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Menaker State Hospital is a curse, a refuge, a place of imprisonment, a necessity, a nightmare, a salvation. Originally funded by a philanthropic endowment, the regional psychiatric facility’s sprawling, oak-studded campus sits atop a bluff on the eastern bank of the Severn River. From the steps of the hospital’s main administration building, the outline of the U.S. Naval Academy can be seen where the river enters the Chesapeake Bay some two and a half miles to the south. There is but one entrance to the facility, and the campus perimeter is demarcated by a wrought-iron fence whose ten-foot spear pickets curve inward at the top. The hospital is not a large central structure as one might imagine, but rather an assortment of redbrick buildings erected at the end of the nineteenth century and disseminated in small clusters across the quiet grounds, as if reflecting the scattered, huddled psyches of the patients themselves. There is a mild sense of neglect to the property. The wooden door frames sag like the spine of an old mare that has been expected to carry too much weight for far too many years. The diligent work of the groundskeeper is no match for the irrepressible thistles that erupt from the earth during the warmer months and lay their barbed tendrils against the base of the edifices, attempting to claim them as their own. The metal railings along the outdoor walkways harbor minute, jagged irregularities on their surfaces that will cut you if you run your fingers along them too quickly.
Twenty-two miles to the north lies the city of Baltimore, its beautiful inner harbor and surrounding crime-ridden streets standing in stark contrast to each other—the ravages of poverty, violence, and drug addiction flowing like a river of human despair into some of the finest medical institutions in the world. Among them is The Johns Hopkins Hospital where I received my medical training. Ironic how, after all these years, the course of my career would take me here, so close to my starting point—as if the distance between those two places was all that was left to show for the totality of so much time, effort, and sacrifice. And why not? At the beginning of our lives the world stretches out before us with infinite possibility—and yet, what is it about the force of nature, or the proclivities within ourselves, that tend to anchor us so steadfastly to our origins? One can travel to the Far East, study particle physics, get married, raise a child, and still … in all that time we’re never too far from where we first started. We belong to our past, each of us serving it in our own way, and to break the tether between that time and the present is to risk shattering ourselves in the process.
Herein lies the crux of my profession as a psychiatrist. Life takes its toll on the mind as well as the body, and just as the body will react and sometimes succumb to forces acting upon it, so too will the mind. There are countless ways in which it can happen: from chemical imbalances to childhood trauma, from genetic predispositions to the ravages of guilt regarding actions past, from fractures of identity to a general dissociation from the outside world. For most patients, treatment can occur in an outpatient setting—in an office or a clinic—and while it is true that short-term hospitalization is sometimes required, with proper medical management and compliance patients can be expected to function in the community and thereby approach some semblance of stability and normality. This is how it is for the majority—the lucky ones, whose illnesses have not claimed them completely—but it is not the case for the patients here. Too ill to be released into the public, or referred by the judicial system after being found either incompetent to stand trial or not responsible by reason of insanity, Menaker houses the intractably psychiatrically impaired. It is not a forgotten place, but it is a place for forgetting—the crimes committed by its patients settling into the dust like the gradual deterioration of the buildings themselves.
The word asylum has long since fallen into disfavor to describe institutions such as this. It conjures up images of patients (there was a time when they were once referred to as lunatics) shackled to concrete slabs in small dingy cells, straining at their chains and cackling madly into the darkness. To admit that we once treated those with mental illness in such a way makes all humanity cringe, and therefore one will no longer find “asylums” for such individuals, but rather “hospitals.” And yet, for places like Menaker, I’ve always preferred the original term. For although we attempt to treat the chronically impaired, much of what we offer here is protection—an asylum from the outside world.
Some of this, perhaps, is too bleak—too fatalistic. It discounts the aspirations and capabilities of modern medicine. But it is important to understand from the beginning what I am trying to say. There are individuals here who will never leave—who will never reside outside of these grounds. Their pathology runs too deep. They will never be restored to sanity, will never return to their former lives. And the danger, I am afraid—and the great tragedy for those who love them—is to cling to the hope that they will.
You’ve got a visitor,” Marjorie said, smiling over at me from the nurses’ station.
I glanced toward the intake room. Through the rectangular glass pane in the door I could see Paul, one of the orderlies, ushering in a new patient. A visitor, I thought. One of Marjorie’s euphemisms.
“Is this going to be one of mine?” I asked, checking the roster board. I hadn’t been advised of any new admissions.
Marjorie nodded. “I think you should see this one.”
“Did he come with any paperwork?”
“Not that I know of.” Marjorie’s eyes were back on the chart in front of her, her attention elsewhere.
I sighed. The protocol was that we were to be advised ahead of time regarding any new transfers to the facility, and that those transfers should arrive with the appropriate paperwork, including a patient history and medical clearance assessment. Patients weren’t supposed to just show up unannounced, and it irritated me when that happened. Still, one had to keep in mind that we were dealing with a state bureaucracy here. Nothing really surprised me anymore. I decided not to be a hardnose and to let the administrative screwup ride for the moment, although I certainly intended to bring it up with Dr. Wagner later.
Paul had stepped through the door and closed it gently behind him. He motioned me over, and I walked across the room to join him.
“What have we got, Paul?”
“Young man to see you,” he said, and we both peered through the glass at the patient seated in the room beyond.
“What’s his story?” I wanted to know, but Paul shook his head.
“You’ll have to ask him.” Apparently, Paul had no more information than Marjorie did.
I pushed through the door. The patient looked up as I entered, smiled tentatively at me. His handsome appearance was the first thing that struck me about him: the eyes pale blue, the face lean but not gaunt. He had the body of a dancer, slight and lithe, and there was a certain gracefulness to his movements that seemed out of place within these walls. A lock of dark black hair fell casually across his face like a shadow. He was, in fact, beautiful in a way that men rarely are, and I felt my breath catch a little as I sat down across from him. I gauged him to be about thirty, although he could’ve been five years in either direction. Mental illness has a way of altering the normal tempo of aging. I’ve seen twenty-two-year-olds who look forty, and sixty-year-olds who appear as if they’re still trapped in adolescence. Medications have something to do with it, of course, although I think there’s more to it than that. In many cases, time simply does not move on for these people, like a skipping record playing the same stanza over and over again. Each year is the same year, and before you know it six decades have gone by.
“I’m Dr. Shields,” I said, smiling warmly, my body