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Commentary


The lives left behind

Vol. 7, No. 5 / May 2008

I appreciate Dr. Nasrallah’s courage in giving voice to an opinion that many of us share but often are reluctant to express because the notion of asylum-based care is not politically correct.

This article was timely for me because I am reading The Lives They Left Behind: Suitcases from a State Hospital Attic, by Darby Penney and Peter Stastny. This book reviews the history of Willard Psychiatric Center in New York, which was the main employer in my hometown and where my mother and sister worked as psychiatric nurses before it closed in 1995.

Although Willard had warts— which I believe were related to its underfunded physical plant and difficulty attracting well-trained staff— it was a respite for many patients who could not live independently.

The book focuses on reconstructing the lives of long-term Willard patients from their belongings found in the hospital’s attic. What troubles me about the book is its nihilistic view of historic and modern psychiatry—a Szaszian view that there is a continuum of normal human responses to stress that includes delusions and hallucinations. According to this view, we have pathologized and medicalized normal behavior and poisoned people in an effort to help or isolate them. The authors liken patients’ meaningful work in kitchens, workshops, and on the farm to slave labor.

Living near Willard for most of my youth, it seemed to me that the benefits of purposeful work far exceeded what I see from the often-redundant arts and crafts recreational programs in today’s day programs and inpatient units. I was impressed with the ripe old age achieved by most of the patients profiled in this book, a luxury that I cannot imagine for many of my current patients. Too many of my patients cannot obtain safe housing or make routine primary care appointments.

This book provides proof of a strong antipsychiatry movement. Politicians seem comfortable under-funding mental health services by using the same misinformation to justify budget decisions.

Rory P. Houghtalen, MD,
Medical director,
Education and adult mental health,
ambulatory services,
Unity Behavioral Health,
Rochester, NY

To comment on articles in this issue or other topics, send letters in care of Erica Vonderheid, Current Psychiatry, 110 Summit Avenue, Montvale, NJ 07645, erica.vonderheid@dowdenhealth.com or click here.

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