The House of Lost Week Ends
Take a free and sober trip to Pinehill San. Dead drunk, it costs $9 a day to sober up — but a cure depends on the patient
THE MAN was standing in the hallway of the sanitarium, an open dressing gown only half concealing his unbuttoned pyjamas. His eyes were wide listless circles ringed in red, his hair fell in a tangled mass over his face, and his jaw, furry from six days’ growth of beard, hung slack.
“You shouldn’t be walking around like that,” the doctor told him. “You ought to be in bed.” He motioned to a cot in an alcove at the end of the hall, partly hidden by a screen.
“I can’t settle down,” the man said, blurring his words into a shapeless mass. “Can’t settle downatall. Gimmeabed innaroom, doc.”
“We want to keep you where we can keep an eye on you,” the doctor said. “Have to watch you with that cigarette. You’ll get a room later. Now, you want to get some rest.”
The man sat down in a chair in the hallway, his head rolling slightly from side to side.
“Can’t rest,” he said. “It’s my nerves, doctor, oh, my nerves.”
“Let me look at that tongue,” the doctor said. The man pushed it out. It was bright yellow. His lips were very dry and they trembled slightly.
“How long have you without foodi”’ the doctor asked him.
The man shrugged. “Oh, week ago last Saturday,” he said. “Who’s he?” pointing at me.
“He’s a friend of mine,” the doctor said.
“You see something today—the worst thing you’ll ever see,” the man said thickly, looking at me.
“Oh, don’t pride yourself that you’re the worst,” the doctor said, with a mild smile. “We’ve had lots here worse than you.”
“No. No. I’m the worst—the worst that ever was.” The man rolled his head from side to side and buried his face in his hands.
“Nonsense,” the doctor said briskly. “You were far worse the last time. You’re not bad this time.” “I wish you could see me when I’m not like this,” the man said to me. “Doctor, can I have a little drink? Maybe, if I had a little one, I Could settle down some.” He looked like a spaniel begging for scraps at the table.
“Well, perhaps we’ll see if you can have a small one,” the doctor said. “But you’ll have to get some rest. You can’t keep on drinking forever. You want to get better, don’t you? You want to help yourself?”
“Yes,” the man said and started to mumble to himself “. . . But an alcoholic CAN’T, he CAN’T, an alcoholic, he CAN’T . . .” He was still mumbling as we walked away down the corridor of the sanitarium.
“He just came in yesterday,” the doctor said.
Another man stopped the doctor in the corridor. He was about the same age and weight as the other man we’d seen—middle fifties, greying hair, paunchy. He was glowing with health, his clothing was neatly pressed, his hair brushed carefully. He was chewing gum and he looked incredibly cheerful. He gripped the doctor’s hand.
“I’m on m’way, doc,” he said. “Just wanted to say thanks and God bless you.”
“Write me in about a month and tell me how you’re getting on,” the doctor said.
“Sure thing, doc,” the man said and bounced off down the hall.
The sight of these two men—the bit of human wreckage that had just arrived and the smiling, healthy man who was about to leave— reminded me of those before-and-after-style pictures which appear with advertisements for hair lotion, reducing pills and nerve tonic. 1 mentioned this to the doctor. He smiled.
“I wouldn’t want, to give an unbiased prognosis about that fellow,” he said. “It’s in the lap of the gods. His company sent him here about six weeks ago—he was a long-time employee. He looks fine now, but it’s a case of not always being able to make a silk purse out of a sow’s ear.”
Pinehill Sanitarium is a highly thought of institution in a small Canadian city. Pinehill is a fictitious name, but the place itself is real enough as several hundred graduates can testify. There were 19 alcoholic cases there the day I visited Pinehill.
They come from all over—from Charlottetown, P.E.I., to Victoria, B. C. A heavy sprinkling come from the United States. They arrive by auto, airplane, taxi, car, ambulance and stretcher. Some just saunter in, fairly sober. Others arrive, escorted by a friend, stupid drunk. One man drove himself up from the U. S. in his own car and collapsed in convulsions at the front door. Some arrive naked except for a blanket. One turned up wearing a woman’s fur coat. But most of them look pretty much alike: dishevelled, unshaven, with suits so badly crumpled and torn that they seem to have literally rolled in the gutter.
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The House of Lost Week Ends
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Some of them phone Pinehill collect: “For God’s sake come and get me—I been here two weeks.” When this happens, one of the veteran drivers goes off and collects the patient, who is usually a “repeater,” pays the hill at the cheap hotel where his quarry is almost invariably to be found, pours a drink into him to steady him, gets him off the bed where he has been lying fully clothed and brings him back. Once a driver went 754 miles in a day to collect his man in this way.
The women look just as bad, though there aren’t as many. In the hallway the doctor and I passed a pretty young woman in a blue blouse. “You should have seen her when she came in,” the doctor said. “She was worse than that guy upstairs—hair all over her face and everything.” Normally, he said, women act better inside the sanitarium, act worse outside it.
In the angry ocean of an alcoholic’s life the sanitarium is the rock to which he can anchor himself, provided he can afford it. It costs nine dollars a day to stay at Pinehill, which eliminates the “rubby-dub” and down-and-outer who have only the jails to turn to. But for even a man of moderate means, the “san” can be a godsend, although the medical staff at Pinehill would be the last to suggest that the place is a cure-all—for the extent of the treatment depends largely on the patient himself.
There are few first-class sanitariums for alcoholics in Canada, all of them private (hospitals won’t take voluntary alcoholic cases), and most people have only vague ideas about them derived mainly from movies or plays or works of fiction.
What is a sanitarium really like? The sanitarium in “The Lost Weekend” was a chill, forbidding place where interns sneered at the patients and the patients screamed at night with the D.T.’s. The sanitarium in the enormously successful Broadway play “Harvey” was a pleasant-enough spot except for the fact that white-coated guards were forever subduing supposed patients by force.
Pinehill, when I visited it recently, was nothing like this. The patients were referred to as “guests” and called “Mr.” to their faces and behind their hacks. No force was used because the sanitarium’s medical staff—all trained mind specialists—have learned that force breeds resistance. The building itself was more like a hotel than a hospital. The walls were tinted in pastel shades, the carpets were rich reds and greens and there were plenty of pictures —snow scenes by Franz Johnson and pleasant woodsy paintings. Even the beds and bathtubs were colored and the bathroom walls were tinted in pink and greens.
They’re Mental Cases
Pinehill is a long way removed from the necromancy of the gold cure, a cure-all potion supposedly containing gold, and the black cocktail, a drink with an emetic in it, still used in some less reputable institutions. (The black cocktail makes the patient vomit and supposedly hoodwinks him into thinking he can never drink again.)
“Aineha goin’ to give him no medicine?” one old man asked, bringing his son in for treatment. The sanitarium does give medicine, but not the kind that comes in bottles. Its alcoholic patients are treated as mental cases (of which this particular institution has a good many of the nonalcoholic type). Alcoholism is treated, not so much as a disease but as a symptom of a personality disorder, or worse still, a mental disorder. New patients, expecting to receive a lecture on the evils of drink, are agreeably surprised to find that the doctors and nurses don’t preach to them, but treat them as sick people.
When a man who has been drinking for some time arrives at the sanitarium, he usually gets a sedative (tuinal or paraldehyde or both) to help him sleep. In a good many cases the doctor also prescribes additional alcohol, perhaps three or four ounces every four hours (although one patient knocked back 81 ounces in a day). The alcohol is prescribed for several reasons: A good many patients arrive shouting and swearing loudly, sometimes fighting with the attendants, and the doctor gives them liquor to quiet them down; some patients if cut off suddenly resist all treatment and refuse to co-operate. “You can’t argue with an alcoholic,” the doctor points out. But, even more important, a sudden cessation of alcohol can bring an attack of delirium tremens.
TD.T.’s aren’t common at Pinehill because the medical staff does all in its power to avoid them. Patients suffering from delirium are put in the “acute ward.” This is an observation room with a bed fixed to the floor so it can’t be broken, and the windowpanes protected.
D.T.’s spring from a toxic condition of the nerve ends and when in delirium the patient has all sorts of hallucinations, the commonest ones being snakes and bugs—or anything else that horrifies him. Spots on the counterpane may turn into animals, for example. A former lumberman saw a bear entering his room; one man felt he was being trampled by an elephant. But no one has yet seen pink elephants in the sanitarium.
The Shock Treatment
Sometimes, in cases where D.T.’s are especially bad, the doctor prescribes electroshock treatment similar to that given other mental cases. The patient receives a powerful sedative and is asleep before the needle leaves his arm. A heavy piece of paper is then put between his teeth (to stop him biting his lip) and two electrodes are attached to his forehead. The physician then manipulates a dial on a small black box attached to the electrodes which shoots a current of from 150 to 225 volts through the patient’s body. The man’s body goes taut, his face tenses up as if in extreme pain and his eyes roll wildly, but after a few moments of convulsion he quietens down. When he awakens he can remember nothing, but his condition is improved. Usually three or four treatments are all that is required. No one yet knows exactly what the electroshock treatment does, but the men who work with it think that the voltage jolts the mind processes out of their well-worn pathways and makes them form new patterns, which banish previous hallucinations.
These cases are, however, the exceptions. Normally, the patient experiences no delirium but continues to take alcohol for two or three days in smaller and smaller doses. (A drink before each meal and one at bedtime.) Usually he cuts himself off. That is what the doctor wants, because to effect any permanent cure he must have the alcoholic’s own co-operation. If, however, the patient himself doesn’t voluntarily quit, the sanitarium cuts him off. Alcoholics, who can easily drink a brimming tumbler of straight spirits in one draft, sometimes balk at the three-ounce drinks offered them. One patient, staring gloomily at his drink and complaining of its size, was abashed when a fellow alcoholic greedily seized it and tossed it back. “It may be too small for you,” he said, “but it’ll do me.”
Sedatives and alcohol are only given when absolutely necessary. “We try to give the patient as few crutches as possible to lean on,” the doctor in charge explains.
A man who has been drinking for some time has no appetite. The alcohol has given him gastritis—a lowgrade inflammation of the stomach lining which interferes with the secretion processes which create hunger. He probably hasn’t eaten for a week by the time he reaches the sanitarium and is suffering from malnutrition. The sanitarium puts him on daily injections of insulin—ten units each morning. The insulin cuts down the blood sugar and makes him hungry again.
Besides the insulin, patients get vitamin B injections. Meanwhile, the rest of the treatment is continuing: a needle shower or spray bath each morning (cold, unless the patient protests) and daily electric steam massages. As soon as possible, the patient is shaved and has his hair cut and every effort is made to get him to take pride in his personal appearance, something which alcoholics have no interest in while they’re drinking. There’s a beauty parlor for women.
Some Skip Class
The rest of the treatment simply consists of occupational and recreational therapy. Most alcoholics have no hobbies, though usually it turns out they’ve always wanted one. The broad surface of their personality has been honed down to a razor’s edge of longing for only one thing: alcohol. Pinehill tries to replace this craving with something more constructive. In the workrooms, patients make everything from bedroom slippers to dolls’ houses. For recreation there’s a bowling alley, a skating rink, lots of room to play golf in, tennis courts and movies. The local branch of Alcoholics Anonymous meets once weekly in the sanitarium building (the president is a former patient) and the sanitarium gives the group a room, doughnuts and coffee and new recruits.
When he first enters, the patient is sent to a closed ward, where the doors are locked and where he is under constant supervision. Despite this, he may still be allowed out-of-doors on his personal responsibility or even allowed to go to another town on business. Some patients even commute daily to Pinehill. The idea is to give the alcoholic as much responsibility as the medical authorities think he can take. After he’s been dry for a few days, he is moved to the open ward where he has Complete personal freedom to come and go. This increase in responsibility benefits him psychologically, although some patients can’t take it. Some time a,go a wealthy American patient, on parole, stole another patient’s car, grove it back to the U. S., hired a plane which he flew until it crashed, stepped put of the wreckage and hired a taxi. He had reached Pittsburgh when apprehended, had been away five days ánd spent $1,500. He was, of course, drunk when picked up. When parole is broken, the patient goes back to the closed ward.
The length of stay in Pinehill runs anywhere from a few days to several months. After about two weeks of treatment the patient begins to feel fine and this is the most dangerous period. If he leaves now, he’ll almost certainly be back again. Even after two months of treatment, the sanitarium has only really begun its task of rehabilitation. Hardened alcoholics have to go dry for at least six months before they can start to think straight again. Despite this, some arrive at Pinehill simply to get sobered up, then leave after a few days (often to get drunk again).
With the exception of a few committed by the courts, the patients are voluntary and sign a statement saying so on arrival. Because they must give three days’ notice in writing before leaving, the sanitarium can legally apprehend them if they depart suddenly. However, this isn’t always done. The
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doctors have found that you can’t cure am alcoholic by keeping him somewhere against his will. He himself must want to be cured.
A good many are cured and Pinehill never sees them again. Two ex-patients now work as attendants in the alcoholic ward. A third has opened up a sanitarium of his own and does a thriving business with rich American souses. But the Pinehill staff is hesitant about talking of “cures” in most cases. One man has been admitted 52 times to the institution, another 44 times. One former patient didn’t touch a drop for 16 years, then landed in the sanitarium again. “I thought I could take it,” he said. “I was wrong.” One man was admitted seven times last year and, at one point, his mother and father, both alcoholics, were fellow patients.
Because the curse of alcohol is psychological, the physicians go deeply into the personal background of their patients, sifting a mass of information into an intelligent pattern, then laying it frankly in front of the patient himself. They’ve found that the alcoholics themselves are interested in what causes their condition. Sometimes, Pinehill is instrumental in getting patients a job, either close by where they can be watched, or in the north woods where it’s more difficult to get liquor. The doctors try to get patients to promise, on leaving, that as soon as they touch their first drink they’ll come back. A good many alcoholics have made arrangements with their friends, while sober, to do this very thing. Two business partners, both alcoholics, have a standing agreement that when one gets drunk, the other will bring him in.
Pinehill divides its patients into two groups medically: those suffering from what is called alcohol addiction and those who are chronic alcoholics. An addict can gain control with help, but a chronic is more difficult to cure, for in his case there is a definite deterioration of character and will. There is no distinct line between the two and the addicts may easily become chronics. The sanitarium authorities feel satisfied if they can accomplish a useful interruption and get the chronic back to his job for a few months.
Extreme alcoholics drink three or four bottles a day and still try to carry on their business. A 26 oz. bottle may be consumed in two gulps by a confirmed alcoholic. Usually this type of man is unstable emotionally—he has crests of elation and troughs of depression: either extreme—success or failure—is liable to start him off on a spree.
A few patients contract an alcoholic condition called Korsakoff’s psychosis after the man who first investigated it. The main symptom is a loss of memory over a certain period which the patient unconsciously bridges with a complete fabrication which he believes to be true. One patient arrived at Pinehill after a year in a General Hospital and told the doctor in charge that he’d just got back from Washington D.C. It was at the time of Hoover’s defeat by Roosevelt. “I went down to congratulate Franklin,” the patient said. “We went for a walk and ran into Hoover. He wouldn’t come near Roosevelt. Started throwing snowballs at us.” Korsakoff patients sometimes set fires, then forget they’ve done it, but for the most part they are harmless.
It Costs Money
The nine dollars a day it costs to stay at Pinehill includes semiprivate room, food, medical treatment and nurse. It’s cheap compared with U. S. institutions, some of which charge as much as $50 a day (one patient«arrived announcing that he’d just paid $3,500 for two interviews with a psychoanalyst in the States). Some patients are picked up without money (one woman was buying clothes on her husband’s charge account and selling them at half price to friends to raise liquor money) but the sanitarium seldom gets stuck for the price. Its customers are all fairly well-to-do, or else their families are. The sanitarium gets men and women from all professions (one clergyman was a patient) but finds alcoholism most pronounced among vocations in which there is some gamble involved—such as farmers with seasonal crops, travelling salesmen and stockbrokers.
It’s difficult for the casual visitor, strolling down the corridors, to tell what a man has been. Most of the patients, working away at woodcarving or leatherwork, or strolling about the grounds, look like normal men and women—unless they’ve just arrived.
I was at Pinehill Sanitarium two days. Before I left, the doctor and I walked hack through the closed ward to see the man we’d met when I first arrived. He was sitting at a table playing cards with one of the inmates and he looked up, a little sheepishly, when we walked over. He looked much better. His hairwas combed and he was shaved.
“How are you feeling?” the doctor asked him.
“I still don’t feel so good,” the man said, but this time his voice wasn’t blurred and he grinned a little.
“We’ll move you into a room tonight,” the doctor told him.
The man looked grateful and we walked away.
“He’s coming on” the doctor said. ★