my control—feelings of speed, instantaneous reaction to people, environment.” Force brought under control had meaning to Lowell; the exertion of will over adversity was an identifying part of his character and what he admired in others. He told Dr. Masterson that he knew he would have to invoke “more manhood to control these episodes.” The psychiatrist noted simply that Lowell felt “humiliated and frightened by the attacks.”
By June, having come down from his mania, Lowell was again depressed and filled with remorse. He told Dr. Masterson that he was “ashamed about myself. I feel I’ve made an awful fool of myself.” The best he thought he could hope for was “to know when symptoms are coming so I can do something about them.” “Mania always is in the background,” he said. It could be “pleasant,” he acknowledged, but only “until it gets out of control.” Then it annihilated everything he valued in himself.
Dr. Masterson recorded time and again Lowell’s horror of madness: “his feelings of terror, his inability to control these attacks, and his shame at some of the things he does during these attacks.” In Masterson’s last clinical note, written the day that Lowell was discharged from the hospital, his final sentence is simple: Lowell, he wrote, “dreads depression and elation.”
Hardwick more than anyone was aware of Lowell’s suffering. “I feel so sorry for Cal I can hardly bear to think of him,” she wrote to Peter Taylor. “This is simply going to break his heart when he comes to and learns he had another of these things….I so fear he will have a depression afterwards because of his anguish about this latest episode.” People would never understand, she said. “They understand that a person is deranged, but at the same time they cannot help but hold such a person responsible for his actions, or some of them.” Time and again she expressed the same concern. “Underneath, Cal feels dreadfully ashamed of this last illness, filled with fear of the future, utterly shattered in his self-esteem. All of this was more than he could endure….I wonder if he will ever be himself again, with the need to escape the pain of this.”
Lowell left Payne Whitney in September 1954. After his first admission to Payne Whitney in 1949, Dr. Blitzer had written in Lowell’s chart that his prognosis was “good.” This time Dr. Masterson wrote that it was “fair.” Hardwick had been reading about prognosis in manic-depressive illness and was shaken by what she read. “Cal will recover from his attacks when they come,” she wrote to a friend. “But they will probably come. I was up at Brentano’s recently reading a large big new book about mental illness; it said about the manic-depressives: as they get older the attacks become more frequent, more prolonged, more diffic
ult to treat. My heart nearly stopped beating.”
Once again Lowell had to sift through the embers to make sense of what he had been through, contend with what might come, and atone for things done and left undone. “According to Paine-Whitney [sic], I have made remarkable progress and the whole business is curable,” he wrote to a friend. “It’s also been imbecilic, inhuman, dangerous, embarrassing, and hell on Elizabeth. Now the world is beginning again for us.” A few months later, Lowell wrote to Elizabeth Bishop about his most recent illness: “I have been sick again, and somehow even with you I shrink both from mentioning and not mentioning. These things come on with a gruesome, vulgar, blasting surge of ‘enthusiasm,’ one becomes a kind of man-aping balloon in a parade—then you subside and eat bitter coffee-grounds of dullness, guilt etc.”
Lowell’s release from Payne Whitney came a long seven months after his tense dinner with Blair Clark in Paris. The look back was dark, the look forward not much better. He wanted peace and the safety of what he had known. “He just wanted to go back to New England,” said Hardwick.
7
Snow-Sugared, Unraveling
We feel the machine slipping from our hands,
as if someone else were steering;
if we see a light at the end of the tunnel,
Robert Lowell, Setting the River on Fire: A Study of Genius, Mania, and Character Page 15