Review and Reflections by Mary E. Latela
Annita Perez Sawyer has written a searing condemnation of her treatment as a patient in the mental health system from the 1960s onward. Now a prominent clinical psychologist, she attests to the horrid system of private and state care in NY state. She was given the “default diagnosis” for a suicidal young woman, namely, borderline schizophrenia, but that diagnosis was inaccurate. The treatment of choice was ECT, (electroconvulsive therapy) thought to jostle the brain with electric currents and thereby bring an end to the swirling thoughts and feelings, replacing them with numbness and memory gaps. She underwent 89 ECTs, an enormous sum, though her doctors recorded no improvement and in fact considered her treatment to be a failure.
As I read Dr. Sawyers’ account I thought about the state system in CT when I grew up and worked, and the similar arbitrary collection of various patients treated with drugs. In the 1950s the first wave of anti-psychotic medication – including trazadone – came out, with terrible side effects such as permanent tardive dyskinesia. Patient stays in mental hospitals began at a month for evaluation, but the meetings with actual psychiatrists were limited. The Ward nurses dispensed medication, watched over the units, and when trouble arose, called in the security trained workers who used physical restraint to “calm the patients.”
After reading the initial section of the book with the terrible, frightening symptoms and her absolute refusal to discuss intimacy, I speculated that Dr. Sawyer’s illness was hidden within her childhood. I was familiar with the symptoms, but she had no memory of anything unusual.
Connecticut closed them to save costs. State facilities housed on different wings: elderly people with dementia like symptoms because of their special care needs; persons deemed to be criminally insane; the lifetime bipolar patients; and the personality disordered. Once the hospitals closed, patients were sent to live in apartments and houses in the community.
I was an early trainee working with former patients making their transition back into the community. Unfortunately, many residents could not survive in the daily routine, and longed for the safety and refuge of the hospitals. As residents were unable to cope with independent housing, they were sent to shelters where fears, symptoms out of control, and poor supervision caused many to leave. Homelessness was a lonely effect for many.
Bloomingdale Insane Asylum where Dr. Sawyer was treated was a private hospital for the care of the mentally ill founded by New York Hospital. It occupied the land in the Morningside Heights neighborhood of Manhattan where Columbia University is now located.
Sawyer was accustomed to being “a good girl,” so she complied with her doctors’ orders, except that she felt she must die because she did not deserve to live. Her suicidal leanings led to extended stays, and even home visits were a nightmare. The family did not have counseling, as they might now, since Annita was the “identified patient.” It was her illness that kept her family hostage. The theory of family systems has replaced this notion. A family and the components all enter into the makeup of a family and functioning of the family. By blaming one person, the problems of the family were not subject for discussion unless the patient introduced them.
Through her own determination, persistence in working with several fine psychiatrists, Annita improved.
She earned advanced degrees, and worked through extended internship to become a bright individual provider of counseling. But first she read her medical records of which she had little or no memory. What she read became the impetus to tell her story, a brutally honest examination of her struggle to come back to the community, to become the accomplished professional her teachers had always expected of her.
This is a courageous book of controntation of a broken system, a haphazard approach to the rising incidence of mental illness. Dr. Sawyer’s clear communication and her willingness to share her story will leave many readers breathless. This is a must read!