No One Cares About Crazy People Read online

  Dorothea Dix expanded her inspection tours to the entire country, and then to Europe, traveling thirty thousand miles by some estimates, via railroad, steamship, stagecoach, and buggy, and whatever else was available, which was not much. She cultivated the friendship and support of President Fillmore and the great Massachusetts senator Charles Sumner. She gave speeches, cajoled legislators, and talked wealthy people into funding asylum building and improvement. She took a detour through the Civil War to serve as superintendent of the Army of Nurses for the Union (where she and her nurses also treated wounded Confederates, including many from the five thousand lying maimed at Gettysburg). And then she went to work for the insane again.

  She is credited with direct roles in the founding of thirty-two asylums by 1880, including the New Jersey State Lunatic Asylum at Trenton in 1848. She died in her guest apartment there in July 1887 at age eighty-five. She was having tea.

  Even as Dorothea Dix’s reputation and accomplishments grew through the 1840s and 1850s, Worcester’s prestige declined. Another baleful law, that of diminishing returns, was beginning to catch up with the asylum and all those that shared its Enlightenment-fired ideals. America’s population kept swelling: to seventeen million in 1840, then to twenty-three million by 1860, near the outbreak of the Civil War. This growth and other factors, evident even at the outset of moral care in America, kept on pushing against the founders’ idealism. There were simply too many more patients, too many more criminals, and too many other kinds of hard cases among those patients. More time was needed for administrative duties and less time for supervisors’ personal visitation; less time for healthful activities; less space—far less space—per patient than the early dreamers had deemed necessary. The righteous fervor and dedication of the early supervisors and staff and caretakers inevitably cooled with their replacements, and the replacements of those replacements.

  Samuel B. Woodward died in Northampton, Massachusetts, in 1850, at age sixty-three. Fully twenty-three years elapsed between his death and the next—and last—effort to rejuvenate his generation’s vision: twenty-three years of policy wars, scrambles for space; the replacement of passion with bureaucracy and systemized procedure. The times also brought societal changes that imposed tough choices unforeseen a half-century earlier—necessities of segregation, for instance: not just racially, but segregation of the violent from the nonviolent, pauper from affluent, immigrant from native-born. A new breed of less idealistic staff members took these distinctions as criteria for the amount of kindness and attention they were willing to confer.

  A national air of pessimism was enveloping the mental health world—certainly on the question of whether insanity could be widely cured. Still, in 1873, Massachusetts pushed ahead to finance construction of a new and larger replacement for Worcester State Hospital. The cost exceeded $1 million. Its administration building virtually announced that moral treatment was here to stay. The signal proved false.

  Kirkbride Hall was the new Worcester asylum’s most prominent structure, crowned by a high Gothic clock tower that could be seen well beyond the borders of the city of 146,000. The tower soared above the five granite stories of the administration hall. It overlooked the nearby Lake Quinsigamond, with its eight graceful islands, to the east, and pointed heavenward in the manner of a church steeple.

  It was named for its designer, the physician-turned-architectural-planner Thomas Kirkbride, who in 1840 had become superintendent of the Pennsylvania Hospital for the Insane. A Quaker like William Tuke, Kirkbride fastened on the Yorkshireman’s espousal of a harmonious environment. He devoured Tuke’s 1815 book Practical Hints on the Construction and Economy of Pauper Lunatic Asylums, and later published his own similar and influential treatise. He created concepts for siting, landscaping, and building design that found nationwide favor and determined the general look of insane asylums for the rest of the nineteenth century.

  Kirkbride asylums were designed as antidungeons, ornate and elegant, incorporating features from the Queen Anne, Second Empire, and Gothic Revival styles: spires and cupolas and gabled roofs, and construction from fine timber or heavy stone. (Kirkbride provided the essential interior plans for his buildings, but construction and landscaping were jobbed out to a number of artisans around the country.)

  No one expressed the vision of an ideal physical layout with greater lyricism or tenderness than Kirkbride himself:

  Great care should be taken in locating the building, that every possible advantage may be derived from the views and scenery adjacent, and especially as seen from the parlors and other rooms occupied during the day. The prevailing winds of summer and the genial influence of the sun’s rays at all seasons, may also be made to minister to the comfort of the inmates, and the grounds immediately adjacent to the hospital should have a gradual descent in all directions, to secure a good surface drainage.15

  Few asylum-building committees cared to deviate from the master’s vision: besides its utilitarian logic, a domed or spired “Kirkbride” on the edge of town (never inside!) lent an aura of elegance to the whole area. More than a few thoughtful observers, though, detected something quite apart from elegance: an indefinable brooding, an opaque heaviness, less elegant than Gothic. Others who were more informed about prevailing trends in mental health care could see even beyond the Gothic, into a gathering void. Kirkbride had meant to endorse and enhance moral treatment with his buildings, but he was enhancing a phantom. In post–Civil War America, urban industry, not the rural cycles, dictated the pace of life. Philosophies of care were changing as well, in sync with the times. Psychiatrists had grown impatient with the notion of therapy that led to cure; they’d seen precious little empirical evidence. What role was left to them, then?

  It was the role of custodianship: basic supervisory care and feeding of those unfortunates whose reason was maimed by fate, yet who lived on.

  This shrunken agenda for moral treatment began to lose its moorings even as the number of public and private asylums, a great many of them “Kirkbrides,” swelled to nearly three hundred over the decades.

  The horrid systematic cruelty of Bedlam never returned. Not completely. But it never completely went away, either. This fact is documented by almost weekly news accounts from the human disposal systems that our large urban prisons and hospitals have become.

  Time has not been kind to the old moral care asylums’ appearance. Broken windows and support beams left unrepaired, lawns and flower beds unmanicured, damaged furniture on the inside unreplaced—all this left the mansions exposed in their decrepitude.

  Increasingly, these asylums were simply abandoned as larger, centralized (and impersonal) hospitals were built to warehouse the mentally ill. The elderly insane especially suffered the transition, as supervisors nudged reluctant families to accept them back into the home. When families refused, these people stayed in the system but endured the usual indignity of indifference, magnified by contempt and revulsion.

  Some asylums burned down; some were (and continue to be) demolished for newer facilities or housing developments or shopping malls. A surprising number of them remain standing on their patches of prairie, but under conditions of decrepitude and debasement that conjure images of the inmates at Bedlam, helpless before the smirks and taunts of strolling visitors. In an inversion that would have devastated the Kirkbrides and Woodwards and Manns and Dixes, and the Tukes and Pinels before them, the remains of these buildings now represent not hope but evil. Mass-marketed commercial evil.

  Many have been purchased by entrepreneurs attuned to the American appetite for the macabre, especially in the computer-generated forms of garroting, throat-slashing, and torture. These businessmen and -women, rejoicing in the caricature presented by the old sanctuaries, have made it pay: by refurbishing the cells and apartments with stage-set spooks and sorcerers and sinister scientists with bloody smocks, and splashing fake blood on the walls. The classic sanctuaries for haunted human beings are thus transformed into haunted houses. They draw att
raction-seeking Americans who travel great distances, stand in line, sometimes for hours, and pay dearly for tickets that allow them to step inside and squeal as computerized mad scientists perform bloody atrocities upon shrieking “inmates” strapped to their beds. “These are the places where physicians cut into their brains with ice picks and robbed them of their personalities,” exults one attraction website. “They are places where they were raped, medicated, abused, murdered.”16

  No definitive theories have explained why this haunted attractions boom (or “BOO-oom,” as TV news websites merrily put it) has become, by some calculations, a billion-dollar business. America Haunts, a trade association, estimates that there are twelve hundred large-scale, for-profit haunted attractions in the United States, not to mention another three thousand haunted houses that open for the Halloween season.

  Some suggest that the haunted-house experience offers a cathartic release in our anxiety-saturated times. (A kind of therapy, as it were.) Some say it offers just another roadside attraction.

  As for shamans, they have persisted, counter to all expectation. Persisted, and proliferated. The contemporary urban world has seen a resurgence in the number of self-described shamans and of shamanistic thought, expressed partly in the New Age revolution of the 1970s. And the affinities between their ecstasies, and epiphanies, remain as strong as ever—as often acknowledged by the believers themselves. Except that the believers seldom if ever describe their experiences as mental illness.

  The author and self-described shaman Paul Levy has recalled insisting to psychiatrists years ago, regarding his involuntary hospitalization after an “ecstatic” episode, that he had simply been trying to express the “good news” of what was being revealed to him about the nature of reality: “I tried to explain to the psychiatrists that I WAS sick,” Levy wrote, “but just not in the way they were imagining. I had a creative, psychological illness, which is to say that my seeming madness was an expression of my creative self.”

  He was not clinically ill, Levy insisted; he was “perturbed,” suffering from a “shamanic illness”—in trauma from recalling the abuse he had endured at the hands of his “desperately sick, sociopathic father.” His father had connected Levy “as a link in a chain to an unbroken lineage of violence… extending far back in time and throughout space.”

  Thus his “seeming madness,” Levy insisted, “was an expression of my creative self, alchemically transforming an underlying perturbance in the field of consciousness so as to heal itself.”17

  These insistences from Paul Levy, and what I’ve learned about shamanism in general, have put me in mind of my son Kevin.

  Like Levy, Kevin refused—as I’ve said—to define himself as mentally ill. He had a condition; that was as far as he would go. I have thought, as well, of the time in the schoolyard in which Kevin admonished the burly ice-hockey athlete for striking the tall young girl—and did not draw a challenge of fisticuffs himself from the bully. I thought of other such moments. Nothing really dramatic or revelatory, but moments in which (in retrospect) Kevin conferred a measure of peace, even laughter, upon a situation, armed only with directness, honesty, and his crooked grin.

  I don’t believe in shamanism as an extrasensory phenomenon. I don’t believe that shamans have, or ever have had, a connection to the divine.

  But if I did believe…

  Are you listening, Kevin?

  5

  Eugenics: Weeding Out the Mad

  Moral treatment represented a pinnacle of society’s humanitarian impulses toward the mentally ill. Diagnosis and medical treatment, however, remained primitive, circumscribed by ignorance. By the first decades of the nineteenth century, “mad science” had not advanced beyond clumsy attempts to drive out demons and bad “humours.”

  All this was about to change—with implications both hopeful and nearly catastrophic for the mentally ill. An accidental chain of discovery, historic in its proportions, was imminent. Even as moral treatment was enjoying the height of its brief prestige, the raw materials for these discoveries, packed in cargo containers, were bobbing northward from the South Atlantic and home to England aboard an obscure two-masted brig sloop, the Beagle. In the early autumn of 1836, Beagle was on its final leg of the most transformative voyage of discovery ever made, Columbus’s accidental collision with the New World perhaps excepted.

  The sloop carried the seeds—metaphoric and literal—of overwhelming evidence that plant and animal species have not existed through history in an unchanging state. They have evolved by variations in inherited traits. This capacity to change, even in minute ways, enables living things to overcome deadly environmental challenges and reproduce themselves as the “fittest” survivors.

  The implications for biologically damaged human brains—a subject not imagined at first even by the ship’s young botanist, Charles Darwin—were to prove momentous and beneficial in the long run. Yet these positive results could happen only after Darwin’s theories were drastically misunderstood and misapplied, threatening mad people with attempted extinction. A prime source of the trouble was that word fittest. As ambiguous in its way as “schizophrenia,” “fittest” proved ripe for misunderstanding and monstrous abuse.

  The cargo containers carried some ten thousand plants, birds, small animals, and fossils gathered from exotic locales around the world by Darwin. The theory that Darwin constructed from this cargo over the next two decades of meticulous study would transform human thought. It would embolden open skepticism about the divine origins of humankind, the first mass Western questioning of Scripture since Scripture was written. It would point the way for breakthroughs in agriculture, medicine, economics, and many fields of learning. But in the hands of biased theorists, scheming industrialists, outright fools, and—inevitably—totalitarian tyrants, the revolutionary theory put forward by Darwin would be perverted into the basis of remorseless experiments upon the human brain and reproductive organs, toward the goal of creating a white master race liberated from any sort of genetic “impurity”: including skin pigmentation, physical imperfection, low intelligence, and homosexuality.

  And madness.

  The discovery of linkage between madness and a person’s genetic makeup figured among the massive chain reaction of breakthroughs in the years and decades after the Beagle docked.

  How strange, almost uncanny, it is, then, to consider the central influence that madness exerted on the Beagle’s and Darwin’s destinies.

  On October 2, 1836, Beagle put in at Falmouth Harbor in a light rain. It had been at sea for nearly five years, surveying the remote coastlines of the world for mapmaking purposes. Beagle’s troubled captain and chief surveyor, Robert FitzRoy, just twenty-three when the voyage began, had sought someone of equal social status to come along and keep him company. Intermediaries recommended a young scion of British intellectuals and aristocrats, a bright but restless scholar named Charles Darwin.

  Darwin, a year younger than FitzRoy, had completed studies at Christ’s College in Cambridge for the Anglican priesthood just before embarkation. His attention lately had swung toward beetles.

  His grandfather Erasmus was an accomplished botanist. Charles may have felt Erasmus’s influence when, wandering beside the River Cam one day, he spotted two rare beetles scurrying under the bark of a log. Darwin ripped the bark open, grabbed one beetle in each fist; then he noticed a third, popped one of the first two into his mouth so he could capture the third as well, and lost two of the three in a paroxysm of gagging and spitting when the beetle on his tongue shot acid down his throat.1

  After that, he took to using a net. He’d evolved.

  Madness hung about the Beagle and was a factor in the voyage’s great destiny. FitzRoy had been given command of the sloop after the captain on its previous voyage lost his mind and shot himself amid the thundering seas around Tierra del Fuego. FitzRoy himself suffered from mood swings that whipsawed him from rages of temper into depression. His uncle, the paranoiac Viscount Castlereagh, had f
atally stabbed himself in the neck in 1822.

  British naval protocol, an extension of the British class system, forbade ships’ officers from socializing with the crew. The ship already had a naturalist, so FitzRoy could not offer the young Cambridge man a commission. Darwin paid his own way. The official naturalist soon felt upstaged by Darwin’s prowess and abandoned the expedition in Rio de Janeiro. Now Darwin had an excuse for doing what he’d wanted to do: forage for specimens when the Beagle put in off some remote coast.

  Darwin’s skills as a raconteur could not cure Robert FitzRoy of the blues. While Darwin was collecting bugs and bird skins in the Chilean Andes forests, FitzRoy grew overwhelmed with his duties and suffered a nervous breakdown. He resigned his captaincy, telling his second-in-command, one Lt. John Wickham, that he could take over the ship. Wickham told FitzRoy that he would be damned if he’d try to guide Beagle around the deadly Cape Horn. FitzRoy thought about that for a moment and changed his mind. Had he continued to pout, Darwin would have missed the Galápagos, and a finch, to paraphrase Freud, would have remained just a finch.

  As for Captain FitzRoy, early in the morning of April 30, 1865, at his home in Norwood, Surrey, he walked into his dressing room, found a knife, and emulated his uncle by slitting his throat with it.2 He died not knowing that he would be remembered in history for his choice of a shipboard conversation-mate who is ranked, with Einstein and Freud, among the greatest thinkers of the past two hundred years.

  It is nearly impossible to make sense of the furious arguments that to this day energize and often impede the interests of the mentally ill without understanding eugenics. This in turn requires a brief review of the genesis, so to speak, of Charles Darwin’s theory.