By Barbara Kristaponis

My first real job when I moved to Manhattan was in a mental hospital. I did television. I was in charge of running the video studio, an insulated box once used for detecting electrical actions in the brain. This box looked like a refrigerator where you would find big hunks of meat, except it was lined in maple veneer and had a faded rose carpet. It was in the third sub-basement of an ivy-covered building on the river.

When you get off the elevator, you see unpainted basement walls, mops, and brooms against wide doors to rooms you know have no windows. Make a left when you exit the elevator. Walk down the narrow ivory-painted hallway to the box. Step up into the box and walk forward. Three large cameras perched on sturdy tripods in shadows on your right as you enter the box. Walk toward the two canvas-back chairs in front of you. If you and your doctor stand facing the back wall, stretch your arms out to your sides and hold hands, your free hands will touch the sides of the box.

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A patient with a razor-blade voice. He says, “They just soldier their spirits up and send them in on top of me.”

The psychiatry resident asks, “They do what? I’m sorry. I didn’t catch the word.”

“Well, you have a spirit inside yourself, and you can move out of your body. That’s how I get cooped up. By these soldiered spirits that move around, and you can learn how to do all kinds of things with your spirit.”

“The word ‘soldier’ means what?”

“Your spirit. Soldier your spirit up.”

“Oh, I see.”

“Develop your spirit from your body and let it go outside of your body and move around. And that’s how I get cooped up by these soldiered spirits that move around.”

“Well, your brother and your sister, do they soldier their spirits?”

“Yes.”

“Anybody else?”

“Friends of mine. Sometimes I’ll be talking with them and then when I leave them and I go home, then they’re still with me.”

“Oh.”

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In the box, the patients talk to their psychiatry residents as if they were their real doctors. You believe the resident is your real doctor. You don’t know that all final decisions about your diagnosis and treatment will be made by the supervising psychiatrist who sees you only on tape and through the words of your resident’s intake notes. Your student doctor is an M.D. Four years of heavy-biology-chemistry college plus four years of medical school plus four more years of a competitive psychiatric residency where they don’t get much sleep. Most often you will be talking to someone in the third or fourth-year of their residency. They will care about you. And they will be nervous. Everything is at stake here. For them and for you.

Almost always the patients have this look in their eyes, a trust there. A look that says “if I just tell you things, tell you that I cannot touch anyone without gloves on, or that this stone has my thoughts in it; if I tell you what I have told no one else, you will know how to make me whole in every way.”

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Black and white. That’s what my cameras are. I have outfitted the cameras with low-light newvicon tubes so I can keep the brightness level in the box-studio under ten foot-candles, one foot-candle being the amount of light made by one candle at a distance of one foot. So it is not so painfully bright or hot under our lights in that room.

I like to think I have made this box studio into a comfortable environment for patient and doctor, but it is, after all, in a third sub-basement, with four walls of fake wood paneling, and it is so tight, the space, that you could not turn around a bicycle should one land in there.

“How do you get so many psychiatric patients to agree to be videotaped?” physicians and therapists ask me. “Nine out of ten patients say yes”? Is that right?”

“Yes, it is,” I say. To be asked to tell one’s story on tape, perhaps they see it as a special honoring of their troubles and uniqueness. Patients often seem to regard our cameras, lights, and the hovering video crew-person as minor annoyances only. And there is the issue of pain in the head or heart so great that the story will out.

A patient newly seated in the box-studio and about to be interviewed often seems anxious to get rid of me, the video person, as if to say, “Move out, move out, I want to begin my song.”

I leave the box, only staying there a few minutes longer to pin lavaliere microphones on patient and resident, and on my way out, to make sure the cameras are focused. Leaving the box, closing tight the insulated four-inch door, I walk down the hall and around the corner to the office where I sit at a control console switching between the three cameras, monitoring the camera shots to be sure no one falls out of the frame. I am also listening so I can go in and rescue a microphone if it gets dislodged during the talk—a talk more revealing of private pain and fear than confession, more intimate than lovers after sex. These videotape therapy sessions happen every day, over three years, and by the end more than three hundred patient tapes each year. Four of us working in the video unit by the end.

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The resident stops a patient’s story to ask questions from the Mental Status Exam: “Who is the President now? What day is this? What year? Where are you right now? Would you count backwards for me from 100 in sevens.”

After the patient answers, the resident writes, “… fidgetity was present.” This patient is 23 years old and in the hospital now because he has horrible stomach pains and all the gastro-intestinal tests have revealed nothing. In his ashram, one night while he was washing dishes, the guru came over and told him, “You are going to die because of what you have done, and it is going to begin slowly with pains in your stomach.”

He is now hospitalized here and terrified. His eyes big and round and dark, he is not moved by any rational explanations for this pain. I never learn exactly what it is that he has done to merit such a curse.

Everyone is worried. We need stronger magic than his guru. We’re trying. We’re trying. But we have nothing in our bag for this. The weeks go on. The young man continues to get thinner and hunches over from the pain. I do nothing. I am only the person who watches.

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Psychiatry Grand Rounds Clinical Case Conference. Three hundred psychiatry faculty, residents, medical students, and nurses. During the 1980s, patients are no longer brought into the amphitheater to be interviewed on stage. Instead, a 15-minute edited videotape of the 55-minute patient-resident video session is shown. It is a difficult case. Or it is a rare case. Or it is a problem case.

I make the whole auditorium go dark just before the video comes on. Except for the little aisle lights at the end-of-the-row seats. The movies work on us the way dreams work on us, especially close-up pictures of the human face. And so I am trying something here. To take us all out of our usual way of looking at “cases.” This was not usual before I worked here, the auditorium going totally dark when the video was shown.

It is also not usual how I record these Grand Rounds videos. The patient is lit like Greta Garbo or Spencer Tracy in classical three-quarter portrait lighting. Soft. Diffusion silk in front of the small lighting instrument spreading a soft glow on the patient’s face. In the dark, Garbo is looking directly at you, extreme close-up on a movie-size video screen in the front of the large amphitheater. As if to say:

“I am not the mad schizo in 304.”

“I am not the manic obsessive from Idaho.”

“Not the masochist battered by her husband.”

“Not the alcoholic with the cane.”

“I am a star. Let my face haunt you if only for a moment, and let me remind you of everything you ever loved.”

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To make deer-hunting medicine, first you learn to see the bush that’s in front of you, then the bush behind that bush, then the deer behind the bush behind the bush that’s in front of you, then the spirit of that deer. Now you can call the deer, his spirit, and he’ll walk up to you. The people with the strongest medicine learn to fly out, their spirits, and find the deer that way. (Thomas Buckley, 1979)

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No one in my house used the word “depressed” about Uncle Edward. When he began to lock the door twenty times, every one in the family used other new words, “obsessive,” “compulsive,” “phobia,” but we never said “depressed,” or “grieving” even though all of this started after his wife Marilyn died of cancer.

He would lock the kitchen door, walk through the yard to the gate that led out to the alley, and then, his hand on the gate hinge, he would pause, drop his hand, turn and go back to the door again to lock it. Walk out to the gate. Pause. Return to the lock. Over and over. Then he quit going out of the house alone.

One time on a walk with his brother, he passed a child in the street and kept turning back to look. He put his hand on his brother’s arm and said, “I hurt that child.”

“No, no,” his brother said, “The child is okay.”

They call me from Baltimore to see what I think about electric shock for Uncle Edward. I feel out of my element here. I am not a medical person. I am a video person.

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The hands, and especially the fingers, are important in all Balinese dances, and provide an effective means of expressing the elegant, the diabolical, the stupid and the aloof. (Gregory Bateson and Margaret Mead, 1942)

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Seeing somebody wheel a patient on a gurney down the second-floor hall, that’s how I knew electroconvulsive therapy and everyone quiet at the nurses’ station. This was a ritual, this moment of quiet, but not like someone said, “and let us have a moment of silence now.”

No, it was rather an embarrassment of quiet, eyes downcast, to avoid meeting the glance of anyone else. Everyone became preoccupied with some small business of the hands, sharpening a pencil at the nurses’ station, rearranging knives and forks on dinner trays, doctors standing in the hallway taking off their glasses to clean them. Everything had a feel about it of looking down, all these small gestures. And quiet, so quiet, no chitchat, a thousand little frozen awkward moments.

As soon as the stretcher was rolled into the electroconvulsive treatment room, activity in the hallway resumed. Like after a game of statues that kids used to play outdoors in back yards. Bustle again, and no one seemed to have noticed that suspended silent minute or two as the gurney passed out of a doorway and down a fluorescent hall into another room.

But this day I am not in the hallway; I am in the electric-shock room to videotape a patient there. This room looks like a regular patient room with windows and thin green and yellow striped curtains separating Patient A bed from Patient B bed, except there are machines with blinking lights and beeps and intravenous tubing lines strung around and no chairs, no lamp for a visitor to read, no bureau for clothes. The two beds are narrow surgical-type beds raised high so that doctors and nurses can minister to the patient without them having to bend over.

The patient is a young man. He is thin, maybe 19, maybe 14, with blond hair and pale skin. His father is an anthropologist and the family had lived in Bali when he was growing up. I do not know why he was being given ECT, usually it is for a severe depression not being helped by medications.

I stay with my sound woman behind the curtain that separates A bed from B bed so the boy will not see the camera and gear in the room when they bring him in. The nurse whispers something to him as he is wheeled in from the hallway and lifted from the stretcher onto bed A. His ankles and wrists are then strapped down, and he is given the injection that will put him to sleep and relax his body so that the muscle contractions will not cause him to thrash around on the hard table-bed.
Once he is unconscious, there is another sound.

“Shhhhuuuuuu – ba…. Shhhhhhuuuuuu – ba.” This is oxygen.

“Pulse 114, “ the Attending says.

“Shhhhuuuu – ba.”

“He looks great,” says the nurse with the intravenous tubing in her hand.

“Shhhuuuu – ba.”

“He looks very relaxed.”

“Shhhhuuuu – ba.”

After the oxygen holds steady, my sound woman and I draw back the curtain and move the camera on its tripod and microphone on its stand closer to the boy’s bed. We set up two lights with blue gels even though the room is flooded with daylight from the windows. The senior doctor comes in and there is a lot of busy back and forth with all the machines wheeled to different places. Then pads that look like white headsets are put to his temples; the headsets attached with wires to a black box. We are recording.

There is a countdown by the nurse: “… four, three, two.”

“Shhhhuuu-ba.”

A switch touched. A knob turned. He is given the first electrical shock. The current goes through his head, and he has the first seizure. His arms and legs jump an inch or two up from the table and then relax.

Then again. “ … four, three, two.” This time his whole body jerks against the restraints. After a few more electric shocks, he goes into convulsions, and they stop the charges. The convulsions are a series of quick jerks of his whole body pounding against the bed. With each jolt of electricity, his face becomes contorted. Everyone knows he will feel sore from this and not remember why, from his body hitting against the hard bed.

There is a chance that his memory will be impaired, more than one study had found this, especially in young people, short-term or long-term memory loss. But this was not the first electric shock for this boy nor would it be his last. Doctors in this hospital believed it worked. No one really knew why.

Although banned in California and out of favor since the 1960s due to the use of the newer anti-depression medications, ECT was being used again elsewhere in the 1980s as the anti-depressants were powerless against some forms of debilitating and immobilizing depressions. By 2016, although it remains the most controversial treatment in all of medicine, not just psychiatry, it is back; but this time, more often as a treatment chosen by patients themselves when they are severely depressed and no other solutions have worked for them.

It had worked somewhat for my uncle in 1983, and I’d also seen in this hospital a young woman roused after ECT from days of laying in bed singing over and over “Three blind mice, three blind mice. See how they run…”

After the ECT treatments for the young boy, nurses release all restraints from his hands and legs. There are no more high-heel sounds or beeps from machines. Everyone is quiet and watching this boy. The oxygen is still going “Shhhhuuu-ba. Shhhhuuu-ba.”

The boy is unconscious and still, and then suddenly his arms come up and his hands form fists as if he holds a dagger with two hands, and he does a series of plunging motions towards his chest. These movements are why the psychiatrists had wanted me to tape this boy’s ECT treatment. They are not usual.

And when it happens, I am as surprised as the doctors and nurses must have been the first time they saw this, but I recognize these movements. They are the ritual movements of Balinese men at the high point of trance when they press their krisses — short double-edged swords — to their chests. I knew these gestures from my college studies of Mead and Bateson’s work in Indonesia. In Bali, trance possession is an important part of religious life. Trance. The taking over of one’s own body by another presence—divine or demonic.

At the end of trance after the men collapse, their limp bodies are gently carried by their relatives to a place in the shade. There they are looked after by someone, often a mother, who fans their sweating brows and gives them drinks when they wake up and is there to be sure they do not hurt themselves if they start thrashing around again.

So different this boy’s coming out of his trance. He would wake up in another Patient-A or Patient-B bed, alone, with no memory of where he had been or why he had such a headache or why his bones felt so weary and his muscles hurting. And no comforting mother by his side to wipe his forehead or hold his hand.

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I was not used to big cities, really, when I came to New York to work. I come from a smaller city, a Southern city. In this video job, I’d go out the double doors to the outside world to pick up a baloney sandwich for lunch, and there I’d cross paths with the psychiatrists and residents who often brought their patients down to my third-basement studio. I would pass them. They would pass me. They never said hello or let me catch their eye.

Buckley, Thomas. “Doing Your Thinking.” Parabola: Myth and the Quest for Meaning (4:4), 1979, 37.
Bateson, Gregory and Margaret Mead. Balinese Character: A Photographic Analysis. New York: New York Academy of Sciences, 1942, 99.

Copyright Kristaponis 2016