Buck, who lived to the age of 102, fought throughout her life for psychiatric reform. She created her own form of mind care, which she called “trialogue.” Buck refused to dismiss the meaning of her psychotic visions or reduce any neurodivergent state to “biological brain disease.” In trialogue, psychosis experiencers, family, and clinicians worked as equals, with respect for the value and knowledge of both experiencer and experience. Buck also demanded recognition of the Nazi murders of the disabled and the mentally ill. Many of these victims were psychiatric patients gassed between 1939 and 1941 in chambers built into German asylums.

I first encountered Dorothea Buck in 2019. Buck died that fall, at the age of one hundred and two, as I was having a psychotic episode. I learned of Buck’s life and her book through an obituary in The New York Times. I found her memoir, On the Trail of the Morning Star: Psychosis as Self-Discovery, and had it translated by the wonderful Eva Lipton. Buck wrote her story at the urging of journalist Hans Krieger, and the book appeared in German under the pseudonym “Sophie Zerchin”—an anagram for the German schizophrenie—in 1990. I encountered a thinker who captured not only the buffeting of neurodivergent experience, but its corollary: the mind engaged in a process of world-making, a making that functions through its own channels. Buck taught me a new respect for the wildly creative work of consciousness.

On the Trail of the Morning Star, from which these two excerpts are taken, appeared in English in May of 2024. It’s available at punctum books, as a physical book or a free download. Buck would have wanted that. Both excerpts describe places where, as Buck acerbically put it, “I had sworn to myself that I’d rather stay mentally ill than ever take part in having the ‘mental health’ being demonstrated here.”

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Excerpts from On the Trail of the Morning Star: Psychosis as Self-Discovery

The first excerpt describes Buck’s experiences in Bethel during her 1936 hospitalization, including her sterilization. Buck was shocked to find inner experiences she found deeply meaningful dismissed as meaningless physical disease. Ignored, tormented by treatments like wet wraps, witness to the brutalization of other patients, Buck later called the Protestant institution of Bethel a “hell amidst Bible quotes.”

A human being can hardly be degraded more. The doctors and nurses who know nothing and want to know nothing about the history and the contextual meaning of the psychosis and think everything is just a meaningless side effect of a physical disease, probably never think about how they degrade and devalue us. As long as they don’t talk to us, they cannot know anything about us.

Was I supposed to recant what I had experienced? Is that what they wanted? Did the old authoritarian demand of the church to recognize only what fit their ideas of God’s path for humans, and keep people from questioning their role as mediators, present itself in a new form of resistance, one that was more contemporary than medieval methods? I swore that I would never exchange what I had experienced as God’s guidance for the “true Christianity” that was being modeled here. Following each narcotic injection and each little glass of paraldehyde [a powerful sedative] I was given, I insisted to Nurse Y. that none of this would ever change my mind, and I repeated this until I passed out.

On the green wall across from me painted in large letters was Jesus’s quote: “Come unto me, all ye that labor and are heavy laden, and I will give you rest [with the sense of ‘refreshment’ in German].” Refresh—with long baths and wet wraps, with cold water showers on the head, with narcotic injections and paraldehyde. That was absurd and incomprehensible. I had to think of God calling the devil “the father of lies.” And then something happened that made an indelible impression on me. Frau Pastor H. was cleaning the hall dressed in the blue-striped ward uniform and talking to herself. Maybe the tone was aggressive and maybe she looked at Nurse Y. Regardless, [nurse Y] suddenly grabbed the Frau Pastor’s long hair, pulled her down to the ground, and dragged her across the floor by her hair. She passed the Bible quote going into the bathroom. Like a strong field horse in front of the plow she looked at us—an unforgettable image of brutal violence and unprotected impotence.

Decades have passed since then and still that image is embedded in my mind’s eye as if it happened yesterday. And that is probably how all of us affected ones feel who have had the most harrowing experiences in our asylums—possibly in Christian asylums with Bible quotes on the walls. If that is supposed to be spiritual health—it could not convince us. We learned to fear this type of “spiritual health.”

Later a young aristocratic woman joined, Fräulein von W. She had been operated on recently. She kept getting up from bed. What were those peculiar scars that she and little R and little P had above their vaginas? I asked Nurse Y. “Appendix scars,” she explained. Earlier on I’d learned that the appendix was located on the side. Had we been lied to about that as well?

In the institution we were robbed of our dignity; we were reduced to being objects to be kept and observed. We were objects to whom it was not worth talking, and who were not worthy of occupation or else considered incapable of being occupied. And to be unable to talk to anyone about it was the same as total inner isolation. As much as Bethel tried to fight my experiences as the expression of “mental illness”—for me they remained something very essential.

In the meantime, I knew we were being kept here because we were “mentally ill.” And I had sworn to myself that I’d rather stay mentally ill than ever take part in having the “mental health” being demonstrated here; it seemed to me not worth aspiring to.

One evening—it was September 17—the friendly ward nurse M. shaved my pubic hair after my bath. Why? I wanted to know. “For a necessary little procedure.” It was obvious that she didn’t want to provide a more detailed explanation and I didn’t ask any further. I had no idea about a sterilization. That is why I hadn’t had any doubts when Nurse Y. referred to my co-patient’s scars as “appendix scars”; many, after all, had their appendices operated on. And I never would have thought it possible such a serious procedure could be done without first talking about it to the concerned party.

Early in the morning, Nurse M. took me to the Gilead hospital. I felt no fear at all as I stood alone in the antechamber of the operating room in my white cotton socks and short shirt. For the first time in more than five months I was able to open a window all the way, and I felt such happiness about this wide open window on a bright morning with the sun rising. I still had no idea what they planned to do with me.

Nurse M. entered and was visibly startled to see me standing at an open window. The thought of jumping out of it had never crossed my mind. She quickly closed the window, and I got on the gurney that was rolled into the antechamber. The anesthesiology nurse—I still see her face—injected my arm and I sank into the unconsciousness I was already so familiar with, though it was faster. than I was used to. This injection worked much faster than the ones that Nurse Y. jabbed into my thigh, once with such force that the discoloration of the skin can still be seen today.

I woke up out of anesthesia in the little four-bedroom area in the ward for the depressed. Now as well, nobody informed me what kind of procedure had been performed.

Another patient, a deaconess who had been living here a long time following an auto accident, explained to me that the operation was a sterilization. She had brought flower garlands she made herself to my sickbed. Without her I would probably not have found out anything in this house.

I was in despair. I had my hair cut, because I at least wanted to watch my hair grow if everything else in my development was to stop.

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This second excerpt describes Buck’s fifth hospitalization in 1959. The relatively new emphasis on psychoactive drugs rendered Buck semi-conscious and she spat out her pills. Though thirty years had passed since Buck’s first hospitalization and National Socialism was over, little had fundamentally changed—care remained negligent, dehumanizing, aimed at suppressing patients’ inner experiences rather than exploring them. Buck and her fellow patients began to speak to each other about their inner lives, and their conversations and mutual support became the roots of Buck’s later psychosis seminars.

I lay in the large admission hall with a number of rows of beds. The female patients lay next to each other one bed after the other, only separated by a nightstand. All of them were sedated with injections. I hadn’t experienced that yet: that we should be incapacitated with psychotropic drugs right after being admitted and then kept sedated. In a brief time, we were also so physically weakened that I stumbled to the bathroom on unstable legs. I had to hold onto the edge of the bed in order not to fall. My hand trembled so much that I could hardly hold the cup and spilled my coffee.

“Don’t carry on so!” the young nurse barked at a female patient who buckled on her way to the bathroom. That was the most eerie part of what I experienced in the institution: a large hall full of intentionally weakened, half- or fully sedated patients. The doctors barely knew what was going on, what they were experiencing, but they had the authority to take our last bit of freedom in a locked house: the freedom of our thoughts, our consciousness, and our bodies.

Even if we were put into duration baths in Bethel in 1936, or got sedative injections, once we woke, we were fully present again and not weakened physically. We didn’t have to swallow our fear and our resistance but could express them anew. Is this forced silence really progress from the “restless wards,” with their justified resistance against psychiatric methods, which fight and devalue the patient and their experiences?

I protested against the forced injections, I tried to explain that my previous break had receded on its own without medication and had actually led to a break-free period of thirteen years. The medication-induced interruption of the psychosis had led to new outbreaks after just five and three years. None of it helped. “Just leave it to us,” one of the doctors in the admission ward said. “We can already see what is going on with you.” The experience of the patient and the meaning it has for them didn’t interest our psychiatrists. They were only interested in the symptoms and behavior that deviated from the NORM. The power of these psychiatrists to force their limited viewpoint on us with medication is frightening for us.

Luckily, I got a rash after three days, so the injections had to be stopped. Instead, the nurse now stuffed pills in my mouth. I had to suffer it, but she didn’t force me to swallow them, as is done nowadays. I kept them under my tongue and waited for an opportunity to flush them down the toilet when nobody was looking. None of the doctors noticed that from that time, until about eight weeks later when I was discharged, I had not been medicated. Prior to being discharged I told the ward doctor that I had never swallowed pills. “We have to treat with medication,” he noted, “insurance demands it of us.”

For the first time, however, we tried to help ourselves on this ward. The summer of 1959 was very hot, so we were allowed to stay in the little ward garden most of the time. A group of about eight female patients sat on recliners that were shoved together and talked about what had struck us most during our psychosis experiences. This way we could give one another confirmation of the meaning of our experience and separate ourselves from the devaluing psychiatric evaluation that undermined our confidence. These hot summer days, above us the crowns of the pines in whose shadows we discussed our psychosis and dreams in a relaxed way, and thought about them, belong to my good memories of my time in institutions. It is the fellow patients through whom institutional time becomes rewarding, because they have known what psychosis is and know more about it than specialists. The specialists neither have the experiences themselves, nor are willing to learn about them by talking to their patients.

For a female patient in her first break who only heard individual sentences, it was still impossible to see a meaning in them; she couldn’t understand the context and connection. Those of us who had experienced a number of breaks and thus had more comprehensive psychosis experiences found it easier to recognize the meaning.

This patient told me about experiences of everything unifying. She much later read about similar events in the biography of an East Indian. She was a woman with a simple background, and she could hardly have known about the book. Aside from such happy experiences, she had a compulsion to add up people’s value by the numerical value of the letters of their names. Where nothing could exist without meaning, even names had to have a secret meaning. In the book Mysticism and Magic of Numbers by F.C. Endres I later read, as I found out about psychoanalysis, that this same transformation of letters into number values and vice-versa had occurred two hundred years earlier among Kabbalistic scholars. That it is much older may be indicated by Roman letters that represent number values. If this patient could have seen such parallels, then she could have understood her compulsive behavior better: a breaking open of “archaic idea possibilities,” as happens in schizophrenia according to C.G. Jung. Perhaps they would then have lost their compulsiveness for her. What one understands affords one more freedom.

Our psychoses had receded. My fellow patients had been suppressed with psychotropic drugs, in my case, the break had receded without medication. We had grown our thick skin back, the close community began to disintegrate. I felt again the slow abatement of the strong impulses of the acute break into just a quiet instinct, as with the previous break, which had also not been interrupted with medication.

We were close to being discharged.

The post Dorothea Buck’s Memoir Tells of the Horrors of Twentieth Century Psychiatry: A “Hell Amidst Bible Quotes” appeared first on Mad In America.

My family was a mess. My brother told me years later that my mother had initiated proceedings to get me removed permanently from our home; he wasn’t sure how, being just slightly older than me, but she had told him about the plan. That tension, and others, certainly were things I sensed at the time.

My first psychiatrist before hospitalization gave me Tofranil, a tricyclic antidepressant and a reasonable thing to prescribe at the time. He also prescribed, very improbably, Dexedrine, an amphetamine and popular street drug. Of course, like the drug user the doctor knew I was, I popped these amphetamines at far more than the prescribed dose. Twenty pounds came off my already thin frame. My moods shifted drastically up and down. Thus the hospitalization.

I am an “organic bipolar,” which I say bearing in mind that the disorder has become wildly over-diagnosed these days and is rare. I believe bipolar disorder is an existential state as well as something that, in my case, might exist in some form  in the body—as the roots of many of our ways of experiencing the world do. It is not an illness. I don’t argue with the term bipolar; I want to redeem it. As I argued in my book A Mind Apart, just as the world needs biodiversity to survive, so too does it need neurodiversity.

I have diaries I began keeping at the age of nine, and they clearly describe my mood swings—my “A moods” and “B moods”—and show evidence of what would fall under the heading of psychotic thinking. I wrote at one point that my family was trying to poison me;  though this was a delusion, I do believe who we are is deeply knit into psychosis. Given what was probably already happening with my mother, that belief gave shape to a reality I intuited and was actually living. Perhaps on this website it goes without saying, but never did any medical interventions look into my life.

So instead, starting at 15, I received multiple rounds of electric-shock treatment, some as an outpatient and some in the hospital where I began this story. These treatments wiped out chunks of my autobiographical memory—my life— and left me with cognitive deficits in spatiality and math that I have to this day. When I had shock treatment (though of course I had no idea of this) the procedure was in a state of public relations crisis stemming from justified reporting and patient testimony about abuses. As David Rothman, a medical historian, reported at a National Institutes of Health conference, it is one of the only psychiatric treatments often used not for cure, but for the benefit of hospital staff.

The knowledge of shock’s use as a threat, and as a way of creating a hazy docility that makes ward life easier, damped down enthusiasm for it. Two years after I last received shock treatment—1974—California outlawed it. ECT was revived in the 1990s, and the talking point I hear from doctors, and see again and again in both popular articles and medical papers on the topic, is this: The abusive stuff was bad, yes, but it all happened in the 1950s.

This judgment wasn’t true to my experience. Shock treatment was often mentioned in connection with bad behavior at my hospital, and as it was a private one (my father had health insurance), we also heard that if staff chose to transfer us to a state hospital, there would be more and worse treatment, and more shock.

Patients called the shock machine the “buzz box” and it spawned a number of rhymes we sang to the tune of “The Hearse Song.“ They all began with the line “If you should see the buzz box go by…” followed by things like, “…remember that if you get high.” A majority of my fellow patients were also young girls and some stole pills from nurse’s carts to get stoned. Not all of these girls were patients who had been drug users on the outside. In a hospital like this, you have slender chance to assert that you are a human being with your own will.

I have clear, if fragmented, mental pictures of the worst moments at that hospital. I recall the chilly conducting gel being pasted on my temples before ECT. And I remember a particularly awful group-therapy session with the chief psychiatrist, a graying man as chilly as that conducting gel. During this session, he announced that a patient, a girl whose name I don’t recall and who was pretty with large breasts, would like to sleep with him, and that he would like to sleep with her but had decided to let us have a say in whether he in fact did.

He was middle-aged and she was a teenager like me, and his face held the same expressionlessness posing this question that it always had. My 15-year-old response is hard to explain now. I mostly registered that I was not pretty or busty enough to be the object of this discussion. Otherwise, it felt like a question arising out of life circumstances far beyond my understanding, and the right answer seemed to be yes. I think most of us said yes, with uncertainty, as we all felt some critical test hovered at the back of his words. I assume they then had sex. I don’t know.

I have had kind psychiatrists and uncaring ones over the years, more of the latter than the former. I will brush over the years I spent on large doses of Haldol to get to this point, for psychiatry is a discipline in which treatment and gaslighting exist in a complex braid. One side might show more than the other at times, but they’re closely woven together and hard to pick apart. Doctors are trained to believe patients lack self-awareness and are likely to be treatment-resistant due to their conditions, particularly if they have been labeled with psychotic disorders. The hardwired belief in treatment resistance means patients must be talked or coerced into treatment, a situation that exists very uneasily with informed consent.

Psychiatrists, by the terms of their profession, need to exist in a mental sphere far above those they deal with, and as a last resort, can point to the “illness” itself as their argument. Many psychiatric papers I’ve read on shock—and I’ve read hundreds—describe cognitive and memory losses as being caused by the “patient’s” depression or other neurodivergence itself. The author of one paper I read on the screaming gender biases in shock administration, with at least two-thirds of patients being female at the time I was treated, said he believed the reason was that women patients might elicit more “caring” from their doctors.

I say all this as one of those people who does use medication, in spite of the fact that I’ve found the dispensing of it rife with problems. My reports on the side effects I experience from what I’m taking, even listed side effects, are generally met with some reassurance that “that can’t be happening,” or at least happening at the levels I report. My responses to the drugs also count for nothing in favor of the all-important “clinical dose,” which means you must take a certain amount even if it is less is helpful. As if taking a few milligrams less of something renders it pointless, like swallowing air.

Our doctors also may not like us, not just individually, but as a tribe. I believe this antipathy is much more prevalent than anyone in the profession would admit. In 2011, the Albany Times-Union newspaper ran a blog post by a doctor-in-training titled “Psychiatry: The One Specialty Where It’s Okay to Hate Your Patients.” This woman had had an encounter with a patient who, she wrote, “really pissed her off.” Her own fury led her to understand that this patient had Borderline Personality Disorder. This soon-to-be doctor learned in her medical training that providers’ emotional reactions to psychiatric patients are part of diagnosing them. She wrote chirpily that “In fact, I hear the psychiatrists discussing their (often negative) feelings about patients every single day.”

Imagine reading “oncologists” and “cancer patients” into this sentence: “I hear oncologists discussing their (often negative) feelings about cancer patients every single day.” It horrifies me that such a thing was ever published. It never would have been if it referred to any other pool of medical patients.

The other psychiatric assumption I encounter over and over again is that things now are “different.” Abuses happened decades ago. Shock treatment, now unilateral and done with pulsing currents, doesn’t do any of those terrible cognitive things. I’m agnostic about whether this “new” form of shock is better: I haven’t had it, and maybe it is. But I question the “now,” a time presented in psychiatric literature as new and enlightened and better, with the bad stuff left in the dust.  That bad stuff includes the astonishing eugenics of the 20th century, the attitude toward the value of neurodiverse people that allowed for the mass sterilization of men and women held in asylums, as well as lobotomies, and the use of shock for punishment and silencing. The last U.S. lobotomy happened in 1967, just three years before I entered the psychiatric system. The patient, a woman named Helen Mortenson, had a brain hemorrhage and died. If this death had not occurred, lobotomy would probably have been on the list of my possible cures.

The last U.S. forced sterilization took place in 1983. All these events are recent enough that doctors trained during that era are still out there practicing, possibly training others. Many are no doubt good people who would knowingly do nothing harmful. But historically, a few decades are an unlikely amount of time for attitudes to have actually changed so much.

Here is a story from today’s “new” psychiatry: Several years ago, I took a bipolar family member (I’ll call her Sarah), to the emergency room. She was having a manic episode, taking extreme risks with her own safety, and I believe she needed to be stabilized, or held until she again became stable. Nurses sedated her—she knew she needed that— and informed me they had no open psychiatric beds.—This is sadly normal at the main hospital of my small city. The ER nurse called places around the state and finally found one with open beds, a privately owned facility near Seattle.

We moved Sarah there by ambulance and I visited her the next day. She was so medicated she drooled and passed out as I spoke. It was clear we needed to move her somewhere, anywhere, else. At my questions about releasing her, a nurse mumbled something I couldn’t catch, then clammed up. My husband and I called hospital administrators, we called lawyers. We finally learned a commitment hearing had been scheduled behind our back, intended to keep her committed for two more weeks. We learned this only through endless persistence and found out just a day and a half before the hearing. We grabbed Sarah and moved her out.

I shared this story with almost no one. It sounded so Cuckoo’s Nest, like something an activist like me would invent. Or a patient like me. Later, though, a friend forwarded me a link to a Seattle Times expose of this hospital, titled “Free to Check-in But Not to Leave.” It detailed similar commitment abuses. Right now, a class-action lawsuit alleges this hospital did extensive, video-recorded strip searches of incoming patients. On Sarah? Maybe. She was too drugged to remember.

I want to end by saying that I have not only encountered psychiatrists who were good, caring people, but also that I believe more are out there. I recently wrote an article for The New York Times about my psychotic episodes, specifically about my rejection of the medical model. Whatever I might choose to do about such an episode, I wrote, there is no sick-me and well-me. There is just me. I cannot condemn a part of myself as sick, and I need control over what to do about my own cognitive and intellectual life.

After this article came out, I heard from people with psychiatric diagnoses and from family members of such folks, which I expected. I also heard from a surprising number of psychiatrists. I was invited to speak to grand rounds of psychiatric practitioners at hospitals and asked to just give them some sense of what their treatments should look like. I felt a hunger in at least some in the profession to provide care that respects that actual human before them, we who now mostly drown in the diagnostic numbers of the DSM-5.  In this I am following in the footsteps of Dorothea Buck, psychiatric activist and Nazi sterilization survivor, who died at 2019 at the age of 101, still asking one thing of psychiatry: listening.

The post Then and Now: Will Psychiatry Ever Change? appeared first on Mad In America.