The Third Table

08: Allen Cooley

Chapter IX

THE COZY CONCEPT OF ‘NURSE’ AS FEMALE

BY Allen and Shirley Cooley


Shirley and Allen Cooley

Shirley and I first came to Riggs in 1953 and then left after two years to gain further training.  We returned in 1959 delighted that the permanent staff retained many of the same luminaries — Drs. Robert Knight, Joseph Chassell, David Shapiro, Margaret Brenman, David Rapaport, Stuart Miller, Ess White, Robert Harris, Eugene Talbot, Professor Eric Erickson, Head Nurse Edith Breed. We were in the right place — a small hospital where we could enter into all aspects of the program and develop relationships with both staff and patients. Foundation Inn looked like a real inn — friendly, inviting, none of the institutional trappings prevalent in most hospitals.

Foundation Inn Living Room

Foundation Inn Living Room

There was no night staff as such in 1959. Nurses participated in all aspects of the Riggs program, in contrast to the fixed day and night shifts of 1953.

We had two reasons for wanting to come to Riggs. It had built a reputation for achieving astounding results without confining patients and by respecting their personal dignity. Personally, there was an advantage in being close to our families in Pittsfield.  Fortunately, Dr. Knight invited us to return in 1959, just before my graduation from NYU.

Our background was initially what it was for most nurses — the three-year diploma program. Shirley graduated from Bishop Memorial Training School in Pittsfield, and I from Manhattan State.  Psychiatric nursing as a specialty was in its infancy, and there was also a preference for Nurses with a broad general background.

Our tenure at Manhattan State Hospital in New York awakened us to what could be done in any psychiatric facility that welcomed alert and dynamic staff.  Shirley often commented on the stark contrast with the torpor and rigidity of the Massachusetts state hospital where she had trained. We saw the possibilities in an open hospital like Riggs, free from the regimentation and crowding of the huge public institutions (Manhattan had nearly 4,000 patients and a staff of hundreds).

Riggs proved enormously stimulating in an intellectual way. We read omnivourously in the literature. We read — not just skimmed — three newspapers every day, and attended seminars and classes. Learning is a taste which Riggs cultivated. Staff never stressed degrees and paper credentials — what mattered was what people did with their talents. And the study of current material — ongoing conferences, seminars, and bulletins — enabled us to stay abreast of developments in the field.

In coming to Riggs we exposed ourselves to new people, new ways of behaving, new ways of thinking.. In the process, we grew by taking risks, dumping limited but often comfortable ideas about ourselves, and familiar ways of living. We divested ourselves of armor by removing our uniforms and abandoning the rigidity of prior role models. Thus a patient showed Shirley why Casals was an artist of the first rank; another time, Shirley made her first grand slam as the partner of a patient who taught her advanced bridge. I had frequent discussions with a patient on articles in the monthly Riggs magazine, The Commentary. These interactions were enjoyable and dissolved stereotypes.

Under Dr. Knight and his successors, the major focus of treatment became psychoanalytically oriented individual therapy of patients endowed with ample financial means, above-average intellect, and adequate time for care. Over the years, the average patient had become progressively younger. By the sixties a patient over forty was something of a fish out of water. The Center’s mission might be described as educative. A schizophrenic could be taught to recognize an impending decompensation and start a regimen of medication. Others learned social skills, or preventing such self-sabotage as missing a final exam or beginning an interview with, “I don’t suppose you’d want to hire a former mental patient?” Learning could cover such common skills as scouring a sink, filling out an application, table manners, cooking food, games and sports, or driving a car. Instruction was offered in speaking, writing, painting, sculpture, ceramics, and drama, enabling patients to find self-esteem through accomplishment. In these ways Riggs worked to restore people to their highest level of functioning.

And since the nursing staff was (with my exception) female, there were inherent prejudices and preconceptions.

Sigmund Freud

Sigmund Freud

The role of the nurses in this process was one which was the subject of intense debate among and between the different hospital staffs. There were conflicts about the Community Program, which we felt risked letting patients get out of control at some risk to themselves, each other, or us.  And since the nursing staff was (with my exception) female, there were inherent prejudices and preconceptions. Freud’s question, “What do women want?” shows deficient grasp of the female psyche. (He thought hysteria applied only to women, ignoring such episodes of male hysteria as battle fatigue). Men who can’t cope with women on a professional level may take refuge in Freudian formulations.  Dr. Knight’s abstract, The Mother Functions of the Riggs Nurse, showed the nurse as a non-threatening nurturant figure. I was a missile headed right toward that cozy concept;  as a man, I walked toward that concept sledgehammer in hand.

We lived in the Sargent Street cottage, a two-story frame structure on Riggs property, now the music building. the Center managed most of the upkeep and were solicitous about our welfare and comfort. There was plenty of room for us, including George, our cat. At first there were so many squirrels in and out of the place that one gnawed a hole in the living room wall.  Lost Weekend revisited. Finally, George took charge. Tommy Barnes on the maintenance crew said the squirrels “come out two abreast.”

Stockbridge was as pretty as Rockwell painted it. But it was not much of a town for working people. We had to go to Lee, the second town East, for much of our shopping and services. Living expenses were high. And like most Yankee villages, those born or brought up in Stockbridge were the only ones to be in step with its customs and particular way of life. So Pittsfield remained our center, since our relatives were there.

The only drawback in living on Riggs property was that we were far too handy. It seems logical that we should be called to respond to the occasional emergency, and we were booked for overtime events and meetings on the premise that we did not have to travel.  So we felt, to an extent, indentured.

Other nurses felt some reluctance to perform extra duties for no extra pay. Since real job security only applied to heads of departments, and  since Riggs did not assist nurses in training toward getting their degrees,  there was a “dead-end” effect. (One of the older nurses said she thought ambitious nurses were “highfalutin'” and pushy).

Several measures to increase the clout and prestige of nurses were suggested, but all fell by the wayside. At one point it was learned that Castle Hospital gave its nurses veto-power over patient admissions. This idea sent everyone into paroxysms — although there were a few brave souls who supported it. No, I wasn’t one of them. It was just too radical for us at the time. After some hesitation, the Center agreed to finance the odd course if at least a “B” grade were attained.

Having come from hospitals where roles were prescribed, we felt that the whole point of Riggs was that roles be not prescribed, instead be fluid, inviting reexamination and recasting of roles. It seemed possible — in this setting,  spending most of their duty time in the presence of patients — for nurses really to make a difference. After all,  only one hour of a patient’s day was spent in therapy,  while the other twenty-three were spent around nurses or activities staff.

Our allegiance was to the “good name of Riggs” and to the welfare of the patients, but there were times when this allegiance was sorely tested.  We were always aware of the dangers inherent in letting patients have so much freedom to work out their problems, and were caught between support for the program and preparing to meet danger. Nurses always carried a burden of guilt after a suicide, tending to go over and over the incident like a film loop.

Riggs  was a pretty permissive place, and this was obvious to us as soon as we arrived.  There were parties all the time, some of them pretty wild. In the fifties patients had private bars in their rooms, with an array of bottles and glasses, right out in public. A great deal of alcohol flowed  through that place. One party, in 1953 or ’54, went on so long and was so disruptive that Doctor Knight called a Community Meeting the next day and “grounded” the entire community for a week –no more parties, he said,  until they came up with some ideas on how to control drinking. “Until you sit down and get some rules around here that you make and intend to keep, that’s it.”  This was one of the events that led to the formation of the Community Committee and other parts of the program.

With Doctor Knight, every member of the staff had a degree of respect for and from everybody else.  We had always enjoyed what  Knight called “the play of mind upon mind.”  That ended when Edelson came sometime in 1964.  We didn’t know where Edelson had come from, or why he had been brought in. He just arrived one day. Knight had been failing for some time, and could no longer keep up with the hospital administration. Eventually Edelson made changes Dr. Knight would never have allowed if he’d been well. And Edelson’s manner, personal and professional, humiliated and insulted the nurses.

The nurses held a regular weekly seminar. It was our support group. One afternoon Edelson walked in with a notepad saying from now on he was going to attend and take notes. We were all stunned at the discourtesy. It was so absolutely foreign to the sort of treatment we had been used to from other doctors, an unspoken rule of courtesy between special people,  in Knight’s  regime.  At first, even Edith Breed was too surprised to protest, but before many minutes had gone by Edelson was told to leave. He got out and never came back.

Edelson seemed to be as surprised by our reaction as we had been by his barging in. But then, he was a complicated mixture of great brains and utter social ineptitude.

He had a profound dislike of women. He reeked of it –his body language, his expressions. At the Tavistock clinics, there were women who would not go into his groups. And  the secretarial staff loathed him. Though he might have made a very good therapist or a superb teacher, it was always on his terms. If he was in the catbird seat,  he was always on a power trip.

Edelson’s autocratic style made for a split among the staff, for the first time.  Under Knight,  nobody who wanted to attend a meeting was absolutely refused access — another example of his rule of courtesy. If you wanted to attend something, you would make a request to the chairperson of the meeting. Either it would be granted or you would be told why not, and an alternative set up. That was the style: your turn to curtsey, my turn to bow. Edelson changed all that. He flatly told certain members of the staff they would not be allowed to attend the Community Meeting, while others were required to attend.  Some were In,  some were Out

Night nurses never did attend CMs regularly, but the day staff did have to attend meetings of various kinds, even on their days off. The result was sixty-hour work weeks with only an occasional extra day off in compensation. Riggs refused to pay any overtime. Staff from the Director on down were inadequately compensated. I knew staff members who could have doubled their salaries by taking comparable positions elsewhere. And the long work week helped cause a pervasive fatigue which contributed to nurse resignations.

More important than the fatigue, perhaps, was a perception that women were held in contempt as care-givers by the Freudian patriarchy. Any hospital operating under the tenets of Freud will have patriarchal allegiances, however attenuated. The whiff of misogyny — the woman as mutilated man — floats about.

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