Sunday, November 13, 2011

Committed



This is The Utah State Hospital in Provo, Utah. When erected, it
was called the Territorial Insane Asylum. This building no longer stands,
having been demolished in 1981.

In my family history research, I have encountered no less than six individuals who were considered mentally ill or in need of confinement due to their unruly behavior. The one consistent factor in each of these cases was gender--so far I have only found women whose situations warranted family members signing them over to state care. Women who would not behave as expected, would not sit quietly at home.

Out of respect for more traditionally discreet, living relatives, I will refrain from pointedly identifying any of these women in this post. (Personally, after reading the files I have so far accessed, I feel only empathy for any past patient of a state-operated mental health facility.)

Of the six women mentioned here, four were patients at this hospital. Their commitments began as early as 1911; one benefited from medication and was released to her family, with three passing away still under supervised care, the last two in 1968. They were all committed by family
members who believed it was in the best interest of their daughter, sister, or wife to be treated by psychiatric professionals. Another young woman was only briefly signed into a slightly different institution--a school for hard-to-handle girls. Luckily for her, no one diagnosed her with any disorders that would put her on a mental ward, and she was released back to her family. The
sixth woman, was never placed in institutionalized custody, owing to a trust left by her father to be paid to whichever of her siblings housed and cared for his "beloved Margaret" .

Even today, science has only a modicum of understanding of the human brain and psyche. The root causes of depression and mental illness elude doctors, still. Medication, while widely available, is far from perfect. Movies have provided horrifying images of early insane asylums and the types of "remedies" given to patients. Salacious and extreme, many of these portrayals are rooted in fact.

What behaviors led to their commitment ? One girl suffered brain damage from a bout of spinal meningitis, three were diagnosed with schizophrenia--but today only one of those would fit the parameters of that illness. One misdiagnosis would now be known as Post Traumatic Stress Disorder (complicated by morphine addiction and alcoholism); the second case of misdiagnosed schizophrenia looks for all the world to be a case of heavy metal toxicity. The lucky girl with the trust fund predates much record keeping, so the possible cause for her developmental limitations escapes modern theorizing.

Over the years, psychiatry has been a forum for innovators, reformers, charlatans, opportunists, humanitarians, eugenicists, and experimenters. Influenced by social mores, religious beliefs, political platforms, and national budgets-public psychiatric care has fluctuated from custodial to moral treatment to genetic engineering to recreation therapy to simple sedation. More than one man found fame as a "medical genius" promoting worthless and harmful techniques backed by bunk research.

In the time periods experienced my family members listed here, the predominant accepted methods of treatment included electroconvulsive shock therapy (ECT), insulin shock therapy(IST), hydrotherapy, and the administration of large doses of phenobarbital and thorazine.

ECT is fairly well-known and still considered useful in extreme cases of depression and catatonia. ECT evolved out of another treatment in which patients were administered seizure-inducing compounds. It was thought of as a sort of "restart" to brain energy . Eventually it was discovered
that the same, violent, bone-breaking convulsions could be produced much cheaper with electric current. At some point before 1960, anesthesia was introduced to the ECT process, and doctors took to calling ECT a "sleep inducing" process. Although anesthetized, the patients body would still arch and flail, the patient awakening to unexplained pain. ECT also causes permanent memory loss.

Insulin Shock Therapy consisted of patients being injected with large doses of insulin to induce coma. Five or six comas per week was the standard. Insulin draws sugar from the blood into muscles. The large doses of insulin stripped the blood of so much sugar that brain cells were starved of fuel, and would shut down. After 20 minutes to two hours of this near-death state, patients were drawn back to consciousness by administration of glucose. This treatment was accompanied by force-feeding through a stomach tube because the patients would invariably be unable to maintain healthy eating habits.

Hydrotherapy ranged from what could be considered a soothing soak in a warm tub to prolonged confinement in a tub of either hot or cold water-sometimes for days. Ice caps were made to facilitate long term application of ice to the head. Other variations included high force water jets
directed at the patient. This was described as "particularly rousing" for depressed patients. The most hated water "therapy" was the wet pack. A cold or hot water-soaked sheet would be tightly wrapped around the patient, with a wool blanket added around the wet sheet. Strapped to their
beds, they would be left there for hours or days.

Thorazine and phenobarbital figure prominently on the drug charts included with these files. They are both still used today, although phenobarbital is (and was) primarily meant to treat epilepsy, not schizophrenia. Thorazine today is administered in drastically smaller doses
than in the time referenced here. A seriously ill patient today would receive 100mg every 6 hours. Three of the women in my family were given 600mg-800mg daily, which at the time was nowhere near the highest doses some patients received of 5,000 mg. When the use of Thorazine was under review by a US Senate subcommittee, former patients testified to their lives in a "fog"
confined to a "drug prison", and being made into "an invalid, all in the name of mental health". The woman who likely was suffering from heavy metal toxicity was subjected to 209 ECT treatments, 47 Insulin Shock Treatments, and years of Thorazine dosage. Notes in the Nurse's Comments column of her daily charts show that each time she became "difficult", "argumentative", or "loud" she was sent for an electroshock treatment, always returning with "good recovery". Or just plain silent. I found these numbers listing her treatments included in a letter from one physician inquiring as to whether he could restart ECT treatment. Mercifully, the treatments were not resumed. When admitted, she denied hearing voices and doctors noted certain components of schizophrenia were not evident. AFTER years of "therapy" she spoke of hearing Japanese voices singing in her head. The constant strain on her body led to her death at age 39. The death certificate read "Cause of Death : Not determined-Presumably natural".

The notes from conversations with the woman showing signs of PTSD and opiate addiction illustrate the tenderness she still held for her mother and regret she had never had children of her own. She also died under supervised care-on home release.

As mental health historians point out, treatments were "the best care available at the time". A blessing in disguise, Utah's delay in erecting a building specifically for lobotomies resulted in none ever being performed at the hospital, as the procedure fell out of favor before the
facility was completed. However, mandatory sterilization was fairly common up to 1960. With the changing attitudes regarding therapy, a bowling alley and swimming pool were installed and later removed to make room for more beds. Patients went to dances and ward parties. Families came to visit, and patients went home for trial visits and work release.

Personally, in reading the history of mental health care, I am struck by the varying levels of compassion (or lack thereof) that has affected the course of psychiatry. The ability of some individuals to persevere. The disconnect some people are able to enact in order to separate themselves from other human beings and set in motion inhumane policies. I could go on and on
with my views of the social roots and implications of what is in these files.

But I'll just finish by quoting Bob Dylan :

"She aches just like a woman, but she breaks just like a little girl. "

1 comment:

  1. It makes me cry to think what these people went through. I can not imagine the emotions they must have felt in response to the treatment they received.

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