by Bette Howland.
Viking. 206 pp. $7.95.
There have been so many books about suicide attempts and nervous breakdowns—either novels, usually thinly fictionalized, or direct autobiographical accounts—that they could be said to comprise a sort of morbid literary sub-genre. As with the recent plethora of books by parents of dead or dying children, attempted suicide is apparently an experience that fairly compels one to write it all down. But write what down exactly? And to what purpose? For the writers, it is perhaps partly an attempt to make sense out of a harrowing time in their lives when they had in fact left their senses, and often these books have the quality of an act undertaken as exorcism, as insurance that it will not happen again. For readers—and books, especially novels in this category, are often very popular—the motives are at least as complicated: they are offered at safe and easy remove a vicarious entry into a world that is half-dreaded and half-wished-for. For them, the peculiar and insidious allure is twofold: many of these books or poems, by virtue of their being books and therefore by novelists or poets, suggest, if inadvertently (and sometimes it is not inadvertent at all), that acute, extreme mental distress is somehow a higher state, a condition akin to or necessary for artistic creation. Indeed it is often suggested that this mental state is art’s substitute or equivalent, and as such does away with the need for the drudging proof of actual work. This particular romantic misconception is most commonly found among adolescents, but adolescence, it seems, has a way of lingering on. (It was Camus who said, “Suicide is prepared within the silence of the heart, as is a great work of art.”)
The second fallacy that many books in this genre propound, again perhaps unwittingly, is even more seductive. That is the notion that surrender to the helplessness of illness can bring, if not salvation, then at least comfort—a kind of perversely luxurious freedom or abdication from not just the necessarily painful and difficult dilemmas of human life, but from its actual shaping and direction. If I can’t cope, then someone else will do it for me, they’ll take care of me. Since the “they” involved is invariably a psychiatrist, such a subtly advocated easy slide into total powerlessness imputes a nearly magical efficacy to psychiatry that psychiatrists themselves would probably be the first to disavow. Even in books that do not enshrine suffering (I Never Promised You a Rose Garden) or are harshly critical of specific psychiatric practices (the various shock treatments in The Bell Jar and Faces in the Water), individual passivity and helplessness as a route to rescue at the hands of a remarkably omnipotent Other are in some ways encouraged or glamorized. A notable exception to this representation of psychiatric hospitals is Ken Kesey’s One Flew Over the Cuckoo’s Nest, but this novel’s objective is specific and polemical to an entirely different end: the authoritarian, brutal mental hospital is viewed as a paradigm of authoritarian, passion-crushing bourgeois “Amerika.”
W-3, Bette Howland’s account of her attempted suicide and attendant brief psychiatric hospitalization, is not burdened with any of the familiar ideological baggage of most books of its genre. It does not purport to be muckraking in what might be called the first-generation tradition (Mary Jane Ward’s The Snakepit, Jane Hillyer’s Reluctantly Told), nor does it belong with those books of subsequent generations whose presenting voice is a dazed, flickering whisper creeping in and out of a sensitive, poetic haze—a haze which in practice, as Mrs. Howland points out, is increasingly due to the overwhelming reliance on psychotropic drugs. This book’s singularity and strength derive not only from the writing itself, which is powerful, lively, and instantly evocative, but above all from Bette Howland’s unusual angle of vision: she writes as if she were a participant-observer, a novelist-anthropologist in a strange, often perplexing new place. This ability to distance herself from her own immediate suffering has yielded a remarkable result: it has enabled her to present a picture of life in a psychiatric ward that is humanly moving and politically astute. She understands and explains the social structure and power configurations of hospital life in a way that neither professionals nor patients commonly come to grips with, and that is rarely written about—only Erving Goffman’s Asylums comes to mind as an example.
Even before she was moved to the psychiatric unit (she had taken an overdose of sleeping pills and so for a while was just not physically well enough—“ready” was the word used by the psychiatrist who came to interview her), Mrs. Howland began to be aware of the peculiar underlife of the hospital: the thin, uniformed black cleaning women listlessly pushing their mops, the white-coated, yawning medical students, the night nurses dully talking: all those people whose working lives are spent in a hospital and whose relation to the individual drama and pathos of illness and suffering is often only incidental. There is a clear sense of a hospital as simply another place of work:
For the sick in their beds were invisible. They were there only by implication. They must have existed, if only for the sake of this other life, full of importance—the bustling arms, starched coats; the carts, mops, ringings, beepings; the brisk comings-and-goings of white-stockinged nurses.
Once her physical condition improved, Mrs. Howland was transferred to W-3, the psychiatric ward, and found herself, willy-nilly, a member of a therapeutic community. It was a membership she had not sought and whose implications she did not immediately understand. Other patients, experienced in the ways of psychiatric wards, did understand it: “Iris was not taken in by all this community stuff. . . . She had been around long enough to know that her survival in a mental ward depended on her status with the doctors. They were the ones who doled out the pills, the Passes, and finally the discharges.” Frequently piously assured by the staff that there were no rules, or rather, that the only existing rules were the ones the patients themselves agreed upon, Mrs. Howland found that to the contrary W-3 was all rules—even if they did not work or were sometimes unspoken. Patients quickly grasped what kinds of behavior, jargonized language included, were expected of them, deemed healthy, and they acted in accordance with the theoretical assumptions that the staff hoped were true. In their various states of druggy confusion and general disarray, they attended a dizzying number of fancily titled meetings: Community Rounds, Team Meetings, Patients Council; they had Halloween parties, went bowling, worked on projects in occupational therapy. “Hooking rugs was all the rage on the ward,” Mrs. Howland reports, but it was only the nurses who hooked their rugs with real enthusiasm. The patients were never allowed to close their doors, they always had to be out “participating, colliding, with life—life which was to be found somewhere out there, and not in ourselves.” Even at night, privacy was nonexistent.
Nowhere does Mrs. Howland suggest that the doctors or nurses were brutal or even lacking in sympathy with their patients. What she saw was sham, confusion, and what she calls “petty deceits.” The professionals on W-3 were bent on seeing their theories succeed, the patients were their proving grounds, and because it was a teaching hospital, most of the professionals were brand new at what they were doing. They were in the process of learning, they did not stay long; their stumbling and faltering was obvious and the more sophisticated patients were able to gauge the status and experience of their doctors by their mannerisms and the size of their offices. Ultimately, Mrs. Howland came to the conclusion that “the patients existed for the sake of the hospital, not the other way around.”
Although this is a confessional book of sorts, Mrs. Howland remains remarkably reticent about herself and her own inner life. That’s her prerogative, of course, but it leaves the reader feeling oddly cheated. She presents the superficial facts of her life and of her acute distress, but if this experience yielded her any redemptive knowledge or new self-understanding, she has simply left it out. She concludes finally that her hospitalization served its purpose because it freed her of “[her] own personality, [her] own particular history.” If actually achieved, this would be a highly dubious, not to say dangerous, goal. But Bette Howland is at her best when her keenly observing eye is turned outward. Watching, always watching, she misses nothing, grasps everything, and puts it all together with an originality and cogency that are rare and memorable.