Asylum

"He drew a deep breath. 'Well, I'm back,' he said."

(Sam), The Return of the King

For a local book club I read Clifford Beers's A Mind That Found Itself (1908) (available free online here), a famous account of mental illness and its generally appalling treatment in the state psychiatric hospitals of the time. While the style was somewhat stilted and self-important, I found it to be remarkably readable and compelling overall. Beers's style was direct and gracefully free of jargon, which helps to keep the text from seeming dated.

The book was sociologically important for its depiction of abuses of psychiatric patients, of which there were many (of both abuses and patients), and this remains a problem to this day. Psychiatric inpatients present challenges on multiple levels that the modestly trained and motivated staff that the state can afford to pay are not well positioned to deal with.

The grim conditions were expected; what surprised me was Beers's crystal-clear description of his descent into (and intermittent ascent from) madness. He recounted a classic history of bipolar disorder, all the more convincingly because he never applied any technical term to his condition, which is a relief these days when it seems that "bipolar" is cried from the rooftops. He suffered a classic depression with psychotic features (including a textbook Capgras delusion), followed, after his hospitalization, by a prolonged and florid manic syndrome. He perfectly catalogued the physical agitation, reduced need for sleep, and pressure to speak and write. Acutely manic patients can be very trying within the confines of a hospital ward, and while Beers obviously could not be blamed for his conduct, it is clear that he was an immensely difficult patient who unwittingly provoked some of the regrettable treatment he encountered. Lithium would not come along for a few more decades, alas.

Here is his account of euphoric mania:

After all, delusions of grandeur are the most entertaining of toys. The assortment which my imagination provided was a comprehensive one. I had tossed aside the blocks of childhood days. Instead of laboriously piling small squares of wood one upon another in an endeavor to build the tiny semblance of a house, I now, this second childhood of mine, projected against thin air phantom edifices planned and completed in the twinkling of an eye. To be sure, such houses of cards almost immediately superseded one another, but the vanishing of one could not disturb a mind that had ever another interesting bauble to take its place. And therein lies part of the secret of the happiness peculiar to that stage of elation which is distinguished by delusions of grandeur--always provided that he who is possessed by them be not subjected to privation and abuse. The sane man who can prove that he is rich in material wealth is not nearly so happy as the mentally disordered man whose delusions trick him into believing himself a modern Croesus. A wealth of Midaslike dulusions is no burden. Such a fortune, though a misfortune in itself, bathes the world in a golden glow. No clouds obscure the vision. Optimism reigns supreme. "Failure" and "impossible" are as worlds from an unknown tongue. And the unique satisfaction about a fortune of this fugitive type is that its loss occasions no regret. One by one the phantom ships of treasure sail away for parts unknown; until, when the last ship has become but a speck on the mental horizon, the observer makes the happy discovery that his pirate fleet has left behind it a priceless wake of Reason!