Sideblog Hill

Oh. Yeah, the late Carrie Fisher was entirely open about her mental health treatments, to the point where her urn was shaped like a Prozac pill. She did say that she had some memory loss due to ECT, but nowadays, you can decide for yourself if that's a decent trade-off and consent to the treatment. What I discovered is that the reason electroshock therapy was originally so dangerous, though, was because the convulsions could break arm and leg bones. Only later was the therapy "modified" with anesthetics and muscle relaxants. So when I quote Jonathan Sadowsky aloud on the video--

I am a historian of psychiatry, and I have published a book on the history of ECT. I had, like many people, been exposed only to the frightening images of ECT, and I grew interested in the history of the treatment after learning how many clinicians and patients consider it a valuable treatment. My book asks the question: Why has this treatment been so controversial?

Well, the broken bones were part of it, certainly.

ECT was invented in Italy in the late 1930s. Psychiatrists had already discovered that inducing seizures could relieve symptoms of mental illness. Before ECT, this was done with the use of chemicals, usually one called Metrazol. By many reports, patients experienced a feeling of terror after taking Metrazol, just before the seizure started. A Cleveland psychiatrist who was active then once told me that the doctors and nurses used to chase the patients around the room to get them to take Metrazol.

That wasn't great either.

(My offhand claim that Benjamin Franklin "cured a woman of hysterical fits" is not sourced as clearly as I would like, although he did have an electrostatic machine, and this subscription-only book chapter, "Benjamin Franklin and the Electrical Cure for Disorders of the Nervous System," may have more info.)

So modern ECT is very different, the current is much milder, and muscle relaxers are given. I don't know that I would choose to have it (today or ever), but I did have to sit there and ask, I'm bipolar. If I were at this hospital back in the day, what treatment would they have given me? I do think I would have been given electroshock therapy, for better or worse. And that's something I want you to think about, especially if you've been listening to me play Silent Hill tour guide for several hours: patients who were given these dangerous and painful treatments were just like me, just like you. You know, actual people.

(I also mention an anti-seizure drug I take, as it's been repurposed to stabilize bipolar mood cycling. I don't specify in the video, but I've been pretty open about my own mental health treatment over the last couple of decades. It's Lamotrigine, also known as Lamictal, and it's one of the most effective medications I've taken.)

So. In terms of Patient 0050's "puzzle," you have to stumble across a generator and turn it on; I don't think there's actually a clue or hint to do so, except an electrical cord that you might follow out of sheer curiosity. Follow it back to the ECT room--where a table? stretcher?) is standing on end like it's ready to shock Frankenstein's monster back to life--and turn on the machine. Four numbers will appear burned into the stretcher, and that's the code you need for the lock on the right side of the box.

This is one of those Silent Hill Moments™ that's intellectually disturbing, but visually, it's cool as hell. Honestly, it's one of my favorite images in the entire game, especially the way the stretcher looks like it's at the center of a spiderweb. I think, also, that this scene looking so unrealistic and fantastical, especially compared to the historical photos we actually saw, takes a bit of the edge off. It's artistically disturbing, like, something James might imagine in a nightmare, rather than a medical tragedy. I mentioned references to Thomas Harris' works and the show Hannibal in commentary 7, and that TV series got away with a lot of really, really horrific imagery by pitching it at the level of a fever dream. That's the approach in Otherworld Brookhaven, I think.

But we also learn something else, which is: Patient 0050 somehow gave ECT to himself. Unlike the control exerted over Patients 0090 and 0130, Patient 0050 sought it out against the staff's will:

Front, handwritten:

I found 0050 in the ECT room again. This time I checked, he was not appointed for the treatment. How is it possible he got there all by himself? And how would he know how to turn the thing on? Somebody's going to answer for this.

Back, typed:

So close. It will happen. Has to

My feeling is that a staff member wrote the note on the front by hand, obviously, but the typing on the back is more of a psychic imprint or dream image, rather than "Patient 0050 actually ran this sheet of paper through a typewriter." My other inference is that he's trying to electroshock himself into some alternate reality--he might potentially be the same patient who blames himself for his daughter's death, and he might want to be in a world where she's still alive. There's a journal we'll see at the end of the video where the doctor discusses the ethics of perhaps letting "him" (unspecified) be happy in his false reality. And all of this, of course, parallels James and the iteration of Silent Hill he's in, where Mary may (or may not) be real and alive.

As I mentioned in the previous commentary, we're shown a preview of the Otherworld Brookhaven puzzles, and this is the one corresponding to Patient 0090. So here's the article excerpt I read in the video commentary:

Surgeons would drill a pair of holes into the skull, either at the side or top, and push a sharp instrument - a leucotome - into the brain. The surgeon would sweep this from side to side, to cut the connections between the frontal lobes and the rest of the brain. [Portuguese neurologist Egas] Moniz reported dramatic improvements for his first 20 patients. The operation was seized on with enthusiasm by the American neurologist Walter Freeman who became an evangelist for the procedure, performing the first lobotomy in the US in 1936, then spreading it across the globe. From the early 1940s, it began to be seen as a miracle cure here in the UK, where surgeons performed proportionately more lobotomies than even in the US. Despite opposition from some doctors - especially psychoanalysts - it became a mainstream part of psychiatry with more than 1,000 operations a year in the UK at its peak. It was used to treat a range of illnesses, from schizophrenia to depression and compulsive disorders. The reason for its popularity was simple - the alternative was worse. "When I visited mental hospitals… you saw straitjackets, padded cells, and it was patently apparent that some of the patients were, I'm sorry to say, subjected to physical violence," recalls retired neurosurgeon Jason Brice. The chance of a cure through lobotomy seemed preferable to the life sentence of incarceration in an institution. "We hoped it would offer a way out," says Mr Brice. "We hoped it would help."

"We hoped it would help" was the idea I wanted to bring us to, because it really, really surprised me that lobotomies actually helped some people. In that article, Hugh Levinson also writes, "Psychiatrist Dr John Pippard followed up several hundred of [neurosurgeon Sir Wylie] McKissock's patients. He found that around a third benefited, a third were unaffected and a third were worse off afterwards." Like, that is wild as hell to me. I had always thought it was a procedure doctors "did to" people, purely as a way of neutralizing "unruly" patients that stopped just short of murder. In the scrapped first take of this commentary, I said that "certainly no one consented to this," but perhaps some of those patients did, hoping for that benefit.

(A quick break for the two famous patients I mention in the video: Rosemary Kennedy and Rose Williams, sister of Tennessee Williams.)

Now, I'm going to quote from Wikipedia here because the "Lobotomy" article has some well-cited information that's not available online:

For medical historian Roy Porter, the often violent and invasive psychiatric interventions developed during the 1930s and 1940s are indicative of both the well-intentioned desire of psychiatrists to find some medical means of alleviating the suffering of the vast number of patients then in psychiatric hospitals and also the relative lack of social power of those same patients to resist the increasingly radical and even reckless interventions of asylum doctors.

So Porter describes both the Brice perspective here, as well as our Director of Brookhaven Hospital, who was mistreating the "three crucial patients" we investigate.

Many doctors, patients, and family members of the period believed that despite potentially catastrophic consequences, the results of lobotomy were seemingly positive in many instances or were at least deemed as such when measured next to the apparent alternative of long-term institutionalisation. Lobotomy has always been controversial, but for a period of the medical mainstream, it was regarded as a legitimate last-resort remedy for categories of patients who were otherwise regarded as hopeless. Today, lobotomy has become a disparaged procedure, a byword for medical barbarism and an exemplary instance of the medical trampling of patients' rights.

And that latter idea is the perspective we get in Brookhaven Hospital. Both Patient 0090 (who is not Eddie, but seems to resonate with him) and Patient 0130 (similarly, "Angela") receive treatments they apparently don't want. Patient 0050 ("James") is a... remarkable exception to that, but we'll get to that in the electroshock therapy post (yeah, we get that too).

So here's what we see in Otherworld Brookhaven:

Note: "The Procedure." Transcript:

oh, how we danced arms flailing, our bodies in perfect synchrony and the music played but in any dance there comes a time one must take the lead and the music got louder and louder pounding piercing and then silence

I believe that the "dance" is between the surgeon and patient. Possibly the patient struggling, "arms flailing," with the staff trying to get him into the chair? This chair, in the next room:

The one who takes the lead would be the doctor; the pounding is the mallet, the "Instrument of Force" that we pick up.

The "piercing" is the orbitoclast: the "icepick" used in the orbital (eye socket) lobotomy, the "Key of Bliss." The "silence" is what happened to the unlucky third of McKissock's patients. As the Wikipedia article phrases it, "many lobotomy patients suffered devastating postoperative complications, including intracranial hemorrhage, epilepsy, alterations in affect and personality, brain abscess, dementia, and death."

Basically, the Patient 0090 "puzzle" is a fetch quest to fight your way past several monsters and find the orbitoclast; once you've obtained it, you go back to that (actual) mannequin in the chair. The one that's shielding its face with its hands, as if saying, Don't do this to me.

I'll bring over what I said in the Patient 0090 post:

I'm not even showing y'all The Longest Staircase in the World, or all the holes James has to jump down in order to get to Toluca Prison at, apparently, the center of the earth. I haven't even mentioned the long walk through the forest to town; elevators and stairwells and looping hallways that always lead you back to where you started; an entire level that's just multi-floor labyrinths; the way that the backyards of South Vale are a throughway to Heaven's Night, which is a throughway to Moonlight Grove, which is a throughway, etc.; the way that James is always fighting his way through one location to get to the next, just an endless chain of forward in real time, never resting.

And the word "rest" Is why I wanted to describe all of that. Late in the Otherworld Brookhaven section, we find a document from the increasingly troubled Director of the hospital, who is (as far as I can tell) a dreamlike projection of James himself:

I won't rest until they are solved I won't rest I can't rest I don't know how anymore

Well, James knows something no one knows (yet)--or rather, even James doesn't know it, because he can't remember it. It's the thing you don't know, because it's the one thing I won't spoil (you probably know it). And room C5 happens to the the one Maria was resting in, and the combination of Maria + hospital beds has some resonances with That Thing. I say on the recording that there's a specific room I need to check, and I'll edit something in after I do.

I wanted to look at Mary's sickroom. Looked at the "Leave" ending; it doesn't show the ceiling. There's a few iterations of this room in the Labyrinth section later in the game, and I do have my first run on video, but I decided to go back to my commentary 3 videos: apartment 201 in Wood Side Apartments. Of course I never thought to point the camera at the ceiling, but if you look at the top of this shot, which I've lightened the hell out of:

1:01:20: Here's first time in this video that I mention being bipolar, and walk straight into claiming to be One of the Good Ones. I had actually just seen a post here about how disgusting it is when people do that, in terms of throwing other mental illness sufferers (experiencers?) under the bus. (I'm not linking to it, because I'm not sending people over to that post.) And that post gave me a lot to think about; it's the subtext of my hedging and hesitation in two different sections of this video—not wanting to speak over or step on other people. And yet, it's also one of the first things I say, even while thinking of that post: no, Dear Listener, you don't have to worry, I don't have psychosis, I'm well-treated. I think there's often an urge to say, "You can trust me because I'm 'stable,' when I try to advocate for people you wouldn't believe." And it's shitty of me to create that distinction, that division, while it's also true that a lot of people don't believe people who have mental illness, and the fact that this is true is also shitty. The urge is understandable, but that doesn't mean you should follow it, you know? I don't say this as an excuse; it's more a necessity of asking yourself, what am I actually doing right now? Who am I benefiting, and who I am hurting? And how would someone else feel about me doing it?

So it's a disservice to the people I wanted to help, bipolar like me. But additionally, you know what? When I say "It can be rough," what I don't say is, "It's also been rough for me, and it will continue to be." In trying to get you to listen to me, I'm not even telling you the whole truth. It's true that I've never had bipolar psychosis—yet. I've got the rest of my life for a medication to stop working, or for the cycling to get worse. I have had extremely deep depression, as may happen when you're bipolar, and, at times, suicidal ideation. [Honestly, I am removing about half of this paragraph. It's not worth the risk to others. Things are harder than I let on sometimes, let's just put it that way.] But in trying to assure random people on YouTube who might stumble across my videos, and haven't read my work for years and don't know me from Adam's housecat, that I am Totally Credible, Of Course I'm Not Crazy—I don't even tell you the entire truth about what I swear I'm telling the truth about. 

But at some points in this video, I'm not speaking to strangers who don't have the full context of me; I'm not even speaking about people who also have bipolar disorder. I'm speaking to those bipolar people—or people with ADHD, or with clinical anxiety (both of which I also have), or any other mental health condition.

2:01:42: So, by the time I get to the diary that says, "The meds made me feel sick today" on the rooftop, I've had time to think about how I might have fucked up earlier. I find myself hesitant to say that medication does work—rather that it can, though not for everyone. I try to separate "concerns about real side effects" from "social stigma and scaremongering," so as not to invalidate people (including me) who have experienced real, negative side effects. I just also know that multiple people have told me that talking about my experiences trying and adjusting medications helped them be less afraid of trying things that ultimately improved their quality of life a lot. But I also know people who tried certain medications and did not feel that meds were worth it. I have heard both sides of the situation in real life, and "You won't know until you try!" (at least I didn't say that) is just too flippant for the real downsides for some of these medications. I just... I don't know. (I stop and start and say that a lot in the video itself.) The side effects in those diary entries are realistic, and some people do experience those. I just wanted it to be said that, here in the present day, some people can benefit from medication.

You don't have to take meds. I'm not pressuring you, or saying that you're remiss if you don't. There are plenty of valid concerns about pharmaceuticals, either in the abstract, or about a specific drug on offer. I just want to encourage people to look at the same real concerns I had to consider (nausea, dizziness, drowsiness, weight gain, dry mouth, "brain zaps," scalp tingling—temporary back pain for one medication), rather than just hear other people tell you that "you won't be your real self anymore," "drugs will turn you into a robot," "doctors will lock you up." Nobody locked me up, I still have a full range of emotions, and I got to find out who I was under a fog (I'm not trying to be cute) of disorders once medications helped lift a lot of it. And it did take a lot of work and some suffering to get the doses right. But it turns out that I like who I am when medications carry some of the weight for me, and I feel like the benefits outweigh a lot of side effects for me. If the stigma had been too intense for me to try medications at all, I never would have found who I can, at least sometimes, be. That opportunity is all I want for anyone else. 

At any rate—the thing is, I have pretty extensive notes for these commentaries, but I don't read from a script (clearly). I feel like I sound more engaging when I speak off the cuff, but sometimes, that bites me in the ass when I don't express things as precisely as I could. And you know what? What I wished I'd said might still be offensive! I don't know! I just know that I did exactly the thing I hadn't wanted to do, straight off, which is say, I'm one of the good ones.

This case bears a disturbing similarity to a situation that took place in the facility a few years back. The patient was admitted on a court order, but with the consent of his remaining family. His condition appeared to be improving for the first few weeks. The administered medications paired with individual sessions with a psychologist and art therapy alleviated his avolition, anhedonia, and social withdrawal. There was no reason for concern. They didn't even know anything was wrong until the night guard reported one of his keys was missing. When they found him, it was already too late.

When I wrote the "Patient 0050" post, I made a fairly good argument that the case is meant to be "reminiscent" of that patient. But the more I thought about it—I nearly titled this clip "(It's not who you think)," because I think it's "about" all three patients. I think the clipboard story is giving us a framework to imagine what happened to each of the three patients—again, to review what I wrote after I recorded:

Something catastrophic happens that ends up with patient committed.

This may have involved the patient hurting or killing a family member, due to the phrase "remaining family" (much the way Angela killed her own father, for example).

The patient was doing well in various types of therapy (when I say "art therapy seems gentle for [a murderer]," I mean "at a hellhole like Brookhaven, so I might not be right about this," not that it should be harsher).

But then, the staff let down their guard (or perhaps staff layoffs meant there were fewer employees in general).

The patient obtained a key, which could have been a key to an internal room (Patient 0090 will be my example here) or to the main entrance of the hospital to leave. And we know there's a main entrance key, because it's the last item we find in Brookhaven Hospital. 

By the time staff located the patient, "it was too late" to prevent... something, most likely the patient's death given how ominous this sounds, but possibly injury to the patient or someone else. I forgot to mention this in the video, but we're going to read in Otherworld Brookhaven that Patient 0050 managed to run electroshock treatment on himself—even the staff can't figure out how—so that's a non-fatal example. 

Re: point #4: I bring in the Secret Garage article about Brookhaven, and I've actually edited in a clip from commentary 6. Basically, we're told that staffing shortages may be putting the patients at risk, and the community fears the repeat of an incident that happened "a couple of years ago." I think the clipboard patient is that incident.