A Mind That Found Itself: An Autobiography

by Clifford Whittingham Beers

XXI

Neither of the attendants involved in the assault upon me was discharged. This fact made me more eager to gain wider knowledge of conditions. The self-control which had enabled me to suspend speech for a whole day now stood me in good stead. It enabled me to avert much suffering that would have been my portion had I been like the majority of my ward-mates. Time and again I surrendered when an attendant was about to chastise me. But at least a score of patients in the ward were not so well equipped mentally, and these were viciously assaulted again and again by the very men who had so thoroughly initiated me into the mysteries of their black art.

I soon observed that the only patients who were not likely to be subjected to abuse were the very ones least in need of care and treatment. The violent, noisy, and troublesome patient was abused because he was violent, noisy, and troublesome. The patient too weak, physically or mentally, to attend to his own wants was frequently abused because of that very helplessness which made it necessary for the attendants to wait upon him.

Usually a restless or troublesome patient placed in the violent ward was assaulted the very first day. This procedure seemed to be a part of the established code of dishonor. The attendants imagined that the best way to gain control of a patient was to cow him from the first. In fact, these fellows—nearly all of them ignorant and untrained—seemed to believe that "violent cases" could not be handled in any other way. One attendant, on the very day he had been discharged for choking a patient into an insensibility so profound that it had been necessary to call a physician to restore him, said to me, "They are getting pretty damned strict these days, discharging a man simply for choking a patient." This illustrates the attitude of many attendants. On the other hand, that the discharged employé soon secured a position in a similar institution not twenty miles distant illustrates the attitude of some hospital managements.

I recall the advent of a new attendant—a young man studying to become a physician. At first he seemed inclined to treat patients kindly, but he soon fell into brutal ways. His change of heart was due partly to the brutalizing environment, but more directly to the attitude of the three hardened attendants who mistook his consideration for cowardice and taunted him for it. Just to prove his mettle he began to assault patients, and one day knocked me down simply for refusing to stop my prattle at his command. That the environment in some institutions is brutalizing, was strikingly shown in the testimony of an attendant at a public investigation in Kentucky, who said, "When I came here, if anyone had told me I would be guilty of striking patients I would have called him crazy himself, but now I take delight in punching hell out of them."

I found also that an unnecessary and continued lack of out-door exercise tended to multiply deeds of violence. Patients were supposed to be taken for a walk at least once a day, and twice, when the weather permitted. Yet those in the violent ward (and it is they who most need the exercise) usually got out of doors only when the attendants saw fit to take them. For weeks a ward-mate—a man sane enough to enjoy freedom, had he had a home to go to—kept a record of the number of our walks. It showed that we averaged not more than one or two a week for a period of two months. This, too, in the face of many pleasant days, which made the close confinement doubly irksome. The lazy fellows on whose leisure we waited preferred to remain in the ward, playing cards, smoking, and telling their kind of stories. The attendants needed regular exercise quite as much as the patients and when they failed to employ their energy in this healthful way, they were likely to use it at the expense of the bodily comfort of their helpless charges.

If lack of exercise produced a need of discipline, each disciplinary move, on the other hand, served only to inflame us the more. Some wild animals can be clubbed into a semblance of obedience, yet it is a treacherous obedience at best, and justly so. And that is the only kind of obedience into which a man can be clubbed. To imagine otherwise of a human being, sane or insane, is the very essence of insanity itself. A temporary leisure may be won for the aggressor, but in the long run he will be put to greater inconvenience than he would be by a more humane method. It was repression and wilful frustration of reasonable desires which kept me a seeming maniac and made seeming maniacs of others. Whenever I was released from lock and key and permitted to mingle with the so-called violent patients, I was surprised to find that comparatively few were by nature troublesome or noisy. A patient, calm in mind and passive in behavior three hundred and sixty days in the year, may, on one of the remaining days, commit some slight transgression, or, more likely, be goaded into one by an attendant or needlessly led into one by a tactless physician. His indiscretion may consist merely in an unmannerly announcement to the doctor of how lightly the latter is regarded by the patient. At once he is banished to the violent ward, there to remain for weeks, perhaps indefinitely.