Dec. 18th, 2011

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A Separate Sphere

Historical note: The turn of the nineteenth century marks a period of profound change in the psychiatric profession. Medical doctors had made huge gains with the discovery of antiseptic and anaesthesia; surgery moved from the barber shop to the operating “theatre” with real success. For the first time, physicians were established as professionals rather than “quacks”, gaining credibility in the public eye for actually possessing curative skills. Psychiatrists hoped to duplicate that feat. Insane asylums (once known as “houses of horror”) were abandoned, and in their wake sprawling estates with parks and farms along the lines of the grand English country homes sprang up. Moral treatment was the order of the day in a society now accustomed to opulence, and asylum doctors firmly believed that compassionate care could and would assuage the ills of modern life.

On other fronts, psychiatrists begin to look at lunacy as a disease of the mind in a very literal sense. The claim by Emil Kraepelin in his Handbook of Psychiatry that madness was caused by organic diseases with corresponding brain pathologies was initially met with derision, but when Alois Alzheimer found distinct differences in the brain tissue of his 51-year-old dementia patient who exhibited short term memory loss and other unusual behaviors, the idea took root, sparking a frenzy of research. The idea was taken to the extreme: Henry Cotton made the bold claim that the root of all insanity was infection and took to removing teeth (the closest culprits to the brain) and vital body parts to cure his patients.

Simultaneously, Sigmund Freud and Carl Jung were on the rise in Europe with differing philosophies of neuroses that caused other types of mental illness, among them paranoia and homosexuality. These camps formed the opposition and very soon the battle of mental neuroses versus organic brain disease was being played out in the medical journals. Asylum doctors formed their own association (Association of Medical Superintendents of American Institutions for the Insane -- the AMSAII) and incorporated one, both, and then some, into their own practices. The asylums -- now called “state hospitals” -- were unique in that a single doctor, the Superintendent, established the culture for his hospital. In the case of Cotton and Trenton State Hospital, this meant tremendous suffering and frequently death for his patients (Cotton was brought before the Bright Committee in 1925 to face his accusers); for the patients of McLean State Hospital, it meant luxury housing with quarters for their servants, fine dining, and leisurely days spent painting or reposing in lawn chairs.

The era of the great asylums ended with the reality that the dollar costs of these institutions were simply too great to be borne by society. With the advent of psycho-tropic drugs, patients were once again returned to the care of their family, relieving the state of the expense. Tragically, these beautiful monuments fell into decay and have for the most part been destroyed to make way for modern facilities. This story is penned in their great memory.

Author’s note:  While some of people (Adolf Meyer, Sigmund Freud, G Stanley Hall), places (Worcester State Hospital, Clark University, Ellis Island), and events (WWI, 1918 pandemic) are real, this is a work of fiction. We have taken a great deal of liberty in re-writing the history of Worcester State Hospital for plot purposes. While the history of the asylums in the early 20th century is most definitely riddled with abuse, the accounts in this story are completely fabricated. Moreover, in the absence of a facility blueprint, we have reconstructed the original complex to the best of our ability based on photographs and the one surviving diagram of the original structure. Any ominous reputation we have bestowed on Lowell Home and its inhabitants stems entirely from our imaginations.

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Prologue

The clocktower of the old asylum is all that remains, the rest long since torn down after the fire. Its windows are boarded up, its walls crumbling. The vampire easily hops the high chain link fence and appears at the entrance he knows so very well. He carefully removes the door blocking the entry and slips undetected into the dark interior of the decaying building. The furniture is worn with time and the fixtures hang askew, but whether from vandals or work crews he isn't sure. Thoughtful, he passes down the hall until he comes to the staircase. It is still standing, a circular marvel spanning four stories. He climbs it, taking note of the weak spots that give under his weight, and opens the door on the landing of the fourth floor that leads further up to the attic of the great tower. There, he stares at the clockworks, stilled by rust, and leaning against the dank, rotting wood, vividly recalls that first day as if it were only yesterday.



Chapter 1: In the Company of Strangers


To His Excellency the Governor and the Honorable Council.

The trustees of the Worcester State Hospital respectfully submit their
eighty-fifth annual report and solicit your careful consideration of the
reports of the superintendent and treasurer which are appended.

To the Trustees of the Worcester State Hospital.

I herewith respectfully submit the following report of the hospital for
the year ending Nov. 30, 1917, it being the eighty- fifth annual report.
…..
Though the number of patients admitted during the year has been appreciably
less than that of the year before, the number remaining in the hospital
is greater, due to a lessened number of discharges. It is pleasant to
note that the percentage of recoveries has been higher and the
percentage of deaths lower. It would be difficult, however, to draw
conclusions of much value from the statistics of a single year. Of the
patients admitted for the first time more than half were foreign born, some
twenty different countries being represented. In type of disease dementia praecox
leads by a large margin, followed by senility, alcoholism and general paralysis, in the
order given.  Of the general paralytics nearly one-half were women.
Considering the ages at which first attacks of insanity occurred it
seems, as perhaps it would be reasonable to expect, that the greatest
prevalence of insanity is during the periods of the greatest
mental and physical activities. A study of environment seems to show
quite conclusively that general paralysis is many times more frequent in
persons admitted from urban than from rural communities. This is also
true in lesser degree of dementia praecox and alcoholism.
...
The general health of the house has been good. A few cases of contagious
disease have developed, all of which had a favorable outcome. Strict
quarantine quickly controlled the spread of disease and no general
outbreak occurred.
...
Dr. Gilfillan was granted indefinite leave of absence to enter the medical
service of the United States Army. Much as we needed his services here
it was felt that his country needed him more.

E. V. SCRIBNER,

Siiperinte7ident. (sic)
Nov. 30, 1917.



Of the figures racing pell-mell through the sudden shower, only one crossed the road at a regular pace, umbrella calmly held aloft. The new resident pathologist at Worcester State Hospital – the first in fact to occupy that new position – was seeing the grounds for the first time and while he loathed inclement weather, nothing could dampen his enthusiasm for the magnificent beauty of what was to be his home for the next several years. He gazed with something akin to pride at the granite and red brick structure that gracefully curved back around itself like an English gentleman’s country estate, every wing unique and critical to the art of the structure. The architectural detail was extraordinary, turrets and towers and arches and stairwells that appeared where one least expected, affecting near perfect if not actual symmetry. The manicured lawns and cultivated gardens pleased him inordinately for they demonstrated an additional touch of civility that he felt necessary for his own recovery. The limestone paths were laid with precision like criss-crossing rail road tracks and meticulously pruned of weeds and detritus so that they shone white against the greenery. The air itself was clean, natural, devoid of the stench of the inner city and the ocean harbor and for the first time he felt he might be able to reconcile himself to this life he was forced to endure.

Stepping under the portico of the clock tower, he folded and neatly deposited his umbrella in a bin where it stood solitary on that wet morning, removed first his gloves and then his hat to smooth his perfectly smooth hair, and unbuttoning his raincoat climbed the twelve unvarying stone steps to the heavy wooden door of the administration building. This he easily opened with his right forefinger (the others being engaged holding his gloves and hat) and stepped inside, preparing himself to face the public.

The hall was in an uproar as staff members struggled out of their sodden garments, leaving muddy puddles on the tiled floor, grumbling to one another about the unexpected downpour. He observed them briefly, lingering a few seconds to memorize the dozens of faces before his gaze fell on a large, stern woman standing in front of the window counter. She, too, watched the scene in the room with a grim satisfaction that he understood immediately. Having gauged her personality, he composed his features in a bland, humble manner and approached the hospital matron softly so as not to interrupt her many more important tasks.

She had already spied him – the only dry, tidy member of the room – and conveyed her complete and utter disapproval of his singularity in a withering stare that was meant to break him. He stifled the urge to rise to the bait and coughed delicately, eyes downcast, saying in what he hoped was an especially winning tone, “I’m Carlisle Cullen. I believe Dr. Wehler is expecting me?” He knew better than to affix a title to his own name.

She observed him coldly – blond hair to black Oxfords – and promptly put him in his place by turning her back to address another question before acknowledging his. “Dr. Wehler,” she said in the clipped manner of the New England blue bloods, “is indisposed. You’ll have to wait.” For emphasis she slammed the wooden clipboard she was holding onto the counter, making him flinch.

He meekly acquiesced, turning to take a seat on a bench as far away from her as possible. Inwardly he sighed; he had just made his first enemy not five minutes into his first day. It wasn’t altogether unexpected - he was the sort of person that aroused jealousy in others -- but he had hoped it might have been later rather than sooner.

Abruptly he cocked his head to one side. Amidst the noisy commotion in the hall, he could distinctly hear the heavy footfalls of a familiar figure approaching from the west end of the adjacent building. He knew Wehler was already on the way to greet him even before his keen eyes spotted him; he could smell him – the odd mixture of rich food, stale sweat on fine wool and expensive cigars.

"Carlisle!" The booming Germanic bass of his superior resounded even in the busyness of the room. "There you are! And didn’t bother to check in, eh?” Wehler clapped him hard on the back. Carlisle did his best to wince as the man’s sizable arm struck him, adding a slight stagger for effect. Wehler continued, undaunted by his own stinging hand, “Thank God someone had the sense to come prepared for the weather! Half the staff is holed up trying to dry out."

Carlisle murmured something polite about an Englishman always being prepared, only to be drowned out by his enormously fat friend who was eager to get started. "Leave your coat and things here and we'll go right in. I don't have an office for you yet," Wehler apologized, looking terribly embarrassed not to have better offerings. “We were lucky to get the position approved at all,” he added in his defense.

Carlisle hastened to assure him that he was delighted to be there and required nothing at the present. Mollified, the older man proposed a tour which was readily accepted and the two men strolled down the foyer past the drenched personnel to descend the steps to the basement. “It’s flooding,” Wehler looked out the window at the sheets of water forming pools in the lawn that then spilled onto the walkways, “We’ll take the tunnels so you don’t get your feet wet.”

Considering he had just hiked a good half-mile from Belmont Street, the idea seemed absurd but he expressed genuine excitement at seeing every part of the structure, even the complex’s connecting tunnels used to convey heat and water.

He followed the assistant superintendent to the basement of the clocktower, chatting amicably about shop matters. The stairs were neither steep nor numerous, but the fat man huffed and puffed and paused frequently to catch his breath. The tunnel was narrow but not uncomfortably so and well-worn so that the going was easy enough.

"You'll get lost the first few days. Or weeks!" The German wagered gleefully when they emerged into Appleton Hall. He was very pleased with his little kingdom.

Carlisle laughed as well -- eyes downcast to hide his real thoughts. He had already formed a complete mental grid of the hospital’s complex lay-out thus far during their walk and knew exactly where he -- and everything else -- was. He would never get lost.

Wehler introduced him to everyone they passed in the many halls, all of whom were delighted to make the pathologist’s acquaintance. (“You see, Carlisle, you are our hope for the future!”). And in response to their polite questions, he offered the standard explanation of his past.

“It’s a step up from the squalor of Ellis Island, at least,” Wehler offered as they walked through Howe on the other side of the complex.

“Ellis Island?” A fellow sniffed distastefully. “That has to be the pit of all humanity!”

Carlisle concurred, but for reasons, he suspected, quite different to those of his interlocutor.

They meandered back through Washburn to the laboratory where he was introduced to the Clark graduate students. He spent some time with them reminiscing about collegiate matters, an experience he in fact had never actually had. “Ah, the dissertation!” he clucked sympathetically to a young man and manufactured one of his own to discuss.

“Hospital life is a whole lot different to college!” a friendly soul laughed and the other attendants in the hall took it up, guffawing as if it were hilarious. Carlisle was baffled but appreciated their enthusiasm. It has been too long since he had felt anything like that.

“Enough!” Wehler roared across the room, causing the petri dishes and test tubes to rattle imperceptibly on the steel lab tables. (Carlisle smiled again, but to himself this time.) “You’ll have time to get acquainted after rounds. Now get to work!” he bellowed and his students all made good-natured retorts to his back as he pushed Carlisle through the door to continue on their way.

The final stop, as anticipated, was the dining hall where Wehler deposited his substantial bottom onto a chair many sizes too small. Carlisle heard the wood groan in protest.

He declined anything other than coffee (“You’ll never survive here on that,” Wehler warned) and listened patiently while his friend ordered almost everything available.

“Between you and me --” by which it was understood that this was common knowledge -- “you already know more than half the senior doctors here.” Wehler was eyeing his plate overflowing with runny eggs, crisp bacon, thick slabs of toasted bread, and a large stack of pancakes drowning in maple syrup. Carlisle paused to marvel at the human appetite. “I suspect you’ll be able to teach me a thing or two, hmmm?” Wehler’s enormous mouth opened like a cave as he shoveled an assortment of food items into the orifice before swallowing it half-masticated and continuing. “And I have decided to assign you your own ward. I think having living case studies will be more conducive to your research. Make you our own Meyer, eh?” He voraciously downed another substantial portion from the plate.

Carlisle was fascinated by the grotesque spectacle. It had been at least 250 years since he had  sat at a table and watched a human being eat. He stared at the man's mouth as it chewed the mass, rolling it this way and that, and then followed the lump as it descended the gorge before speaking. “Will I be given the opportunity to perform my own autopsies?” Human clumsiness invariably destroyed valuable information and he preferred to work with the raw material, to observe the brain untouched, rather than having to reconstruct what it might have looked like before the careless slip of a finger.

“Oh, I am certain that can be arranged,” Wehler said airily, waving his fork. “Each of the wards has a staff surgeon but really we perform so few autopsies here. Most of the specimens we have come in from elsewhere. Still, just a matter of putting you in touch with the right people, I think.” And he turned his attention back to his breakfast.

Carlisle sat back, mulling over the possibilities. He was quite pleased with the state of things thus far.

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