Suffer Little Children
The history of hospitalizing minors for mental health issues is deeply entwined with that of youth incarceration. Sometimes the two share a room.
*See end for author’s note on anonymization of the child patient-detainees who appear in this essay.
I was born in the maternity ward of a hospital that had once been the first institution specifically for the mad: Philadelphia’s Pennsylvania Hospital. Exactly fourteen years and one month later, I was incarcerated in a psychiatric facility after breaking the first and only rule of safe psychiatric disclosure.
My psychologist had asked me if I had recently hurt myself. I said yes. She said how? I said a safety pin. She said where? I rolled up my sleeve and showed her the shallow marks that read, in the pre-irony parlance of early adolescence, Life sucks. She teared up and asked if I would do it again. I said sure; as long as life sucks, this helps. She asked me if I’d thought about suicide. I said yeah. She asked me if I’d ever try. I said probably not again soon. She cried and asked when I had tried. I said a few weeks ago. It was then she told me I would have to be “admitted,” but she would do her best not to have me go through the emergency department. She called in a special favor at a private clinic in the bedroom suburbs of Philadelphia, and my mother, having good insurance, took me there the following day.
The admission process took well into the evening. When I was finally escorted to my unit on the evening of the 1st of _____ in 2003, they gave me the “Welcome to the Child and Adolescent Unit” guide. I had been assigned to Adolescent I, a unit consisting solely of teenage girls, but maybe there was only one general “patient admission guide”. A few pages are now missing (it was not stapled; staples are contraband), and the fourth remaining page reads, in part,
125 points per day
1. Confined to the unit.
2. One phone call per day to or from parents only. Calls must be made during scheduled phone times and are limited to ten minutes.
3. Can be in TV lounge area during scheduled activities only.
— Ages 5–8: 8:30 PM
— Ages 9–13: 9:00 PM
— Ages 14–17: 9:30 PM
After remaining in good standing on level 1 for at least 2 full days, an increase may be requested at community meeting.
I’ve also kept my diary from my time there. We were given composition books and required to journal. There was not much else to do during free time, and I loved to write, so I filled most of the pages. I devoted as much felt-tip marker ink to my feelings as I did to observations about rules, norms, and other people. Often these observations stood in for events.
2nd of _____: We can’t go outside. I miss the trees. This place is like a prison. [Accompanied by a photo, carefully torn from a magazine without the aid of scissors, of a butterfly chained to a stake in the ground]
I recall with clarity what happened this first morning, the 2nd of _____. I was on Level I, unable to leave the ward to be escorted across the grounds to the cafeteria. My breakfast was brought to me in the common room, and I was reminded not to keep any of the food and certainly not to take it to my assigned bedroom. I instinctively bristled. When no one was looking I took half a croissant, wrapped it in a napkin, and shoved it up my sleeve. I claimed I needed to pee, which we did in the en-suite bathrooms. Out of the orderlies’ eyesight, I cached the pastry in the top drawer of my dresser. I returned for it during free time, ostensibly going to the bathroom again, and opened the drawer with a burning anticipation. I uncovered a croissant crawling with ants. I took them to the bathroom and flicked them into the toilet, several at a time. Then I ate a small piece anyway and smuggled the rest back to the common area to throw away.
2nd of _____: ‘SIP’ — It stands for “self injury precaution” or something to that extent. There are 3 levels of it:1. Might injure yourself. They check on you every 30 minutes.2. Crisis. I’m on that now. Checked on every 15 minutes.3. You injure yourself – watched even when you pee and shower. Back to Level I.
2nd of _____: Shanika – Fairly short. [Born in] the Dominican Republic. Has long, thin dreadlocks. [...] She told us a story about how this guy (she was 15, he 19) who lived in the apartment across from her dumped his long-time girlfriend and asked her to marry him. She was freaked out and he came after her so she hit him with a vase. She was transferred to Adolescent II. We don’t know why.
3rd of _____: Kendra – I thought she was anorexic. She would sit at the table and just stare at food. Or pick it, pull it. Then she started eating. It was just cucumbers at first. Then toast. Then orange juice. It escalated to ice cream! I was so proud of her, so happy. “I don’t trust her,” Molly said. I asked if she’s bulimic. “Yea. But I keep an eye on her.” [...] I believe she had been abused by her father but I can’t remember. She left yesterday and might be going to [eating disorder clinic]. I wish her the best of luck.
[No date:] Brit – Brit has been here a month and five days. She came in for drug problems. [...] She’s the one who has ‘problems’ with Mr. L [an orderly]. She’s only 13. [...] She’s been molested by her brother. I’m not that close with her but I’m growing closer because we’re both freaked out by the Tasha-Tiffany thing. They might put her in a group home. She’s been here so long because they’re looking for a foster home for her. I do hope it’s a good one and they find it soon.
[No date:] Alicia – She’s from Alabama and African-American. She’s great, she really is. She’s not like the rest of the people in here [at this point, incarcerated mostly for drug use] – she’s like me.
One night a week or so in, I awoke sitting up and breathing fast, staring at the shadows of the bars above Tasha’s bed. I scurried to the bathroom. Throughout my confinement I had been aware of the toilet tank: its lid was bolted down in the center, as was every heavy thing. I had laid something on the lid the second night and the bolt wobbled. I had pulled on it and it’d come clean out, each ridge a sixteenth of an inch of iron and rust. Amazed, I’d put it back, feeling just as I’d had when I’d eaten the piece of croissant. Now I removed the bolt. I squeezed it in my fist. I dragged it lightly across my arm. I thought of the SIP – watched while you pee, back to Level I, at least another four days until release – and I marched down to the nurse’s station to drop the bolt in front of the shatterproof plastic barrier.
“This came off the toilet,” I said. “I had a nightmare, and I can’t sleep.” K. was my favorite nurse. She emerged from behind her barrier to collect the bolt with only a hint of suspicion.
“If the nightmares are keeping you up, you can have a pill, or you can try what Alicia’s doing.”
I turned to see Alicia’s soft figure bent over a Dixie cup. She was inhaling deeply and with focus, but her chin quivered.
“What is it?” I whispered to K.
“Peppermint oil,” K. said.
I sat next to Alicia, holding the cup uncertainly. It cradled a strong-smelling cotton ball. I inhaled. I fidgeted.
Quietly, Alicia spoke. “It works for me sometimes.”
I don’t know how she disclosed; intimacy was so easy there, with no privacy and no social pretense. But she told me what her uncle did.
“I’m so sorry. I... I haven’t been... There’s a teacher at my school, though. I don’t know how to explain – Like with Brit and Mr. L?“
9th of _____: My mom told the school nurse, Mrs. P, about HIM [my junior high history teacher] when she was explaining why I was absent (it is part of the reason). I asked my mom what Mrs. P said, hoping for something like “it’s happened before.” She just said she wouldn’t say a word. I WANT her to say a word, more than one would be nice. I need her to tell [the principal]. No, I need to. I’m not sure if I’m right [anymore] but I’m going to. A lot of people here aren’t sure if they’re right. Jessica... Alicia... I’m not alone.
The advent of the modern psychiatric hospital was also the advent of the modern orphanage, and, too, the modern prison: the poorhouse. Paris’s Hôpital Général was the first such institution constructed for the purposes of undifferentiated confinement. Founded in 1656, it was described by historian Fernand Braundel as a “‘great enclosure’ of the poor, mad, and delinquent, as well as sons of good family placed under supervision by their parents” (Civilization and Capitalism, 15th-18th Century: The Structure of Everyday Life, 76). His turn of phrase here obscures the prevalence of young female patients, who were institutionalized along with the young men. A youth wing of the Hôpital was decreed in April 1684, alongside a pronouncement – here reported by Foucault – “that work must occupy the greater part of the day” (Madness and Civilization: A History of Insanity in the Age of Reason, 55). The poorhouse –the orphanage, the prison, the hospital – was also the workhouse.
The same year the Hôpital announced a youth wing to increase the general confinement of the “poor, mad and delinquent,” a treatise was published urging a specialized approach to madness. English physician Thomas Willis’s “XI. Two Discourses Concerning the Soul of Brutes,” in The Practice of Physick (1684),had its inspiration in the works of Francis Bacon and John Locke; it claimed that reason was the unique characteristic of mankind, and so to lose one’s reason was to lose one’s humanity. Willis proposed that to restore the human soul to the maniac would require specialized treatment rather than general work-penance. And that treatment would need to address the maniac in its present state, as “animal Spirit.” Willis writes, “The first Indication, viz. Curatory, requires Discipline, viz. threats, bindings, or stripes, as well as Physick; and therefore the mad Person, being put into a House fit for that purpose, let him be so managed ... that he be kept in a manner always in his due behaviour ... and is reduced to order” (482).