TIMES CHANGE WITH THE TREATMENTS:
ON ASYLUM WRITING
This essay has three parts. Click here for the FIRST part, “IT’s A KIND OF MAGNET”. Click here for the third part, “THROUGH THE CLOUDS”.
4. Janet Frame, Faces in the Water (London: Virago Press, 2009), pp. 15.
5. Ken Kesey, One Flew Over the Cuckoo’s Nest (London: Penguin Classics, 2005), p. 167.
6 Joanne Greenberg, I Never Promised You a Rose Garden (London: Pan Books, 1978), p. 212. Originally published under the pseudonym Hannah Green.
7. Ronald Leifer, In the Name of Mental Health: The Social Functions of Psychiatry (New York: Science House, 1969), p. 242.
8. Kesey, One Flew Over the Cuckoo’s Nest, p. 274.
9. Albert Deutsch, The Shame of the States (New York: Arno Press, 1973), p. 184.
10. Erving Goffman, Asylums: Essays on the Social Situation of Mental Patients and Other Inmates (Garden City, NY: Anchor Books, 1961), pp. 80, 238, 246.
11. Michel Foucault, History of Madness, ed. Jean Khalifi, trans. Jonathan Murphy and Jean Khalfa (Routledge, 2006), p. 515. This passage didn’t appear in the first, abridged 1965 English translation, Madness and Civilization (cited below).
12. Richard Yates, Disturbing the Peace (London: Vintage, 2008), pp. 47, 46. 13 Janet Frame, An Angel at My Table (London: Virago Press, 2008), p. 206.
14. Erving Goffman, “The Insanity of Place,” in Nick Black, David Boswell, Alastair Gray, Seán Murphy and Jenny Popay (eds), Health and Disease: A Reader (Milton Keynes, Buckinghamshire: Open University Press, 1984), p. 239.
15. Frame, Faces in the Water, p. 64.
16. Frame, An Angel at My Table, p. 221.
17. Susanna Kaysen, Girl, Interrupted (London: Virago, 1995), p. 94.
18. Barbara Taylor, The Last Asylum: A Memoir of Madness in Our Times (London: Hamish Hamilton, 2014), p. 127.
19. William Styron, Darkness Visible: A Memoir of Madness (London: Vintage, 2001), p. 70.
20. Jenny Diski, Skating to Antarctica (London: Granta Books, 1997), p. 2 (both quotes).
21. Goffman, Asylums, p. 386.
22. Gregory Bateson, Don D. Jackson, Jay Haley, and John Weakland, “Toward a Theory of Schizophrenia,” Behavioral Science vol. 1 no. 4 (1956), 251–64: 254.
23. Frame, Faces in the Water, pp. 13, 30.
24. Kesey, One Flew Over the Cuckoo’s Nest, pp. 112, 100, 4.
25. Frame, Faces in the Water, p. 30.
26. Yates, Disturbing the Peace, pp. 129–30.
27. Ivan Illich, Limits to Medicine—Medical Nemesis: The Expropriation of Health (London: Marion Boyars Publishers, 1995), p. 271.
28. Castel et al., The Psychiatric Society, p. 295.
II
TOTALLY INSTITUTIONAL
TOTALLY INSTITUTIONAL
At the heart of asylum novels were different attitudes to rebellion and escape. “The doors to the outside world are locked,” says Istina, the narrator of Janet Frame’s Faces in the Water (1961), “there is nowhere to run to.”4 Despondent but defiant, she doesn’t buckle under even in this situation of total captivity. Most patients in One Flew Over the Cuckoo’s Nest (1962) are less brave. They half-heartedly prefer confinement to the stress of life outside. Ken Kesey’s psychiatric ward is mainly full of voluntary inmates, who concur with what one patient tells Randle, a rebellious newcomer who is detained by law, “I could go outside today, if I had the guts.”5 They are pragmatic because they know the time may never come when they reject the hospital’s shelter. It is a short step from this realpolitik to the willingly compliant frame of mind described in I Never Promised You a Rose Garden (1964) by Joanne Greenberg. Two patients discuss a freer kind of hospital after they abscond from their ward:
“I would do away with all the bars on the windows,” Carla said.
Deborah wasn’t sure. “The patients would have to be strong enough to stand it, first,” she said. “Sometimes you have to fight what won’t yield and put yourself where it’s safe to be crazy.”
“Let’s make our doctors-on-call really on call.”
“All my attendants will spend a week as patients.”
They found themselves in the meadow far beyond the last hospital building.
“Look where we are.”
“I’m not allowed out here,” Deborah said.
“Neither am I.”
They felt good. The afternoon was settling into evening and a light rain was beginning to fall, but neither of them could bear to part with this small and special mutiny against Sunday, supervision, and the world. They sat in the field, stupid with pleasure and let the Sunday God’s rain fall on them. The day went to twilight. The rain got cold. They stood up in their sopping clothes and began wistfully to walk back towards the hospital.6
The conversation about institutional reform is whimsical. Underneath it is the assumption that independence had to be traded off for security if the supervised battle for sanity was to be won. So the women’s outing isn’t much of a mutiny. Carla and Deborah adhere so dutifully to the hospital mindset that, with nobody around to enforce the rules, they fall back in line on their own initiative. The libertarian doctor Ronald Leifer lamented the fact that psychiatric treatment was “eagerly sought by its victims” to conform with a spurious doctrine of mental hygiene.7 The criticism oversimplified asylum obedience as mindless enthusiasm rather than a more complicated collusion. In One Flew Over the Cuckoo’s Nest, the volunteer madmen join Randle in his rebellion against staff authority up until the point that reprisals start in earnest, and then they pass the buck. Freedom-fighting is turned into a spectator sport to satisfy shared curiosity about the institution’s will to power. “It wasn’t the nurse that that was forcing him” to carry on, Chief the narrator comments ruefully, “it was our need” for somebody to show why real mutinousness wasn’t for the half-hearted.8
To the reader of asylum writing, freedom seems after a while such a muddled idea. The liberal journalist Albert Deutsch demanded in The Shame of the States (1948) that “the relaxed atmosphere of the free, not the electric tension of the repressed or the defeatist aspect of the beaten” should prevail in American psychiatric institutions,9 but by the Sixties mental hospitals were reported to have replaced outright brutality toward inmates with coercion techniques which were all the more effective for being less forceful. Moonlighting as an attendant at St. Elizabeth’s Hospital, Washington D.C., the sociologist Erving Goffman observed an environment where patients were controlled more through snubbing and surveillance than violence. Their liberty wasn’t violated, it was continually disrespected. Goffman remarked in Asylums (1961) that what counted most was to nudge inmates into a compliant attitude by means of warnings, inducements, and withholding information about their treatment. Using such methods, “human objects can be given instructions and relied upon to carry them out on their own” to the extent that “even in the limiting case of catatonic schizophrenics a considerable amount of such reliance is possible.” The aim was to ensure cooperation and stamp out defiance. This left patients with as much room to maneuver as tightrope walkers. So hemmed-in was the situation that what Goffman called “free places” were mere sectors of a corridor or a yard that were briefly unsupervised from time to time. There were also perches such as a radiator or a window sill, where one inmate or another was sometimes seen “pressing the nose of his whole body up against the outside, and in this way somewhat removing himself from the ward.” If there wasn’t a corner to cower in, a patient’s last resort was to nestle under his blanket on the floor—“within this covered space each had some margin of control”—although staff considered the habit backward.10 Freedom in these places was merely casual vagrancy and even that met with disapproval. As Michel Foucault put it in his French history of madness, also published in 1961, the psychiatric patient “was free in the open space where his liberty had already been lost.”11
Asylums described a Kafkaesque institution, a place where patients could just as easily be driven to distraction as rescued from madness. Other texts backed up this account. In the novel Disturbing the Peace (1975) by Richard Yates, John the central character stops himself from speaking his mind at the end of a brief confinement in Bellevue Hospital, New York, because he doesn’t want to stay any longer than he has to: “this place is enough to drive anybody out of their—.” The grievance is made poignantly explicit in a rare asylum documentary, Titicut Follies (1967), filmed by Frederick Wiseman at Bridgewater State Hospital for the Criminally Insane, Massachusetts. Something John says in Disturbing the Peace applied there, “they don’t listen to you: they listen at you.”12 Inmate feedback was invited then discredited as a matter of routine. During one outdoors encounter a man named Vladimir questions a doctor who has reminded him to take his medication: “May I ask just why I need this help that you are literally forcing on me?” The physician, who looks like Dr. Strangelove, replies that psychological testing has confirmed the man’s sickness and, besides, anybody can see something is wrong with him. Expressing himself gets Vladimir nowhere at a subsequent case review either. “All I want is to go back to prison where I belong,” Vladimir says. “I’ve been here for a year and a half, and this place is doing me harm.” When the staff compare notes subsequently, one interpretation of his appeal is that “he’s terrified of leaving,” which artfully turns the whole complaint inside-out. Vladimir’s request is rejected and his dose of tranquilizers increased. In such a climate everything a patient said could be made to mean its opposite so long as the institution was vindicated. In her autobiography, An Angel at My Table (1984), Janet Frame wrote about being a patient in New Zealand shortly after the Second World War. Her diagnosis baffled her: “the idea of my suffering from schizophrenia seemed so unreal,” she wrote, and it “only increased my confusion when I learned that one of the symptoms was ‘things seeming unreal.’” She was faced, like Vladimir, with an infallible definition. “There was,” she said, “no escape.”13
Goffman called the mental hospital a total institution, meaning among other things that it might evolve but was never going to be overthrown by revolution. The asylum was like society itself—the very order of reality not a temporary structure. It followed that although Goffman was an expert in the plight of being locked up in a mental hospital, he didn’t show sympathy. He can easily be imagined in his short-term junior hospital position, watching with dispassionate interest as a patient huddled under a blanket for lack of anywhere else to be on his own. The experience of anxiety and assaulted identity was present in Asylums only between quotation marks. In fact, Goffman doubted whether there was such a thing as a personal self that somebody might instinctively defend or, as a last resort, try to conceal. Selves were roles on loan from society which could easily be taken away again. “The self,” Goffman wrote in “The Insanity of Place” (1969), “is what can be read about the individual by interpreting the place he takes in an organization.”14
Getting locked up was just the beginning of institutional capture. What followed for anybody who didn’t toe the line was disorientation, humiliation, and bitter insight. That the mental hospital wasn’t the place it pretended to be frightens Istina in Faces in the Water: “I felt increasingly like a guest who is given every hospitality in a country mansion yet who finds in unexpected moments a trace of a mysterious presence; sliding panels; secret tappings; and at last surprises the host and hostess in clandestine conversations and plottings.”15
Not every author worried about entrapment and deception. Being stripped of their independence was no hardship for patients who sought a quiet and sealed quarantine. Some asylum writers saw nothing wrong with mental hospitals. As Frame put it in An Angel at My Table, “a trap is also a refuge.”16 Susanna Kaysen recalled in Girl, Interrupted (1993) that McLean Hospital, Boston was “as much a refuge as it was a prison.”17 Twenty years later Barbara Taylor was a voluntary patient in Friern Hospital, London. It was “a refuge from unmanageable suffering,” she wrote in The Last Asylum (2014).18 Around the same time William Styron was treated for depression in the Yale-New Haven hospital. He called it “a sanctuary where peace can return to the mind” in Darkness Visible (1990).19 It apparently didn’t occur to those who reached such safety that being invaded by the asylum and feeling sheltered there were two sides of the same experience of subordination. Jenny Diski was a patient at the Maudsley Hospital in London in the late Sixties and in her memoir Skating to Antarctica (1997) she said she went willingly snow-blind there. “White hospital sheets seemed to hold out the promise of what I really wanted: a place of safety, a white oblivion,” she wrote.20
But from another perspective, any feeling of security patients had was accidental at best because close scrutiny revealed that asylums served themselves not their inmates. “Mental patients find themselves in a special bind,” Goffman wrote: “To get out of the hospital, or to ease their life within it, they must show acceptance of the place accorded them, and the place accorded them is to support the occupational role of those who appear to force this bargain.”21 Or as Gregory Bateson put it, “hospitals exist for the benefit of personnel as well as—as much as—more than—for the patient’s benefit.”22 Perhaps writers disagreed about whether the mental hospital was a safe or dangerous place because the solidarity needed to settle the matter was sabotaged. It was the institution’s major divide-and-rule achievement to classify compliance as health while diagnosing resistance to treatment as a sign of illness, which had nothing to do with an environment that professional advocates insisted was thoroughly beneficial.
People stare out the dayroom windows in Faces in the Water, and Istina wonders what preoccupies them. But when she follows the gaze it leads nowhere. “It was an occasion of loneliness, of vision on a closed, private circuit,” she says. The mental hospital was a haven for the faithful alone, who got chilly comfort from mirages of sanctuary or imaginary wastelands while they turned a blind eye to the ordeal others endured. Istina is shaken by sorrow among the silent and averted congregation—“I could not bear to face the thought that not all prisoners dream of freedom.”23
Escape in asylum writing was always understood to involve more than the physical act of flight. In One Flew Over the Cuckoo’s Nest Randle passes up the opportunity of leaving so he can carry on his unwinnable rebellion against the institution. It is Chief who smashes a reinforced window and then heads for the fishing rivers of his childhood. But in order to make his break for it, first he had to clear the fog from his mind. The fog, which he thinks hidden machines pump out, is where he hides—“as bad as it is, you can slip back in it and feel safe”—and the fog is his despair—“the more I think about how nothing can be helped, the faster the fog rolls in.” All his life he has survived by being “cagey” and only after Randle helps him find his way out of this profounder entrapment can he take the next steps in escaping (for more, see “Asylum Politics”).24
That there was a wider world beyond the hospital, and separate from it, was an article of faith for many asylum writers. “I thought of The World, because I was beyond it,” says Istina in Faces in the Water.25 There is a variation on the theme in Disturbing the Peace when somebody suggests that the asylum is “society in microcosm.”26 But, more eerily, Ivan Illich feared it was almost the other way around. He lamented “a world turned into a hospital ward,”27 and the authors of The Psychiatric Society shuddered at how self-help had turned America into a “padded world,”28 as though (Chief might have said) before the gates of the mental hospitals were shut for the last time, the fog machines and magnets where relocated on the outside and then turned back on so that people wouldn’t mutiny once the last padded cells were replaced by padded selves. In this cagey world view, escape became almost unthinkable, which potentially made the work of inner liberation even more vital. But the final developments which accompanied the asylum’s abolition didn’t favor anything like that. On the contrary, psychiatry found new ways of persuading people to accept the identity of a patient whose suffering was an illness to be managed.
GO TO PART 3