To my great surprise a cab came with a Gentleman in it, and did not say to me what he wanted with me, drove me to Morningside Asylum. They have no witness to prove me insane.
- Letter by Catherine M. to friend, February 2, 1896
Hunched over, gripping her bony knees to her chest on the wholesale office chair across from me, Gloria was despondent, weary, repeatedly muttering that her life no longer had meaning, not after her boyfriend left, taking with him their two-year-old daughter, off to God knows where. Gloria had been picked up in the early morning by the county sheriff, who described her as shuffling like a tightrope walker along the white line of the interstate, facing oncoming traffic. She reported that she was trying to decide which large truck could put her out of her misery.
We sat together at the community mental health center where I was completing my pre-doctoral internship. I worked Fridays in the emergency services department, stationed in the shared office that was assigned to whichever clinician was on duty that day. The wall art was generic: a blurry beach scene with a seagull soaring above, a bouquet of muted-purple flowers, some framed Chinese characters. In the corner stood a fake ficus tree in a ribbed, beige pot. I held a clipboard with a crisis evaluation packet in my lap. My job was to determine whether Gloria should be sent to the state hospital’s inpatient psychiatric unit, and if so, to get her to agree to go voluntarily. I started asking her questions from the packet.
The first page covered the basics: Caucasian woman, age twenty-five. Unmarried. One child. One cat. No alcohol/drug use. Referred by sheriff’s dept. Pt currently suicidal. 3 pvs attempts. Pills each time. Hx of bipolar disorder. One pvs hospitalization. No meds.
Mine would have looked like this: Caucasian male, age twenty-eight. Engaged. No children. One dog. Moderate alcohol use. Hx of panic disorder. Existential crisis since age 9. No meds.
Page two got into more detail as I asked Gloria about the history of her relationship. She and her boyfriend often fought about sex. He wanted it. She did not. Ever. Not since June was born. He was fed up with her. Her mood swings were wild, unpredictable. A year ago she bought a horse, spent all of her savings. They couldn’t make rent on their apartment. He threw a lamp across the room. She took a handful of sleeping pills. They almost broke up. Last night, he gave an ultimatum. Either they would have sex or he would leave. She had been depressed for weeks, no appetite or energy. Her body felt foreign. She locked herself in her room. He left with June at midnight. She started walking toward the highway at dawn.
My hand strained as I recorded these details in the packet. Documentation, one supervisor had told me. Any patient could be a potential litigant. Document everything. I dutifully kept a record of Gloria’s suffering. It is easy enough to teach trainees how to keep extensive notes. Empathy is a more elusive lesson.
Gloria sat in her gargoyle pose, staring out at me from behind the strands of straight, brown hair that covered her eyes. I clicked my pen closed then asked about her relationship with her daughter. She dropped her head and looked down motionlessly at the floor. She was not crying. She seemed empty of tears. Click. I documented her lack of emotional expression.
In the ensuing silence, my mind drifted. I conjured an image of a 19th-century asylum physician, so self-assured in his white coat and clinical dominion. This one is a slight lunatic. Perhaps a blast of hydrotherapy will do. This woman suffers from hysteria, clearly a moral failing. Let’s put her in restraints. The authority of the clinician, along with the will-breaking effects of such inhumane interventions propelled change in patients. Over the last century, we have learned how empathy is a far more powerful agent, but I offered Gloria neither authority nor compassion. I asked questions and wrote down her responses. I could have been anyone.
“I need to get home,” she said. “My cat is going to tear up the place if I don’t get back soon.”
I clenched my toes inside of my loafers and spoke in the hushed tone of a funeral director.
“I can’t let you go home if I don’t think you’re going to be safe,” I said.
Gloria’s eyes widened. She sprang to her feet and began to panic, audibly sucking in breaths and gripping fistfuls of her hair as she paced across the worn, beige carpet saying “no, no, no, no.” She stepped backward into the corner and knocked over the ficus before collapsing to the ground. She leaned her narrow shoulders forward then shot her head back in a blunt strike against the wall.
“I’m not crazy,” she said.
I tried to sell the state hospital as a place where she could at least get a few days of rest, to consider a treatment plan for her going forward, but Gloria refused to go voluntarily.
“They are just going to pump me full of drugs,” she said.
This was not far off. She would certainly be encouraged to get back on psychiatric medications. She would have to meet with a psychiatrist on site, a social worker, maybe join a therapy group. A strict schedule would be kept. Her room would be sparse, checked regularly for sharp objects. The rehabilitation plan would be far from the torture-like regiments that asylums employed in centuries past, but they would nonetheless emphasize self-control and treatment compliance as determinants for her release.
I explained to Gloria that, given the severity of her symptoms, I had no choice but to initiate an involuntary hospitalization, citing her own safety as the guiding principle. I was basing the decision on the legal and ethical standards of the field, but as gently as I communicated this to Gloria, I could not help but think of myself as one of those Victorian-era physicians in the white coats.
“You can’t do this to me,” she said. She rested her head on the wall and pulled the fake ficus tree upright.
I thumbed through the notes in the evaluation packet, searching the hurried transcription. It was a log of some of the most painful experiences in her life, culminating with her on the ratty carpet of a community mental health center, talking to a graduate intern in a Goodwill tie. I reached behind me and placed the clipboard on the faux-cherry desk next to the Zen Page-A-Day calendar. I then leaned forward towards Gloria and dried my hands on my corduroy pants.
“Tell me about your cat,” I said.
