Into the light: the post-"asylum" experience — 3

Here are Parts One and Two.

Psychiatry as it was practiced in the cheerful bright wing on the fourth floor of the Montreal General Hospital was, to quote myself, "leaping ahead by a couple of centuries" from our experience at the Verdun Protestant Hospital. I'm pretty sure there's been another great leap ahead since then but at least at the time, we felt we had very much moved into modern day.

My most vivid memories of the fourth floor are not so much the dramatic treatments still in use — electro-convulsive therapy (ECT) and insulin shock therapy — but the relaxed atmosphere and the emphasis on talking. The patients weren't nearly as ill as the patients in the Verdun and individual psycho-therapy and group therapy were widely used. A lot of the therapy was private between the patient and her psychiatrist but we got to sit in on certain group therapy sessions and it was endlessly fascinating.

We were also encouraged to sit and talk with our patients as much as possible and they really meant it in this case. In theory, we were supposed to talk to our patients on our other floors but in practice, we never felt quite comfortable with that. We felt there were more points to be scored by looking busy even if we had to invent extra tasks.

But on the fourth floor, talking — listening really — and taking and recording copious notes, were both expected and evaluated. Many of the patients, suffering from what is now known as bi-polar disorder (known then as manic-depressive disorder), depression and schizophrenia were often pleasant and good conversationalists. Our notes were expected to be detailed, reporting dialogue, facial expressions, hand gestures — we were to paint a word picture so a psychiatrist reading it would feel all aspects of our encounters.

Our patients also were prescribed lots and lots of drugs. Many of the psychiatric drugs were in their infancy so much of our job was also to watch what happened after the drugs were administered — behaviour, thought and speech patterns, side effects.

I have specific memories of only a few patients; the great majority have become anonymous beings that I remember only as treatments or as room locations. One of the patients I do remember was a 17-year-old boy, a very smart boy who was bi-polar and who was barely in control when he was manic but who also spent whole days in bed. It was always very mysterious to see a brain working two very different occupations.

Even though the listening and the talking and the writing are the most memorable, most of our patients also were treated with ECT and insulin and these were major events in our nursing week. Both these treatments were labour-intensive for the nursing staff, in the preparation stage, at the height of the treatment and probably most importantly, bringing our patients back from a sometimes terrifying trip. After ECT particularly, the patient's memory would be mostly gone with even the simplest functions forgotten as the brain waves had been zapped and fragmented with the electric shock. The patients were also usually sore after having had violent seizures. It took days to recover.

Following the insulin, they were often sick and disoriented.

My goodness. What they went through all just to try to feel somewhat normal and to be able to function out in the world.

The treatment I haven't mentioned, which in fact I only encountered once, was the lobotomy — a procedure almost too painful to think about.

The purpose of the operation was to reduce the symptoms of mental disorder, and it was recognized that this was accomplished at the expense of a person's personality and intellect. . . Following the operation, spontaneity, responsiveness, self-awareness and self-control were reduced. Activity was replaced by inertia, and people were left emotionally blunted and restricted in their intellectual range.

The woman I saw who had had a lobotomy appeared to me to be simply a shell, looking straight ahead out of empty eyes, not reacting to anything around her. No one knew quite what to say.

There was a very dramatic incident during my time on the fourth floor. We had a patient who was suffering severe post-partum depression. She had spoken not a word since the birth of her baby and was non-reactive to everything around her. She was admitted because she was considered a severe danger to herself and was on high suicide alert. This meant that anything that could cause any harm was removed from the room and someone popped into her room every 10 minutes or so.

Shortly after one of the routine checks, there was a mighty crash from her room. Now you have to remember, this was a woman who hadn't spoken or moved or reacted to anything in weeks. This crash was unfathomable.

But apparently, someone had left a heavy glass ashtray in her room.

That is thick glass and it must have taken superhuman strength to hurl it with such force that it broke on the tile floor. But break it did and by the time staff reached her room, she had used a piece of the glass to cut her wrist and was bleeding heavily. Staff sprang into action, got the material needed to stop the bleeding, called emergency and within a very short time a stretcher arrived and she was taken down to the emergency department where she was met by a team to deal with all aspects of the care that was needed.

As far as I know, she survived and I've always hoped that she defeated the post-partum depression and was able to enjoy her family and the new baby.