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After this, unable to move much at all, the poor wretch in the chair gave up the fight and her body slumped. No dignity remained to her and, lacking any other means of defiance, she carried out her threat and opened her bladder and urine began to drip from the chair and pool upon the floor below.
I watched in horror, appalled at what I was seeing, but Morgan seemed completely unmoved by the woman’s plight, as did O’Reilly and the other attendant. All three were so extremely matter-of-fact about the whole affair, it was obvious it must be a daily occurrence in their lives. Morgan strolled back into the other room and retrieved the clipboard from where O’Reilly had put it down. Returning to us, he studied it, lifting the top sheet of paper, then the one underneath.
‘I see we gave her only three hours last time.’
‘That’s right, sir,’ said O’Reilly.
‘I think then that this time we’ll try six. That should do the trick.’
The eyes of the woman in the chair widened in terror at these words. It was her only method of expression. Morgan walked over to her and said, in a kindly tone, ‘Now then, Lizzie, you may as well settle down because you are going to be here for quite the long haul. During that time I want you to consider the foolish behaviour that has led you to this situation and to consider modifying it so that you never have to find yourself here again. I hope that after this there will be no more soiling of yourself.’
He stood and smiled benignly, with the air of one who is conferring the greatest of favours, and as if waiting for some kind of response, though of course there was no way the unfortunate woman could give any, except to blink. Then, in that abrupt way he had of doing things, he turned to O’Reilly, thrust the clipboard into her hands and without another word marched out of the room. I caught up with him in the corridor.
‘Six hours to be so restrained seems a terrible long time,’ I ventured.
‘You think so?’ He stopped and looked at me with surprise. ‘Why, not at all, man, not at all. Ten or twelve is sometimes necessary.’
‘It seems so – so, well, harsh. Is there truly no other way?’
He looked exasperated. ‘There we go again, with your old-style ideas. Ideas I may say that were formulated by a gaggle of well-meaning but ill-informed, completely unqualified Quakers, rather than doctors, and that have no basis in science. Come, man, let’s have it out now, why don’t we? I can’t have you working here if you mean to challenge everything we do.’
I had no notion of how I had pushed him into this. His rage seemed out of all proportion to the objection I had made. His face was red with indignation, his cheeks puffed out, like an angry bullfrog. I thought his head was going to explode. I did not know what to say. It was not like drying up on stage, for I had no script. Indeed, I was not at all sure what my role here was. I tried to improvise but all that came out was a stammer. His features relaxed and his old calm smugness seemed to flow back. ‘Well? Cat got your tongue?’
‘I will gladly fight my corner, sir, only I would like the opportunity to reflect upon what I have seen here, if I may, and to formulate my reply carefully before making it.’
‘Very well,’ he snapped. ‘Take all the time you want; it won’t make any difference. We’ll discuss it tomorrow.’
I breathed a sigh of relief. I would read Moral Treatment after dinner this evening and have whatever arguments it contained for my ammunition. As I followed him along the corridor, though, the thought came to me, why do I want to argue with him? Why should I of all people care so much about the treatment of these lunatics, I who was wholly ignorant of such things not twenty-four hours ago? Why put myself at risk by stirring the waters of this safe harbour, given what the consequences might be? But all that carried no weight. I knew I would continue on this course even though to do so lacked any sort of logic. What a piece of work is man! So full of contradictions. I thought not to find such compassion in myself. It troubled me to discover I knew so little of me.
We were now near Morgan’s office and he begged to be excused as he had a letter he must dictate to his secretary, although I had the sense that this was a pretext, that he was still so angry with me he wanted to remove himself from my presence until he could calm down and reappear as his other, more familiar, urbane character. He was a man who did not like to lose control. I told him that as I hadn’t after all visited the library last night, I would do so now.
It was strange how ordinary in broad daylight, robbed of its black corners and sinister shadows, the passage I had trod the night before was. The library, too, had lost the terror darkness had given it. There was nothing atmospheric about it now; it had only the air of a musty neglected storeroom and not even very much of the romance of books. I examined the dusty shelves and found they contained a good few novels, and several volumes of stories by one of my favourite authors, Edgar Allan Poe. For the moment, though, I restrained myself from taking one; there was enough horror about the place for me not to seek to add to it. I settled for the Shakespeare. Should a man ever find himself upon a desert island, it is the only book he would need and the only one he could not do without.
I returned with it to Morgan’s office and hung about outside and shortly he emerged. He reached out a hand for the book and I surrendered it to him. He examined the title on the spine before flicking it open and regarding the list of contents, then he slammed it shut, releasing a little cloud of dust, and handed it back to me. ‘Shakespeare, eh? Never could understand what all the fuss was about.’
Well, I thought, that is no great surprise. It would be difficult for a lover of the bard to show so little sympathy for others. Still, I did not want to take him on over this, not after our earlier spat. Save your battles for the things worth fighting for has always been my motto, so I merely smiled, like someone appreciating the confession of a venial weakness by a superior being. This evidently put me back into Morgan’s good books and I realised he was a man who did not like to be challenged on anything. I’ve often observed this in those who are completely sure of everything they do. It’s as if the exposure of any small chink in their certainty would demolish the whole edifice.
Morgan pulled out his watch. ‘The boat will be in by now and we will have to review the new intake. They will be arriving directly at the examination room.’
We passed through the day room on our way there and, immediately Morgan opened the door, in contrast to the dead silence of the day before, were greeted by a great noise. I saw that at this early hour the inmates were not seated listlessly around the room as on the previous afternoon, but instead were on their hands and knees scrubbing the floor. I could have kicked myself for my naïveté in thinking it was thanks to the attendants that the place was spotless.
‘The patients do the housework?’ I asked, pausing to look at them.
‘Yes, they do some of the physical work around the place, mainly cleaning in the mornings. The physical exertion tires them and makes them less violent and more compliant. In the afternoons they are fatigued from the exercise and more likely to sit here quietly. And it kills two birds with one stone. The place would not be viable if we had to pay for staff to clean it on top of everything else.’ He began to walk away.
I looked at the women and was thinking how exhausting their chores must be on the meagre rations I had seen them consuming yesterday, when I noticed one of them had stopped her scrubbing and had sat back on her haunches and was staring at me. It was the young girl I had seen sharing her bread yesterday. Our eyes locked again and I began once more to feel uncomfortable but then, at the very moment I thought I should have to be the one to break the spell, her lips trembled into the suggestion of a smile, which I could not help returning. It was the first communication I had had with any of the lunatics.
I realised Morgan was nearly at the other end of the room by now and turned and hurried after him, but such was the impression made by those black eyes and that suspicion of a smile that they lingered in my mind the rest of the day.
4
The daily morning boat had delivered us three new inmates, judged insane by the doctors at the city asylum. One was an old woman, with untidy straggly grey hair, who sat in a chair, muttering away to herself and carefully picking imaginary fleas from her clothes, imaginary because she had been thoroughly bathed and reclothed at the hospital. She was just the sort of woman one saw about the streets of big cities all the time, begging and sleeping in doorways. I said as much to Morgan.
‘Yes,’ he replied, ‘but that does not mean she isn’t mad. A good percentage, if not all, of such creatures would not pass the test for sanity. It is their madness that has led them to their unfortunate situation. But the state cannot afford to treat every one of them.’
He asked the woman her name, to which she replied, ‘Mary, Mary quite contrary,’ and made herself laugh, a most hideous cackle that revealed she lacked a good few teeth; most of the survivors were blackened stumps. She stared at us a moment and then resumed her flea harvesting, giving it her full concentration as though we were not there. Morgan asked the attendant standing with us for the woman’s history.
The attendant consulted a paper file she was holding. ‘Persistent vagrant, well known to the city police. Her mind has been ailing for some time now, it seems, and it has finally got to the stage where she is a danger to others and to herself. She tried to take a lady’s purse, being quite convinced it was her own. The police judged it not a simple matter of theft as the woman herself did not consider it stealing but taking back what was rightfully hers.’
‘A diagnosis of senile dementia,’ said Morgan, studying the notes. ‘One that I agree with. And this one?’
The second woman was very young, perhaps twenty or so, and catatonic. Her eyes looked vacantly ahead of her. It was obvious nobody was home.
‘May have smothered her baby, sir, although that’s not certain,’ replied the attendant, passing him more notes.
Morgan stood reading them for several minutes, then handed them to me. There was a coroner’s report into the death of the baby that was inconclusive. The mother had been found in her lodging house sitting holding the body of the infant, which had been dead for several days. She had not spoken and was completely unresponsive to questions and so had been sent to the city asylum for an assessment, where she was judged insane and referred to the island.
Morgan approached her. He waved his hand up and down across her line of vision. There was no reaction. She did not even blink. He turned to me. ‘Some pathology of the brain means it has failed to function properly. In all likelihood she killed her baby without realising what she was doing. Do you agree?’
I tried to read those lifeless eyes. ‘Yes,’ I said, slowly, ‘but do you not think, sir, that it’s possible the baby died by some accident or illness and that the woman fell into this state through grief at losing her child?’
‘There you go again!’ It was said wearily. He shook his head. ‘People do not go mad because they are upset, man. We all get upset but few of us become mad. Science shows madness has a pathological cause. There is some physical malfunction in the brain. You can require no better proof than this woman here. She shows none of the normal signs of grief, no weeping, no tearing of the hair. As you can clearly see, she is completely unemotional.’
I did not know what to say. I could not argue with his science. I had only the evidence of my own eyes and my knowledge of human nature. I thought of Lady Macduff and her frenzy after the murder of her children. I thought of Ophelia with her flowers, unable to be reached after the death of her father at the hand of her lover. And I remembered too the suggestion in the Scottish Play that the somnambulant queen has lost a child or is unable to have children. Does she murder Duncan because she is mad or does she go mad only because of the guilt of murdering him? I could not help thinking that Shakespeare understood what makes us humans tick better than modern science as related to me by Dr Morgan.
I was tempted to say all this but then, remembering my earlier diagnosis of Morgan’s character, decided discretion was the wiser part. There was nothing to be gained by taking him on over this. He was not about to release the woman, and anyway, what was Hecuba to me?
We moved on to the third woman who, in contrast to the others, had an intelligent, alert expression. Before the attendant could say anything, she herself spoke. ‘I have been sent here by mistake, sir. There is nothing wrong with my mind, I assure you.’
Morgan turned to the attendant and raised an eyebrow, saying to me in a whisper, ‘They nearly all say that.’
The attendant looked at the notes. ‘She caused a disturbance at the restaurant where she had previously been employed as a waitress. She’d been dismissed for being absent from work two days in a row.’
Morgan took the notes and looked them over. He raised his eyebrows. ‘Quite an impressive disturbance, I see. Smashed the place up, threw a plate through the window, broke crockery, swore at the manager and screamed at the customers.’ He lifted his eyes from the notes to the woman.
She coloured. ‘I was not myself, sir. You see, my little girl – she’s only two, sir – was sick, sir, and I was too worried about her to leave her and go to work. I sent word to explain but they wouldn’t hear of it, sir. And so I lost my job and then I couldn’t pay the doctor’s bills.’
Morgan looked again at the notes. ‘I see you assaulted the doctor, too.’ There was a stern gravity about the way he said this, as though he named the worst of all possible crimes.
The woman looked down. ‘I did, sir. I don’t know what came over me. He wouldn’t take my promise for payment for the medicine. He wouldn’t give me anything for my daughter. My head was in a spin, sir. I lost control. But my daughter is better. She’s being looked after by a relative now. And I’m all right, sir. I’m not crazy, really I’m not.’
‘We don’t like to use words like “crazy” here,’ Morgan said kindly. ‘What you are is mentally ill.’
The woman began to protest but he held up a hand to silence her and you had to admire the natural authority the man possessed, because she immediately fell quiet. She was smart enough to know that arguing might reinforce the diagnosis against her.
‘You’re mentally ill. It is not something to be ashamed of; it is a physical illness, no different from heart disease or diabetes. There are hundreds, perhaps thousands, of people in this great city who suffer setbacks and difficulties daily in their lives. They do not go smashing up restaurants. They do not attack doctors.’
‘It wasn’t really what you would call an attack, sir. I slapped his face, and then only the once, sir.’
‘They do not attack doctors. The fact that you did these things, which mentally healthy people do not do, no matter how much pressure they are under, indicates there is something faulty in your brain. This is the best place for you.’
‘But, sir, I cannot stay here. I must go home and look after my daughter.’
‘Madam, stay here you must. You have been committed. Believe me, this is the right home for you at present. Here you will get the treatment you need.’
Tears ran down the woman’s cheeks and she began wringing her hands. ‘But sir, I – I—’
‘There, there, calm yourself. Everything will be all right. It’s a great shock to find yourself in a place like this, I know. But it is your best chance of becoming well again.’ He smiled, handed the notes back to the attendant, turned to me and said, ‘Right, let’s be getting along now,’ and made for the door.
‘How long will it take?’ I said, as I struggled as usual to keep up with him.
‘How long will what take?’
‘For that woman to recover her health and get back to her child. She seemed perfectly sane and sensible to me.’
He stopped and smiled at me patronisingly. ‘To you, yes, because you have no practical experience. Here the woman is under no pressure, but what would happen if she were let loose in the world again and some little thing in her life went wrong? How many restaurants would she destroy then, eh? How many doctors would she beat up – or worse?’
I said nothing. I could see he would only grow angry again if I took him on.
‘You and I would not behave so. At least I know I wouldn’t, and I hope you wouldn’t either. But she will do the same again because there is a pathological illness of the brain underlying her actions. It’s a physical thing and not something that can be altered by “kindness”. Now do you understand?’
This last question was rhetorical and he strode on. I stared after him. How easily I could imagine him smashing something or striking someone, there was the irony of the thing! I couldn’t help but smile at his assuming me to be so peaceable too. Seeming, seeming! How simple it is to judge a sane man mad and a mad man sane! What a combination Morgan and I made. The lunatics had taken over the asylum.
I had an hour to myself before dinner and, although the Shakespeare called invitingly from my bedside table, settled down to read Moral Treatment.
The introduction itself was sufficient to make me understand Morgan’s hostility. ‘In the past,’ wrote the Reverend Abrahams, ‘a cruel and inhuman regime was practised against those unfortunates judged to be suffering from mental illness. They were treated more like animals than humans with souls. They were imprisoned, beaten, put under restraint and subjected to all manner of indignities. They lost all their rights and were often committed to institutions for life with no recourse to appeal. In most cases this treatment had no therapeutic value.
‘In twenty years of dealing with the mentally ill, I have treated them according to my Christian principles, with the result that the vast majority have had their symptoms sufficiently alleviated to be able to take their places in society and lead a contented and useful life …’
This was so at odds with Morgan’s philosophy that I found myself utterly absorbed. In the opening chapters Abrahams, who acknowledged himself a Quaker, explained the day-to-day running of his small hospital. Patients were treated as fellow members of the human race. They were kept busy at simple tasks such as gardening, sewing, carpentry and the like according to their tastes and abilities. During their leisure times they were encouraged to read, to take walks around the grounds, to play games both indoor and outdoor, including card games, chess, croquet and tennis; they were offered entertainment in the form of lectures, plays and musical gatherings. They were not made to feel different from the rest of mankind but wore their own clothes and were spoken to with respect by the staff. They were rarely locked up and only then on occasions when they were thought to represent a physical threat to themselves or others, which were rare. They were given wholesome and nutritious food. Above all, the people who looked after them, who were not doctors but ministers and trained nurses, talked with them regularly and listened to their accounts of what troubled them.
Under this system, according to Abrahams, the vast majority of his patients recovered, usually in a matter of months, and were well enough to be restored to their families. It was his firm belief that for most people mental illness was not a permanent state of being but a temporary crisis, brought about by some misfortune, which might be anything from a family death to a financial collapse. When handled with sympathy and kindness, patients recovered and became, with only a few exceptions, their former selves.
All of this was so reasonably argued, and put down in such a matter-of-fact way, with many examples of individual cases, that by the time I closed the book, I was already well on the way to being convinced.
5
Dinner found Morgan in affable mood. He discoursed upon his youth and his experiences as a doctor practising in an ordinary hospital, treating all manner of illnesses and injuries, and recounted anecdotes, some of which were genuinely amusing and others so concerned with the blood and gore often associated with doctoring that I didn’t consider them conducive to enjoying my dinner, although I made sure I ate my fill anyway.
At one stage he asked me about myself, saying he would like to know a little of my history beyond what he had seen in my application for employment, that he knew all about my education at medical school, but nothing personal about me. I improvised easily the rest of my background, cheerfully killing off my father, an attorney, when I was ten, when he was trampled to death by an unruly horse (‘You seem to have inherited his misfortune for accidents involving transportation,’ Morgan interposed at this point, a remark I could not help thinking would have been insensitive had either of the incidents he was referring to actually happened), and disposing of my mother by means of the scarlet fever, which carried her off when I was sixteen. The result of recounting my struggles as an orphan was to see Morgan look at me with something like admiration, seeing me in a new light, as I described the various vicissitudes I’d endured as I single-handedly worked my way through school. The whole was a mixture of truth and invention. It was a technique I’d used so many times before, it came easily to me – creating the background for a character, the bits in between the lines that aren’t written down.
‘Bravo,’ he said, pouring us another glass of wine and then lifting his in a toast that I copied. ‘Your unfortunate past has been the making of you. It has provided you with grit and determination to work hard. It will serve you far better than being born with a silver spoon in your mouth and treading the primrose path.’
I beamed with pride, feeling very satisfied with my new self.
Back in my room I spent a long evening absorbed by more of Moral Treatment. It was not the sort of book I had been used to. Drama, novels and poetry had been my literary meat and drink, and I had some difficulty following all the arguments put forward in it, although my interest always picked up when I came across any case history the author included by way of example. It was always people that fascinated me. Facts are too malleable to make me have much respect for them.
I heard the clock strike midnight as I struggled through the second half of the book, yawning all the while. It was no wonder I was tired. There was the business of the wreck and the injuries I had suffered. Besides the blow to the head, I had sore ribs and an ache in my back that made it hard for me to sit comfortably, no matter how I tried to arrange myself. Then there had been all the stress to my nerves of arriving here, the pressure of being a new, untried employee, the battle within myself to keep in line, to overcome my obstreperous nature and not speak against the hard treatment of the poor wretches who were my fellow inhabitants of this place, separated from me by that most fragile of borders, chance. The wine at dinner had not helped either, so that at some point, notwithstanding my determination to plough through to the end of the book and prepare my arguments for the morrow, I must have fallen asleep.
I had the dream again, the one that always seems to return in times of trouble. I was back on my uncle’s chicken farm, where I’d arrived the day before following the death of my mother. I’d never had a father; he’d run off before I was even born. I was eleven years old and my uncle had just strapped me because he’d told me I had to earn my keep and I’d refused to kill a chicken.
I stood before him, my pants around my ankles, my bare backside sore from the blows. I put a tentative hand behind me and felt something wet. When I inspected it, I saw it was stained with blood. My uncle watched me, breathing heavily, his belt swinging from his right hand. ‘Well, boy, what’s it to be,’ he said, ‘you or the chicken?’