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The subject matter for The Lives They Left Behind stems from a random discovery of abandoned suitcases in the attic of the vacated Willard State Hospital in upstate New York. The authors merged their various professional and personal roles to become an amalgam of investigative reporter, anthropologist/historian, and mental health researcher. Penney & Stastny thus begin a remarkable journey to discover the past, present, and last known histories of the various patients whose suitcases and other personal belongings were so haphazardly left in the decaying attic.
The Lives They Left Behind is a poignant and rich narrative of what it means to find the remnants of people that society has otherwise forgotten. Writing from a narrative perspective, the authors convincingly blend the details, medical histories, and outcomes of a select group of patients who were committed to Willard State Hospital.
On the subject of involuntary commitment for psychiatric patients, the authors artfully avoid making any value judgments or assuming a position as to the propriety and utility of such lifelong commitments. By balancing patient stories – ranging from the story of Mr. Lawrence Marek, a patient who became the informal grounds-keeper, to the tragic story of Dmytre Zarchuk, an East European immigrant patient who spend two-thirds of his adult life committed because he was unable to cope with his wife's untimely death -- with historical discussions of the nature, history, and types of mental health treatment, the authors create a readable and credible compilation. The overall tone and sentiment of The Lives They Left Behind is designed to elicit sympathy, understanding, and recognition of how far the field of mental health has come in the past few decades.
Some patient stories in The Lives They Left Behind leave the reader with a sense of distaste, particularly in terms of the lack of advocates and options for patients who seem to have been abandoned at state psychiatric institutions with no real recourse, appeal, nor sounding boards. In the case of Dmytre Zarchuk, the medical record note by the physician states,
"This 38 year old white, short, and well nourished patient has been interviewed today in order to fill in the deportation papers. It was very difficult to get the proper information because patient is very paranoid, suspicious, incoherent, and irrelevant…" (p. 133)
Given the life history, circumstances, and fact that Mr. Zarchuk was an East European immigrant fleeing the oppressive communist bloc, is it any wonder that when approached to prepare him for deportation back to that land, he became suspicious and paranoid? Were patients given any legal representation, patient advocates, or ombudsperson? Were family members or friends ever contacted for additional insight or context into such reactions? The authors leave the reader with a clear impression of "no", however, the lack of explicit discussion on the historical trends and movement towards patient rights, would have been a welcome addition.
Another contemporary topic currently in debate is electroshock therapy (ECT). For whatever reason, the author(s) make passing reference as to this controversial therapy, more often than not used inappropriately and without regard to true medical therapeutic value. When discussing the eventual electroshock therapy for Mr. Zarchuk, the authors summarily state,
"Since Mr. Zarchuk had no blood relatives in America, the Willard superintendant authorized the procedure. Questions of competency and informed consent were never raised. Electroshock was quite popular in American institutions of the time. But was it reasonable to administer shock to a patient like Zarchuk, even according to the rather loose standards of the day? Probably not." (p. 136).
The only other context and discussion of ECT occurs a few chapters earlier, aptly titled "How People Were Treated at Willard," where a former occupational therapist recalls the "almost assembly-line like [electroshock] procedure from the early 1960's." (p. 110). Again, the somewhat disjoined and abbreviated discussions of such disturbing facets of psychiatry might be better connected to a thematic acknowledgment of how medicine often failed those who most needed its help; then again, perhaps the disjointed nature was the desired effect, similar to the architectural design of museums such as the Jewish Museum in Berlin, designed to leave the visitor in disbelief and wonder about how we humans treat one another.
Overall, the combination of photographs, patient stories, historical facts, and commentary from mental health professionals, makes The Lives They Left Behind an interesting and absorbing read. The average layperson may not fully appreciate the nuances and issues touching upon medical ethics, psychiatry, and patient rights; however, it would certainly be an item of value in the curriculum for medical ethics, law school, and medical anthropology courses.
© 2008 Kari Karsjens
Link: The Willard Suitcase Exhibit
Kari Karsjens, JD, San Mateo, CA