On the Rocks with a Twist

John Reilly, M.D.

In the ‘70s, first year students at New York University School of Medicine were required to participate in informal preceptor-led tours. These day-long ventures were meant to cultivate an appreciation for the unique clinical and sociologic ingredients that flavored the reputation and personality of Bellevue Hospital, our main teaching venue. It was such that in the winter of 1970, I joined a group gathered in a hallway outside the locked door of the main receiving ward of Bellevue Psychiatric Hospital at 30th Street and First Avenue in Manhattan. After some introductory comments and words of caution our preceptor, a Psychiatry Resident, brandished a large key and, with some effort, unlocked and pushed open the heavy door. We were ushered into a large common hall. The room conjured up the unsavory specter of a medieval asylum. Drab walls of green and brown defined a space filled with stale smells and a hazy mixture of fluorescent and incandescent light with little natural light coming through the barred yellowed windows. The brokenness contained within those walls was best captured by the muffled scraping and scratching sounds of men and women in pajamas and paper slippers shuffling around in no particular direction. Standing “gloomy and gated”, Bellevue Psychiatric Hospital was Bedlam surviving into the 20th Century.

As noted by Frederick Covan, Chief Psychologist at Bellevue 1980-94, it took “a lot to get into Bellevue. It was not the place for you if you (were) not feeling good today or you (were) really worried about the stock market”. The majority of people brought in by the police were, in his words, “severely mentally ill.” They presented a “danger to themselves or others”. Growing up in New York in the 50s, (even before TV’s “Law and Order”), it was understood that if you didn’t behave you could “wind up in Bellevue”. And there I was!

Fifty years ago, pharmacologic management of mental illness remained in a relatively early stage of development and aggressive treatment of the most severely mentally ill often began with detention leading to institutionalization for varying periods of time in state hospitals for the “criminally insane” (or when financially feasible, private institutions). The promise of effective and egalitarian treatment with medications managed through clinics or physician offices was yet to be realized. By the ‘80s, new classes of medications would foster a movement to de-institutionalize many of the mentally ill. Until then, hospitals like Bellevue served as clearing houses for people brought by the police for rapid assessment and disposition.

On the margin of the quiet commotion, I spotted a sad young man who was sitting in silence with his back rigidly propped against the wall and his legs, equally rigid, outstretched. Noting my interest, my preceptor explained that, unlike the others, that gentleman had been a ward resident for several days. He couldn’t walk. He exhibited paralysis of his lower extremities but despite thorough and intense evaluation, no cause for the disability had yet been found.

My studied scrutiny of the seated gentleman was disrupted by a loud commotion. I was shoved aside by a squadron of well-muscled attendants charging a patient who had become unexpectedly violent. After he was tackled and restrained, he received a shot of Thorazine a short time after which he more