The Lives They Left Behind: Suitcases From the State Hospital Attic

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I got The Lives They Left Behind from the library after reading a description that I found by chance: several hundred suitcases belonging to ex-patients were found in the attic of the abandoned Willard Psychiatric Centre in New York; this book uses these suitcases to explore the lives of patients and look more broadly at the state of psychiatry in the past.

At its base, it’s a very interesting premise: it allows for stories which would be otherwise untold to be heard, while the personal element of the patients’ suitcases (with photographs and descriptions of items such as handkerchiefs, clothing, photo albums, or letters) makes the stories more moving, in a way.  These aren’t just the stories of nameless masses, but of real people — nameless masses don’t keep sewing notions or silk gowns.  It’s the human interest touch.  And rather than making these personal stories simply individual cases, they are used to expand upon broader social issues, such as the place of gender, race, colonialism, immigration, trauma, and class in connection with diagnoses of mental illnesses (usually dementia praecox, or schizophrenia).  This was great!  Although I thought overall the book was not written that well (the tone felt too casual for my taste), I appreciated this look at intersectionality, which was insightful.  I also appreciated historical background on psychiatric facilities, medications, treatments, therapies, and so on, as well as the sensitivity with which the authors dealt with each patient referenced, attempting to understand what brought these people to Willard.

However, the biggest problem I had was with the way the authors seemed intent on almost denying that any of the patients were unwell.  The agenda of this book was clearly an anti-psychiatry one, and with good reason, but the point was largely that patients at Willard, where they were often kept for decades, if not until their deaths, should not have been at this hospital.  In some cases, this seems entirely fair: marginalized people who made rich, white, established Americans uncomfortable could be called crazy and locked up.  People with brief issues (one angry outburst, a night of drunkenness) would be condemned as incurable schizophrenics and given torturous treatments.  Patients who desired their freedom and showed no signs of any kind of mental distress would live out their lives and die at Willard.  There is no doubt that these people were harmed irreparably by the institution, and denied their freedom and often even health, such as in the case of patients given antipsychotics who developed permanent tardive dyskensia.  But a lot of the cases seem to describe people who were generally quite mentally ill and in need of care.  A patient with consistent delusions that he was Jesus Christ and that he must marry Margaret Truman, for example, was likely unwell.  Though this psychosis may have been triggered by trauma, and though he was mistreated, denied his freedom, and abused with violent therapies, it is evident that he required care and help, and was, from descriptions of his life before admittance to Willard, unable to care for himself and without anyone to care for him.  Yet the authors persist in writing in a way which suggests that the issue is not that this man, or other patients like him, are unwell and in need of care.

While the mistreatment and incarceration of people who are not mentally ill or whose mental illness can be explained by outside (that is, non-biological) causes was and is a terrible problem, the mistreatment and incarceration of people whose mental illnesses are biological or not brief, singular episodes is just as bad.  In an epilogue, the authors discuss how therapy can be helpful to patients, which is true, and without a doubt enforcing treatments which have horrific side effects and low chances of working is not helpful.  But it felt too much like the authors were overly biased towards therapy and community-based care rather than inpatient and medicinal treatments.  It is my opinion that it’s not really one or the other.  Really, to me at least, it’s neither.  Both talk therapies and medicine (as well as other treatments such as electroconvulsive therapy) have varying success rates.  Depending on where you live, all are far too expensive, while many treatments can have quite severe physical and mental side effects — they are not accessible and can make things much worse.  Until we have treatments with higher success rates and fewer negative side effects, I won’t consider mental health care to be advanced.  While this book shows the differences between how patients were treated decades ago and now, I am wary of thinking that things being worse then means things are good now.  Things are just less worse.

So overall: a very interesting book which does well in terms of intersectionality, and is a very fast read; overly biased but with good historical information.  6.5/10

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