She flushed, embarrassed that he had read her so well.I won’t tellwas such a juvenile inducement, like something a child might say to another to elicit a confession. He was right about it working, though. Marion had kept her mounting anger about deinstitutionalization bottled up so tight, she reached for the chance to let some of it out.
Still, it was difficult to admit everything right away. “It doesn’t matter what I think.”
“No?” His eyes narrowed. “I don’t buy it. Come on, Marion. Loosen up. Let me in on what’s going on in that brilliant mind of yours.”
She was right that it didn’t matter what she thought. So why not think it out loud?
“I think it’s a terrible mistake.”
He leaned back and folded his arms, rapt. “Aha. Interesting. Over a hundred years of guesswork and leg irons for people who often didn’t need treatment at all, and you think we should keep that?”
“You’re suggesting that treatments today are the same as they were in 1850? Considering the progress that has been made since then, I feel safe in disagreeing with your antiquated and simplistic approach.”
“Simplistic. Interesting again. All right. I’ll bite. Please continue, Doctor. You’re hot when you’re bothered.”
She rolled her eyes. “And you’re ridiculous. Do you want to continue this or not?”
“I do. I do. I apologize. Please go on.”
After all this time, it felt good to line up all her thoughts on the topic, organize them in a manner that would make the most sense, then finally say them out loud. She waited for the waiter to finish pouring, then she took a deep swallow of wine for strength.
“I will not claim that our hospitals are perfect,” she said, “but they arenot the institutions from a century ago. We used to sedate or confine anxious or morbidly depressed patients—”
“—or punish them for not conducting themselves in a normal way.”
“Exactly. Very different from today. Now we have imipramine, mepro-bamate, and others. Work out the correct dosage, and that person can often live a pretty steady life.”
He frowned. “So? If they close the hospital, they continue on those meds and live a ‘pretty steady life’ along with the general population.”
“Don’t be dense, Paul. I’m talking about the most severe cases. How many of your patients would remember when to take their meds or how much? Can they discern chlorpromazine from haloperidol? Many have no idea what day it is, let alone the hour.” She shook her head. “To rely on their own competence means we have been treating them unnecessarily all along, which we know isn’t the case.”
He was paying attention, encouraging her with his expression. She sipped more wine, automatically analyzing his expression as she swallowed.
“Group therapy. Psychoanalysis. The old Watsonian and Skinnerian conditioning has finally led to constructive behavioural treatment. Patients are no longer Pavlov’s dogs, but individuals who identify a cue and are able to adjust their actions accordingly. Then there’s the miracle of neurochemistry, and electron microscopes capable of exposing the most miniscule details of neurons. All of that will lead to therapies and medications that will only improve over time.”
“All right,” he said. “We have progressed. So?”
She dabbed the corners of her mouth with her napkin. The wine was delicious. “The answer’s obvious. Outpatient therapy in community health centres may work for the people who are suffering from manageable afflictions and who have progressed to the point where they can look after themselves, at least in basic ways. But serious inpatients need a central location where they are cared for and can function properly. In its infinite wisdom, the government is demolishing those places.”
He nodded slowly. “I am so glad I asked. This is fascinating, coming from a woman who barely says three words in a staff meeting. They’redemolishing them because of cost, and those savings are being redirected to new protocols like community centres. Isn’t that good, at least?”
“Government costs will skyrocket. Those with the worst problems and no support will turn to crime and become inmates instead. I can’t imagine jails are cheaper to run than our hospitals. Much of our work is done by volunteers. I could be wrong, but I don’t think volunteerism is a major contributor to improving life in prison.”
“You could be right about that.”
“Couldbe? Come on, Paul. There are far too many factors we haven’t addressed for this to go well. The proponents of this foolish idea believe the latest antipsychotic medications will offer a cure. Ridiculous! A cure to what? Do all these people have the same problems? Can they all be fixed by the same drugs? Of course not. It’s so wrong, Paul. The other day, one patient of mine was paralyzed at the thought of leaving her room, then another—a violent sociopath—wanted to go home immediately, even though he can barely remember his name. When we open the doors and push them both out, what will they do?”
“Maybe she’ll find courage. She’ll have to. And there will be community centres, so she could drop in there if she needs help.”
“Or maybe this new course of action destroys all the courage and confidence she has worked on for months. And what about the other guy? He’s in 6B. He doesn’t know how to do anything on his own. He barely feeds himself. Everyone’s talking about freedom this and freedom that. Freedom to live independently with dignity? Or freedom to die on the street?”
He nodded and sipped his own glass of wine. “So tell me, Marion, why didn’t you say any of this before? Why didn’t you talk to Bernstein about it?”
That was the question she had sat on for so long. She dropped her gaze. “Because I’m a coward.”
“Really? Something that rouses you this much, and you didn’t want to fight it?”
“It’s not that I didn’t want to. I just… You’ve never had to worry about protecting your job or your reputation. I am constantly working just to maintain my status.”
