Medicine: Part-Time Mental Patients

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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.