In 1837 the Georgia legislature approved funding for the Georgia Lunatic Asylum, a single large building for the state’s mentally ill. By the time I finished graduate school and landed a job there it had grown into the largest psychiatric hospital on the planet and had been renamed Central State Hospital (CSH). The size of a small city, the hospital contained over 200 buildings and sat on 1,750 lush pine-forested acres. The complex contained a number of large weather-beaten, multi-storied red-bricked psychiatric units that housed over ten thousand patients. It was a virtual sea of insanity containing every mental illness known to man. For a curious adrenalin junkie like me, who was fascinated with abnormal psychology, finally having access to a clinical population after six years of college and graduate school was akin to setting a kid free in a candy store.
One of the things I hated about the way our higher educational institutions taught psychology was that we were expected to believe and regurgitate everything without access to real-life verification.
For example, we were told that schizophrenics were incapable of carrying out complex planning.
One day I was sitting across from Ed, a colleague, in the hospital cafeteria amid the buzz of scores of voices as he filled me in on one of the strangest patient assaults on a psychiatrist I’d ever heard of. Ed had introduced me to this particular psychiatrist on a previous visit to his unit. This doctor was a strange bird with a huge ego. Somehow he had managed to get a massive ornate oak desk squeezed through the door of his office behind which he stationed himself like a little god ruling over his domain. Unlike many of his peers, Dr. Lewis was always dressed in a sharp sports jacket and polished shoes. Stranger still, his beard and mustache were trimmed to precisely match that of Sigmund Freud’s. He topped off this image by walking around smoking a pipe.
As Ed began his story I could clearly visualize the physical environment and the time of day this bizarre incident. We sat in the hospital cafeteria gnawing on fried chicken and Okra as Ed recounted an incident that had taken place in the wee hours of the previous morning.
“Do you remember Dr. Lewis, the psychiatrist on my unit?” he asked.
“You mean the Freud clone with the sports jackets and pipe?” I asked.
“Yep, that’s him, well hang onto your britches, you got to hear this one. Very early this morning one of our psychotic patients broke into his office and left him a present,” Ed said with a Cheshire grin.
Psychotic Sam as he was affectionately known by staff was a paranoid schizophrenic whose medications had been progressively increased by Dr. Lewis, alias Dr. Freud. Psychotic Sam struggled with depression. His mind was wracked by diabolical auditory hallucinations that kept him pacing the floor late into the night and had been commanding him to kill himself. Upon finding this out, Dr. Freud ordered Sam isolated and put on a suicide watch. Sam’s protests were ignored and he grew more vehement. Over the period of a week as his protests grew more vocal, Sam was put on a watch-swallow regimen. The more he screamed the more mind-numbing Thorazine he was prescribed.
The drug eventually transformed Sam into a chemically lobotomized zombie. Sam’s resentment toward Dr. Freud’s attempt to bring him a better life through chemistry soared. Shortly after being taken off of suicide watch, Sam’s revenge made it into the annals of psychiatric assaults. Ed took a gulp of bug juice and recounted the tail. I could clearly envision the event.
It was late October and the air outside of Ed’s unit would have been crisp and cold. Inside the obsolete building, old arterial steam pipes broke the silence clanking in protest to repeated infusions from the steam plant where aging boilers struggled to fill dusty, paint-cracked radiators. The system was inadequate to deal with the bone-chilling damp southern cold. Even the most disturbed patients would have been huddled under surplus wool blankets, all but Psychotic Sam.
On the third floor at around three in the morning, the unit’s day-room would have been as quiet as a mausoleum. Any attempt to open any of the creaky doors connected to the dimly lit cavernous hallways would have echoed like a freight train and been heard by attendant staff stationed in the day-room.
In order to reach Dr. Freud’s office on the first floor, psychotic Sam would have to slip by two manned attendant stations and navigate several flights of concrete-walled stairwells which magnified the sound of the slightest footstep. Nevertheless, like an invisible wraith, Sam managed to reach Dr. Freud’s office undetected.
Silently slipping down three floors of the echo chamber staircase was one thing but breaking into a locked office unnoticed was quite another.
“Once inside he climbed onto Dr. Freud’s big oak desk and shit right smack in the middle of it.” Ed erupted with laughter as I stared trying to figure out if he was pulling my leg.
“He must have been saving it up for days,” Ed said.
I laughed so hard I put my drink down for fear of spilling it.
“Oh, that’s not the end of it,” Ed said with a jackass grin.
“While in there, he must have spent a half-hour shaping the stinking mess into a replica of Dr. Freud’s pipe before he escaped the hospital. One of the attendants caught a glimpse of him running under a streetlight dressed in a red pair of sneakers with one of Dr. Freud’s sports jackets over his hospital gown.”
When Ed reported that he was still on the loose, we both roared with laughter. They never did catch him.
Once we regained our composure, I said, “I’ve got one for you.”
“Last Tuesday in the Rivers Unit a patient bit the ear off another while she slept. Not knowing quite what to do with the severed ear, attendants put it in a box and placed it on the nurse’s desk. The next morning the nurse determined it was too mangled to be reattached and went to dispose of it. She was stopped by a patient rebellion. Half the ward insisted the ear be given a proper funeral. Rather than having to deal with several upset patients, she allowed them to dig a grave where they said some prayers and buried it.”
“Strange place this is huh?”
Lunch was over and we left the cafeteria. I pondered the complex planning and execution of psychotic Sam’s act. Once again, the professors were wrong.
Like the thousands of pills patients had dumped down a stairwell banister, this was another piece of a complex puzzle not mentioned by the university.
As time went on, lurking among the many bizarre tales carried by the cafeteria grapevine there was a steady stream of reported attacks upon psychiatrists throughout the hospital. What didn’t make sense was the high rate of patient attacks upon psychiatrists compared to all other staff except attendants who were around patients 24/7. Even more perplexing was the fact that psychiatrists were with patients only fifteen to twenty minutes a month on average. This was due to having to deal with patient caseloads sometimes in excess of more than a hundred. I wondered what psychiatrists could be doing in such a short period of time to piss off these patients.
Over the years as this odd phenomenon persisted throughout other psychiatric settings, and since nobody else seemed to be paying much attention to this, I decided to investigate. This is what I found:
In one study done on patient violence against health care professionals published March 3, 2011, the following was reported.
The annual rate of nonfatal violent crime for all occupations between 1993 and 1999 was 12.6 per 1000 workers" (Dublin WE, Nig A. Violence toward mental health professionals. In: Simon RI, Tardiff K. eds. Textbook Violence Assessment and Management. Arlington, VA: American Psychiatric Publishing Inc; 2008). For physicians, the rate was 16.2. For psychiatrists, the rate was 68.2 per 1000. For custodial staff, the rate was 69 per 1000. Even more notable were the findings presented at the Schizophrenia International Research Society in 2018 at their Biennial meeting. Of all psychiatrists murdered by their patients, it was found the most common diagnosis among perpetrators was Schizophrenia in 54.5% of such cases.
Why were psychiatrists being attacked and murdered by their patients at such a high rate? More perplexing still was the fact that the suicide rate of both schizophrenics and psychiatrists was roughly equivalent to 3 to 5 times higher than the normal population.
What was going on here? It would take another decade to find out.