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Faces in the Water - Janet Frame My first real experience with severe mental illness came on my psychology internship at Beth Israel Hospital in NYC in 1993-94. In the inpatient world of New York in the 1990s, most treatment for severe mental illnesses such as major depression, bipoloar disorder, and schizophrenia was delivered via short (a few days to a few weeks) inpatient stays featuring medication, group therapy and brief individual or family sessions followed by regular outpatient care in the form of ongoing medication and weekly psychotherapy and group sessions. Most of the patients lived on their own, with family, or in group homes. Newer antipsychotic medications were replacing the older more disabling sedative treatments for schizophrenia, and electroconvulsive therapy (ECT) was used mainly in the elderly, with appropriate anesthesia, as it tended to be more effective and less risky than medication. When patients received ECT, it was willingly, and without fear. Thus it was somewhat heartwrenching to delve into the world of Janet Frame’s Faces In The Water, which describes the experiences of a young woman hospitalized for most of 8 years in the psychiatric hospitals of New Zealand in the 1950s. Treatment seemed to have been largely a matter of ECT (or EST as it was called in the book) with apparently little anesthetic, or lobotomy. Patients lived in their own mini-society with its own rituals and routines, with little human contact other than that of burned-out ward nurses and brief exchanges with a few fairly helpless doctors. Frame can speak realistically of this world, as she herself was incorrectly diagnosed as schizophrenic and hospitalized for years.

While the world she portrays is a bleak one, Frame’s novel is a beautiful work of fiction. Here is her opening sentence: “They have said that we owe allegiance to Safety, that he is our Red Cross who will provide us with the ointment and bandages for our wounds and remove the foreign ideas the glass beads of fantasy the bent hairpins of unreason embedded in our minds.” In the prose we see both the madness that led to protagonist Estina Mavet’s hospitalization, but also the intelligence and insight that indicate how much is lost by her being trapped there. From her first hospitalization, Estina is eventually released into her sister’s care, but soon finds herself a patient at another hospital in another part of the country. In her description of a cheery demonstration unit for the least troubled patients which provides a bright facade hiding a darker warren of disturbing wards for the more symptomatic and chronic patients, I felt a horrible echo of the descriptions I have recently been reading of the public and secret sides of Nazi internment camps. When Estina finds herself reassigned to one of the less public units, she finds that she is left with little to call her own, dressed in hospital garb that may or may not even fit, and denied most personal possessions. She was a teacher before her hospitalization, and one item she does manage to keep is a volume of Shakespeare. “I seldom read my book yet it became more and more dilapidated physically, with pictures falling out and pages unleaving as if an unknown person were devoting time to studying it. The evidence of secret reading gave me a feeling of gratitude. It seemed as if the book understood how things were and agreed to be company for me and to breathe, even without my opening it, an overwhelming dignity of riches; but because, after all, the first passion of books is to be read, it had decided to read itself; which explained the gradual falling out of the pages.” She then goes on to describe moments when Shakespeare’s words come to her mind as she watches the situation of the patients around her. Estina travels back and forth between two hospitals and the cultures of the different wards within each hospital, terrified of the only treatments she can be offered, and often hopeless about the possibility of returning to the outside world.

I will leave you to discover where the journey ultimately takes her, but I will say that bleak as the vision of mid 20th century mental health care is in this tale, the vision of human courage and emotional depth conveyed in this novel is equally inspiring.