In December 1951, I went on an annual Christmas visit to Willowbrook Psychiatric Hospital on Staten Island with the Cub Scouts. I was somewhat aware as an astute 8 year old as to what I was getting into because my grandmother’s roommate from Med school, Louise Despert MD, was at this point a close family friend and a well know psychiatrist on Park Avenue, treating wealthy psychotic children, a somewhat correlated event at the time. She often spoke with me under the assumption I was normal. I hope I have never disappointed her.
The experience at Willowbrook was somewhat shocking. I can remember it still today as if it had just happened. It was one of those events which had quite strong limbic valence. We were all in our neat Cub Scout uniforms and we had Christmas decorations and we had small wrapped presents for the patients in the ward. The wards were immense halls, no walls, with beds stacked one upon another with bright lights overhead.
The smell of urine was pervasive and the patients wandered aimlessly around in some state of confusion in white tied gowns, the steam heat was high, steam heat with the hissing of the steam and the increase humidity it brings to intensify any and all smells. There were well over a hundred or more inmates, yes they were called inmates as if they were in prison, in the hall. This was the group we were to bring presents to and sing our well prepared Christmas carols. I often wondered what drove the patients there; parents, the police, the courts, just what was the driving factor. That was eight.
Segway to the late 60s and McLean Hospital in Belmont, the Harvard affiliate institution for psychiatry. Meds were being used and it was much cleaner with many people with depression and bipolar disorder, fewer paranoid schizophrenics. Smaller rooms, better care, less of a smell. Patients were confined in “group” sessions. But there were meds, and to understand psychiatry, you learned the meds, what to use to quiet them down, to sedate them and pretend that they were back to normal. The meds with the side effects which at times could be just as bad.
From 68 to 72 when the meds came on in full force the institutions were then closed one by one. The Willowbrook facility was considered Medieval and was shut with the help of the New York Press. I often wondered where they all went, those people twenty years earlier who we had given gifts to, but in no time the streets became crowded with “homeless”, and the faces became all too familiar again.
There is a quote from Martin Kelly MD which states:
“When chlorpromazine was first introduced in the United States in 156, the number of patients in mental hospitals was steadily rising, and 50% of all hospital beds were devoted to psychiatric patients. Since that time the population of patients chronically hospitalized for psychiatric reasons has steadily declined. Forty years ago in Massachusetts there were 20,000 to 25,000 patients in mental hospitals; now there are fewer than 2,000.This remarkable decrease can be attributed primarily to the use of antipsychotic drugs.” (by Martin Kelly, MD, Psychiatry in Brunwald and Rose, Review of Internal Medicine, Harvard Med School, 1993.)
So in this short period of time we saw tens of thousands sent out on their own, assuming that the meds would “cure” them, namely would just allow them to exist quietly in society. Unlike the statements made by many “television docs”, it was not Reagan and the 80s, it was meds and the 60s which drove these folks out. As physicians one could now write script for quieting meds, assuming that the patient was compliant. That was the nub, compliance.
Then came the rights of people, of patients, so that committing someone became a difficult process, something which required judges and lawyers to prove that they were an imminent harm to themselves and others. Which gets us where we are today, with those random “rocks from heaven” which fall on the rest of us, it is not the John Wilkes booth of Lincoln, but the madman who shot Teddy Roosevelt, and if not a gun, then a bomb, as we have seen from so many terrorists.
It is not a simple problem with a simple answer. Sometimes family members never really recognize the problem for what it is, even if the family member may be trained to do so, it is often the frog in the pot syndrome, the heat rises slowly and the frog never sees the bubbles of boiling coming its way. Thus for problems with no real easy answer, we should not expect easy solutions. That is the real problem. It is a hard problem, but a problem.
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