88 pages • 2 hours read
Susanna KaysenA modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more. For select classroom titles, we also provide Teaching Guides with discussion and quiz questions to prompt student engagement.
The head day nurse, Valerie, is described as a fair, lean 30-year-old who generally connected well with the patients. Kaysen notes that she was strict and consistent, and unlike some of the nurses, was not afraid of the patients, which earns her their respect. The patients were required to see a ward doctor, resident doctor and therapist in separate appointments once per day. Kaysen characterizes her therapy as unhelpful since the professionals used medical jargon to make everyday patient activities sound suspicious and did not try to relate to their patients. Kaysen shares that resident doctors generally served the ward for six months and left either exhausted or embittered from their experience, since the patients often manipulated them. The therapists, and sometimes the residents, prescribed a medley of medications to patients, such as Thorazine, Stelazine, and Valium. Kaysen feels that it was the staff, not the patients, who became more reliant on the patients taking these pills, as it made patient behavior more manageable.
Kaysen and the other patients dreaded the mid-afternoon, when power shifted from Valerie to another nurse named Mrs. McWeeney, who Kaysen considers “an undisguised prison matron” (83). She hated Mrs. McWeeney’s temperamental behavior and lack of humor, and the patients frequently complained to Valerie about her. Other “keepers” on the ward included student nurses, who were generally about 19 or 20 years old, and so were peers to most of the patients. These nurses were constant reminders of the “alternate lives” the patients could have been living if they were not in the hospital. The student nurses often developed close relationships with the patients and even asked them for life advice about school, family, and boyfriends.
The year 1968 was tumultuous, and the patients kept up with the outer world by watching TV, where they saw the constant disruption and violence of protests and the ongoing war in Vietnam. They also followed news stories about the assassinations of prominent leaders such as Martin Luther King and Robert Kennedy. Kaysen and the other patients related to the perspective of anti-war and anti-establishment protesters and “cheer[ed] them on” (87). Kaysen notes that it was easy to, since supporting the movement from inside the hospital left them insulated from the violence and imprisonment that many protestors faced. Kaysen shares that as the protests gained momentum, the patients were more docile, since they felt that all their rage was acted out for them by the protestors. However, their devotion to the cause ended in disappointment when they saw Black Panther activist Bobby Seale bound and gagged in a courtroom, “in chains like a slave” (88).
Kaysen reveals that while McLean could feel like a prison, it also functioned as a refuge for patients, since they were completely freed from social and financial obligations while inside. While patients could choose to study or maintain contact with friends and family, they could also refuse to do anything other than take medication and eat. Kaysen claims that it was somewhat liberating for patients to lose “our privacy, our liberty, our dignity” because this meant they have “nothing more to lose” (89).
Families of patients had to pay for them to remain at McLean, and Kaysen feels that many families had significant problems but elected one family member to be “designated as crazy” and put away (90). While most families were determined to distance themselves from the “crazy one” in the family and continue to pay for their hospitalization, other families were uncomfortable with it and wanted to get their family member out of McLean.
Torrey was a well-liked patient who struggled with an addiction to amphetamines. Her family was not supportive of her stay at McLean and resented paying for her treatment. They blamed her for other family problems and eventually insisted that she return to the family home in Mexico with them. Lisa, Georgina, and Kaysen all conspired to give Torrey their pocket money and helped her plan an escape from her taxi on the way to the airport. However, Valerie gave her Thorazine, which had a sedative effect, and her friends knew she would be unable to escape, which was distressing for them. To avoid thinking about Torrey leaving, Kaysen began examining her hands and was suddenly anxious at the thought that she might not have bones. Increasingly angry and nervous, Kaysen began biting her own hand to try to see inside. Her friend Georgina was alarmed at this, and Valerie gave Kaysen Thorazine, which she says made her legs and feet feel like “mattresses”, and she needed help walking to her room (97). At the end of the passage, Kaysen hints that she felt more safe and secure thinking that she is “really crazy”, and no one could take her out of McLean (97).
Kaysen developed a painful swelling in her mouth, and saw a dentist at McLean, who advised her to have her infected wisdom tooth taken out. Feeling distrustful of the dentist, she refused and instead opted to take antibiotics. Her medication successfully controlled the infection, but she had an allergic reaction to the Penicillin. Valerie took her to Boston to visit a different dentist, who performed a surgery to remove her wisdom tooth. When Kaysen woke up from the anesthetic, she was concerned about how long the surgery took, since she felt that she lost that time. When no one tells her, Kaysen became upset, and cries in the taxi on the way back to the hospital.
A new patient named Alice Calais entered the ward, and the other patients were surprised by how quiet and naive she was. Alice did not seem to know very much about the world, and claimed to have missed many everyday life experiences, such as trying honey. Kaysen and the other patients were curious about why Alice wanted or needed to stay at McLean, and she comments that for several weeks she offered “no evidence of being either really crazy or interesting” (103). After a month, Alice’s condition worsened and the other patients heard loud sounds from the seclusion room before seeing her transferred to the maximum-security ward. Kaysen and her friends requested a visit to Alice, which the nurses allowed. When they arrived in the maximum-security ward, they were struck by the sparse, prison-like atmosphere with bars over the windows, doorless bathrooms, and secure nursing station. Each room was furnished only with a mattress, and Kaysen and her friends found Alice sitting on her mattress, with excrement smeared on herself and her walls. After a brief visit, Kaysen, Georgina, and Lisa returned to their ward, where they wondered if they could also end up like Alice. Kaysen was anxious that the same thing could happen to her, and Georgina advised her, “Don’t let it” (106).
Kaysen suggests that student nurses had a better effect on the behavior and wellbeing of patients than therapists, which Kaysen attributes to the cultural and personal gulf between McLean’s middle-aged doctors and therapists and their patients. The doctors and therapists used language that Kaysen found pretentious and unnecessarily negative. She explains, “They had a special language: regression, acting out, hostility, withdrawal, indulging in behavior” (79). These terms left Kaysen feeling demonized and further misunderstood. Kaysen describes one of her therapists, a South African named Dr. Wick, as “utterly innocent about American culture, which made her an odd choice to head an adolescent girls’ ward” (80). Kaysen admits to lying to Dr. Wick in therapy by telling her what she seemed to want to hear.
In contrast, the student nurses elicited close connections with their patients and their presence in the ward prompted patients to be on their best behavior. Kaysen claims that this is because of their status as peers. She explains, “...when we looked at the student nurses, we saw alternate visions of ourselves. They were living out lives we might have been living, if we hadn’t been preoccupied with being mental patients” (85). Indeed, Kaysen argues that the patients wanted to live vicariously through the student nurses and felt a sense of protectiveness towards them. She writes, “We wanted to protect them so they could go on living these lives. They were our proxies” (85). By including these details, Kaysen contradicts the notion that doctors and therapists always understand what is best for their patients and demonstrates the power of genuine friendships and connections to foster mental health.
Kaysen builds on her theme of consent in medicine by explaining Torrey’s plight. The other patients tried to help Torrey plan a successful escape, much like a prisoner trying to escape from jail. However, before she could leave the hospital, she was drugged with a sedative, which incapacitated her and left her unable to escape from McLean or her family. Kaysen also explores the relationship between stress and mental illness. After Torrey’s distressing departure, an upset Kaysen began to overanalyze her own hands and question if she had bones. She writes out her inner thoughts, saying, “I started getting worried. Where were my bones? I put my hand in my mouth and bit it, to see if I crunched down on something hard […] ‘It’s my hand,’ I said. I was angry. And I was getting really nervous. Oh God, I thought, there aren’t any bones in there, there’s nothing in there” (96). She expresses that she felt unsafe, and she, too, was sedated. By including these two experiences in the same chapter, Kaysen draws a connecting line between the trauma of witnessing Torrey’s coerced departure and her own anxious experience that caused her to question reality.
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