Part-Time Mental Patients

Each morning Emma B. got up and dressed, joined the rest of the household for breakfast, then caught a bus to an old stone mansion on Montreal's Pine Avenue. At 34, Emma looked like any other secretary going to work. But her destination was no office: it was the Allan Memorial Institute of Psychiatry. There, from 9 to 5, Emma was a mental patient. In the evening, she took the bus home again.

Ever since high-school days in Burlington, Vt., Emma had had a mysterious breathing difficulty. For no apparent reason she would take a deep breath and then, as she thought, "stop breathing"; actually, she took shallow breaths on top of what she was holding, finally let all the air out with a giant sigh. Afraid of suffocating, she had spent years going from doctor to doctor, finally quit her work. Last October, a neurologist decided that her trouble was emotional, referred her to Montreal's famed Allan Institute.

Beneath the Surface. There, a psychiatrist concluded that Emma B. needed more treatment than he could give her as an outpatient, but not enough to require admission to the full-time inpatient hospital. Since she could stay with relatives in Montreal, she was an ideal subject for the in-between type of care offered by the Allan's day hospital, founded by Director D. Ewen Cameron in 1946, and first of its kind in North America.

Emma immediately accepted her position as one of the hospital's 40 patients (two-thirds of them women), and enjoyed mixing with the others in the high-ceilinged day rooms, comparing problems, reading or just listening to the radio. (There is no TV; the doctors doubt that it would help.) Beneath the surface, things were not quite so smooth. Her psychiatrist diagnosed Emma's case as hysteria; she was an immature personality who playacted in real life and shut out problems by simply pretending that they did not exist, especially in regard to sex.

Her psychiatrist helped Emma to see how her emotional tensions were linked with fears of drowning and other accidents which involved stoppage of breathing. Chlorpromazine (TIME, March 7) made her feel considerably less anxious and nervous. Most important, daily interviews with the psychiatrist enabled Emma to understand the ways in which she had failed to grow up and gave her the guidance to do something about them. After two weeks in the day hospital, Emma went home--not cured, but so improved that she now has only slight breathing difficulty about once a week. She is back at work half time, will go on full time in the new year. She still takes small doses of chlorpromazine, and goes back periodically to see a psychiatrist.

Full-time hospitalization would have cost her at least twice as much as the $137 (plus doctors' fees) that she paid at the Allan day hospital.

Day & Night Shift. The day hospital, directed by Dr. Graham Taylor, draws its in-and-out patients from all walks of life.

Last week's population, smaller than usual because of pre-Christmas discharges, included 18 women, 13 of them housewives, as well as a stenographer, a telephone supervisor, a clerk, an artist and one unemployed; among the eight men were two mechanics, a cleaner, a hairdresser, a steel inspector and three unemployed. Their illnesses range from the commonest neuroses to severe psychoses. The decision as to whether a patient can be admitted and effectively treated is made not on the basis of a diagnostic label, but on whether he or she is too disturbed, and thus likely to disturb others. Though the sexes are mixed deliberately--Dr. Cameron wants the inside of the hospital to resemble the outside world as far as possible--sex causes no trouble. Only exception in the memory of the present staff: a schizophrenic prostitute who was homosexual during psychotic episodes and made advances to nurses, became heterosexual when her illness faded, and ogled the men.

One reason why many victims of emotional illness "give up" and accept full-time hospitalization is their desire to escape from the world. Being shut away may make this worse instead of better. So Dr. Cameron also uses the day hospital as a weaning station or halfway house for patients who have been in the Allan Institute's full-time hospital and need help in readjusting to the world at large. For patients who might find the transition from the day hospital to life "on the outside" too abrupt, the Allan Institute has just added a "three-quarter-way house": an evening treatment center where electrotherapy and mild insulin treatments are given, and blood samples taken for various laboratory tests. The evening hours make it possible for a worker to attend without taking time off from the job, or for a mother to leave the children with her husband instead of a babysitter.

Less than a mile from the Allan on Pine Avenue towers the new ten-story, redbrick pile of Montreal General Hospital. Here Director Albert Edward Moll of the Psychiatry Division has carried the half-day hospital principle to its logical conclusion: a compact space at the west end of the fourth floor is a day hospital by day and a night hospital by night. Its 15 beds serve day-hospital patients in much the same way as the Allan unit. But at 4:30 p.m. the day patients leave. At 5:30 the night patients begin to arrive from their jobs--six men, nine women. These are patients for whom Dr. Moll considers it especially important to get away from a family situation which is causing or aggravating an emotional upset. They do this neatly, get all necessary treatment and a sound night's sleep, and still keep their jobs. Many who formerly would have struggled to carry on at home and on the job until they reached the breaking point are spared that hazard.

Though these treatment units in Montreal are small, their influence is spreading. Day hospitals, patterned after them, have been set up in the U.S., notably at Topeka's Menninger Clinic and Boston Community Clinic, and others are abuilding.

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