On a late summer day, my student and I walked into a patient’s room on the chronic ward of the state psychiatric hospital. “Kevin,” a chronic schizophrenic, lay in his bed, staring vacantly at the wall. His tall frame was too long for the state-issued bed. His skin was gray and translucent. The only sunlight he was ever exposed to was the little bit that filtered through his steel mesh–encased window. He moved his lips repeatedly, as if he were eating something or trying to talk. But he did not speak. Kevin had been my patient for three months, and I had never heard him form a word.
That day, my student and I were to perform a physical exam at the request of Kevin’s psychiatrist, to clear him medically for electroconvulsive therapy (ECT). Some catatonic patients show a dramatic improvement in their symptoms after this treatment.
As my student and I performed our examination, I made sure to emphasize to her that even though Kevin could not move much, and he tended to stare off into space a lot of the time, he was present in mind and body and aware of everything we were doing to him. Sadly, though, it did feel a bit like performing an autopsy. Kevin stared at the ceiling while we examined his lungs and heart. His muteness seemed to propel me to make constant conversation to fill the silence. “We’re going to touch your stomach now. You’re doing a great job, Kevin.” I could see a glimmer behind his blue eyes.
Catatonia is a cruel form of mental illness. Affected patients often cannot initiate movement. They are like a car in neutral. They can see and hear and think, but it’s difficult for them to get going. They need something to put them in drive.
For Kevin, this could mean helping him to stand up and guiding him along with a gait belt, or it could be the voice of his mother on the phone. Talking to her was when he was closest to being verbal. He would get excited and spurt out garbled noises to her in a gravelly, excited torrent. She seemed to understand him.
Kevin’s mother visited every Tuesday. She is tall like Kevin and does not smile. She would always bring him a quart of chocolate ice cream. They sat in the day hall, and she dutifully fed him the entire quart. At times, he looked like a three-year-old, with chocolate all around his mouth and down his shirt. When he wanted more ice cream, he would rock back and forth in his chair. He truly enjoyed this time with her. He and his mother seemed to have their own private language.
Kevin is young, the same age as I am—42. He was one of several children born into a large Irish Catholic family in New England. Kevin’s childhood history included head trauma at the age of 8, when he fell off a bike. He started to develop signs and symptoms of schizophrenia at age 16. He had been on our chronic ward for three years before my arrival. I wasn’t even aware of his existence until I started to cover the unit.
Patients can have long stays, but it seemed particularly cruel that Kevin had not made any progress during his three years there. In fact, he had grown worse. He was now very deconditioned because of his lack of activity, and forced to wear a diaper at all times due to incontinence. He required an extensive bowel regimen and full care from our mental health workers for all activities of daily living. Feeding himself and toileting himself were impossible. I could not clear him fast enough for the ECT.
He received three ECT treatments per week to start. My student’s rotation ended, so she would not be able to see whether Kevin’s treatments had helped. I went away on vacation for a couple of weeks, too.
When I returned, I arrived on the ward to do my rounds. As I was walking by the day hall, I could sense someone’s eyes following me. I turned and there was Kevin, sitting at a table, looking at me. His long right arm shot up suddenly, and he said, “Hi!”
I was rendered speechless. The attendant next to him, a kind man who had built a relationship with Kevin, beamed a smile at me. “Doesn’t he look great!” he exclaimed. Indeed!
I wasn’t sure what to ask him first. “Do you know who I am, Kevin?”