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Enoch Callaway has written an entertaining, idiosyncratic story of Worcester State Hospital, where he worked as a psychiatric resident between 1948 and 1950. This is a personal history, and an opinionated one, giving it an almost conversational tone. He largely shuns jargon, and writes clearly and with humor. It seems primarily for a specialized readership of psychiatrists and historians of medicine, although others interested in the history of psychiatric treatment would find it approachable.
It reminds me of The Last of the Lunatics (Melbourne University Press, 1998) written by John Cawte, an Australian psychiatrist who worked as a resident in the early 1950s. He describes similar experiences and feelings about patients and their treatment in that era. Worcester State Hospital in Massachusetts was a huge building on a 500 acre working farm with a structural organization that 'perhaps unintentionally imitat[ed] the labyrinth we call the human mind.' It was built in 1877 to supplement the old hospital a few miles away, and accidentally burned down in 1991. By that time, it was a shell of its former self, functionally.
Callaway's memories of the place are overwhelmingly positive, both for the patients and the staff. He notes that the hospital pioneered treatment without restraints as early as 1900, but also makes it clear what it was like to be working in the pre-psychopharmacological age. The 'back wards' were full of their 'failures', that is people whose mental illnesses did not respond to whatever treatment was available. Thus, those with recurrent untreated psychotic episodes deteriorated over years so that even their delusions became 'impoverished and colorless'. There were also movement disorder patients who progressed through terminal dementia: those with tertiary syphilis, for example, in the pre-penicillin era.
While they enabled residents to obtain good training in the progress of such illnesses, the author describes the terrible lives these patients endured. He also writes of the inspirational doctors and medical administrators who enabled the hospital to provide the best treatment possible at the time. For Callaway's term as a resident there, this was psychotherapy (psychoanalytic), insulin shock therapy, electroconvulsive therapy, and occasionally lobotomy. He stresses how valuable their training was, and how completely the residents were absorbed in their work. Unfortunately, the chapter on psychosurgery I found offensive, as the author does not make the benefits convincing, and writes of the procedure somewhat flippantly. He includes a very off color story about a politician who functioned well after a lobotomy because that occupation does not require the frontal lobe (I'm not sure if this is meant to be a well-worn joke). I could not help but think of the New Zealand author Janet Frame and her misdiagnosis: it was no joke to her to be faced with such drastic surgery.
The only other problem I had with the text was the author's comment on research requiring both male and female participants being a 'fallout of feminism'. This seemed a facile statement, as there are sound reasons for including females in research. Two other chapters (the mink farming tale and 'Folie à Deux') were underdeveloped.
Otherwise, I found Callaway to be a sensitive and thoughtful writer with valuable things to say. He comments in the latter part of the book on the anti-psychiatry movement and how it was formed by an 'unholy alliance' between those who wished to save money and those who wished to save people from being labeled mentally ill. Deinstitutionalisation has severe consequences, and he makes this clear in no uncertain terms. Care and compassion do not include forcing the mentally ill out onto the streets to fend for themselves or end up in prison.
He does note that lithium and the antipsychotics began to empty the hospitals earlier on, as well as economic considerations and philosophical movements such as civil rights.
Callaway ends with a chapter of hope. He is not a fan of managed care and insurance companies controlling treatment options: 'The hope for the mentally ill lies in public awareness, in a healthy skepticism, and in testing our ideas so we can know when we are wrong.' An important addition to this is compassion, because 'how a society treats its most vulnerable members tells us who we really are.'
© 2008 Sue Bond
Sue Bond has degrees in medicine and literature and a Master of Arts in Creative Writing. Reviews for online and print publications. She lives in Queensland, Australia.
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