Saturday, 20 May 2017

The first modern survivor advocate?

I could not but respect the mind that had laid out so comprehensive and devilishly ingenious and, at times, artistic a Third Degree as I was called upon to bear. And an innate modesty (more or less fugitive since these peculiar experiences) does not forbid my mentioning that I still respect that mind. 
A Mind That Found Itself-p.31
Clifford Beers seemed to have everything going for him. A young and talented graduate of Yale, he started work at the New Haven tax office in 1897 anticipating a better job in New York. Months later his dream was realised and Beers took up a job for an insurance company near Wall Street, staying until 1900. But all was not well and Beers increasingly succumbed to what he later described as depression and depletion of his vitality. Beers moved home to his parents in New Haven, rapidly descending into fantasies of suicide. Unable to tolerate his "terrific nervous strain" any longer, Beers threw himself from the fourth floor of the townhouse in which his parents lived.

Beers' darkest moment was the start of one of the most extraordinary stories in psychiatric history. To become a psychiatric patient in America at the start of the 20th Century was to fall mercy to entrepreneurial hacks or sprawling and anonymous state asylums. Beers experienced both of these, but would later go on to be one of the most important survivor advocates in history. It started with his memoir A Mind That Found Itself (a title I love for its mind boggling implications) in which he writes of his experiences of what then passed for mental health care.

Beers spent time in three different institutions, two private sanatoriums before being moved to the state asylum in Middletown. His description of what he encountered is a disarming mix of the tragic, the enraging, and the comic. Beers is repeatedly beaten and restrained, including in a "muff," something I hadn't learned about before reading his book. A picture of one (courtesy of MissCreepers) helps us to understand how it would work:

He also describes acutely the petty and largely invisible cruelty experienced at the hands of staff unable to recognise and constrain their own punitive impulses. A Mind That Found Itself is a catalogue of small but poisonous interactions which escalate to physical violence. Beers does not profess complete innocence in all this and does not shy away from candid reflections on his own sometimes provovative conduct. Indeed when he had completed his manuscript he sent a copy to William James. James wrote back:
You were doubtless a pretty intolerable character when the maniacal condition came on and you were bossing the universe.
But as a man who was viewed by his treaters as "insane," the onus was not on Beers to maintain the highest standards of conduct. The repeated failure of his custodians to avoid reflexive and punitive reactions to unusual behavior is a problem that still runs shamefully through mental health treatment today. Bringing it to light will stand as one of Beers' greatest legacies. He is at his most heartbreaking when describing the treatment of others:
Of all the patients known to me, the one who was assaulted with the greatest frequency was an incoherent and irresponsible man of sixty years. This patient was restless and forever talking or shouting, as any man might if oppressed by such delusions as his. He was profoundly convinced that one of the patients had stolen his stomach—an idea inspired perhaps by the remarkable corpulency of the person he accused. His loss he would woefully voice even while eating. Of course, argument to the contrary had no effect; and his monotonous recital of his imaginary troubles made him unpopular with those whose business it was to care for him. They showed him no mercy. Each day—including the hours of the night, when the night watch took a hand—he was belabored with fists, broom handles, and frequently with the heavy bunch of keys which attendants usually carry on a long chain. He was also kicked and choked, and his suffering was aggravated by his almost continuous confinement in the Bull Pen. An exception to the general rule (for such continued abuse often causes death), this man lived a long time—five years, as I learned later. 
A Mind That Found Itself-p.139

A Mind That Found Itself is also fascinating psychologically, for its reflections on the thinking and reasoning involved in what we might now describe as an affective psychosis:
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 belief—that 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 error—that 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. 
A Mind That Found Itself-p.42

And this, along with Beers' experience of a Capgras-style delusion, may be part of why William James found the book so compelling. He wrote to Beers:
The most striking thing in it to my mind is the sudden conversion of you from a delusional subject to a maniacal one—how the whole delusional system disintegrated the moment one pin was drawn out by your proving your brother to be genuine. I never heard of so rapid a change in a mental system.
When he was discharged from the state asylum, Beers became an energetic advocate for the rights of people receiving psychiatric treatment. Among other things, Beers went on to found an outpatient clinic in New Haven, which just happens to be at the bottom of the road I currently live on:

But not everyone was impressed with Beers' book. Shortly after its publication, the superintendent of the Connecticut state asylum, Alfred Noble, felt moved to write a defensive response in one of his regular reports. Irritably and awkwardly, Dr. Noble blames the victim, saying "insane people do not always manifest the angelic temperament which some would have us believe," before going on to indulge some egregious character assassination:

(I am indebted to a librarian at the Connecticut Valley Hospital library for making this available)

But Beers has the last laugh. The grounds of the old asylum house the campus of what is now called Connecticut Valley Hospital. Dotted around the grounds are buildings named for various esteemed former superintendents. Noble Hall stands in abandoned disrepair, but at the crest of the hill overlooking the eponymous valley stands a building still in use. Its name? Beers Hall.


You can read more about Beers' reform work here
A Mind That Found Itself is available online in its entirety courtesy of Project Gutenberg

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