Life and Fantasy: Andernach on the Rhine

On my ward for the mentally deficient, there lived a 25 year‑old girl, quite pretty, blonde, mute, who had been hospitalized since childhood.

She communicated by grunts and lallic sounds with the ward nurse, and could draw very nicely. She carried the diagnosis of a mentally deficient by reason of early brain damage, and had spent years in a school for the defectives at Schoenecken in the Eifel, an abominably overpopulated and understaffed facility in the middle of nowhere.

After the girl threw a few tantrums, she was transferred to the State Hospital as an aggressive and chronically unpredictable feeble‑minded patient.

When I examined her, I found that the girl was far from deficient, showing rather evidence of a total deafness. It turned out she was a deaf-mute from birth, and that her so‑called aggressive bouts were actually frustrated attempts at communication.

The yearlong deprivation, lack of schooling, etc., accounted for a far‑reaching lack of intellectual maturation and emotional stability.

Doctors would periodically review Veronika's records, omitting to talk to the patient personally; and so she stayed on year after year, imprisoned not only in the hospital walls on the ward, but in the even more restrictive confinement of her unrecognized deaf‑muteness as well. She was  a victim of the deplorable conditions resulting from the archaic structure of German Institutional psychiatry.

Like many other patients, she had been treated mainly by intra-gluteal injections of a strong sedative called Truxal, and her posterior on both sides looked like a moon‑crater landscape with more pits and scar‑tissue than anything I had ever witnessed before.

How such legal medical crimes can ever be atoned for, I don't know. I brought up the case at a medical conference, and the girl was sent to a special center of the University in Mainz, where our clinical results could be objectified by tests.

Still the damage caused by the life‑long institutionalization was such that a total rehabilitation was deemed impossible.

Veronika S. was transferred to a School for the Deaf‑Mute where she had a tough time adjusting, but I never saw her back at the State Hospital, at least, not as a patient.

The Basaglia developments in Italy contributed to a stiffening of the resistance of German professional circles. The North Italian psychiatrist had led Maxwell Jones' concept of the Therapeutic Community, to its ultimate consequences. He turned over much of the decision making to a forum that was heavily influenced by patient representatives; in the end the State Hospitals were dissolved as such. Once again the psychiatric patients became the responsibility of the local hospitals and physicians. A lot of turmoil was created when those ideas were made into binding laws by the Italian parliament.

It has remained unchanged since and it works, probably no worse than in the previous system. What bothered the German psychiatric circles mostly was that Basaglia was a member of the Italian Communist party! That fact, in line with the contemporary political currents, resulted in a tightening of the ranks and a hoisting of the flag, as the old song of the SA said under Hitler.

For years though, Dr Katscher maintained a kind of status quo. In one sense he was proud to have within the institution that he headed, a group of progressives; he could let them do their thing as long as their modernistic waves didn't threaten to get out of control.

Slowly he got me encapsulated, skillfully occupying me on the Alcoholism Treatment Unit, while he meanwhile retired to the security of the newly erec­ted “Clinical Center”, where he was able to practice that which was his brand of psychiatry, his school of therapy, surrounded by his type of coworkers and assistants.

He found solace in that arrangement, banning those who he felt were rocking the boat too much to the periphery, i.e. the chronic wards, the day‑clinic, the alcoholism unit etc.