This post is an exercise in remembering, a recollection of some of the people and experiences burned into my memory during my first job in the field of mental health, decades before I became a licensed clinician and a few years before I discovered Quakerism. I tell the story here briefly, with respect for patients’ privacy, and as accurately as memory allows, in hope that it will be of interest to some who find it.
I. Surviving Training
The year is 1971, and I am 21 years old. Just four years ago, I was a naïve, pious candidate for the priesthood in a religious order, living with a select group of young men in a safe, highly ordered institutional environment. I have a blurry photo from those days: a lean but healthy young man, I wore a white shirt with black suit, tie, and shoes. I was clean-shaven, and my hair, having been cut by a classmate, was short but unevenly trimmed. Now, however, the white shirt is matched by white pants, brass keys heavy in a pocket: I wear the uniform of my new job, Health Assistant I—attendant—at a state psychiatric hospital. The beard that I grew after seminary is trimmed, and my long hair is cut straight at the shoulders: I want to make the best impression I can short of sacrificing my “freak flag,”1 my emblem of resistance to the dominant culture of consumption, racism, and war. The hair is dull and brittle, though, because after a year and a half of a hippie lifestyle, with its chronic malnutrition and lack of medical care, I am no longer healthy.
During this morning’s training, after much talk about policies and paperwork, we were taught two rules. First, “When you talk with patients, don’t challenge their delusions; it won’t help, and it might damage your relationship.” Second, “When writing your notes, use ‘apparently’ to avoid stating things as if you were certain of them when you’re not. For example, if a patient were lying down with his eyes closed, you would write, ‘Pt. appeared to be asleep,’ not ‘Pt. was asleep.'” Very soon, I will begin to learn the hard way to generalize that: especially in this place, things are often not as they seem.
Now, our group of new hires enters the males’ side of a locked patient residence: we are about to have our first look at a working ward. We pause just inside while the instructor talks, his back to the door. I have wandered to the rear of the group, half-listening to him while trying to get a glimpse of the ward, most of which is around a corner, when a tall, solid man emerges from a storage room and asks me to help him with something in there. He is dressed, I think, like a maintenance worker: plaid shirt, tan pants. I spontaneously agree. The second thought comes almost immediately, but I’ve already said yes, so I enter the room with him.
As he closes the door behind us, the man points to a closed cardboard box in the center of the room. “I just need a little help sliding that box over to the wall. It’s heavy.” This seems all right. We both walk toward the box, but then the man steps back, an odd look on his face. Only now do I think that a worker would probably wear a uniform or ID badge; this man has neither, and he is between me and the door. Should I call for help? But I want to think well of him—and of myself. And I see that I have done something stupid, and I don’t want to draw the instructor’s attention: until now, work had been impossible to find, and this place hired me only after another long-haired man successfully sued the state (before refusing the job). It’s likely that no one would hear me anyway: the door is thick and solid, the ward is noisy, and my throat feels tight. And maybe this man really is an employee, or at least someone who means me no harm.
It is not until the man moves toward it that I notice the heavy brass door-closer, detached from the door and stored near it on an overhead rack. Feeling that I am watching a movie, I see him reach up and grasp that door-closer by its long, hinged arm. He holds it like a flail as he steps toward me.
“I could bash your skull in with this,” he says evenly.
I am maintaining eye contact; I am amazed at my calmness. Or maybe I’m in shock: shouldn’t I be strategizing? “Don’t challenge delusions” is all that comes to mind. But I can’t use that until I hear one.
“Yes, you could.”
“And they wouldn’t know I did it.”
“They couldn’t figure it out?”
“Nah. And even if they did, it wouldn’t matter. I’m crazy; that’s why I’m here.”
“People get discharged from here. You probably want to leave as soon as you can. I believe you about how clueless they are, but if they somehow did find out, you could be here forever.” It’s weak, I know, but it’s all I have.
The man laughs, and then he replaces the door-closer on the rack. “You don’t know this place, man. They’d never know who did it; they don’t pay attention. But I’m not gonna hurt you. I was just trying to teach you something. Don’t do that again: don’t trust nobody here—I mean staff, too. You gotta look out for yourself, because nobody gives a shit, and people here will hurt you—staff, too, I’m telling you. That’s how this place is.”
I thank the man; I tell him that he has given me a very valuable lesson. He opens the door and I walk out behind him, hoping to escape notice. But I needn’t have worried: the instructor and students have moved on without me. The patient, who has disappeared, was right. Still unnoticed, I rejoin the group as the instructor is unlocking the far exit. I am shaken. But I am fascinated, too.
II. Working the Day Shift
After a bit more training, I am assigned to the 7-3 shift on the male side of a locked building. I will be inside of that building almost all of the time: my job is to be with the patients, and they are rarely, if ever, permitted outside. They get no exercise, but spend their waking hours in the stale, piss-stink air of the ward, watching TV in the dayroom, sitting in their rooms or dorms, or doing the “Thorazine shuffle”—sliding their slippered feet along the floor—in the dull halls until a staff member clears them with shouts, shoves, and threats. Years later, when I learn about the late 19th-century Quaker “moral treatment” movement,2 I will wonder if such concepts as sunlight, exercise, and respect had ever reached the hospital’s leaders. But at this point I am as many years from encountering Quakerism as I am, in the other direction, from leaving the Catholic Church for its defection from Christ’s way of compassion and peace. At this point, having long been alienated from faith and family over my refusal to take up arms pro Deo et patria, I find that my only community is the fading media-made mirage called “the counterculture.” In other words, I will have no support in this work.
Compassion and peace: the patients here are obviously in need of both. I promise myself that I will stay for at least a year. But I wonder how I will survive: despite their lack of exercise, most of the patients are healthier and stronger than I, and some of them know it all too well. And I couldn’t even get through training without putting my life in jeopardy. I’d pray, but God fell with the Church. I really am on my own.
I remain on the day shift for a couple of months, working every day as scheduled, now and then wrestling a violent patient, being attacked for my cigarettes or keys, or being warned off by staff members when I question their treatment of patients. My world has become bizarre, a universe of people and events unimaginable, unforgettable—
- A man who has bitten off his lip and blinded his eyes, who feels his way around the fetid halls, hitting himself in the face and head and shouting curses and obscenities. I am shocked by my first sight of him, relieved that he can’t see my reaction. I’ve never before seen or even imagined such behavior, but the consulting doctor’s notes convince me that the man can’t control it. Nonetheless, he is frequently mistreated by staff members. The charge nurse, whose presence unfailingly stimulates him to stream profanity, often demands that he be locked in the Rubber Room. But, unable to do otherwise, I treat him as I would anyone else, and eventually he begins to converse with me, his sentences often interrupted by violent spasms and urgent vulgarities.
Every day, I seek him out for conversation, if only brief. He soon learns my footfall, and often he calls my name when I walk near. Eventually, he asks me into his room, to speak in private, and only there does he tell something of his story.
One afternoon the man is taken to be seen by a psychiatrist at another institution. The next morning, he stops me in the hall. “I learned a new one yesterday,” he says; “look!” His left hand arcs swiftly to his head, smacking his ear. “Is it,” I ask, “that the spasms are involuntary, but you have some control over the form they take?” His mutilated mouth grins, but he says nothing. I don’t know whether he is pleased that I understand or has been playing with me.
- A lithe, apparently mute man, his face pasty, his impenetrable gray eyes narrow and narrowly focused after distribution of cigarettes. I’ve been told to watch “Sam” at this time. He has finished his cigarette in moments, more quickly than I thought possible, and now he stands perfectly still, surrounded by men still relishing their smokes. Suddenly, without the slightest sign of tensing, he’s in a motion so smooth that I don’t so much see him moving as sense the sliding of his slippers across the gritty floor. A startled patient cries out as the half-smoked cigarette is snatched from his mouth and sucked to a nub by the still-moving blur named Sam. The other man is angry, but he knows that, whereas a fight could get him a stay in the Room, self-restraint could get him a new cigarette. Sam seems to know how to play this scene, too: he hangs his head as he and I are scolded by the angry nurse. This won’t be the last time.
Sam, it will turn out, is not completely mute. In all of the months that I work on the ward, he speaks but once, pulling me aside in the hallway to whisper, “Aliens put a transmitter up my ass; they always know where I am.” Surprised more by the speaking than by its content, and recalling my training, I just nod. The gray eyes scan mine for an instant, and then he glides away.
One day many years after I’ve left the hospital, I am waiting for an elevator in a parking garage just off the street. There is a freestanding cylindrical ashtray near the elevator doors. Silently, snakelike, a thin middle-aged man moves to the ashtray from somewhere behind me. In a flash, he has plucked the butts from the sand and disappeared. For a moment I wonder: “Where have I seen those eyes before?” Then it clicks, and I wonder in the other sense. Sam is still around, and he still lives for smokes. I can’t help but smile.
- A young man who has appeared to be depressed but otherwise normal. One day, I look into the dayroom to see him calmly pulling apart his lower lip, dropping the pieces into a butt bucket. Alerting the nurse, I rush in and restrain his arms until a physician arrives. Then, after leading him to the treatment room, I hold the young man down on an exam table while the doctor, who refuses the anesthetic in the cabinet, stitches him. As soon as I hear “Done,” my ears buzz and I begin to black out. The doctor, laughing, tells me to sit with my head between my knees. For years after, the sight of blood will call up the buzzing.
The next day, the young man is taken to another building for Electro-Convulsive Therapy (ECT), the first in a series of such treatments. After he is returned to the ward, he tells me that the shock has taken away his memories. “I don’t want to lose everything,” he says, crying. I touch his arm. “The nurse told me that memories return after a while,” I reply. I hope that the nurse was right, but I have doubts, and I see that he does, too. Nonetheless, the treatments will continue.
Some time later, at dusk on one of my days off, I am walking up the hill to my apartment when I see that same young man at my building’s front door. I don’t know whether he has eloped or been discharged, but I know that I cannot take him in. Luckily, the old building is locked and has no buzzer system; he can’t gain entry. From the shadows across the street, I watch until he gives up and leaves, and then I trail him awhile before hurrying back and letting myself in.
I had planned to walk to a Chinese restaurant for fried rice and tea, but now I dare not go out: I hope I can find something that the roaches, who have managed even to get into the refrigerator, have not touched.3 As I eat some cheese that was sealed in a bag, I ask myself how the young man found my place. And then I remember: he had once asked me where I lived, and yes, I had described the location—adjacent to two landmark buildings; easily found—without thinking. I worry about him through the night.
And I worry about myself. It’s clear that if I am to keep the job, something must change radically. It’s also clear that that something won’t be me: better diet, cleaner living, and regular zazen haven’t been enough, and I’ve learned not to count on sudden enlightenment. But in my present work environment, I—like a person about to be committed to a mental hospital, I reflect with grim amusement—am a danger to myself and others. If I can’t change myself sufficiently, then I must change my environment, and there’s only one way to do that short of quitting. I must transfer to the night shift, so that the patients are asleep when I’m there.
When I go back to work I find the young man, returned from elopement, staring at the dayroom floor. I put in the shift-change request that morning. Someone on nights is eager to move to daytime, they tell me, and has been waiting for just such an opportunity: within a few weeks I will be working the graveyard shift—and, ironically, getting a small shift bonus in my check.
Before that happens, however, new patients arrive on the ward—
- A middle-aged poet who usually sits on the floor, his head weighing on knees pressed together by clasped hands as he rocks back and forth. Sometimes I sit with him (although the supervisor is displeased: I should refuse to talk with him unless he’ll sit in a chair) and get to know him a little. He is a gentle soul, and when he is discharged I invite him to my apartment, where I hear his poetry and his story. (My roommate and I will not forgive each other about this.) Most winters, the poet says, he signs himself into the hospital; the depression usually starts late in the fall, and he has no one to take care of him. Years later, after a new health care model has closed that opportunity for him, I will worry when I think of him.
- A quiet but articulate young man with long hair (like mine, but much healthier: a female nurse expresses envy) who tells me a credible story of unjust commitment. He is both angry and resigned. I feel a connection with him, and I talk with him when I can. One day, while the two of us are discussing my imminent move to the late shift, a tall, strong man of about 35 is brought through the door. All too obviously in psychosis, he is wrestled immediately into the Rubber Room, where he will spend a couple of days repeatedly counting from 1 to 10. “See what I mean?” asks the young man, shaking his head. “I’m nothing like that.”
III. Working the Night Shift
The night shift brings its own troubles.
- When the psychotic man stopped counting and told the psychiatrist that he was OK, he was moved to the private bedroom next to the main exit—around a corner and far from the nurses’ station, impossible to see from there. These facts I discover on my first night after a weekend off. I read the patient’s chart: “apparently,” he’s doing well. At midnight, the head nurse makes a tour of the ward. She returns angry with me, despite the fact that, as she well knows, my shift began after the patients had gone to bed. “That man at the end of the hall is sleeping in his clothes!” she says. “He’ll stink in the morning. You will wake him up and get him into pajamas. I’ll be back later to check on him.” She walks me down the hall, leaving me at his door as she exits the ward noisily. A few yards away, the man sleeps soundly in his bed.
Anxiously, I enter the room. My first calls and touches are tentative and have no effect. I want to leave, but I have my orders, and the nurse promised to return to see that I’ve obeyed, so I grasp the man’s shoulder and shake. Waking suddenly, he leaps from the bed and grabs me by the neck. Wordlessly, he carries me out of the room, across the dim hall, and slams me against the tiled wall. He is slamming me again as the long-haired young man, awakened by the noise, runs out of his room, takes in the scene, and hits the man across the back with a wooden chair. The man drops me, stares at us for a moment, and then returns quietly to his room, apparently unharmed.
Somehow I find the courage to ask the man if he is hurt. He indicates that he is not, so I turn and thank the young man, assure him that I’m OK, and walk weakly to the nurses’ station, where my colleague is already napping. When I wake him and tell him what happened, he asks why I didn’t call for help. I think that the answer would include “shock” and “pointless,” but I just shrug. Although I insist that I am not hurt beyond minor bruising, he advises me to claim a back injury, and he tells me a doctor’s name and locale. “He’ll write it up for you, and then you get state money to stay home. And his fee is low. Be smart: go see him. Next time you might really get hurt.” The colleague seems to be sincere in his desire to help me, so I thank him and ask him to check on the patient. “I’ll check on him,” he replies, laughing, “but I’m not making him change.”
After calming down with a couple of cigarettes, I peer into the room myself and see that the patient is indeed asleep in his clothes again. I don’t try to wake him: I’d much rather face the head nurse. But she doesn’t return that night to see that I’ve failed. Much later, I will realize that I don’t remember ever seeing her on the unit except for that one time—and I worked nights for maybe eight months.
- One morning soon after that, I am working long past 7 a.m. because my “relief” has not shown up on time. (This is a common occurrence, and one is not permitted to sign out until a replacement has signed in.) That same patient, I am told, has an early appointment for Electro-Convulsive Therapy and must be accompanied by someone from the unit; namely, me. Soon, three large men in white come onto the ward. They tell the patient that during transport to the ECT lab he must wear a straitjacket. He stares at them with some hostility as they approach with the jacket, but he lets them put it on him. They have fastened some of the buckles when he bursts out of the thing. Awed, I am grateful that one of the big men pushes me out of the way as they wrestle with him. The patient throws them off repeatedly, saying that he doesn’t want the jacket, until they are worn down and decide to try asking nicely: “If we leave the jacket off, will you go quietly?” He agrees immediately. I don’t trust this, but he walks peacefully out of the building with the four of us, two at each side.
The transport van is waiting, its rear door open. Inside, a bench runs along the van’s length. One of the big men enters first. As he sits at the far end of the bench, the other two motion for the patient to enter. He does so, leaving space for one more person between him and the door. One of the men tells me to sit there, and then they close the door on the three of us.
As the van moves slowly to the other building, I prepare for the worst. But the patient sits placidly, hands in his lap, a blank expression on his face. On arrival, he walks calmly into the ECT room and allows a nurse to position him on the treatment table. The table is surrounded by people in white; they are talking and joking as if the patient weren’t real. I had feared what he might do to me, but now I fear what they will do to him.
Once again, it seems as if I am watching a movie: I feel detached yet deeply involved. An arm is tied off. Drugs are injected. An airway is inserted. White paste is applied to both temples. Electrodes are placed. The doctor activates the charge. The arm twitches.
Already that afternoon, I won’t be able to remember whether more than one shock was administered. And later I will wonder if the patient really did have burn marks at his temples as I led him, ghost-like, back to the van. But I will not learn about trauma’s possible effects on an observer’s brain until I get clinical training, more than thirty years later.4
- The long night that will haunt me: a slight boy of maybe 12 or 13 years—why has he been moved to this ward with violent men?—is in asthmatic crisis. He lies on a gurney in the dim light by the nurses’ station. I expect that he’ll be moved to a medical hospital, but the nurse says, “He’s staying here, and you will monitor him. He won’t die if you watch him properly.” The child and I don’t know what’s ahead; I feel almost as frightened as he obviously is, but I resolve not to let him see my fear. Somehow simulating composure, I sit next to his gurney through the night, monitoring his condition, calming him when he cries, signaling the nurse as necessary. After the first injection, I marvel at the efficacy of epinephrine and hope that we don’t, as the nurse said we might, run out of it. When finally I’m told that the crisis over, I shed tears of relief, walking away so that the boy won’t know that I, too, had been scared.
But in some measure I am frightened every night—for myself; for the mentally ill, wherever they are, but especially in this place; for the mad human race and the inhuman world it inhabits. Scared, yes, and angry, and somehow still stunned by the myriad shapes of suffering I’ve seen and felt. As I leave the unit one morning, I realize that although the year is not quite finished, I am. Even homelessness, I think, is physically and psychologically safer for the likes of me—not to mention what could happen to someone in my care. And I am right. But knowing that I am right about this doesn’t make me feel right about it. Someday, I tell myself, when I am emotionally, cognitively, and physically stronger—”when I finally get myself together”—I will atone for this.
Decades later, after working in fields unrelated to mental health, I become a clinical social worker and accept a position in a locked-ward setting. Much more mature and aware, a member of a supportive Quaker community, fresh from two years of intensive training, and working under professional supervision in a modern facility, I can’t help but do a better job this time. But I retain some fragility, something that I realize with a shock when, keys in hand, I hear the lock of a ward door click behind me for the first time in 35 years. I pause for a moment, feeling the old trauma stir, but then I continue onto the unit. “I feel like I owe it to someone.”
 The phrase “freak flag” is from David Crosby’s 1970 song “Almost Cut My Hair.” A track on the Crosby, Stills, Nash & Young album called Déjà Vu, it includes these words: “Almost cut my hair … / But I didn’t, and I wonder why / I feel like letting my freak flag fly / I guess I feel like I owe it to someone.” The phrase “when I finally get myself together” (in my penultimate paragraph) is also from the song. VIDEO LINK
 “Moral treatment” of the mentally ill was developed by Quakers in response to appalling conditions. See http://www.sanctuaryweb.com/moral-treatment.php. Charles Cherry’s book, A Quiet Haven: Quakers, Moral Treatment, and Asylum Reform, is a good reference.
 I thought to escape roaches at the restaurant—until the evening when I saw a roach inside the plastic pitcher as a waitress poured water into my glass.
 For a number of reasons, then, my memory of the event may be unreliable: the description I have given should be taken with that caveat in mind.