Articles

SPENDS a day in a Mental Hospital

The fugitive fleeing nameless pursuers, and the youth who inhabits a black pit of despair, are each being helped as never before by new drugs and new techniques.

SIDNEY KATZ October 15 1953
Articles

SPENDS a day in a Mental Hospital

The fugitive fleeing nameless pursuers, and the youth who inhabits a black pit of despair, are each being helped as never before by new drugs and new techniques.

SIDNEY KATZ October 15 1953

SIDNEY KATZ

The fugitive fleeing nameless pursuers, and the youth who inhabits a black pit of despair, are each being helped as never before by new drugs and new techniques.

HAVE been living inside the provincial mental hospital at Weyburn, Saskatchewan. I have the authority to visit every nook and cranny of the hospital at any hour of the day or night. I have keys that unlock every door. I can speak to any patient I choose.

It is past midnight and a new day is just beginning. I am looking out the window. The darkness is pierced by automobile headlights. Two RCMP officers are bringing another patient to the hospital. The party is met at the entrance by two male psychiatric attendants, known as aides. One of the officers hands over some medical documents to an aide; the aide signs a delivery receipt form and the patient is conducted to 6-B, the admission ward.

Now the patient is seated in the little office of the ward supervisor. He’s smoking a cigarette and glancing around the room apprehensively. He’s a wiry man of average height in his mid-forties with high cheekbones, a prominent nose and large deep-set brown eyes. He’s wearing an open-neck khaki shirt and a pair

SPENDS a day in a Mental Hospital

Now a Maclean’s editor — back from life among the insane — concludes the greatest need is individual care that only bigger budgets can provide

of navy blue trousers. His deep red sunburn and strong arms and hands suggest he’s a farmer. The supervisor is now glancing at the papers that accompanied the patient and points out an underlined passage to one of the aides, “suicide risk.” The admission routine starts - emptying the pockets and listing the contents: $25.52 in cash, four letters, keys, a fountain pen and a bottle opener.

The patient is telling the aides about his hundred - and - thirty - acre ’farm. “So I put in the wheat and the barley and then comes the goddam rain and washes it all up.” There is nothing abnormal about the things he is saying or the way he is saying them. Nothing—until he gets on the weight scale.

“You weigh one hundred and thirty-six pounds,” says the aide.

“Only that? Dammit, I’ve lost thirty pounds in the last three months.”

“How come?” asks the aide.

This simple question unleashes a torrent of emotion. “I can’t eat and I can’t sleep. It’s my wife. She’s ruined me. She spends all my money.

She runs around with other men ...” He talks for the next ten minutes, his voice mounting with excitement. The story he tells is not quite the same as the one contained in his file history. The patient’s wife had always been a thrifty housekeeper, faithful to her husband and devoted to her two daughters, aged twelve and fifteen. Six months ago the patient began to make accusations which became more fantastic as the weeks passed. She was trying to poison him, she was plotting his financial ruin, she was having affairs with other men, and finally, that her children had been fathered by another man. During the past few days the patient began threatening to kill himself. His wife became alarmed and sent for the family doctor. The doctor examined him, a colleague did likewise and the patient was certified as being mentally ill and sent to the hospital.

While the patient is being bathed the night-duty doctor, Derry Hubbard, examines him and decides that he doesn’t require any immediate special care and can be put to bed. The supervisor assigns him to a bed

More Pictures, Story, Next Two Pages

Each day brings tragedy — and victory too. No more is a mental hospital a prison of despair but an active clinic where those sick in mind come for help. These are scenes in the daily life of men on their long road back to sanity

near the corridor where the aides can keep an eye on him. In the morning the patient will start life anew as a mental patient—a life which, hopefully, will end in his return to his farm, wife and children.

What kind of life will it be? Many people still think of the mental hospital as a house of horror where “raving maniacs” are restrained by chains, handcuffs or strait jackets and manhandled by a staff of sadistic and uninterested doctors and attendants.

Such a concept is born of ignorance. The mental hospital is the same as any other hospital—a place for sick people to regain their health. Despite a small staff, a tremendous volume of treatment is given: of every hundred patients who enter Weyburn this year seventy will return home to their families. The mental hospital’s bad name is in large measure due to the fact that of all diseases those of the mind are the most baffling.

A mental hospital is a community; its neighborhoods are the different wards. I am in 6-B, the admission ward, where patients first come to be examined, diagnosed and treated. I have watched a succession of patients being admitted. The behavior of each is different, yet there is a sameness in their unhappiness and their inability to cope with the dayto-day problems of living in the outside world.

i

A World War I veteran past middle age is brought to hospital by his wartime buddies for the second time in the past five years. “If I start acting queer take me to Weyburn; that’s the best place for me,” he has told his friends several times. He is rather excited and jumps up frequently to bark military commands. “Have the men fall in, corporal . . . we’ll charge now.” Several days later his behavior becomes normal and he tells me, “I don’t remember coming here. The first thing I remember was when the aide woke me this morning and said, ‘Would you like som breakfast?’ I looked at his white coat and I knew where I was.”

While going through the admission routine, a lanky youth of twenty-one sits in the chair talking and laughing to himself. A few days ago he shot his brother dead after an inconsequential quarrel and now the court has sent him here for observation. Most of what he’s saying is unintelligible but one can make out the words, “Heaps of bodies lying there.” He speaks of a buzzing in his ears and a pain in his throat. He refuses to submit to a blood test. He jumps to his feet, his face becomes red and his whole body is trembling, “They won’t take my blood,” he shouts. Heb resents the doctor’s questions an refuses to answer them.

There are three alcoholics in the ward. The newest of these is a blond

farmer in his late twenties. He is sober now but his hands have a slight tremor as he talks. “There’s no use going on the way I am,” he says. “I work hard, then spend it all on booze.

On the last binge I passed two bum cheques. The police told me I could either go to jail or come here. I came here.” A twenty-year-old is admitted in a stupor. He remains completely motionless, staring down at the floor and on the few occasions that he does speak his voice is a low whisper. A burly man of fifty mutters over and over to the aide, “I didn’t do it ... I didn’t do it.” He comes from a small farming settlement. Recently the local schoolteacher became pregnant and he imagines that everyone is accusing him of being responsible. Persecution seems to be the most common element in the phantasy life of the patients. One man wears colored glasses and keeps glancing over his shoulder. “The devil is chasing me,” he explains. Another patient constantly speaks of a fifty-thousand-dollar mail robbery engineered by the hospital’s doctors who are keeping him locked up so he won’t expose them.

I watch a white-haired man of sixty being admitted. He sits in the supervisor’s office, refusing to undress, take a bath or go to bed. He carries a heavy cane in his right hand.

“We want to help you get to bed,” says the supervisor.

The old man glares at him and raises his cane. “You come near me and I’ll let you have it,” he threatens.

He suddenly looks around at a vacant corner of the room. “I have heard him again,” he says. He thinks he hears his dead father calling to him; he hears mysterious voices threatening to take his son away and kill him.

For fifteen minutes the supervisor and aide coax, cajole and plead with the old man. “Let’s help you get to bed, you’re tired. You’ll feel better in bed.” He is adamant. Finally the two men in white coats seize him and proceed to undress him. After ten minutes of struggling they are exhausted and their shirts are torn, but the old man is tucked in bed. “If this is what you wanted me to do, why didn’t you ask me?” he says to them.

On the average, eleven male and female patients enter Weyburn each week. The variety of hallucinations, delusions, obsessions and fears they experience , is infinite. One patient believes himself to be Harry S. Truman; another maintains that he should have succeeded King George V. One man seizes my arm and eagerly tells me, “I’m the president of the CPR. Before that, I was the chief of the Winnipeg police force.”

A mild little man in his forties imagines himself being changed into a devil then back to a man again. Another patient feels himself being transformed into a horse. He whinnies and prances about, explaining,

Continued on page 82

CONTINUED FROM PAGE 29

“This makes me feel better.” After a week or so the delusion leaves him. The outside world is no place for people like these. The hospital is a haven where their fractured minds may heal and where they will do no harm to themselves or others.

It is six a.m., the lights are switched on, and life on the ward begins. Some patients leap out of bed, dress and begin to shave with special hospital razors with locked-in blades. Others open their eyes and then lie still, unwilling to face yet another bleak day. The will to go on living has all but vanished. One such patient is a blond youth of twenty. He requires a “total push”—help with even the simplest rites of living.

Breakfast of porridge, milk, bacon, eggs, coffee, bread and jam is brought down from the kitchen in a pushcart and served in 6-B’s own plainly furnished dining room. Some patients have healthy appetites and finish their meal in fifteen minutes; others eat cautiously and may take more than an hour. In the corner, the blond youth is being fed by an aide. Left to himself, there is a possibility that he would slowly starve himself to death. “I don’t want to eat ... a glass of cold water will be enough,” he whispers. Refusal to eat can be an indirect method of suicide. In extreme cases, a patient may have to be kept alive by tube or intravenous feeding.

After breakfast a half-dozen patients volunteer to help the aides do the ward’s housekeeping — making beds, polishing and washing floors. Some patients like to do exactly the same job every day and are insulted if somebody else does it. Compulsive patients do their chores with extraordinary scrupulousness. One man, who makes up the beds, wants them to be all perfectly smooth when the supervisor carries out his inspection. If someone should happen to sit on a bed before inspection and ruffle it, the patient rips up the twentyfive beds and starts all over again. Another patient, a stocky man of forty, will continue to mop the same two square feet of floor until someone moves him on to a new area.

By nine the daily chores are finished and the patients disperse. One group will continue to be medically investigated—X-rays, blood tests, psychiatric interviews and so on. Others will be sent for electric or insulin shock treatment. Some go outside for lawn bowling or a ball game; others work in the occupational therapy shop or play cards or billiards in the recreation room. A half dozen or so sit by themselves, completely engrossed in the terrors and wonders of their own private world.

I go along with a group of six men to a screened-in portion of the dormitory where electric shock treatment is given. The exact physiological process by which a series of brief electric shocks helps the patient is not known. But what is apparent is that these shocks cheer up the depressed patient and calm down the excited one. It is as though the patient is sharply jolted out of his abyss back into the world of normalcy.

The new patients fear shock treatment. “Will it hurt?” they ask. “What if the machine goes haywire and I’m electrocuted?” Dr. John Smythies stands waiting at the head of the treatment table; around the table are six aides. The doctor’s equipment is simple. The shock box is of black metal, no larger than a cigar box. Beside him is oxygen equipment in

case the patient develops respiratory difficulty. In his pocket are his forceps. Sometimes the patient’s tongue flies back into his throat and has to be hurriedly pulled out.

The first patient lies down on the table. He is a dark man of thirty-eight who was admitted two weeks ago. His cousin, with whom he lived, reported that three months earlier he began to lose interest in his work and became increasingly seclusi ve and depressed. The doctor applies the electrodes to either side of the patient’s head and 1 places a hard rubber heel, wrapped in white gauze, in his mouth. He clicks the power switch on for a fraction of a second, which sends seventy volts through the patient. His whole body jerks; six pairs of strong hands hold him to the table to prevent bone fractures. Now his body is tightening and stiffening. His neck is turning a deep red and the arteries bulge. Suddenly, the tightening and stiffening cease. The patient relaxes for a fraction of a second and then his whole body convulses wildly. There are about a dozen spasms, each one briefer and spaced farther apart than the one before. It ends in a few minutes with the patient in a coma, snoring loudly. The aides roll the patient over on a stretcher and wheel him to a nearby bed.

The next patient, scheduled for his second shock, is reluctant to get on the table. “It’s my back,” he says. “I’ve got a pain in my back. This thing will kill me.” Treatment is postponed. Although like all other patients he has been X-rayed and found physically sound the hospital takes no chances. He will be X-rayed again. The next patient, a veteran of twelve treatments, jumps on the table in a matter-ofcourse way.

The Shock That Cures

When the treatments are completed I go over to the beds and speak to the first patient. He has slept for fifteen minutes. Now he is sitting up, looking around. “What are you doing in bed?”

1 ask him. He doesn’t know. “What year is it?” I ask. He is confused by my questions. “Is it 1954?” he asks cautiously. This state of confusion is only temporary. After a few hours he will be able to think as clearly as before. He has experienced no pain from the shock and remembers nothing after the electrodes were placed on his head.

1 go down the hall to a private ward where there are seven beds surrounded by high canvas guards. This is where insulin shock therapy is given—therapy that is more elaborate, takes longer, but is more effective in certain types of schizophrenia. At seven a.m., the selected patients are given an injection of insulin; the highest dosage is two hundred units. Soon they grow drowsy and go into a sub-coma state called a sopor. I watch a patient in his early twenties, who since his admittance has complained of a mysterious radar-like machine which reads all his thoughts. By nine o’clock his body begins to convulse and he is entering a state of coma. He is wrapped in a white sheet and his protruding toes twitch sharply while he thrashes his arms. The movement stops and he is staring ahead, eyes open, as immobile as a marble statue. Dr. Derry Hubbard, the physician in charge, pulls the hair sharply at the side of his head. There is no response. “He is now in a coma,” he says. “He can’t be roused from this state without doses of glucose.”

After an hour and a half of this deathlike sleep, the patient is given fifty cc’s of glucose through his nose. Because carbohydrates, abundant in sugar, potatoes and bread, offset the effect of the insulin, the patient is

awake in a few minutes. The heavy carbohydrate diet continues all day. As soon as he sits up the patient drinks two glasses of sugary apple juice followed by a few cups of sweet tea and tof.st. After a shower he eats a heavy meal with large portions of potatoes and bread. At 2.30 he will be given cereal and milk which has been heavily sugared. Thereafter, along with the other insulin-shock patients, he will follow the hospital routine of work and recreation. An aide will always be near the group, carrying a large bottle of glucose mixture in case any patient begins to feel dizzy. After a complete course of insulin treatment — fifty comas within three months—patients will gain twenty or thirty pounds because of the heavy carbohydrate diet.

The patient usually has no recollections of the sopor or coma. One patient, who for several minutes thrashed his arms wildly about and groaned, wakes up and says, “It’s the most restful sleep I’ve had in years.” But sometimes the sleep is accompanied by haunting nightmares. One patient says, “I dreamt that my bowels and my head were being twisted and braided like two pieces of rope.” Another recalls: “I was being chopped up into little cubes of meat.”

But this unpleasantness is minor compared to the benefits. The long series of death-like sleeps seems to give the mind a chance to heal. Weyburn doctors estimate that seventy percent of all patients receiving insulin shock benefit greatly from it, with a relapse rate of ten percent. The earlier the disease of schizophrenia is attacked by insulin the more effectively it works. But, like all other mental hospitals, short of both space and staff, Weyburn has to be selective in its insulin treatment program. The patient whose illness is of comparatively recent origin is given priority. Long-term sufferers must wait.

I go back to the ward where the investigation of more new arrivals is under way. In a side room, psychologist Charles Jillings is giving an epileptic patient one of a series of tests. Some of the tests are complicated like the Rorschach “ink blot” test: the patient views a series of cards containing ink blots and describes what they suggest to him. By studying the replies, Jillings hopes to detect the patient’s abnormal pattern of thinking and feeling. The test now under way is a simple one. “Draw a picture of a person,” says Jillings. No one test is conclusive; it is only one of many diagnostic tools used to penetrate the inner workings of the patient’s mind. I he patient pencils the crude outline of a male body with faint, disjointed lines. Later Jillings says, “This is probably

the way the patient feels—shattered, incomplete.” After analyzing hundreds of such drawings Jillings has learned to spot significant details. A figure may contain several huge popping eyes, which Jillings interprets as meaning that the patient “imagines that he’s under surveillance—people are staring at him.” Absence of feet may mean that the patient is insecure. “He literally feels that he hasn’t a leg to stand on.

I look at one drawing in which the stomach is huge and grotesque. This patient is convinced that his internal organs have become swollen and calcified. It is not unusual for patients to have equally terrifying bodily sensations. Their skin may feel silken or scaly or furry or appear to wither away until nothing is left but bone. One patient, hospitalized for thirteen years, explains to me, “I’ve got cancer and my liver has turned to stone. They took my main nerve out. I’m being kept alive by radar and X-ray machines. It’s a miracle.”

The psychotic patient experiences these sensations with an intensity and sense of reality unknown to the normal person. I know. A few days earlier, to help in Weyburn’s research into mental illness, I had taken lysergic acid diethylamide, an experimental drug which for twelve hours turned me into a madman. At several points, 1 was deathly ill because I was convinced that I had turned into a black stone surrounded by a ghastly yellowish-greenish vapor. (See Maclean's, Oct. 1.)

In another side room, a sodium amytal interview is in progress. This drug, which is slowly dripped into a vein of the arm by a hypodermic needle, encourages talkativeness and is sometimes known as “the truth serum.” The patient is a lanky teen-ager who has been sent for observation by the criminal court after he had shot seventeen bullets into his home, narrowly missing his father. The youth has been uncommunicative since his arrival. Little is known about him: he quarreled with his father a good deal, he resented his father’s remarriage a few months ago, and he was apparently a normally sociable person until three years ago when he suddenly began to drop all his friends and became a social recluse. The doctor poses his questions in a quiet voice. The patient is lying down and answers in a drowsy hesitating voice.

“How do you like your father?”

“I don’t . . . he’s cross and grouchy and he wouldn’t pay me enough for working for him.”

“Do you remember your mother?”

“She died ... I remember she kept asking for water when she was dying . . . I felt sad . . . sad . . . sad.”

“Do you ever have a good time, like going out with girls?”

“I like girls but they won’t go out with me ...”

“Why?”

“It’s on account of the disease.”

The doctor sharpens his questions and listens to the answers attentively. Here is significant information. Four years ago, the patient began to give up his friends because of a disease which he imagined made him “smell.” He was not fit to associate with anyone. With the passage of the years, this delusion had become firmly entrenched. The interview continues; the teenager’s eyes are closed now and his voice is reduced to a whisper.

“I want you to re-live the day of the shooting. You are outside the house. There’s a gun in your hands. What’s the country look like?”

“There’s a range of hills ...” “What are you thinking?”

“I’m angry at my father. I’m crossing a fence and I get the idea of shooting.”

“Had you been drinking?”

“Yes . . . I had half a bottle of rye. I am tight. I see things double. Just before I shot at some crows and missed.”

“Why do you drink? Do you like the taste?”

“1 hate the taste but it makes me feel strong and at ease.”

The patient’s voice falters and becomes inaudible. His feet stop waggling. Soon, the only sound in the room is his deep regular breathing.

The Man Who Smells Smoke

At this moment the doctor doesn’t know exactly what all this adds up to. His final diagnosis will require extensive investigation but a picture of the patient is beginning to form in his mind. There’s the important fact that the patient re-lived the shooting affair with a singular lack of emotion. A less seriously ill person would have shown excitement, anger, remorse and might perhaps have broken into tears. The doctor notes the possibilities of schizophrenia-a possibility strengthened by the fact that the patient has olfactory hallucinations. In this disease, the senses often run amok as if some monstrous practical joker has jumbled the sensitive nerve-nets in the brain. One patient, for example, is convinced that he smells smoke wherever he goes. Another, a little white-haired man, “hears” someone trying to get into his head via his left ear and tries to frighten them off by shouting, “Keep away! Get out!” Still another patient, a middle-aged farmer, hears voices from heaven. One day while out on the grounds with a working party he attempts to jump in the path of a truck because “that’s what God told me to do.”

I go to lunch with the patients at 11.30 (beef stew, peas, potatoes, coffee, milk, ice cream, bread) and later 1 accompany a group down to the hospital canteen in the basement. Relatives may leave a spending allowance of up to four dollars a week for coffee, cigarettes, candy, pop, and other sundries. Some patients guard every penny carefully; others, like the grey-haired man of seventy who always writes cheques on mysterious banks, shoots his entire four dollars at once, buying things for other patients. The next morning he is found pilfering cigarettes out of another patient’s pocket because he can’t afford to buy his own. Matches are never sold to patients because of the danger of fire; their cigarettes are always lighted for them.

Outside, a storm is threatening and now most of the patients are back on the ward. Some patients stay to them-

selves, completely absorbed in their own world of phantasy. They are the ones who are always found in the exact'' same spot, as if they derive a feeling of security from familiar surroundings. One patient is always sitting at the left of the door leading to the next ward; another arranges his chair exactly ten inches from the wall before sitting down; still another is slumped against the wall in the washroom. If anyone enters, he leaves and will not return until the room is empty again. The loneliest ones are the catatonic schizophrenics. They remain motionless, hour after hour, like cast-iron statues. One stands over his bed, clutching a corner of his blanket; another spends all afternoon staring at the same page of an opened book.

The patient’s desire for privacy is respected. A patient who is about to be discharged tells me, “I don’t interfere with anyone. I watch and if a fellow wants to talk, I talk. But I don’t go up to a fellow I don’t know well. You never know what’s on his mind and I don’t want to upset him.”

Those who are less ill lead a more sociable life. I join a group of three men who are sitting around a table casually playing cards. The first, an alcoholic, starts telling me about his last binge and the trouble it got him into. “This damned drinking is a disease,” he says. “I remember that my uncle was a drunk and how awful it was for his family but now I do the same myself—me with three young kids. Yup . . . it’s a damned disease.” One of his companions is sceptical. “There’s nothing wrong with you,” he says. “My bed’s next to yours and you sleep at night so you must be all right. Take me. I can’t sleep. Nerves in my stomach. I’ve lost thirty pounds in three months. It’s my wife. She makes expenses for me. I buy a new car so she drives it around ...”

“Gas doesn’t cost much,” I interrupt.

He ignores my remark and keeps talking, his anger rising. “I have a son fifteen and I gave him the best of everything. Then my wife tells me he’s not my son. It killed me ... it made me crazy.” Most of the time the patient appears to be normal and rational, but when he gets on the subject of his wife he is carried away. The third man in the card game is a soft-spoken pleasant man in his early thirties. His condition has been difficult to diagnose. He has no dramatic symptoms, only a constantly gnawing sense of anxiety and fear that something terrible is going to happen; it’s so crippling that he can’t concentrate on his work when he gets a job, nor can he enjoy a social life on the outside. “I’d like to be like other people,” he’s saying. “I’d like to have a job. I’d like to get married. But I wouldn’t be able to support a wife . . . this thing keeps eating away at me ... ”

Over in the corner a bespectacled man in his mid-twenties is sitting with a Bible in his hands, facing another patient in his teens. He has heen talking uninterruptedly about religion for about forty minutes. His companion stares at him and makes no reply. A loud clap of thunder outside is followed almost immediately by a flash of lightning. The man with the Bible leaps up and comes to our table. “Do you read your Bible?” he asks us earnestly. “Do you make the sign of the cross?” No one answers so he goes away. A player shrugs his shoulders. “He’s all tied up. He’s got religion on the brain.”

These men will soon be moving on from here. In the admission ward, the average stay is only about three or four months. Patients are observed, diagnosed, treated and then either transferred to another part of the hospital or discharged. In the chronic wards

some patients have remained for five, ten, fifteen years or longer. I spend some of my time in these wards. Here life assumes a more static quality. The society here is a million miles removed from the busy town of Weyburn where the hospital is located.

In the chronic ward I find that, more than in other parts of the hospital, patients group themselves in exactly the same manner, day after day, month after month. There are the single ones: a tall man with thinning hair, carefully paces off thirty feet of corridor, abruptly turns and retraces his steps; another patient stands at the same window all day watching the sun move across the sky. There are the same groups of two, three or more; there is little or no communication between them.

I am haunted by the question: Why do some chronic schizophrenics stand alone? It is difficult and usually impossible to break into each patient’s prison of madness to find the explanaI tion. My own vivid memories from | my voluntary drug-induced madness and from talks with psychiatrists give me what may be a partial answer. The lonely ones may isolate themselves through fear of being hurt or through fear that they may hurt others or because they appear monstrous in their own eyes and unfit to associate with their fellow man. One patient explains, “I had the feeling that people are against me as if I was dead or something ... I saw a fellow’s hand turn white before my eyes. I had the power to make him a skeleton so I turned away.” The patient at the window watching the sun all day feels no other course of action is open to him. “It is the eye of God,” he explains. “That’s the way he speaks to me and tells me what’s going to happen.” This patient has a confused sense of time. He predicts such things as the death of a staff member and the demolition of the powerhouse roof by a windstorm several days after these events have occurred.

Why do some patients cluster silently in groups, so close together that they are touching each other? My own explanation is that they derive a measure of comfort and security from physical contact with another human being. When I was a temporary madman, I repeatedly felt myself being pulled by an invisible force to a bottomless pit where utter pain and wretchedness awaited me. Merely touching the hand of the doctor beside me did much to allay my fear.

The task of the hospital staff is to lead these chronic patients back to the world of reality. But it is a formidable task. The psychotic is completely absorbed by his nightmare realm. Our weapons to rescue him are meager. There is an urgent need for research into new methods of treatment.

We do have some successful treatment methods: shock treatment; psycotherapy; social, recreational and ! work activity. But even these services ; have to be doled out sparsely because j of staff, accommodation and equipment j shortages. The Weyburn hospital, with two thousand patients, has only thirteen doctors and a hundred and sixtyfive aides. Most other institutions are in the same position. Thus, the patient who fails to respond to treatment often has to be abandoned in favor of more promising cases. Forgotten and neglected, he sinks deeper and deeper into his nightmare world.

Two years ago, the Weyburn hospital gave a remarkable demonstration of how many “hopeless” patients could be salvaged simply by filling their days with supervised activity. Doctors j Derek Miller and John Clancy selected j one hundred male patients—a cross ¡

section of the hospital’s most serious cases. They had been in hospital anywhere from two to seventeen years. They were placed in the brightest ward in the hospital and divided into small groups with an aide assigned to each one. All day they were kept busy. After six months this group required a total of only twelve sedatives, compared to the hospital average of six hundred and eight sedatives per hundred patients. The room reserved for noisy patients, went unused. Restraint cuff's were employed on only one occasion for one hour. Total destruction of property amounted to five pairs of pants, two cups, one flower pot and two window panes—far below the average. Twenty-five patients were well enough to be discharged to their homes.

Now it is four o’clock in the afternoon, the regular visiting time. The hospital encourages visits and letters from friends and families because continued contact with the outside world is important to the patient. I am sitting in the corridor outside the ward where outside visitors are received by the patients. A grey-haired couple are talking earnestly to their son, a man in his mid-thirties. He is looking away from them and remains utterly silent. The mother turns to her husband and shrugs her shoulders; tears drop down her cheeks. Visits can be painful to relatives. The patient may show little or no sign of recognition or affection. Sometimes he may become openly abusive. “But,” says Dr. Humphry Osmond, the hospital’s acting superintendent, “even if the sick patient can’t show it, he values seeing familiar and friendly faces.”

Privately, the doctors advise the relatives, “Act natural. Bring pleasant news of home. Don’t advise or scold. Don’t be disturbed by harrowing accounts of how your relative is being abused and punished. That’s part of the illness.” But some visits are marked by tears, others are punctuated by laughter. Across from me, a pretty young woman is talking to her husband who was admitted to hospital a month ago. She is relating the antics of their four-year-old daughter when she took her out to dine for the first time in a restaurant.

Back in the ward, the mail has just arrived and lies in a pile on the supervisor’s desk. He glances through the letters, censoring parts of them in the interests of the patient. One letter contains a paragraph describing a trafficdeath. “The man that was killed was the patient’s closest friend,” explains the supervisor. “The patient is depressed—he just can’t take that news now.” He turns to a pile of outgoing letters written by patients and starts going through them. He stops and carefully re-reads a passage in one of them. It is from an uncommunicative patient written to his brother. In a neat handwriting he describes how a voice has told him that a former associate is trying to kill him. The supervisor lays the letter aside. “I will show it to the doctor,” he says. “It will be useful to

hip} in treating the patient.”

Every evening, from si< to eight, theye is a program for the patients. Topight’s activity is a dance in the assembly hall. By the time I get there, there are already about two hundred men and women on the floor or sitting arqiind watching. Fc r members of the orchestra are patiei t . The pianist is ’a girl of twenty-two who suddenly returned to her music after an absence of four years. “Since she began playing agpin,” the aide tells me, “her behavior on, the ward has improved.” The drummer is mentally retarded but he is gifted with an unusually fine sense of rhythm.

The floor is now covered with dancers. A tall man and a short woman walk carefully around the perimeter of the floor in time to the music. An attractive girl in her early twenties is dancing joyously by herself. Seldom do the patients have a strong sexual interest in each other: mental illness impairs the natural instincts. I dance with a comely blonde in a pink dress. We comment on the orchestra and the other dancers. I compliment her on her gracefulness. The next day she sends her nurse to thank me for dancing with her. The conclusion of each number is met with applause and cheers. Everyone seems to be having a good time.

One night when a movie was being shown a mistake was made in the choice of the picture. The story concerned a psychopathic killer who murdered several people before he was caught. One of the patients said, “I don’t like it. It makes me feel uncomfortable.” Others shared his uneasiness. On another evening, a panel of patients opposed a panel of experts in the game of Twenty Questions. Eight times out of ten, the patients emerged victorious. Mental illness usually leaves what might be called “mechanical intelligence” intact. There is one patient who can beat all the staff doctors at chess; another can work out complicated mathematical problems with little difficulty.

Amateur nights are a regular feature of the hospital. They encourage the patients to emerge from their shells, to express themselves. A middle-aged man with the physique of a wrestler vigorously recites The Shooting of Dan McGrew. Another patient sings a cowboy lament. While he plays through the chorus on a comb and a piece of tissue paper, a stout woman mounts the stage and performs the exercises she has been taking in her calisthenics class.

Not all the patients are well enough to engage in these evening activities. The extremely senile, the disturbed, the brain-injury cases remain in their wards. Not long ago, as an experiment, a noisy, boisterous film was shown to a selected group of deteriorated schizophrenics, who had long withdrawn from the real world. They watched in silence, showing no visible reaction.

As therapy, work is considered even more valuable than play. In all wards, patients are encouraged to volunteer

for housekeeping chores, but the greatest concentration of able-bodied workers is in the parole ward. Of one hundred and fifty patients, all but twenty-five are employed full or part time. They not only do all the work on the ward, a few of them also supervise it. They have free access to the hospital grounds and work on the farm, in the cow-barn, piggery, laundry, kitchen, carpentry shop or with the plumbing or garbage gang. They leave the ward early in the morning, put in a gojd day’s work and return to the ward at night. Many of these patients have been going through this routine for as long as fifteen years. The supervisor tells me. “Most of these patients shouldn’t be in a mental hospital. They’re here only because nobody else wants them. They’ve got nowhere else to go.”

[ learn the truth of this observation af-er talking to several patients and looking through their records. Most of them are older people—a hundrèd of the one hundred and forty-seven are over fifty—whose relatives are not interested in them. They never have visitors. Some have no families. One of these patients was admitted in 1934. For two years he was slightly disturbed, but for the last seventeen years, the record shows, he’s been industrious, polite, tidy and dependable. For one period he had assumed control of the tailor shop. Another patient was admitted five years ago and was discharged as “recovered” after two months. He went to work for a farmer, but in two weeks he was back in the hospital. “He makes me sleep in the chicken house and doesn’t treat me right, he explained. He had no place to go so he returned to the hospital where he’s been ever since. Another patient got a job working in town. He finally built himself a small cottage just outside the hospital grounds where he lives today. The supervisor says, “Sixty percent of the patients in this ward could live and work on the outside with little or no supervision.”

I speak to a man in his mid-sixties, with a broad sunburnt face who has been in hospital for five years. He has the occasional mild epileptic seizure but these can be controlled by tk-'— hunhiol. He is bitter about being kept in a mental hospital. “I wish I was dead,” he says. He has a wife and several married children but none of them want him. He tells me, “My wife says, ‘Stay in the crazy house until you die.’ ”

It’s an old story. Weyburn, like most mental hospitals, is too frequently used as a dumping ground for the aged, the senile, the homeless and the mentally defective. The proper job of the mental hospital is to treat people who are mentally ill and restore them to normal health. But how can they do their job well when their resource^ are expended providing custodial care for patients who should be elsewhere?

It is now nine o’clock and the lights in the dormitory are switched off. The hospital day is ending. The supervisor sits in his small room checking records. Outside in the corridor, two aides walk up and down keeping an eye on the dormitories. An uneventful hour passes. Then a man of fifty hobbles out to the aide and points down to the next corridor. “I could hear him coming,” he says. “He’s out to get me.” The aide offers a few reassuring words, gives the old man a sedative and leads him back to bed.

Now it is past midnight and I am looking out the hospital window. The darkness outside is pierced by the headlights of an automobile which is pulling up at the door. Two RCMP officers are bringing another patient to the hospital .. . *