“Missing out? Are we talking about you still?” she joked, but he wore a serious expression.
“I’m talking about life. Doesn’t matter if you like me or not. You need to expand your horizons. You live at your apartment and at work, and that’s it, from what I can tell. As a doctor, I’m suggesting you challenge yourself to do something you wouldn’t normally do. Do something that scares you.”
“Where’s this coming from?”
“Don’t take this the wrong way, but you are predictable, Marion. That’s not a bad thing. You seem satisfied with your life. But tonight I saw you truly happy, and it was because of something you’d never experienced before. You saw that singer, and you lit up. You must have felt the difference in you.”
She had, and his words brought on an unexpected wave of emotion. She took a beat, letting his words sink in. Was he right? Was she completely happy in her life? She’d asked herself the same thing so many times.
“I get your point,” she relented, then she gave him a quiet smile. “Whoknows. Maybe someday I’ll surprise us both. Thanks, Paul. I do appreciate what you’re saying.”
“You still want that Neumann file?”
She’d almost forgotten. “I do, thank you.”
“I’ll put it out for you. Good luck with that guy. He has a temper when you let him loose, so watch it.”
“I will. Thank you again. You know, Paul, you should go back to the coffeehouse and see if that blond is still there. The one you were watching all night.” She laughed at his expression. “I might be square, but I’m not blind. Good luck with her. I’ll see you Monday. Thank you again for this evening.”
She wasn’t thinking about that conversation as she stepped into the library. Today wasn’t about her own life, it was about his. Her attention was on finding up-to-date papers and treatment options with regard to “war neurosis” and “combat stress reaction.” She wanted to learn the root cause, and how she could help.
From the shelves, she pulled out what sources she could think of, then she flipped through pages and came upon the first known mention of battle fatigue. Three thousand years ago, it was written, the Mesopotamians believed that soldiers’ nightmares, depression, amnesia, and other symptoms were brought on by avenging ghosts of those slain in battle. Twenty-five hundred years after that, Herodotus described an Athenian soldier who went blind after witnessing the Battle of Marathon, but who had no physical injuries to either his eyes or his brain. In 1600, Shakespeare’s General Macbeth murdered his king. For years, Macbeth had hardened his mind to slaughtering countless men on battlefields, then he suddenly lost all reason by following a dream of witches professing he would be king.O, full of scorpions is my mind, dear wife!
From a nearby shelf, Marion pulled out a more recent book, set during and after World War I. That conflict had ended the lives of more than twenty million people, and so many men had come home changed forever by the utter horror of what they had seen and done. The termshell shockhad come from the Great War, she discovered, because the initial assumptionwas that close contact with exploding shells was responsible for the damage done to a man’s brain. They had no other answers.
The men’s symptoms were a puzzle, and the sheer flood of cases arriving after the wars forced the medical field to pay closer attention. Veterans came home with inexplicable symptoms like extreme anxiety, involuntary tics, stutters or mutism, a refusal to eat or drink, and debilitating headaches. There were cases of soldiers experiencing functional paralysis with no physical causes, vomiting for no apparent reason, and suffering unpredictable bouts of hysteria. Dozens of private mental institutions, lunatic asylums, and empty sanatoriums filled to overcapacity with these men. The doctors did what they could, but for the most part, they still had no real explanations.
There were valid reasons why the place where Marion worked, and every other similar institution, was known as a “snake pit” or “house of horror.” For about a century, doctors had basically worked in the dark, trying different approaches. But the truth was, the treatments were often worse than the symptoms.
Like Marion, some doctors believed in the moral solution. They encouraged patients to talk about their experiences, and they provided soothing therapy to try to ease the suffering.
Other doctors worked more with the concept that an affected man’s behaviour was a weakness, and one that should have a simple fix. Their conclusion was that if a man’s brain had gone off track during combat, it needed to be snapped back into place. Unfortunately, that “snapping” was often carried out through brutal methods, like forced and extended ice baths, locking patients in closets, purging, bloodletting, using straitjackets for restraint, injections, electric shock therapy, and even lobotomies.
Riveted, Marion kept reading, and even though she had read plenty of horror stories, some still caught her off guard. Like the account of Henry Cotton, director of the Trenton Psychiatric Hospital in New Jersey in 1907. He believed his patients’ troubles were brought on by internal infections, and he “cured” them by surgically removing teeth, appendixes, and colons. Hundreds of patients died, and thousands were maimed for life.
For nine months in 1918, a British psychiatrist named Dr. LewisYealland treated a patient who had not spoken since his return from the front. Regarding the man’s silence as a failing, Dr. Yealland decided to treat the problem with force. He demanded that the patient speak as he had before, insisting he “must behave as the hero” he expected, and he was not squeamish about reaching his goal. To elicit any sort of sound from the man, Dr. Yealland applied electric shock to the patient’s neck, he extinguished cigarettes on his tongue, and he placed hot plates at the back of the poor man’s throat. Frustrated by months of unproductive attempts, Dr. Yealland finally strapped the patient down and applied a powerful and prolonged electric shock to his throat. When at last he removed the charges, the patient whispered, “Ah.” Dr. Yealland was so encouraged by the sound that he continued with the shock therapy for another hour, until the patient finally began to cry. In the end, the patient whispered that he wanted a drink of water. Dr. Yealland recorded his treatment as a success.
Then there were lobotomies. Despite having no surgical training, Dr. Walter Freeman II created a “transorbital lobotomy” as recently as 1949. Marion knew all about Freeman, including the horrible fact that he had performed his final transorbital lobotomy just last February. He boasted that the procedure could be performed with neither anesthesia nor operating rooms—in fact, his transorbital lobotomy was a simple office procedure with no need for a surgeon at all. First, he applied electroconvulsive therapy to induce a seizure so the patient felt nothing. Then he inserted an instrument resembling an ice pick under the patient’s eyelid, against the top of the eye socket. Using a mallet, he drove the tool through the thin layer of bone and into the brain, where he swept the tip around the area to clear out what he called frontal lobe tissue. Many of his patients died of cerebral hemorrhages. Others needed to relearn how to eat and use the bathroom.
Yes, there were sound reasons why mental institutions had a bad name, but those were mistakes that many doctors—if not all—learned from. Medicine had moved forward, constantly improving. Physical therapy, group sessions, and new medications were among the “new” and progressive treatments that had risen from the snake pit’s ashes.
Sometimes, unexpectedly positive results came from unusual method-ology. In 1934, Dr. Ladislas Meduna discovered that the brains of patients with epilepsy had greater concentrations of microglia—the brain cells whose job was to search for harmful scavenger cells in the central nervous system—than those of patients with schizophrenia. From this, he surmised that seizures could possibly be beneficial. He injected camphor into a catatonic patient to cause seizures, and after four sessions, the patient was walking and talking on his own.
Seizures, it was discovered, could be brought on more quickly and with fewer side effects through electroconvulsive therapy, and those sessions began to show progress.
So many years of work, producing so little understanding.
Marion closed the last textbook, deep in thought. The general understanding over the years was that people diagnosed with this illness were broken. Marion had a different theory, and she wanted to explore it with Daniel. What if he, and men like him, weren’t broken at all? Obviously, he had experienced at least one shocking, life-altering traumatic injury in Vietnam. What if, to maintain his sanity in an insane situation, he had constructed a wall around the trauma in his brain? Was it possible that he was living within that protective wall while undergoing an unconscious process of sorting through what happened? Maybe, rather than being broken, Daniel was searching for the right doorway to get back to where he belonged.
Marion would never punish him for something over which he had no control and for which he was not to blame. The first step she wanted to take in his treatment was to reduce his sedation, if it was physically safe. If they were going to work together, she needed him to be able to think clearly.
Paul was in the front administration office when she arrived at the hospital later. “There she is. Prettiest psychiatrist in the place.”
She couldn’t help smiling. “And the only female one.”
He held out a file, which she assumed was Daniel’s. “I believe we talked about an exchange of sorts.”
“Certainly. I will grab those other patient files for you.”
