Authors: Emily Hammond
AT ARCADIA METHODIST: The patient was admitted to Arcadia Methodist Hospital on 2/5/63 upon a Involuntary Application by Dr. Mead who stated: “According to the application, completed once patient had regained consciousness, the patient states that she is very depressed and fears she might try to kill herself again. On examination today, this is a 39-year-old brunette Caucasian woman of average height and weight, who appears to be in fair physical health, despite loss of blood. She appears to be depressed and her affect confirms these observations. She is fairly well-oriented for time, place and person, and is aware of the nature of her surroundings.”
PHYSICAL EXAMINATION: By Dr. Martin, 2/7/63
Physical findings essentially negative except those regarding patient's recent suicide attempt: weakness, dizziness, possible anemia from blood loss; stitches on both wrists. One wrist appears markedly inflamed.
MENTAL EXAMINATION: By Dr. Martin, 2/7/63
This is a 39-year-old Caucasian female who is markedly depressed, tearful, anxious and tense during the interview. She admitted to being in the Huntington and St. Vincent's last year, receiving electroshock treatments for depression. She is reluctant to discuss suicide attempts, both recent and previous. Her speech is coherent; her associations are well-preserved. She denies hallucinatory experiences and exhibited none. There were no persecutory feelings, no paranoid trends, no hypochrondriacal ideas. Sensorium is clear. Insight and judgment limited.
INITIAL PRESENTATION: By Dr. C.H. Franklin, 2/28/63
This 39-year-old woman has grown up in this area and except for college, lived here all her life. There is no history of suicide in her immediate family, although there may have been a distant cousin who killed himself. There is alcoholism in the family, her father possibly, although she remains vague on this point. She doesn't feel her own drinking is a problem, which is rather hard to believe. She claims a close relationship with her parents in that she sees than frequently, although she faults her father for being overbearing and her mother for being a “mouse.” Somewhat contradictorily, she says her parents irritate her greatly, her father in particular, although as a child she worshipped him. She reports her marriage to her husband is satisfactory although she admits to a cessation of sexual relations. She is not sure why, perhaps her husband is no longer attracted to herâor perhaps it results from the death of the baby. She is inconsolable on this latter subject and blames herself extremely. She claims to be a bad mother and when asked why, says she cannot protect her children adequately, although it is unclear what she wishes to protect them from. She says now that the baby is dead, she has little to offer her other children, her daughter in particular. She speaks of this daughter, Theodora, frequently, almost obsessively. But the content of what she says seems to have not much bearing on the actual childâshe speaks in generalities about mothers and daughters and the responsibility of mothers to their daughters. The tone of her words approach hysteria on this subject, although the words themselves are lucid and quite sensible. She says she is a poor example to both her children, and an inconstant wife, lost to fits of mental illness, and that all would be better off without herâthus her most recent suicide attempt.
She has been depressed since the death of the baby, maybe even prior to that. She says she has always suffered from periods of depression and anxiety, even when she was a child. She was happiest when she was first married and after the birth of her first child.
She is not presently suicidal. Nor is she hopeful about the future.
The diagnosis here is difficult. This looks like a chronically insecure, schizoid woman with depressive tendencies whose defenses finally gave up. The outlook here seems to be extremely bad. She is too young for menopause although unquestionably she will develop an involutional psychosis when the time comes. At the present time she could be diagnosed as such:
Tentative Diagnosis:
DEPRESSIVE PSYCHOSIS, DEPRESSIVE TYPE. Recommendations: 1. No final certification (Voluntary). 2. Individual and Group Psychotherapy. 3. Electroshock treatments.
SUBSEQUENT COURSE: After admission the patient was placed on Ward 3 where she was depressed, tearful, and quite seclusive. She was not delusional. She was able to maintain a sensible conversation; was placed on Mellaril 100 mg. t.i.d. and Tofranil 25 mg. t.i.d. During her 2-month stay, the patient received Individual and Group Psychotherapy and Electroshock treatment. However, she showed very little improvement. Most of the time she was preoccupied with herself and mostly sat by herself on the ward. Off and on her depression was diminishing but later on became even worse. At times she had suicidal ideas; other times she had violent thoughts about her father. Patient was approved for Home Visit for four days and has had two successful ones; however, after each of them she was quite depressed on returning to the hospital.
On 2/28, the patient was transferred to the Intensive Treatment Unit where electroshock treatment was approved. Her pre-electroshock treatment EKG revealed an incomplete bundle block on the right side; therefore, patient was checked by Dr. Curtis who okayed electroshock treatments.
DISCUSSION:
Hereditary Factors: There is inconclusive evidence of a family history of suicide. Same for mental illness. Strong family history of alcoholism.
Developmental Factors: The patient suffered bouts of depression and anxiety as a child. She has always feared mental illness, believing that her father had a breakdown a long time ago as a young man that nobody speaks of.
Precipitating Factors: It is felt that in this patient's mental disturbance a great role was played by the loss of her infant daughter, whom she can barely bring herself to discuss. Nor can she discuss sensibly her surviving children, particularly the daughter, without linking them inexorably to the dead child.
DIAGNOSIS: DEPRESSIVE PSYCHOSIS.
CONDITION: SLIGHTLY IMPROVED.
TREATMENT: MELLARIL 100 MG. T.I.D. AND TOFRANIL 25 MG. TO 75 MG. T.I.D., OCCUPATIONAL THERAPY, INDIVIDUAL AND GROUP THERAPY, ELECTROSHOCK TREATMENT.
PROGNOSIS: GUARDED
Dr. Martin/nen/tfh
MAY 4, 1963: This patient has handed in her notice. Because of the suicidal history she is referred for screening.
DISCHARGE DEFERRED
Dr. C.H. Franklin: rr/tfh
Assistant Director
MAY 6, 1963: This case has been screened by Drs. Clardy and Rochlin and also seen by the undersigned. The following observations were made: “This patient was admitted on an Involuntary Application, later a Voluntary Application and has turned in her notice. At the present time she is quite depressed and admits she is still sick, to the point of commenting recently that she may as well throw herself out the window, for all the good this hospital has done her. The patient has also been observed befriending another patient for the purpose of obtaining that patient's medications.
“She has agreed to withdraw her notice and has made a signed statement to this effect on the letter.
“If the patient again turns in her notice and is not well, the question of having her committed should be considered since she is still in a dangerous state.”
DISCHARGE DISAPPROVED.
DR. C.H. Franklin: rr/tfh
Assistant Director
PRESENTATION FOR DISCHARGE
BY: DR. IVERSON
JULY 26, 1963
SUBSEQUENT COURSE: The patient has been in the hospital approximately 6 months. She has a past history of recurrent depressions and suicidal tendencies as well as two attempts. In the Intensive Treatment Unit she has improved to the degree where she was able to socialize a bit, able to function fairly well. Her depression lifted so that she was no longer suicidal. Since April 18 she has been going on weekend visits rather regularly. She is on the open ward, has her I.D. card. She now socializes to a degree. She has one or two friends on the ward. She is rather inactive, preferring to read, and had to be coerced into working in the sewing roan by threatening to remove her I.D. card. She walks around the ward with a supercilious expression on her face, smiling rather stiffly if at all. She is on a combination of Elavil 25 mg. t.i.d. and Trilafon 4 mg. t.i.d. It is unlikely that she will get much benefit from these medications as her present behavior is probably not the result of her depression but probably represents her longstanding personality. It is felt that she could not benefit from further hospitalization here but would do better outside with the continuation of her psychotherapy with Dr. Robert Gris. It is also felt that the patient at the present time is not a risk to herself or to her family. There is no evidence of suicidal or homicidal tendencies.
PLAN: The plan is to release the patient to the care of her husband, Mr. Harold Mapes, 342 Bonitas St., San Marino, Calif. He has engaged a nurse for her as well as a housekeeper so that she will be under less pressure at home. Arrangements have also been made for the patient to continue treatment with Dr. Gris.
DIAGNOSIS: DEPRESSIVE PSYCHOSIS.
CONDTION: IMPROVED.
RECOMMENDATIONS: RELEASE ACCORDING TO ABOVE PLAN. PATIENT TO CONTINUE WITH ELAVIL 25 MG. T.I.D. AND TRILAFON 4 MG. T.I.D.
PROGNOSIS: GUARDED.
Dr. Iverson/sa/tfh
PRESENTATION FOR DISCHARGE
BY: DR. IVERSON
SEPT. 2, 1963
There is a suicidal history. Referred for screening.
DISCHARGE DEFERRED.
DR. C. H. FRANKLIN rr/thf
Assistant Director
PRESENTATION FOR DISCHARGE
BY: DR. BUCHANAN
SEPT. 4, 1963
This patient was today screened by Drs. Rockwood and winne and was also seen by the undersigned. The following observations were made: “The patient who is here in the hospital on a Voluntary Application has handed in her notice to leave. A plan has been made for her to be seen by Dr. Robert Gris. Her husband apparently wishes her home. At the present time she is in good contact, makes a favorable impression and it is felt has no dangerous tendencies. Discharge is approved.”
DIAGNOSIS: DEPRESSIVE PSYCHOSIS.
CONDITION: IMPROVED.
DISCHARGE APPROVED.
DR. C. H. FRANKLIN mgt/tfh
Assistant Director
S
IXTEEN
Diffidently, I finger the nightgown I'm still wearing, though it's one in the afternoon. In the hallway outside my room at the Alta Vista, I hear a person with a walker plunking down the corridor.
Last night's dream after reading my mother's hospital records:
My mother's dead body is being brought into the mortuary and I am waiting for her there. There are tables for the dead peopleâsort of like a clinicâand I am standing by the one reserved for her. They bring my mother to me in a clear case packed in fluid, her dark hair undulating within, and I think,
That's her
. They remove her from her case and lay her out on the table, naked. I'm to get her ready for burial. She is accompanied by a list of requests, written in her own hand, but her writing is sloppy with many misspellings, provoking a comment from one of the employees at the mortuary.
But that just shows how far her mind was gone
, I want to say;
she was smart, she could write
. I prepare to put her body inside a white tent, along with some of the things she requestedâan infant's blanket, a red papier mâché bird. Meanwhile, almost imperceptibly at first, her body starts to move a little here and there, her arms, her handsâthe next thing I know, she's sitting up, her rubbery white legs dangling off the table. She's trying to stand and I help her. “Oh no,” she says, “I'm a boy.” She thinks she has a penis. I look down and check. “No, you're a girl, just swollen from the packing fluid.” I mean to ask her about Charlotte, my baby sister, but before I can my mother lets loose with a stream of urine, smiling ecstatically with greenish teeth.
I haven't dreamt of her in years.
As a child I wrote myself postcards, pretending they were from my mother. Postcards I would get in stacks from my father's friends as souvenirs, brand new, not sent through the mail. Postcards of bears in Bern, Switzerland, beergartens in Germany, the Black Forest; cherry blossoms in Japan, kimonoed girls with fans upheld; the Queen of England, the Tower of London, a village in WalesâI pinned them up on my bulletin board in a mural, but on their backs were the notes I had written. Starting from when I could first write, they were like a child's letters from camp, except they were about heaven or some such place.
“It's nice here. They have haarps.” “Weather is fine, no moskitos.”
Supposedly, my mother wrote them from heaven, but I feared she was somewhere else, floating and vaporous in the sky or maybe right in my own back yard, behind the azaleas, or in my closet, reflected in a doorknob, in the pantry with the cans of Campbell's soup. She hovered beneath the floor of my room listening to me with a glass and sometimes she was good and sometimes she was bad.
At thirteen I became convinced I could contact her, that she was trying to contact me. From a book I taught myself self-hypnosis (many hours in my bedroom with a candle burning, picturing myself going down a set of stairs backwards: ten, nine, eight, seven, six); I sent away for books about spirits, tried to obtain the
Tibetan Book of the Dead
. I studied Tarot cards, wrapping them in a silk scarf inside one of my mother's old lacquered cigarette boxes.
Every day I hurried home from school to watch “Dark Shadows” and eat mouthfuls of saltinesâEvan wasn't there anymore to warn me about my figureâand after sating myself with milk, I'd begin. Forays around the house for an item belonging to my mother: a necklace, a shoe, an old bobbie pin wedged in the crevice of a drawer. I'd hold it in my palm and repeat her name over and over again very fast until I was dizzy, my scalp prickling. Then I'd wait. Nothing. I read Tarot cards by the hour, or I'd meditate on a particular card, the High Priestess or the Hanged Man. Never the Death card. I was too frightened, though I understood perfectly well that it wasn't about death, but rebirth.