16

SOUL ON ICE

Meanwhile, in the same facility, Bill’s time on the acute ward was coming to an end. He spent forty-eight hours there before the hospital deemed him well—or rather, still unwell enough to be moved to the residential floor. The residential floor was less like a hospital, with lounge chairs and windows that lined the dayroom, giving it a “homier” feeling than the dark, gloomy acute floor. An outdoor space was open to those with grounds privileges (until a patient successfully jumped the wooden fence around it). Psychiatrists rarely visited the wards, and when they did their interactions with patients were swift and dismissive. A blunt male psychiatrist whose pointed questions bordered on the absurd had already been primed to ask Bill about his drug use and sexual orientation—foregone conclusions made by the previous psychiatrist, who had spent a mere half hour with him. Bill still received three daily doses of antipsychotic medication, but after that first incident in the cafeteria, he had learned how to properly dispose of the pills.

The other patients were like him, young hippies. Well, most of them. There was “the crawler,” a young man in his mid-twenties who spent the majority of the day on his hands and knees navigating the grounds like a baby. “He was a very weird dude, obviously,” Bill said. “But I was talking with some other guys at one point, and we were just standing around talking and he’s crawling around. He crawls over to our area, gets up, and we start talking about college. He knew I was a college student, and he had been at junior college, community college somewhere in the area, and so we started talking about college courses, you know, and how hard it was and all that kind of stuff, and then we finished our conversation and he got back on his hands and knees and crawled off.”

“Wow. It’s kind of comical,” I said.

“It is, but it’s also… I mean, I think for a lot of people who are labeled psychotic, if you keep them out of the area that their psychosis is focused on, they can seem normal.” This observation would become the linchpin of Rosenhan’s work—that crazy people didn’t act crazy all the time; that there was a continuum of behavior that ran from “normal” to “abnormal” within all of us. We all slide around it at various times in our lives, and context often shapes the way we interpret these behaviors.

Under the harsh glare of the hospital’s lights, Bill couldn’t help but reexamine his own idiosyncrasies, like his tendency to make loose associations and veer into tangents. “When people talk about something it reminds me of something extraneous, and… I often bring that into the conversation,” he said. “But taken to the extreme, you end up with the clang associations that you get with [serious mental illness]. There’s a dividing line in there somewhere. You could probably argue that everyone has something odd. I mean what is normal, what is sane?”

Bill’s friend Samson joined him in the step-down unit. He and a few other patients had Bill pegged for a journalist because of his constant writing. “I don’t believe you’re a real patient. I think you’re checking up on the doctors,” Samson would say, reflecting a suspicion that Rosenhan also encountered. But not one of the doctors caught on, Bill told me.

One morning, a nurse woke Bill up with a start. “Wake up, Mr. Dickson, you have to go see a doctor. You have diabetes.”

Bill was shocked. He’d never had medical issues before—he’d hardly ever had a fever, let alone diabetes. How could he be so sick and no one told him? As he walked with the nurse to the doctor’s office, he remembered that his uncle had diabetes and had suffered debilitating side effects. The realization that Bill now had it, too, was chilling—especially when the nurse seemed so nonchalant about it. He’d have to make arrangements to get out as soon as possible to see a doctor; he’d have to tell his wife; he’d have to take those shots every day. Lost in thought, he hardly noticed when the nurse returned and told him he could leave.

“You’re the wrong guy,” she said. She didn’t seem embarrassed or even apologetic. He was simply the wrong guy. Apparently, there was another Dickson on the ward (who was a good deal older, looked nothing like Bill, and lived in another building). The breeziness of the hospital’s mistake unnerved Bill. “I mean, jeez, if I was this close to getting treated for diabetes, what if it had been, you know, a lobotomy?”

Maryon visited as often as she could, juggling the kids and the chores while ignoring the chorus of neighborhood questions about her missing husband. She couldn’t relax. “I guess I’d seen enough movies or something to know that they could haul him off and, you know, do a brain…,” she began, and then stopped. Even from the safe distance of nearly half a century, it was still hard for her to finish. “That they could do a lobotomy.”

She wasn’t exactly being dramatic. Bad things could and did happen. Bill did not know this, but a psychiatrist who worked at Agnews at the time was nicknamed “Dr. Sparky” by the staff because of his fondness for electroshock therapy. “He would do [it] on anybody—and that includes the staff—if he had the chance,” former Agnews social worker Jo Gampon told me. Electroshock started with Italian doctor Ugo Cerletti, who came up with the idea after his assistant visited a Roman slaughterhouse and witnessed how subdued the pigs became after they were shocked with electrical prods on the way to be slaughtered. Oddly, a lightbulb went off. Electroshock took off in America in the 1940s, and Agnews zealously embraced the procedure. A psych technician from that era shuddered when he recalled the weekly lineups. “Our job was to hold the bodies down,” he told me. “One, after the other, after the other.”

I saw an electroshock box at Patton State Hospital’s History of Psychiatry Museum and was pretty surprised at how small and portable the machine looked. This cute machine could do all that? I thought of the movie The Snake Pit, when Olivia de Havilland seizes on the table, her head thrashing back and forth, her body stiffening—it turned out the filmmakers did a good job of portraying the procedure, I learned. Patients would sometimes break their backs or necks during the induced seizures. Some would bite straight through their tongues. The “clever little procedure,” Ken Kesey wrote in One Flew Over the Cuckoo’s Nest, “might be said to do the work of the sleeping pill, the electric chair and the torture rack.”

Doctors tell me that the treatment today, now called electroconvulsive therapy (ECT), has little in common with the electroshock therapy that Kesey described. ECT is deployed today for patients who are “treatment resistant,” the third of people with depression who don’t respond to meds. Psychiatrists say that it has evolved “to the point that it is now a fully safe and painless procedure” and is paired with an immobilizing agent to temper any body movements and with general anesthesia so that the patient is unconscious for the duration of the procedure. The amount of current administered is far less than it was then—and memory impairments are reportedly minimal. In one study, 65 percent of patients reported that getting ECT was no worse than going to the dentist. Still, a vocal community, who often picket at APA meetings, say that the possible side effects, including memory loss and cognitive defects, make it “a crime against humanity.” In recent years, more hospitals have used it on the East Coast than the West—a product, some say, of Hollywood’s vilification of the procedure.

Maryon smuggled in for Bill a copy of the book Soul on Ice, a collection of essays written by Eldridge Cleaver, who, while an inmate in a maximum-security prison, chronicled his awakening from a drug dealer and a rapist to a Black Panther and a Marxist.

One of the attendants saw Bill reading the book and struck up a conversation, as if seeing Bill as a human being for the first time.

“What did you talk about?” I asked.

“Well, just about the book, and just about stuff, you know, life in general, women.”

“That’s interesting, because I haven’t heard much about any interactions with the ward, with the attendants. But it seems like it was pretty positive, he treated you like…”

“Yeah, yeah, he treated me like a person, in fact he said as he was leaving to go to something else, he said, well, ‘You probably won’t be around here long,’ which I took to mean you’re kind of normal so you’ll be getting out of here.”

As Rosenhan had valued his original, respectful conversation with the attendant Harris (before Harris learned that Rosenhan was a patient, not a doctor), Bill found this interaction gratifying, precisely because it was so rare. He missed being treated as a normal human. He decided it was time to leave.

The how of his release is fuzzy. Rosenhan didn’t write anything in his book about it, just that after eight days Bill “suddenly” remembered that he had an event that he had to attend. Bill said he just told the hospital that he wanted to leave (he really wanted to attend a motocross off-road racing event north of San Francisco), and they let him go. There is no indication that he even left with a discharge plan or against medical advice, as Rosenhan said all of the patients did. Did his psychiatrists use the term in remission? Did they arrange for him to take meds on the outside or set him up with a support system in the community? Bill didn’t think so. I tried to track down the hospital records, but all that remained was one sheet of paper with the “reason for discharge” blank.

One psychiatrist did pull Bill aside, though, and say, “Sometimes, you know, things just kind of seem to build up on people and it’s just hard to deal with, and it’s really tragic if people do something when they’re feeling under that kind of stress that can’t be undone.”

Bill appreciated the sentiment—clearly, even as Bill was being released, the doctor worried that he was not yet cured, that Bill might become suicidal, and took an extra effort to offer some wisdom on the way out. A day later, he was discharged. He spent nine days in Agnews. That was ten days less than the norm for Rosenhan’s pseudopatients, and also a good deal less than Agnews’s average stay just four years before, which hovered around 130 days.

In the years that followed his hospitalization, Bill did some informal guest lecturing with Rosenhan at several schools around the country, showing that Rosenhan wasn’t quite as careful about keeping identities anonymous as I thought. The resulting fanfare amused Bill, but he was never tempted to steal any of the spotlight for himself. As time passed, Bill’s experience faded into just another seldom-mentioned story from his California days, one that had remained largely unexamined in his own life. When I approached Bill’s daughter about the study, she had no knowledge that he had even participated in it.

Bill was one of the final few psychiatric patients to enter Agnews. Two years before, Agnews had begun aggressively rebranding itself as a facility for people with developmental disabilities—and eventually discharged its psychiatric patients, some of whom had been there for decades, to the community or to Northern California’s remaining large-scale state institution, Napa State. In 2009, Agnews closed for good, leaving the whole of California with six state psychiatric hospitals, five of which are dedicated solely to housing forensic (criminal) patients.

All that remains of Agnews today is a small, one-room museum on the manicured grounds of software giant Oracle and a sign on the freeway advertising the exit for AGNEWS DEVELOPMENTAL HOSPITAL CENTER, a place that no longer exists.