Chapter Eleven Marion
eleven MARION
On the morning after her date with Paul, Marion left the apartment at nine o’clock, slung her purse over her shoulder, then quick-walked the twenty minutes to the medical library. Having accomplished the first step in her mission to help Daniel Neumann by securing him as her patient, now she had to see if she could dig up anything that might work for him.
The date with Paul had been all right, she could admit. He was beguiling and amusing, and she claimed victory over their discussion about deinstitutionalization, but the evening’s ending had turned her a little sour. She’d gotten such a kick out of watching her neighbour perform a few songs. She’d commented a few times to Paul about how talented she thought the girl was. Paul had nodded, but after the fourth mention, he’d looked a little bewildered.
“I get that you think she’s good,” he said. “Why are you so excited about it?”
“She’s my neighbour. I practically know her! Isn’t that exciting? It’s like she’s a celebrity.”
“You’re all worked up over an amateur singer in a club who lives in your building. Unreal, Marion. You really need to get out more often.”
He couldn’t dampen her spirits, though. After the first song, her neighbour played two encores. The last was “Where Have All the Flowers Gone,” and everyone in the coffeehouse had sung along. It was beautiful, and Marion decided that one of these days she would work up the nerve to go and introduce herself at the apartment. After the set was done and the girl had left the stage, Marion lost interest in the show. Especially since the next performer was a long-haired, bearded man who looked like he hadn’t showered in a week. He hunched over his guitar and sang in kind of a growly, incoherent voice she didn’t recognize as English. Paul had laughed at her twisted expression then driven her home.
“Let me walk you up,” he offered, his blue eyes sparkling in the streetlight.
“I wasn’t born yesterday, Dr. McKenny,” she reminded him. “I’ll see you at work.”
“You don’t want to offer me a cup of tea or something?”
“I just had drinks with you for the past two hours. I’m not thirsty anymore. Thank you, Paul. I enjoyed tonight. Now, say good night.”
They climbed out of the car and regarded each other over its roof.
He let out a huff, looking resigned. “I’m sorry to say it, Marion, but you’re missing out.”
“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. “Who knows. 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 term shell shock had come from the Great War, she discovered, because the initial assumption was 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. Lewis Yealland 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.”
He wiggled a finger side to side. “We had a different kind of deal, if I recall correctly.”
Marion shot a horrified glance at him then at Miss Prentice. The secretary was pretending not to listen, but her fingers were poised suspiciously over the typewriter keyboard. Furious at his lack of discretion, Marion breezed past Paul and headed toward the corridor.
“Dr. McKenny, please come with me.”
“Gladly.”
She could hear the smile in his voice, the teasing that she no longer found funny. She wheeled on him after they were in the privacy of the staff room.
“How dare you? In front of Miss Prentice, too. Do you plan on telling the entire building that we went on a date?”
“Hey, a deal’s a deal.”
Her eyes narrowed. “We did not seal any deal on that front. You know that.” She reached for Daniel’s file, but he whisked it behind his back, out of reach. “You are behaving like a child.”
“I enjoyed Thursday night very much,” he said, a glint in his eye.
His charm was not working on her today. “I already said thank you, and you agreed to trade patient files. I told you I would get back to you about the second date, but this morning’s shenanigans have not helped your cause.”
“Sure, they have. They’ve helped you remember Thursday night and how much you enjoyed it.”
“Give me the file. Now.”
He did, so she swallowed her pride and felt her resolve weakening. It wasn’t worth making an enemy out of Paul. Most of the time he was a pretty good guy.
“What were you thinking of for a date?”
“Dinner Friday. Maybe French this time.” He winked. “ Cela pourrait être très romantique .”
She opened the staff room door and exited into the corridor. “I will let you know, monsieur. Thank you for the file.”