Susan Sheehan (journalist) made a study in the 1980s of Sylvia Frumkin, a mental patient diagnosed with schizophrenia who was hospitalized multiple times at various locations in and around New York. She spent most of her later teenage years (1970s) and early adulthood in and out of hospitals, dealing with auditory hallucinations, disorganized thoughts, violent and anti-social behaviors, and a host of other problems brought on by her illness. Sheehan interviewed the patient (Miss Frumkin), family members (her parents and sister, Joyce), Sylvia’s doctors, therapists, psychiatrists, and others whose lives were touched by her illness in order to create this portrait of Sylvia and the mental hospital environment at that time.
Sheehan paints a picture of a chaotic and largely disorganized system (not unlike Sylvia’s illness). The state mental hospitals (like Creedmoor) were largely overpopulated and under-staffed. It was difficult to give patients the attention or care that they needed (and in some cases craved). Most of the doctors were foreign-born and educated and there were cultural and language barriers between them and their patients. Prevailing practices and attitudes regarding the medication of patients were to put patients on several different medications at a time, and then wean them off of them as their symptoms/psychoses improved (or if side-effects became too uncomfortable). Because doctors didn’t really understand how the medications worked, and because the individual metabolisms and physiologies of their patients meant they worked differently for everyone (and often differently at different times over patients’ lifetimes), this was sort of a crapshoot. In Sylvia’s case, these practices probably made her illness worse – doctors didn’t know or bother to become familiar with her case history, she wasn’t given enough of medications to actually control her symptoms, and life on the ward (and at home) was incredibly stressful for her. Sylvia is often described as “pesty” and “irritating” by those who knew her, and she often resorted to violence when she was frustrated. When she was able to control these impulses, she could be quite affable and charming, and she struck people as being particularly bright. In an afterword, Susan Sheehan writes that after publication of this book, Sylvia’s condition improved and she was able to go home to live. It’s difficult to believe that this period of wellness lasted any longer than others, but publicity after publication brought her to the attention of a prominent psychiatrist, who took on her case personally, so perhaps she’s finally receiving the care (and attention) she needs.
I’m still mystified by the workings of schizophrenia, which seems to be a catch-all for various mental illnesses that can’t be classified elsewhere, but which share certain similarities. I think the hardest thing to come to terms with (both for me and for psychiatrists during Sylvia’s time) is that schizophrenia can’t be cured. It can only be treated. The “bad” behavior of schizophrenics seems like something that an ordinary person could easily control – the impulses, the violence, the acting out. Why is it that some people are overwhelmed by these things and other “normal” people can deal with the same stresses and not have a psychotic break? There was one point where Sylvia really seemed to understand what was going on in her life – when she was seeing a therapist (a young woman, to whom she could relate) who understood her problems, was honest with her, and was able to get her to work on being her own individual person. Other doctors seemed to think they could improve her condition solely by throwing drugs at it (and then never enough medication to actually help her). Part of me wonders whether Sylvia was just a self-indulgent, irritating pip who never learned to deal with the strength of her emotions. Is that all that mental illness is? Or was she seriously crippled by a chemical imbalance (dopamine uptake deficiency)? After reading this, I’d like to find something more recent that gets into the whys and hows of schizophrenia. I hope some progress has been made since the 1980s.