by Stannie Anderson

Phil Carson arrived at the C. F. Menninger Memorial Hospital with long hair, hippie-style boots, corduroy pants and a “roach holder" dangling around his  neck. A roach holder, to the initiated, is a holder - perhaps tweezers - used so marijuana smokers may smoke almost all of the cigarette without burning their fingers. The last puff of the cigarette is considered by smokers to be the best part of it. "People were so nice here, it almost made me gag," he recalled. "A lot of the hospital staff were religious and conventional. A lot of hippies can't tolerate this at all, and they leave. They would rather stay with the drugs or go somewhere else, because it is so hard." Phil's contacts with LSD, marijuana and heroin had left him in a curiously stalled attitude. He could drive a car -- but otherwise he did nothing all day long, all evening long, all night long. He was belligerent, mixed up. Other psychiatric hospitals, other psychiatrists had tried to help him but were unsuccessful. And so he came to the Menninger hospital. Through the nearly half-century of its existence, this hospital has gained the reputation of being one of the finest psychiatric hospitals in the world.  Hope walks its corridors.Phil now fits in well with the more conventional patients at the hospital. "I had to make a lot of major adjustments. I’ve settled down quite a bit since then. Now I feel I can have a decent life." Phil's eyes were troubled as he talked. “Often, I’ve wondered why I haven’t killed myself during the last three years - my life has been so messed up." He looked absently out the big dining room windows of the Menninger hospital. "Every part of this place has helped me. Acid -- grass -- bennies (LSD, marijuana and benzedrine piils) -- I wouldn't take them now for anything. I don't need them. I'm a lot happier, and even when I get upset, I don't want to take drugs." Phil's first contact with drugs came when he had a job and began to feel bored.   He was depressed and tired. He took a caffeine pill "that didn't do a thing at all for me." "Then a friend gave me a benny. Then  another friend gave me two bennies. Once you get into the drug world, you fall into the whole line easily. It's a closed group and there's always constant fear about the police. It's very secretive and rather fun in a way to drive to strange towns and wait in car - interesting- and exciting. "A friend introduced me to grass (marijuana). It had never occurred to me to try it. It was very enjoyable.  I think I'd still find it enjoyable in a way, but I don't think I want to go through~ all the bother of the illegality and the worry. H (heroin) is rough stuff. I tried it a few times." Phil is somewhat cynical about his family's attitude toward his illness. "I'm not ashamed to be in a hospital and it doesn't bother me. My family, before I was admitted, kept telling me, 'There's no shame, it's just like physical illness.' All my friends knew I was coming here -- I told them myself. It was no big deal to me. "But my family didn't tell distant relatives for quite a while. People who don't know me very well have been told I'm in a college in the Midwest. I can't understand why they do this. "They've made a great outlay of time and money to have me here, yet it’s not just I who is sick.  I didn’t do it by myself. They're sick, too, in away.  Things will have to change when I leave. I can't go back to being just a little boy. "I haven't seen my friends for many months and don’t want to see them again, frankly. My friends really are right here in the hospital. Some will be my friends for the rest of my life." There are many public misconceptions about the- Menninger hospital. Through the years the myths have grown, along with the curiosity of the public about the cloak of silence that envelops its patients. Often it has been felt that is is a place for" country club living" for the wealthy and famous; that patients sleep in luxurious bedrooms with heart-shaped beds and bathe in sunken bathtubs with gold fixtures. Often it’s considered a place where movie stars come for a rest between films and husbands. Or a convenient parking place for teenagers whose wealthy parents want to go to Europe. But the truth is far more dramatic than the myths. Some patients are wealthy, but others have borrowed money to come here. Some are famous; others are here because they have enough insurance and savings to afford the treatment. There are no fabulous bedrooms--only small ones that look like college dormitories. And instead of country club fun-lovers, there are troubled people who stir compassion. Debra Simms (names of all patients in this story are fictitious), attractive young brunette mother of two, several times had been in and out of a quite reputable psychiatric hospital elsewhere in the United States. "I remember being taken through the Menninger hospital doors and told to follow somebody. Then the door was closing behind me. I was following the man in the real!' Some patients don't believe they're ill. But I knew I belonged here, somewhere." Much of Debra's concern was for her children. Would the attitudes of other people about her hospitalization hurt them? "Sometimes I wonder what I would think if I were a child and my mother were off in a mental hospital. I wouldn't see any bandages. How do you explain a nervous breakdown? Is my mother insane? If she is, could I go insane, too? "If you were a child and you have father's brown eyes or your mother's good legs --and all of a sudden something happens to theparent—you would wonder, could this happen to me, too?'' Before coming to Topeka, Debra had fallen apart slowly over a five-month period. First she took an increasing number of sleeping pills. Then she began to drink a lot. More sleeping pills, followed by Scotch. Debra, upon admittance, found the Menninger hospital would not bar her children. It believes the total family is important and that the patient cannot be treated in a vacuum. Debra's children soon came to Topeka on visits, ate in the dining room with their mother and other patients, made some small objects out of clay in a ceramics group, and listened to the laughing, relaxed talk of other patients. Then they were sure their mother was comfortable and not locked up in some awful place. Debra calls getting well "gutting through." "Being so sick you want to die and yet having to continue with daily activities because this is what is prescribed. And there is no let up from it day after day after day." "Everybody is strange to you doctors, .nurses and patients. You have no loving arms to run to. You can't even pick up the telephone and call somebody who is close to you. "Many people believe patients at the Menninger hospital are pampered. Yet within three weeks after my arrival I was tossed into a project group. I was cutting wood at the woodpile in the middle of January in 10-degrees-above- zero temperatures, with the wind blowing. And I'm from the South! This doctor was going to kill me before he cured me" she laughingly said. "It's been a steady climb upward. I have slowly, at a snail’s pace, over a period of months, built up the tolerance and coping ability. Every once in awhile I'll hit a snag and become depressed and feel as I did when I first came. But it leaves quicker now," she said. Menninger psychiatrists always squirma little when they hear the word “magic”applied to treatment at their hospital. Yet the faith that has grown in the treatment is touching. This 150-bed hospital has  become a last resort for the mentally ill, a place where people get well, The Menninger hospital ranks in its psychiatric field equal to the famous Mayo Clinic at Rochester, Minn. Like the Mayo Clinic, the Menninger hospital grew from a family partnership—gentle Dr. C.F. Menninger and his two  brilliant psychiatrist sons,  Dr. Karl and Dr. Will made psychiatry come alive for the masses through their vivid books. The hospital grew from things like Dr. Kari's childhood scary experience of watching guards march "the wild men" past as He and some young companions hunted forwalnuts on the grounds of the  asylum at Topeka. It grew from Dr. Will’s experiences as a general during World War II, when he tried to find out why some soldiers break at times of stress, while others don't. There's a kind of magic in the personalities of these two brothers, and their warmth and wisdom are part of the fabric of the place.  In a sense, Dr. Will lives on--and Dr. Karl's touch is everywhere. The director of the hospital, Dr. Peter D. Fleming, was a graduate in the first class of the Menninger School of Psychiatry,the largest school for psychiatrists in the world.  He, too,helps keep the Menninger spirit alive. A new generation of Menninger’s has come into the picture, Dr. Roy Menninger, president of the foundation; Philip Menninger, in charge of development services; Dr. Robert Menninger, in charge of admissions to the hospital, and Dr. W. Walter Menninger, hospital staff psychiatrist. The Menninger hospital uses a team approach. Staff members work together 24 hours a day to help people get well. Somewhere in the hospital - on some shift - there are sure to be staff members who mean something to the patients. “The real story in this hospital is one that a few patients here will tell, one patient said quietly. "You can't walk up to a a patient and ask, 'What’s your problem?" And, although I can tell you some things about myself, you won't really know what I'm talking to my doctor about or what I'm thinking at night when my door is closed." Yet this human aspect of the hospital is the one that tugs most at the heart. Menninger patients - almost as a whole -- are unusually charming and well-mannered people. Most are highly educated, witty and sophisticated. They've traveled widely and can talk about books, paintings and music. Many patients, upon superficial observation, show no signs of mental illness. Sometimes, with closer observation, the symptoms of trouble become obvious: An underlying, hard, bright anger; a withdrawn,far-away look; depression; a too-keyed up gaiety; irritability or trigger-fast frustration. The Menninger staff has culled the medical records of the past for some examples of why people come here for help. These cases have been somewhat disguised, but they are real people: A 20-year-old man who always dressed completely in black, which he explained on the basis that he was a believer in Nazism. A heavy user of drugs, he had attempted suicide several times. A woman in her late 2Qs, who had a constant need to perform the ritual of hand washing. A 25-year-old woman who, after the birth of her first child, had developed frightening thoughts and fantasies and had strange ideas about being under the influence of other people. A man who had had an unhappy love affair 30 years before, referred by  another hospital because of periodic mood swings. A 56-year-old man who had had a gradual onset of symptoms over the previous year, which seemed to be connected to promotion to a better job which promotion he doubted he deserved. A 23-year-old man who was awkward physically and socially and doing borderline college work, in contrast to his many brothers who where extremely successful scholastically and who were all lettermen. For an idea of how psychiatrists attempt to help patients, let’s take a look at the case of Charles, a middle-aged married man who gradually developed fears of being alone, of driving his car, of eating in restaurants, of saying the wrong thing and of using poor judgment so that he finally was unable to look after his business. Over a 6-to-12 month period following the death of his father, Charles began to develop phobias. The successful head of a demanding business, Charles hid his illness from his co-workers, who noticed only irritability and complaints of minor illness that kept him home a lot. Ordinarily an energetic person, he had lost the old verve. Charles first developed a fear of eating. He was afraid he would choke. Then he would start coughing up what he had eaten, with the terrifying fear, "This is it!" Although he became afraid to drive a car, he still had to go to work. So his wife drove him. Charles was quite sensitive to having his wife drive for him, so he hid his discomfort by sitting in the back seat of the car, lighting up a cigar and putting his fee up on the front seat.  This made it appear there was a joke between them as if she’d lost a bet, perhaps. Fear is a very real thing. Charles would sweat and tremble, with extreme anxiety. "What if I were driving with my wife and she suddenly would die of a heart attack? What would I do? I just can't drive the car," he would fret. When Charles came to the Menninger hospital, his eating symptoms disappeared immediately. This distressed his: wife, who felt the illness must be her fault. But the doctor felt there was no marriage difficulty of importance. The Menninger doctor, leaning back in his chair, discussed Charles' problems. "By his food phobia, Charles was saying, ‘I am afraid of sudden death from some problem with food.' Then one wonders whether the basic food given to him was prepared by his mother--this might be some problem he had with his mother. "The father was a very powerful kind of person strong, forbidding, frightening, but also much loved. All the children‘hopped to' when Dad said something--and this included Mama, too. Yet she had ways of getting father to do things by nagging and yelling. So his mother could handle his powerful father. "Then the father died of heart trouble. Charles foresaw all kinds of terrible problems and feared being battered between his wife and his mother. Mostly he feared giving in to his mother, who was older and not in good health, and who could take on this dragon- like character.  Yet he loved her, too. Although the food phobia left him, a new one came along to plague him--the fear of heart trouble. "This had to do with the feeling, 'If Dad only hadn't died and left me in this predicament, with Mother to handle--' And yet a person really can't be angry with a dead person, particularly one he loved. So Charles developed phony heart trouble as a punishment for himself for being angry with his father's abandoning him to the terrible pressures of the mother. These pressures, of course, were somewhat exaggerated by the patient." The doctor noticed the patient occasionally, while reaching for a cigarette in his left shirt pocket, sometimes took a long time getting it out, as if he were feeling his heart. "You're still afraid you're going to keel over and die, even though you have had as good examinations as any there are," the doctor observed quietly. "You're still afraid you are going to drop dead like your father. This then led to discussion of "Why do you think the feeling came on just then?" "How come you had it all day yesterday until you went to bed?" "Why do you think you had it only in the afternoon the day before? " By these questions, the doctor attempted to discover what kinds of things augmented or diminished the patient’s phobia. In the discussion there is an interplay of feelings Charles has about the doctor as a guy who knows things and makes decisions-- somewhat in the father role. By exploring the rational and irrational feelings he has toward the doctor, he gets to learn a little about rational or irrational feelings he has about his father. Charles eventually made a full recovery from his illness. The start of a new day at the Menninger hospital for activities staff, is at 8:15 a.m. They gather informally around tables, drink coffee and listen to the morning report. patients do not arrive until 8:30 a.m. Dean Page, supervisor of the AT department--junctive or activities therapy--begins reading from a page of notes. "Dr.---will be out of town for a week and has asked that everyone give extra support to one of his patients, Miss Garrity,"Mr. Jones has been restricted to the floor for a few days." "Mrs. Argan's husband and children are visiting here." "Mrs. Tyler received a gift package from home and ordered it sent back." "Mr. Stokes is ‘low voltage’ at this time. His doctor says he should not be asked to take on any extra responsibility for awhile." The most awaited news, however, comes at the last. The staff is concerned about Myra Allison, a 16-year-old who lost contact with reality--or flipped out--two days ago. “Miss Allison still is extremely assaultive, requiring several staff people to assist her in controlling her impulses. She has been talking in rhymes, making barking sounds, and generally makes a lot of noise—screaming, spitting and fighting.  Her doctor ordered her put in wet sheet packs.  She is having special nursing around the clock." With the wet sheet pack treatment. Miss Allison is immobilized by having cold wet sheets wrapped around her. For her comfort, hot water bottles are placed at the back of her neck and feet, and she is given warm tea to drink. No one really knows why this treatment helps but often it does.  The warmth of her body quickly makes a cocoon inside the wet sheets, and she feels protected and secure. Miss Allison is kept in the wet sheet packs two hours, and then is out of them two hours, around the clock. It has been a year since a patient has flipped out to this extent at the Menninger hospital.  In previous years, before there were tranquilizers, perhaps 50 per cent of the patients flipped out at some time during their hospitalization. Miss Allison's illness is noted especially by the staff, because additional support of other patients now is necessary. Sometimes such an occurrence can cause severe disturbance in other patients who are shaky. Now the patients begin to filter in from breakfast, a few at a time, then in a wave. They get out their projects and pick up where they left off the day before. Activities are individually prescribed for patients. Some may have a full day of them; others only one or two. Daytime activities fall into two-hour blocks mostly. They include such things as a women's service group that sews for children's institutions in the Topeka area; greenhouse; ceramics; jewelry; art; personal clothing sewing; project groups for construction of walls and paving of sidewalks; physical fitness; manual arts; publications; chorus; men's service group that makes furniture for other institutions; crafts; and a patient's library. Younger patients go to the Menninger hospital school, which is an extension of Topeka High School. Upon graduation they are awarded THS diplomas. Classes are small and schedules are adapted to the capabilities of the patients. With the sun streaming through the large windows, the Rosenberry Activities Building is a colorful, pleasant place. Music plays softly in the background. Most of the patients have been here awhile, so don't require more than an occasional word of instruction from the adjunctive therapist - or the A.T., as  he is called. Supervising the ceramics department is John Tarlton, a big, rangy man with what must be the broadest, warmest smile in the world. Tarlton's style with the patients is easy, practiced and even to the casual observer, not limited to teaching patients how to make a clay pot. Tarlton's work is treatment. He's part of the team. Although relaxed, he's aware and often is able to circumvent a blow-up before it occurs. Now he sits down at a table at which a number of the patients are working on projects. There is lots of laughing banter, "She's screamed all night for the two nights," one worried teenage girl said. “None of us on the floor have had much sleep. I wonder how long she can go on that way?” Tarlton's reply is quiet, "Yes, I imagine most of you are a little upset." "This bothers us." the girl said, "because somehow it is a threat to us. 'We can’t let it happen to us. Things have been so quiet since we came here. We've never seen a patient flip out this much before. I suppose we got the idea that such things don’t happen in a mental hospital anymore." As she talked, her fingers smoothed an upturned clay pot. Another teenage girl said, "My doctor told me Miss Allison slept only two hours out of 48.  It must be terribly hard on her.' Tarlton is listening, saying little.  He gives support just by being there. He isn’t always this quiet, though. Tarlton has group of young patients. “They're wild -- but I'm wild, too!" he says, with that infectious smile. "I kind of get with them. As long as they don’t get vulgar or hostile or start throwing clay, I let them go.  I think when you get too professional, it can be very cold. There is a middle-of-the-road sort of thing. I think if you're so intense and looking for something all the time, nobody relates to you." Tim, a teenage patient, said he hated ceramics and referred to "that damn clay." He complained bitterly that he hadn’t made mud pies" since he was a kid. At the same time he was attempting to split the staff by telling Tarlton "what a bitch" the female A.T. was, and telling what "an S.O.B." Tarlton was. This young man began turning out mass- produced identical monsters, all with their tongues sticking out. "That's the way I feel!" he told the A.T.’s bitterly. The staff, by working with him to let him know they were  concerned about his treatment and weren't just trying to make him angry or get in a fight with him, eventually were able to convince the patient he should destroy all his monsters. They had served their purpose. But it wasn't easy for the A.T.'s for awhile. "He became more confident in us and could talk to us. But naturally, we wandered,will he lambast us tomorrow? We weren't extra-careful in our relationships him, but at the same time we tried not  to let some of our own cuts get opened up.  When he’d say something irritating, we would try not to fight fire with fire." Patient government is serious business at the Menninger hospital. Patients have a direct line to the administration through their floor meetings and the Patient Council. Changes sometimes are slow -- but they can happen, and patients know it. Reported smuggling of marijuana by a patient into the hospital was an explosive and touchy topic of conversation at recent meetings. Ordinarily these meetings cover such mundane things as a request for more bowling trips, a discussion of the proper dress for patients at dinnertime and the need for additional brands of shampoo. Faces were serious at the Patient Council meeting. The representatives were aware of their  responsibility as the voice of the other patients but intermingled also were their own feelings about marijuana. For several days the circulated report of the smuggled marijuana had led to numerous little jokes among patients about "tea leaves." But now the subject was out in the open. Staff had asked the Patient Council-and floor meetings-to discuss their feelings about marijuana. "God, it scares me to know that stuff might have been in the hospital," one patient, who had had previous experience with drugs, commented. "I wasn't offered any." A few minutes later he asked the council to excuse him. "I feel quite ill and nauseous ... You see, I had a big trip on some Mexican pot that led to my admission, and I can almost smell it again." Then he left the room. After floor meetings of patients all over the hospital, the Patient Council met the following week to discuss attitudes. It was obvious there were many mixed feelings. Most of the patients in the hospital had agreed that marijuana is not good for treatment. But some also were hostile. Many felt it was a staff problem. Some were angry, because they thought the staff was trying to get them to promise to tell on each other if the problem should come up. "You can't tell people they must go and squeal on their friends," one patient said. "Some couldn't possibly do it, and it would be asking a tremendous amount. For others, it is absolutely necessary that they tell, because it would be threatening to them to have it around. So you can't make a cut-and- dried ruling about it." Dances, while often the scene of merriment, still cannot penetrate into the sadness of some patients. Sam Darwin recently sat in a pocket of  silence watching other patients square dance in a blare of country music. An older, earnest man, he is about the deep-down depression he is to shake. "I've only been here a few months, he said in a quiet manner that shut out the music. "I think I'm worse than when I came here. I'm more depressed." With a wry smile he added, "Then I was up four months and down four months now I'm up one day and down one day. I'm sure this is an improvement. " Darwin, a top executive in a large industry, said his first bout with depression began during World War II. "My factory had to increase and I began working 12 to 14 hours a day seven days a week. I became depressed went into a clinic. I improved. When I went back to work, I cut down on my working hours. For 12 years I was all right. "Then the depression came back. I fought it off.  I kept working.  Then I would lay off work. One day, for no apparent reason, I would wake up and the depression be there." Broodingly he watched the dancers and idly twirled the handle of his coffee cup. "I thought the work and strain caused the depression.  But I know that it didn't. I'm not working and I'm in a hospital but the depression still is here. I don't know if I'1l ever be better. "I can't afford to stay here forever. People think everyone's a millionaire who comes to Menninger's. There are some millionaires who come here, but I’m not one of them. If it weren’t for company insurance, I wouldn’t be able to afford it. "I'd like to go back to my old job. I know I could go back right now, and my job would be waiting for me. But I don’t know whether I'11 ever be able to lick this depression." With an obvious attempt to lighten the conversation, he joked, "Maybe I’ll leave here and retire to mowing grass." The tired, laughing dancers returned the small tables in the dining room to sip soft drinks or coffee. Many gathered at table with Darwin. He continued softly, almost as if they weren't there: "I came here for six weeks, I thought. I came looking for a miracle, and then they told me here they don't work miracles. It has extended to several months. And I just don't know." Now Jim Garton, a successful young lawyer, begins to talk. "I’d been at Menninger's a couple of months before I began to realize that I'd been quite close to suicide. I just hadn't recognized it. I’m afraid of such a depression. He reflected, "Since childhood, it's always been impossible for me to say ‘no.’ My practice has grown steadily, and it's hard to say 'no.' With all this pulling at me, I felt tremendous pressure.  Even when I went on vacation and another attorney was taking care or my practice, I was sure things were going to pieces while I was away" He paused, then said softly, "It's hard to be a perfectionist in a perfect world." "Recently someone asked me to do something in church," Garton said.  "I was able to say ‘no’ and realize that it isn’t unpleasant at all. I know now I’ll have to say ‘no' when I return to my practice.  I’ll have to draw some lines." "I remember one of the doctors here asked  me, 'What are you hoping to achieve while being here?' I told him, ‘I want to be comfortable.' I'm not sure the doctor thought that was much Of an answer. But I think it's the right one. "I certainly couldn't say I want to be happy, because no one is that, all the time. Something might happen--there might be a death in my family. Then I certainly couldn't be happy. But a person who is comfortable is the one who is able to weather all kinds of things: Happiness, sadness, despair, joy, grief," Garton said. Hospitalization is a difficult situation for teenagers, who are aware life is passing them by. Sue, a pretty teenager with long, shining hair, ordinarily is supercharged with excitement and brimming with fun. But sometimes the wistfulness shows through. "All these activities and parties sound like fun, don't they?' she asked. "But they're not all that great.  It’s kind of artificial.' It's hard to be here, when I really don't want to be. I'm 17. I'm young. I want to have dates. But it's against the rules here to kiss someone or to have someone hold you." The word "restriction" can raise the hackles of every teenager in the hospital. When staff feels the attachment between two patients of the opposite sex is becoming too great, both may be placed on restriction. This means they must have no further contact with each other or even speak to each other. This could last a month--but in at least one case, it lasted two years. Psychiatrists are aware of the angry reactions of the patients. But, they say, getting too involved can interfere with treatment. The rule is "No hanky-panky." "Patients see a great deal of each other," one staff psychiatrist said. "If they do become infatuated, it becomes very difficult, because it is hard to be pretty and sweet  at breakfast,pretty and sweet at lunch and pretty and sweet at night. They get very frustrated. If the infatuation develops into something more-- Where they're thinking of marriage it is just a simple point that this relationship has developed in a very sheltered environment between two people who are in treatment.  The circumstances are soon traindicated for developing such a relationship. "Both people are supposed to be in a state of change. If they're falling in love with each other one week - and changing -- then the next week they may be out of love. In addition, there really is little privacy in the building. This is not the couple's own home, and such behavior can be very stimulating and disturbing to other patients." But doctors do want to encourage some healthy relationships, with opportunities for patients to converse with those of the opposite sex. "Typically the patient is not really ready for dating,'one psychiatrist said. They have usually been having lots of dates before they came here and we were in over their heads-- and without ever finding it a really rewarding experience. "There is nothing more distant than a physical relationship without any emotional experience. We'd like our patients to have an experience in which they really get to know somebody and share dreams and hopes this can be a lot more intimate relationship than a physical one." “There are some feeling both ways about restrictions," one teenage boy said. "You don't have to be frightened of getting involved in a relationship with somebody else. But you’re also angry because you wanted to get involved." A new trend in recent years in the hospital is the steadily increasing percentage of younger persons. Currently 50 per cent of the patients are under the age of 25. The 0'25 Club--for patients over 25--teasingly is referred to as the "Geriatrics Club." In the Menninger Children's Hospital, youngsters are separated by sex and by age. But in the adult hospital, patients have room arrangements like those of a hotel, with persons of both sexes living side-by-side. And teenagers are mixed with the adults. Minimum age for the adult hospital is 15 years. Unfortunately, not all people who want to came to the Menninger hospital can do so. Through the years the fame of the Menninger hospital has steadily grown. Now more than 3,000 requests for information or admission pour into the hospital each year. Letters, telegrams and postcards arrive, although senders sometimes have mistaken the location of the hospital. Some have been addressed to the Menninger hospital in such cities as St. Louis, Kansas City, Chicago,Denver, Wichita and even one addressed to "Tapioca, Kansas." Dr. Robert Menninger, whose pleasant voice is disconcertingly like that of his famous father, Dr. Karl Menninger, admits his job in the admissions office is  "fascinating, discouraging, exciting, frustrating, rewarding, sad, lonely" -- but "a safe job, because nobody else wants it." It's an important job, too, because it is here the first contacts are made with patients who eventually are admitted to the Menninger hospital. “These letters are a panorama of life-- struggles, trials, tribulations, failures, heartaches from people all over the world," Dr. Menninger said. "Some are simply expressed, some beautifully written, most are touching, some clumsily written and unclear, but they all contain the cry of help in some form and they all affect us who read them. Every letter, every card is answered personally." Here's a small sampling: A middle-aged woman asking for admission to the hospital for her physician- husband, who has been on drugs and is a "graduate" of 17 different private psychiatric hospitals in the country. A letter from a prominent industrial family, pleading for an examination for their teenage son who, while under the influence of alcohol, held up a filling station and was arrested. Parents who write on notebook paper in pencil, saytheir only child had a mental breakdown 10 years ago and has been in a state hospital all that time. They just know that if they could get her to Topeka, Menninger's could help her. They would be glad to mortgage their house, sell their car, borrow from relatives, anything--if she could come to Topeka for treatment. “How can I say no, without extinguishing the faint flicker of hope, but I MUST say it," Dr. Menninger said. The tremendous faith that people have in the Menninger hospital is somewhat disturbing to the staff. They fear people will come here with over expectation about what they'll get. The Menninger hospital may be unable to help. If people consider it a last resort, this may shatter hope and cause disillusionment. “We're well aware that we don't help everybody," Dr. Menninger said. "We don't see this as criticism of ourselves or of the Patient.  From the purely scientific view, we are interested in what brings about changes. It’s possible that, after extended tries, we can’t help them then they go elsewhere and are well within three weeks. Obviously someone else could and did help." Ordinarily admission to the Menninger hospital takes time--four months on the average from the first contact until the patient walks through the door. In an emergency, he could be admitted within two minutes. But the hospital feels its first obligation is to the persons on the waiting list. Usually, a gentle recommendation is made to take the patient to another hospital "because he needs help now and we won't have a bed for four months." The Menninger hospital cannot accept certain patients for some quite realistic reasons, which Dr. Menninger lists: The basic monthly treatment cost at the adult hospital is $1,800. This is $21,600 a year. In addition, a large number of patients get an hour of psychotherapy two or three times a week--with cost ranging from $30 to $50 an hour and averaging $35 an hour. This can raise the total to about $25,000 a year. Occasionally a patient gets psychoanalysis, which is five times a week. The basic amount covers all costs of hospitalization other than personal expenses, such as cleaning bills, toothpaste and similar items. Not many persons can afford this treatment. The hospital doesn't believe a family should bankrupt itself--and perhaps deprive its other children in order to seek treatment that may not help. So the hospital takes a careful look at whether a family really can afford the treatment, particularly if it is to be for several years. The adult hospital has no below-cost beds. The Menninger hospital is aware there are certain types of patients that it doesn't do well with: Those with senility; brain damage from an auto accident; mental retardation; certain kinds of alcohol problems("Alcoholics Anonymous helps them more than we do"); those really addicted to heroin or cocaine: The hospital also discourages admission of persons who are in trouble with the law. It feels it is best for them to serve their debt to society first and then  if they want some help, apply for admission. The new patient at the Menninger hospital enters a strange world in which everything he says and does is evaluated. "There are people around you every moment of the day," one patient recalled. "You're spending all your time with the same patients-having meals with them,dancing with them, working with them in activities. It's a weird experience when four nurses watch you walk down the hall. "It's also unusual to be half-awake at night when at about half-hour intervals the door opens, a flashlight shines--usually in your eyes-and this strange face peers at you (the nurse, making rounds). “The staff calls you Miss, or Mrs., or Mr.-and at the same time they are asking you the most intensely personal questions. You're forced to live as a family with people you may not want to know anything about. You are forced into an atmosphere that exactly duplicates a family--with the other patients as brothers and sisters, the doctor as the parent, and the nurses running around acting like Grandma or maiden aunts." The new patient also learns to his surprise that he is expected to control his behavior to the best of his ability. One young woman who came here from a hospital elsewhere in the country was stunned when she learned that she could not scream and cry and throw herself on the floor as she had before. Group disapproval by patients is potent. "We don't like people to act sick around here," one patient said succinctly. The patient, then, is encouraged to act in as normal a manner as possible and to cover up the symptoms of his illness except with his doctor. The knowledge that they'll have a roommate at the Menninger hospital often is a shock to some of the patients. They've never had to share a room with anybody. This is not true of all of them, because some have acquired wealth. But the majority have never had to clean their own room, get the groceries, or do their own shopping.  Many have had stores bring things to their homes. After they have made their selection,they send some of the things back to the store. So the hospital is a rude awakening for about half the patients share rooms with another patient. Even the wealthiest patients at the hospital aregiven an allowance.  This may range from $3 a week to about $50 a week.  Some patients who go downtown are allowed only enough money for cab fare and a cup of coffee. When they buy things in Topeka stores, no cash exchanges hands. This is handled through the Menninger business office. When a patient begins to progress to the point that he may be getting ready to leave the hospital at times to go to college or work, he may be transferred to Rippel East Hospital, a group of homelike buildings situated somewhat apart from the main hospital. These East Hospital patients--almost in a chorus-say the thing they appreciate most about their situation is the lack of security screens on the windows. It isn't that the security screens prevent patients from seeing outdoors. But they do somehow darken the scene a patient sees. The new patients at first are restricted to the floor--their living unit. While they are undergoing a batter of physical and psychological testing, they even have their meals on trays in the living units and work in craft shops there. This leads to the strange feeling of being locked in, even though doctors point out, "You're not locked in--the doors are open except at night." But there's a definite feeling of being trapped. Locking someone up to keep him from running away would be a temporary expedience. If a patient insists on repeatedly trying to run away, the hospital has no choice but to discharge him. Patients are more likely to be locked out of their rooms than into them. This happens when staff feels the patients are too withdrawn and need to get more involved with other patients and staff. Menninger patients sometimes are restricted to their unlocked rooms. Occasionally an angry patient will rip off the molding in his room. It can really look like a shambles, with big black molding all over the place. But with a little glue, the molding is easily replaced and the room looks fine again. "It is interesting that even angry patients set a limit on what they do,' the psychiatrist said.  'There are some things which are not cricket.  For example, when we were moving a pool table in- one of the lounges, a window got broken. A patient had only to go out the window to be free." But then a teenage patient suggested, "Don't worry. We can just put up a sign, 'No fair out through this window! " The staff did--and no one went out the window, because that wouldn't have been playing the game. New patients have special problems that need airing. The hospital recently has begun a new patient meeting, with social worker Phil Towle discussing problems with them. Patients talk about such things as the shower they're supposed to take upon admission, thus giving hospital staff a chance to go through their belongings for pills, sharp objects and other things that might harmful to them or others. "It seems like an invasion of privacy," one new patient said, "but I suppose that's why we're here--to have our privacy invaded." "The explanation given to me about having to take a shower was that an internist was going to do a physical on me," one patient said, 'but I realized this wasn’t quite truthful,because I didn’t have my physical until two weeks later.  The staff seems afraid to say, ‘We're going to strip you down, because you may have pills and hypos."' There are other universal feelings of new patients. “This is a timeless place,' one boy said dreamily. "I don't really notice the time getting better. I like athletics, so I realize time is going by just from the seasonal sports on television. First there is baseball, then football, now some basketball games. When I first came here, I wasn't aware of much of anything. I was kind of in a daze. Now I'm aware of waking up in the morning and living through one day-and then another day." There also is the fear of striking the wrong note with other patients. "You don't want to ask, 'How're the wife and kids?'" one patient said.'- 'Maybe there's been a divorce and this would be the wrong thing to say. Usually small topicshave been eliminated.  You certainly can’t  ask, ‘What's your problem?' It seems that really the only safe topics for a new patient in the hospital are: weather, food, where's your hometown and who's your doctor." The Menninger hospital treats people with other people. Staff members use their own personalities in a warm, constructive way to help patients get well. There's Bill Roberts, acting director of nursing, who admires the example of Dr. Karl and Dr. Will in believing nothing is impossible and that many other ways should who can be firm when needed--or if special care is indicated, "I've got staff that can just smother you." There's quiet Mrs. Ursula Zimmerman, nursing clinical supervisor, who says, "Some patients you never forget because there is something very unique or special about them. I think it’s because you do some little insignificant thing for them, and theyrespond. Or you listen to them scream when they're disturbed. When they get well, they're so grateful for what you did for them." Big John Mills, a psychiatric aide, can walk into a lounge where patients are extremely angry and beckon a patient in a non-threatening way. Outside in the hallway he'll tell the patient, "You're not going to do that." Mills, who takes great pride in his work, has dignity and professional bearing. He's a most warm person but can be very firm. Sometimes he sits for hours at the side of a depressed patient, with neither saying a word. Then when he gets up to leave, the patient often will tell him, with meaning, "I’m feeling better now." There's Agnes Mellenbruch, a nurse who can talk to patients like a tough sergeant, while at the same time putting her arm around them and giving them the support they must have. There's sensitive Minnie Harlow, a group social worker, who wondered why patients were not using a lounge. She discovered they felt under constant surveillance because of a nursing station window. Once the window was covered, the lounge became a popular place.  There are hundreds of them -- most of them special. And all are part of the team. In all, there is a full-time equivalent of 300 people working in the hospital. "Full-time equivalent" is important, because the hospital does not have a single full-time doctor, psychologist or social worker. Everyone does something else, too, such as teaching or psychoanalysis or out-patient work. The ratio of staff to patients is about one staff member to each patient. From all of these persons -- every day -- flow notes and observations about the actions or words of the patients. Dr. Peter Fleming is at his best when speaking to a group of patients. He's relaxed and humorous, yet sensitive. Recently he talked to some patients about notions Menninger doctors have about people - and also about the unusual relationship between doctors and their patients. Human beings are under the compulsion to repeat over and over again the same error or difficulty in living. “When we repeat unimportant things,we’re not in big trouble.  When we repeat important errors, we are in big trouble.  It is true of me. It is true of you. “Tommy Manville pretty much explains his marraige problems in all instances to certain  apparently coincidental recurring factors. “The guy who has had trouble with his math teacher, his mother, his wife, his boss, the captain while in service, may say he has trouble with people. But usually if one looks, one sees the same kind of trouble, seemingly slightly different 1l superficially examined, but basically the same when carefully examined. He will, come what may, repeat the basic situation here at this hospital with the staff, and probably most clearly, with the doctor.' Menninger doctors, he said, believe the relationship  between them and their patients basically is like that of a parent and child. This is also true of the relationship between pupils and teachers, between squadron leaders and airplane pilots, store managers and employees. Menninger doctors believe each person is made up of a certain basic matrix which early experiences of a child influence the way he responds to life. Menninger patients find their doctors fascinating--and irritating. They never  tire of wondering, "Why is my doctor doing this?" or "Why did he say no?” “The feeling that a patient develops for adoctor sometimes reaches considerable intensity so that the doctor sometimes is thought to be the world's finest, and he can do no wrong.  Sometimes the feelings are negative, and the doctor is experienced as a dictator,a boob.' With a merry smile, he added, 'A powerful, plotting, lying fool, to quote a patient recently." “If a doctor says ‘no’ to something, he can be experienced as harsh and cold, or nice and tough and straightforward. And if the doctor is silent, I've had him called ‘stupid and uninformed’ but also ‘so accepting and non-judgmental" It’s pretty simple when a patient has only one doctor. But sometimes he can have two, three, four or five. He can have a hospital doctor whom he sees six days a week, a therapist he sees two or three times a week, a substitute doctor in the summertime, a group psychotherapist and he can be seeing one of the hospital's internists because his stomach hurts. When there are so many doctors, the feelings of the patient split'and then there will be the good doctors and the bad doctors. It is possible for a doctor to be the good guy or the bad guy, and some particular nurse , aide in the role of the good person or the villain. “We don't worry about those kinds of things," Dr. Fleming said. "What we worry about is when no one here means anything to the patient. "I like it best when the doctor is seen the bad guy; when the doctor is seen the negative force; when the doctor is seen as the great ‘no' man;, when the doctor is seen as lacking in understanding and feeling--and the rest of the personnel are seen as the good guys. "The simple reason for this is that it's the rage inside of you, the anger inside of you, the frustration in your earlier lives that we think has caused most of the difficulties-- and of all of the people trying to help--it is the doctor who is best equipped to help you discover what is wrapped up in your negative feelings. Dr. Fleming touched on a subject that puzzles most patients. "What most people who are here are asking for, as I understand it, is for help to live a better, happier, more efficient life. And they naturally expect that some doctor they consult here will be able to answer the question of what they should do. "Shall I divorce my husband? Shall I return to school? And actually, we're not in the business of giving advice. In those rare instances where advice can be given, we are glad enough to give it. "But most situations are much more complex. People, for example, who run out of a marriage only to get into another one are not ahead. And youngsters, for example, where the advice is obviously, 'You should return to school,' don't take kindly to such advice. So that's no help. They know they should go to school. "What the young patient wants is 'Make me dislike school less; or help me control my impulses more so I can go to school.' It is in the concept of the relationship between the patient and the doctor that impulses can be controlled more, and school or regular; work can be disliked less." Of all the workers at the Menninger hospital, none has more impact on the families of patients than the social worker. Families have a large role in the treatment of a patient. They must bring the patient personally to Topeka and be prepared  to spend three to five days in initial interviews. Then families return here every month to six weeks for additional three-day periods, so they may understand what is going on with the patient. Virginia Heisey, a social worker, says all sorts of feelings are at play when a family first comes here. "These include such things as bewilderment, frustration, feelings of fear and guilt. They are constantly asking, 'What did we do, how did we contribute to the problems?' They are faced with an undeniable fact that something has gone wrong, and this is blatently in front of them at the time the patient comes into the hospital." Miss Heisey said it is important to help relatives understand the patient's problem--which is quite different from causing the problem. "The relatives are so close to the action that they can't sometimes really understand what is motivating the action or can't see what the results of the action are. One of the goals is to help them understand this. Marilyn, an intelligent young girl who covers her sensitivity with wisecracks and a tough exterior, says she sometimes feels as though mental patients have a sign on their backs, "I'm a Nut" or "I'm an Ex- Nut." "We're not people with four ears or with two heads and we don't like being gawked at and pointed at and stared at. I think a lot of people still have the archaic idea that mental patients run around screaming, tearing their clothes off and banging their heads against the wall. ''But this isn't what goes on any more in mental hospitals.  If you walked around here, you would think it was a high school or college campus. Outwardly at least we look like anybody else you see walking the streets in any town, anywhere. The difference is that we have a lot of fears and a lot of misunderstandings that we have to overcome before we can cope with reality and life." Marilyn's parents have come through a difficult period  in which their child-for several years--was seen by a number of reputable doctors who were unable to help her. “We knew she was having problems when she was four years old. We thought her troubles were physical. I took her to doctors and took her--until they absolutely loathed me. They thought it was I who was the difficult one, the sick one," her mother said. “Other people thought she was just a difficultteenager and there was nothing really wrong with her until just before we came here to Menninger's. Same thought we were just bad parents. Some said we disciplined her too much; some said, not enough." Marilyn's illness came at a time when there were some serious physical illnesses among the other children in the large family. Marilyn occasionally blacked out and had severe headaches. Often she would either be too keyed-up or terribly sleepy. Her schoolwork gradually slid downhill.  In school she would fall off her chair. While walking to school, she would fall two or three times--then excuse it by saying she had slipped on ice or turned her ankle. In a sense, she tried to make herself out the fool by saying, “I’m just clumsy.'"She used to bug me," her father said. 'One day she would be sweet and considerate; and another day, meaner than the cat. It would only take a brief span of hours for the change. Then I couldn't understand it--but now I do." "Looking at Marilyn made me cry and ache inside,'  her mother said.  'I never saw such a pathetic, unhappy child. She was like children in pictures of bombed-out ruins --absolutely lost and lonely.  She always reminded me of a shucked oyster--a quivering mass. She disliked herself so terribly--yet there was this angel child inside--the Marilyn we knew who has so much love to give and so much concern." “The psychiatrists we took her to-supposedly tops in their field--couldn't find the trouble. I think they thought we were a pair of kooky parents,' Marilyn's mother said. The showdown came when Marilyn took every pill in the house, in an unmistakeable appeal for help. The parents turned to the Menninger hospital as a last resort. The initial evaluation here was exhaustive. Doctors found something had been missed through the years in other physical examinations-undetected diabetes. But even regulation of diabetes was not the total answer for Marilyn, who still has problems . For the first year at the Menninger hospital, she spent most of her time in her room, in bed. She fought constantly with staff and turned her parents inside-out when they visited her. Marilyn says now, "I've changed a lot since I came here. I'm happy with myself, whereas I hated myself before. "I don't think any of us want to be coddled when we get out," Marilyn added. "We want to get what life has to give us. Nobody should solve problems for us or hold things from us. Since I've been here, I know my parents have been withholding some of their problems. I've told them, 'look, I'm going to be living out there--I want to know these things now so I can handle them.' Don't try to shelter and shield us. Just accept us for what we are and not what you'd like us to be." Marilyn's parents particularly are grateful to the Menninger social worker for her help with the total family. “While my wife and I have a fine relationship, we felt we had done a miserable job as parents," Marilyn's father said. "The children would gang up and play one off against the other. The social worker made us sit there and talk it out with her. We got our thinking squared away. "I think we appreciated most being able to bring our children here to visit Marilyn. The Menninger staff worked extremely well with us—not only with Marilyn but the whole family. This is the only place we have ever gotten the answers." Marilyn's mother added softly, "We came here and now we have a child that we didn't have." The dinner hour is over, and the long evening begins at the Menninger hospital. This night there are no scheduled activities, so there are many patients around. Phil Rice, a psychiatric aide, watches with increasing intentness as a young male patient looks through glass of the nursing station at mail for patients spread out over a desk. Somehow there is a stark loneliness about the patient -- an aimlessness in the way he stands, not really expecting to find Rice, lounging inside the nursing station, cocks his head slightly in an attempt to attract the patient’s attention. After a few minutes the patient glances up and sees Rice, who points a questioning finger toward the empty ping; pong table in the hall. The patient's face lights up in smiling assent, and the two begin to play. Down in West Lounge the teenagers begin to gather, bringing along their favorite psychedelic stereo records. The atmosphere is LOUD!  There’s a sadness among the teenagers. Next week the door in the middle of the second floor will be closed, so staff will be able to concentrate more on patients. There's special pain among friends who, next week will see each other during central activities. But there's still laughter, because, with the natural resiliency of youth, they bounce back. Down the hall in another lounge, patients are listening to classical music, playing cards and writing letters. They're worried,too, about the invasion of their peaceful kingdom by teenagers. An older patient--a worried, withdrawn . look on her face - clutches the collar of her robe together as she walks down the long corridor. Three young girls have permission from their doctors to go to a movie at West Campus, as long as they’re back by 11 o’clock. Some patients are straightening their rooms. Others bake cookies for all the other patients. The ever-present coffee pot is steaming at a hallway table, and soft drinks are in a refrigerator. A few patients dressed in nightclothes -- with the drawn look of the very ill- wander up to the nursing station and ask for their medication. The nurse watches as they take the medicine in her presence and they head  back for their rooms. Outside the closed door of Miss Allison, a male psychiatric aide sits on a hallway chair and reads a newspaper. She lies quietly inside her cocoon of wet sheets, a female psychiatric aide sitting at her bedside. She rouses momentarily to say, "I'm sorry I'm causing you so much trouble." The aide smiles reassuringly. There is silence inside the room, as the young girl drifts off in much- needed sleep. The patients are feeling less worried now about Miss Allison, but her illness still is very much on their minds. Sitting with the other teenagers in West Lounge, one young girl, who has been here three years, remembers how it was when she was in wet sheet packs much of the time during her first year. ''This is a lonely place," she said pensively, looking into the quickening flames in the fireplace. "Despite all these people, it's a lonely place. But it saved my life."