My attendant, who had had training as a nurse, detected the unmistakable signs of impending death. He forthwith informed the owner of the sanatorium that the patient was in a dying condition, and urged him (a doctor) to go at once to the bedside. The doctor refused to comply with the request on the plea that he was at the time "too busy." When at last he did visit the room, the patient was dead. Then came the supervisor, who took charge of the body. As it was being carried from the room the supervisor, the "handy man" of the owner, said: "There goes the best paying patient the institution had; the doctor" (meaning the owner) "was getting eighty-five dollars a week out of him." Of this sum not more than twenty dollars at most, at the time this happened, could be considered as "cost of maintenance." The remaining sixty-five dollars went into the pocket of the owner. Had the man lived for one year, the owner might have pocketed (so far as this one case was concerned) the neat but wicked profit of thirty-three hundred and eighty dollars. And what would the patient have received? The same privilege of living in neglect and dying neglected.
VIII
For the first few weeks after my arrival at the sanatorium, I was cared for by two attendants, one by day and one by night. I was still helpless, being unable to put my feet out of bed, much less upon the floor, and it was necessary that I be continually watched lest an impulse to walk should seize me. After a month or six weeks, however, I grew stronger, and from that time only one person was assigned to care for me. He was with me all day, and slept at night in the same room.
The earliest possible dismissal of one of my two attendants was expedient for the family purse; but such are the deficiencies in the prevailing treatment of the insane that relief in one direction often occasions evil in another. No sooner was the expense thus reduced than I was subjected to a detestable form of restraint which amounted to torture. To guard me at night while the remaining attendant slept, my hands were imprisoned in what is known as a "muff." A muff, innocent enough to the eyes of those who have never worn one, is in reality a relic of the Inquisition. It is an instrument of restraint which has been in use for centuries and even in many of our public and private institutions is still in use. The muff I wore was made of canvas, and differed in construction from a muff designed for the hands of fashion only in the inner partition, also of canvas, which separated my hands, but allowed them to overlap. At either end was a strap which buckled tightly around the wrist and was locked.
The assistant physician, when he announced to me that I was to be subjected at night to this restraint, broke the news gentlyso gently that I did not then know, nor did I guess for several months, why this thing was done to me. And thus it was that I drew deductions of my own which added not a little to my torture.
The gas jet in my room was situated at a distance, and stronger light was needed to find the keyholes and lock the muff when adjusted. Hence, an attendant was standing by with a lighted candle. Seating himself on the side of the bed, the physician said: "You won't try again to do what you did in New Haven, will you?" Now one may have done many things in a city where he has lived for a score of years, and it is not surprising that I failed to catch the meaning of the doctor's question. It was only after months of secret puzzling that I at last did discover his reference to my attempted suicide. But now the burning candle in the hands of the attendant, and a certain similarity between the doctor's name and the name of a man whose trial for arson I once attended out of idle curiosity, led me to imagine that in some way I had been connected with that crime. For months I firmly believed I stood charged as an accomplice.
The putting on of the muff was the most humiliating incident of my life. The shaving of my legs and the wearing of the court-plaster brand of infamy had been humiliating, but those experiences had not overwhelmed my very heart as did this bitter ordeal. I resisted weakly, and, after the muff was adjusted and locked, for the first time since my mental collapse I wept. And I remember distinctly why I wept. The key that locked the muff unlocked in imagination the door of the home in New Haven which I believed I had disgracedand seemed for a time to unlock my heart. Anguish beat my mind into a momentary sanity, and with a wholly sane emotion I keenly felt my imagined disgrace. My thoughts centred on my mother. Her (and other members of the family) I could plainly see at home in a state of dejection and despair over her imprisoned and heartless son. I wore the muff each night for several weeks, and for the first few nights the unhappy glimpses of a ruined home recurred and increased my sufferings.
It was not always as an instrument of restraint that the muff was employed. Frequently it was used as a means of discipline on account of supposed stubborn disobedience. Many times was I roughly overpowered by two attendants who locked my hands and coerced me to do whatever I had refused to do. My arms and hands were my only weapons of defence. My feet were still in plaster casts, and my back had been so severely injured as to necessitate my lying flat upon it most of the time. It was thus that these unequal fights were fought. And I had not even the satisfaction of tongue-lashing my oppressors, for I was practically speechless.
My attendants, like most others in such institutions, were incapable of understanding the operations of my mind, and what they could not understand they would seldom tolerate. Yet they were not entirely to blame. They were simply carrying out to the letter orders received from the doctors.
To ask a patient in my condition to take a little medicated sugar seemed reasonable. But from my point of view my refusal was justifiable. That innocuous sugar disc to me seemed saturated with the blood of loved ones; and so much as to touch it was to shed their bloodperhaps on the very scaffold on which I was destined to die. For myself I cared little. I was anxious to die, and eagerly would I have taken the sugar disc had I had any reason to believe that it was deadly poison. The sooner I could die and be forgotten, the better for all with whom I had ever come in contact. To continue to live was simply to be the treacherous tool of unscrupulous detectives, eager to exterminate my innocent relatives and friends, if so their fame could be made secure in the annals of their craft.
But the thoughts associated with the taking of the medicine were seldom twice alike. If before taking it something happened to remind me of mother, father, some other relative, or a friend, I imagined that compliance would compromise, if not eventually destroy, that particular person. Who would not resist when meek acceptance would be a confession which would doom his own mother or father to prison, or ignominy, or death? It was for this that I was reviled, for this, subjected to cruel restraint.
They thought I was stubborn. In the strict sense of the word there is no such thing as a stubborn insane person. The truly stubborn men and women in the world are sane; and the fortunate prevalence of sanity may be approximately estimated by the preponderance of stubbornness in society at large. When one possessed of the power of recognizing his own errors continues to hold an unreasonable beliefthat is stubbornness. But for a man bereft of reason to adhere to an idea which to him seems absolutely correct and true because he has been deprived of the means of detecting his errorthat is not stubbornness. It is a symptom of his disease, and merits the indulgence of forbearance, if not genuine sympathy. Certainly the afflicted one deserves no punishment. As well punish with a blow the cheek that is disfigured by the mumps.
The attendant who was with me most of the time while I remained at the sanatorium was the kindly one already mentioned. Him I regarded, however, as a detective, or, rather, as two detectives, one of whom watched me by day, and the othera perfect doubleby night. He was an enemy, and his professed sympathywhich I now know was genuineonly made me hate him the more. As he was ignorant of the methods of treatment in vogue in hospitals for the insane, it was several weeks before he dared put in jeopardy his position by presuming to shield me against unwise orders of the doctors. But when at last he awoke to the situation, he repeatedly intervened in my behalf. More than once the doctor who was both owner and superintendent threatened to discharge him for alleged officiousness. But better judgment usually held the doctor's wrath in check, for he realized that not one attendant in a hundred was so competent.
Not only did the friendly attendant frequently exhibit more wisdom than the superintendent, but he also obeyed the dictates of a better conscience than that of his nominal superior, the assistant physician. On three occasions this man treated me with a signal lack of consideration, and in at least one instance he was vicious. When this latter incident occurred, I was both physically and mentally helpless. My feet were swollen and still in plaster bandages. I was all but mute, uttering only an occasional expletive when forced to perform acts against my will.
One morning Doctor No-name (he represents a type) entered my room.
"Good morning! How are you feeling?" he asked.
No answer.
"Aren't you feeling well?"
No answer.
"Why don't you talk?" he asked with irritation.
Still no answer, except perhaps a contemptuous look such as is so often the essence of eloquence. Suddenly, and without the slightest warning, as a petulant child locked in a room for disobedience might treat a pillow, he seized me by an arm and jerked me from the bed. It was fortunate that the bones of my ankles and feet, not yet thoroughly knitted, were not again injured. And this was the performance of the very man who had locked my hands in the muff, that I might not injure myself!
"Why don't you talk?" he again asked.
Though rather slow in replying, I will take pleasure in doing so by sending that doctor a copy of this bookmy answerif he will but send me his address.
It is not a pleasant duty to brand any physician for cruelty and incompetence, for the worst that ever lived has undoubtedly done many good deeds. But here is the type of man that has wrought havoc among the helpless insane. And the owner represented a type that has too long profited through the misfortunes of others. "Pay the price or put your relative in a public institution!" is the burden of his discordant song before commitment. "Pay or get out!" is his jarring refrain when satisfied that the family's resources are exhausted. I later learned that this grasping owner had bragged of making a profit of $98,000 in a single year. About twenty years later he left an estate of approximately $1,500,000. Some of the money, however, wrung from patients and their relatives in the past may yet benefit similar sufferers in the future, for, under the will of the owner, several hundred thousand dollars will eventually be available as an endowment for the institution.
IX
It was at the sanatorium that my ankles were finally restored to a semblance of their former utility. They were there subjected to a course of heroic treatment; but as to-day they permit me to walk, run, dance, and play tennis and golf, as do those who have never been crippled, my hours of torture endured under my first attempts to walk are almost pleasant to recall. About five months from the date of my injury I was allowed, or rather compelled, to place my feet on the floor and attempt to walk. My ankles were still swollen, absolutely without action, and acutely sensitive to the slightest pressure. From the time they were hurt until I again began to talktwo years laterI asked not one question as to the probability of my ever regaining the use of them. The fact was, I never expected to walk naturally again. The desire of the doctors to have me walk I believed to be inspired by the detectives, of whom, indeed, I supposed the doctor himself to be one. Had there been any confession to make, I am sure it would have been yielded under the stress of this ultimate torture. The million needle points which, just prior to my mental collapse, seemed to goad my brain, now centred their unwelcome attention on the soles of my feet. Had the floor been studded with minute stilettos my sufferings could hardly have been more intense. For several weeks assistance was necessary with each attempt to walk, and each attempt was an ordeal. Sweat stood in beads on either foot, wrung from my blood by agony. Believing that it would be only a question of time when I should be tried, condemned, and executed for some one of my countless felonies, I thought that the attempt to prevent my continuing a cripple for the brief remainder of my days was prompted by anything but benevolence.
The superintendent would have proved himself more humane had he not peremptorily ordered my attendant to discontinue the use of a support which, until the plaster bandages were removed, had enabled me to keep my legs in a horizontal position when I sat up. His order was that I should put my legs down and keep them down, whether it hurt or not. The pain was of course intense when the blood again began to circulate freely through tissues long unused to its full pressure, and so evident was my distress that the attendant ignored the doctor's command and secretly favored me. He would remove the forbidden support for only a few minutes at a time, gradually lengthening the intervals until at last I was able to do without the support entirely. Before long and each day for several weeks I was forced at first to stagger and finally to walk across the room and back to the bed. The distance was increased as the pain diminished, until I was able to walk without more discomfort than a comparatively pleasant sensation of lameness. For at least two months after my feet first touched the floor I had to be carried up and downstairs, and for several months longer I went flat-footed.
Delusions of persecutionwhich include "delusions of self-reference"though a source of annoyance while I was in an inactive state, annoyed and distressed me even more when I began to move about and was obliged to associate with other patients. To my mind, not only were the doctors and attendants detectives; each patient was a detective and the whole institution was a part of the Third Degree. Scarcely any remark was made in my presence that I could not twist into a cleverly veiled reference to myself. In each person I could see a resemblance to persons I had known, or to the principals or victims of the crimes with which I imagined myself charged. I refused to read; for to read veiled charges and fail to assert my innocence was to incriminate both myself and others. But I looked with longing glances upon all printed matter and, as my curiosity was continually piqued, this enforced abstinence grew to be well-nigh intolerable.
It became again necessary to the family purse that every possible saving be made. Accordingly, I was transferred from the main building, where I had a private room and a special attendant, to a ward where I was to mingle, under an aggregate sort of supervision, with fifteen or twenty other patients. Here I had no special attendant by day, though one slept in my room at night.
Of this ward I had heard alarming reportsand these from the lips of several attendants. I was, therefore, greatly disturbed at the proposed change. But, the transfer once accomplished, after a few days I really liked my new quarters better than the old. During the entire time I remained at the sanatorium I was more alert mentally than I gave evidence of being. But not until after my removal to this ward, where I was left alone for hours every day, did I dare to show my alertness. Here I even went so far on one occasion as to joke with the attendant in charge. He had been trying to persuade me to take a bath. I refused, mainly because I did not like the looks of the bath room, which, with its cement floor and central drain, resembled the room in which vehicles are washed in a modern stable. After all else had failed, the attendant tried the rôle of sympathizer.