Non-fiction by Valerie Wagner
Sally Stockford had been locked up in mental hospitals since the age of eighteen. When I met her, she was sixty. She had been institutionalized for over forty years. Our group of nursing students was doing our psychiatric rotation at Fort Logan Mental Hospital outside of Denver, Colorado. I had been assigned Sally by the staff. Her diagnosis: schizophrenia.
Some of my fellow students were nervous about going to a psychiatric hospital, but I wasn’t. When I was a girl, my mother volunteered at Cleveland State Hospital, better known as the Northern Ohio Lunatic Asylum. She belonged to an entertainment troupe that put on skits for the patients. She told me sad stories about things she saw there, but more often she came home uplifted by the joy she had seen on the faces of the audience, the patients. It made her feel good to know she helped make their day better. I entered my psychiatric rotation with the same spirit.
After a brief orientation in a claustrophobic boardroom, we were instructed to check in at the nurse’s station for our assignments. A nurse showed me the way to the dayroom, where I was to meet my patient.
“It will be quiet this time of day, between breakfast and lunch,” she explained.
The room was nearly deserted; only a few patients milled about or shuffled by. The room appeared clean and orderly, yet the fluorescent lights enclosed everything in a sickly greenish hue. The nurse pointed to Sally, who sat alone in one of the chairs lined up near the far wall.
Sally wore a skirt that came just to the top of her knees. It fit snugly on her stocky body, as did her tucked-in blouse. Her hands were folded on her lap. Her legs were bare and white. Her clothes were going-to-church clothes, except for her naked legs. I could tell she had dressed up for our meeting.
I bent down and introduced myself. “I’m Valerie and I’m going to be your nurse today. I’m from the college.”
“Hello,” Sally answered.
Her face held no expression. She glanced up for the briefest of moments. I had read in her chart that her eyes were blue, but today they were the murky gray of a stagnant pond. Sally sat politely, knees pressed together, looking straight ahead, as if waiting for something to happen. When I sat beside her, she began to rock rhythmically in her chair. I wondered if my presence agitated her. I had to think of something to say.
I glanced at her bare legs again and wondered if she felt cold with them so exposed. “Sally, why aren’t you wearing stockings?” I asked in my best I-am-a-nurse-and-here-to-help voice.
Sally said something in a fast slur of words I could not understand.
“I’m sorry, I didn’t hear you.”
“Silly Sally hangs herself,” she repeated rapidly.
Her words shocked me to silence. A rush of shame coursed through my body as I realized my stupidity. I fought an urge to run out of the room. It took everything in my power to sit there, composed. My palms felt moist, my heart raced, my mouth went dry and my head reeled with what I had just heard. Of course they would not allow something like stockings in a place where people could be suicidal.
* * *
Early in my training, I had a strict ex-army nurse as an instructor. She called me on the carpet for having what she called “exaggerated body language and facial expressions.” At the time, I felt offended. I came from an emotional family. I didn’t know I was being overly expressive. My instructor told me to be effective, to be professional, I must be aware of my own emotions and reactions. It was a hard lesson at the time, but invaluable. I took a calming breath and turned to Sally, who didn’t seem to notice how her words had impacted me. She looked instead to be waiting to see what we would do next.
“Would you like to show me your room?” I asked, changing the subject.
Sally nodded with a slight show of enthusiasm. I followed her down the stark hall: no pictures or decorations hung on the dull beige walls. The green tiled linoleum had a waxy shine and my white nursing shoes squeaked as I walked.
Sally walked with a surprisingly strong stride. Her legs were short but sturdy. Her hair lay matted in the back, where the comb didn’t reach. I had noticed earlier that it had been neatly combed and parted in the front.
* * *
I had read in Sally’s chart that she never had visitors. She had no living family, but even when she had, they never came. What I figured out after perusing her records was that Sally had been brought up in a strict Christian family. She left her rural home in Watkins, Colorado, in 1940 and moved to Denver to take a job. In that year, something happened. I couldn’t find out what exactly. Maybe she had a mental breakdown. Maybe she had been sexually active and doing things her family didn’t approve of. Maybe she wrote asking her family for money. Whatever had happened, her father had come to Denver to deal with Sally’s situation.
The simple truth for Sally was that her father had her committed to a mental hospital at the age of eighteen, where she was labeled mentally unstable. She would never be free again. Her family cut all ties.
Back in the Forties, when Sally was committed, there wasn’t a definitive way of diagnosing mental illness. The Diagnostic and Statistics Manual of Mental Health Disorders, better known as the DSM, didn’t exist until 1952. People were admitted to mental hospitals to languish for years for vague and various reasons. During Sally’s years in the mental hospital, she could have suffered any of the treatment fads of the time. Many were brutal. Some of the various treatment modalities during those years included being immersed in an ice bath for long periods of time, being given an overdose of insulin to induce coma, electric shock therapy (which is still used today), and ice pick lobotomies.
Dr. Walter Freeman developed the ice pick lobotomy. Its method used a tool much like an ice pick, which was pushed through the patient’s eye socket into the brain. It did not require anesthesia and could be done by non-surgeons. It was often performed after electric shock therapy while the patient lay unconscious. The tool was put in place, hammered through a thin bone, and then twisted around to break up fibers in the brain in the frontal cortex. Dr. Freeman personally gave 3,400 lobotomies during his career and that included children as young as twelve. He traveled in a van he called the “Lobotomobile,” visiting mental hospitals in twenty-three states. The most famous of his disasters was John F. Kennedy’s sister Rosemary. She was left physically and mentally disabled for life.
I found nothing in Sally’s chart that showed what she had endured during her forty years of institutionalization. Those old records, if they still existed, were not available to me; I had access to only the last ten years. At the time I cared for Sally, she had been on anti-psychotic medication for many years.
I remember thinking, who wouldn’t be crazy, after being locked up for forty years? If I lived in a different era, that could have been me. My father, a violent alcoholic, ruled our house like a tyrant. I had acted out, mostly outside of the home. My behavior in high school was wild and unpredictable. I cut classes, drank beer in cars with boys, smoked cigarettes, smoked marijuana, defied authority and made some bad choices. My behavior could be erratic and definitely considered crazy by some. It was a passing phase for me but what if my behavior back then had determined my whole future? What if I had lived at a time when a father, tired of his daughter, could have her institutionalized?
My heart ached for Sally and what her life had been. I carefully worked out my Treatment Plan for her. My main goal would be to increase her stimulation and exposure to things beyond the mental hospital and hopefully bring more joy into her world.
I was charged with enthusiasm for my mission. I spent time gathering things I thought would be of interest to Sally. I checked out books from the library with pictures of animals, gardens and artwork. She showed no interest. I tried to engage her in conversation about a number of topics. She remained silent. I invited her to the music therapy group, where I assisted. She never attended.
During the time I cared for Sally I never saw her smile or frown. Her facial expressions and tone of voice were devoid of most emotion. I began to suspect she may have been subjected to an ice pick lobotomy, although I would never know for sure. Her expressiveness manifested in her body movements. The two things she seemed to enjoy were walking and eating. She had vigor in her sturdy gait and always had a healthy appetite. I also could tell by her body when she became bored or tired of me. That’s when the rocking would begin.
On my last day with Sally, we sat in her room relaxing after our brisk walk around the halls. My chair faced a good-sized window. It had no bars, only thick glass. I looked upon a lovely little maple tree. All of a sudden, like magic, came a flurry of activity, as hundreds of tiny little birds descended upon the tree. The tree became alive with the flitting and fluttering of little bird bodies.
“Sally, come look!” My heart pounded with excitement.
Sally approached. I pointed to the birds and watched for her response. She had none. Her expression stayed the same as usual. Flat.
“Do you see all the birds?” I asked more specifically.
Sally looked out the window, then turned her head toward the little wind-up clock that sat on her bedside table.
“It’s time for lunch,” she said to me, same as she did every day, during this hour. I left the fluttering birds and followed her to the dayroom, for lunch.
* * *
It took me a while to realize it—I didn’t on that day, or for several more—but it finally hit me: Sally could not see beyond the window glass. She could not see the birds. Not because she was blind but because after forty years of being locked in the interior world of hospitals, she was no longer capable. She had grown blind to the world beyond her narrow confines, living only by the predictable routine of her days.
It has now been over thirty years since I met Sally. I am the exact age she was then, and as I have grown older, I have reflected on my life and on the lives of others. What I have noticed in all these years is that many people live in a world confined by barriers of their own creation like Sally’s window. We create our own realities and then believe them to be true.
I had felt captive in my father’s house for most of my childhood, living in almost constant fear of his angry alcoholic outbursts and rage. I left at seventeen, and I can still remember the rush of freedom I felt when I realized I had escaped. Although I had no idea what would come next, it had to be better than what had been. I chose to change my reality, and being able to choose was the greatest freedom.
As I think of Sally today, I realize that the biggest tragedy of her life was not her mental illness; it was that someone else decided her life for her. Sally never had a choice.