A psychiatrist since 1949, I was psychiatrically hospitalized on December 21, 1963 at New York City’s Mt. Sinai Hospital. I stayed for three months, was diagnosed correctly as “schizophrenic reaction, paranoid type,” and recovered fully. This report examines the cause, development and treatment of my illness, how and why I recovered, and the often irrelevant responses of the psychiatric colleagues from whom I sought professional help.
I was forty when I was hospitalized. I had been happily married for nineteen years and was the father of three. I had been certified in psychiatry in 1953 by the American Board of Psychiatry and Neurology, and was a 1954 graduate of the Comprehensive Course in Psychoanalysis at the New York Medical College, which included four years of my own personal psychoanalysis. By 1963, I had spent ten years in the private practice of psychiatry (psychotherapy and psychoanalysis) in suburban Great Neck, Long Island, and was Clinical Instructor on the Albert Einstein College of Medicine faculty.
Why the Breakdown?
In the fall of 1959, I became deeply involved in efforts to defend our local school district – where my three children were students – against county-wide attacks on public education. In response to these attacks, I helped expose and defeat a skillful, hidden effort to use anti-Semitism to discredit Long Island’s public schools, about which I then published a report. A host of attacks upon me then began from many different directions. Although Hitler’s Mein Kampf specifically described “breaking the nerves” of his opponents by attacking them from several directions simultaneously, my insistence that that was happening to me was written off as evidences of paranoia – especially when some of those supposed attacks turned out not to be so. My efforts to combat the attacks led to my becoming hypervigilant – seeing malignant purpose in minor, accidental annoyances. I sought help from psychoanalytic and psychiatric colleagues, who, because I sometimes exaggerated the extent of attacks upon me, essentially denied the reality, or minimized the significance, of all of them. As I became increasingly suspicious and disabled, my relationship with my wise and loving wife, who saw the errors in my thinking, became increasingly strained. I became too tense to continue my psychiatric practice effectively, and seemed on a downhill course, with which none of the psychiatric colleagues I consulted seemed to be able to help. Finally, a cousin, Louis J. Soffer, M.D., an internist and endocrinologist at New York’s Mt. Sinai Hospital, persuaded me to enter that hospital’s psychiatric ward as a voluntary patient. That hospitalization, and Dr. Soffer, saved my life.
In the Hospital
I was given Thorazine for about a week, and started “tonguing” it during the second week, when the dosage was increased. Then, in response to my continued complaints about the medication – how it made me unsteady both physically and mentally – it was discontinued. I had therapy sessions with both the resident and attending psychiatrists, some of which were pleasant while others were rather combative, but none was of any significance; my notes reveal that I was sometimes quite sarcastic during them.
Soon after my medication was discontinued, I began regular physical exercise, running a mile a day in the hospital gym. I also began practicing my violin regularly. And toward the middle of my stay, I obtained permission to go to the nearby New York Academy of Medicine library to research a paper, which I then started, on psychiatry’s misrepresentation (particularly by my former teacher, Gregory Zilboorg, M.D.) of the medieval witchcraft epidemic. My paper showed how his writings had resulted in grave misunderstanding of that phenomenon. These three activities helped me become stable, and on March 24, 1964, I was discharged from the hospital. (The witchcraft paper was presented at the 1966 Annual Meeting of the American Psychiatric Association.)
The Hospital Summary
The summary’s “Identification” section described me as a “physician,” rather than a psychiatrist, said nothing about my three children or my several scientific publications, and described my being admitted “because of depression, anxiety, confusion and delusion of persecutions.”
Its “Present Illness” section said “(he) dated the onset of his illness to March, 1959, when he became actively involved in a local school issue. He was extremely bitter towards religious intervention, claiming that the Catholic Church was manipulating the community. He feared retaliation from the Church and began to have fear of people following him, trying to poison him and ruining his reputation. These paranoid ideas were also associated with the F.B.I., who he thought was tampering with his mail and tapping his telephone. His memory, concentration and frustration tolerance all became impaired. He could not take care of his patients. His practice decreased markedly. He became depressed, tired and fatigued. His sleep was very poor. A private psychiatrist advised hospitalization.”
In the hospital, according to the “Hospital Course” section, “he did well,… Thorazine was discontinued after a few days” – and symptoms gradually diminished, with no specific reasons given for that fact.
Serious defects mar this summary. Although I had even published a report on the fight over the schools, the summary totally denied the intermittent harassment to which both my patients and I had then been subjected, and on which I had taken careful notes as it occurred. Indeed, the psychiatrist caring for me in hospital totally refused, despite my strenuous urging, even to look at those notes; recognizing that some of my persecutory ideas were indeed exaggerated, he dismissed them all as paranoid. The hospital’s unawareness of the real reasons for my recovery – the three activities listed above, plus the hospital’s protective atmosphere – is also shown in its summary.
In 1985, when I originally prepared this critique of my hospital experience, I wrote that “this 1963 psychiatrist (who cared for me) had little awareness of what was really happening with his patient – me. There would be even less awareness today. Psychiatrists’ efforts to understand patients’ thinking, which mine did try then, have been almost completely replaced by attempting to determine the correct ‘diagnosis’ and drug for the patient’s particular symptoms.” Now, in 2012, that statement is even truer.
What Happened Afterward
I had great difficulty finding work after my discharge from hospital, even though I was a board-certified psychiatrist. I was finally hired late that summer as a staff psychiatrist at Kings Park (State) Psychiatric Center on Long Island. Two years later, I transferred to Bronx Psychiatric Center, where I was soon promoted to Chief of Service and then Assistant Director. In 1973, on the basis of a civil service examination, I was appointed Deputy Director, Clinical, at Kingsboro (Brooklyn) Psychiatric Center. In 1978, having reached fifty-five, and with twenty years of pensionable service, I retired from there. After a visit to Cambridge, England, where I saw a care system based on “continuity of care” – and therefore far more effective than ours – I took on a part-time after-care clinic position at Creedmoor Psychiatric Center, another State facility. There I was extremely successful treating unselected aftercare patients using what I had learned from my own illness: getting them involved in useful and satisfying activities – as well as examining their present and past lives and problems, and reducing medications to a minimum. But that is another story.