Part 12 (1/2)

A day or two before the police picked Nash up, Nash showed up on campus covered with scratches ”Johann von Nassau has been a bad boy,” he said, visibly terrified ”They're going to coet me now”35

CHAPTER 40

Tower of Silence Trenton State Hospital, 1961 Trenton State Hospital, 1961

Reposing in the midst of the most beautiful scenery in the valley of the Delaware, co all the influences which human art and skill can co intellects that are gathered in its bosom

- First annual report of the New Jersey State Lunatic Asylum, 1848 First annual report of the New Jersey State Lunatic Asylum, 1848

I'm as if left to rot in a ”Tower of Silence,” with anti-Pro away at my vitals

- JOHN N NASH, 1967

AT THE END OF J JANUARY, ten inia Nash and her daughter Martha boarded a train in Roanoke and traveled north all day, arriving in Princeton in the late afternoon ten inia Nash and her daughter Martha boarded a train in Roanoke and traveled north all day, arriving in Princeton in the late afternoon1 The last tiether was a decade earlier, to attend Johnny's graduation, and the contrast between that trip and the present one was much on their minds As they disembarked, tearful and weary, John Milnor, now a full professor in the Princetonfor thehtly After a feard exchanges, Milnor showed theave them directions to West Trenton The last tiether was a decade earlier, to attend Johnny's graduation, and the contrast between that trip and the present one was much on their minds As they disembarked, tearful and weary, John Milnor, now a full professor in the Princetonfor thehtly After a feard exchanges, Milnor showed theave them directions to West Trenton

Martha took the wheel and the to and sliding on the thin layer of slick ice that now covered the road They were almost thankful for the distraction They dreaded what lay ahead Johnny was already at the Trenton State Hospital He had been picked up earlier in the day by the police, taken first to Princeton Hospital, a seneral hospital, and then transported by a down to talk to the doctors, sign the necessary forms, and, if possible, see Johnny They would see Alicia, at whose apart, afterward

Full of doubt and self-reproach, they felt they had little choice but to accede to another co in Princeton, in fa oldabout some improvement in his condition had been shattered weeks before Alicia's telephone calls had becoly frantic The psychiatrist whom Alicia had been in touch with had tried, without success, to convince Johnny to go into the hospital on his own Johnny had been dead set against the idea Finally, the three wo theo would bring about some improvement in his condition had been shattered weeks before Alicia's telephone calls had becoly frantic The psychiatrist whom Alicia had been in touch with had tried, without success, to convince Johnny to go into the hospital on his own Johnny had been dead set against the idea Finally, the three wo theo

And this time it wouldn't be to a private hospital As Martha recalled in 1995: ”At first, we had thought that thirty days at McLean would straighten him out By then we knew there were no short-term answers We were concerned that John's illness would eat into Mother's capital and that she couldn't afford a private hospital”2 In the , with its white entle wooded slope, looked reassuringly solid and respectable Institutions like the Trenton State Hospital owed their existence to the same mid-nineteenth-century refore3 Many, in fact, owed their existence to the efforts of Dorothea Dix, a fiery, single-ht of the insane - condemned to almshouses, prisons, and the streets - her life's crusade Many, in fact, owed their existence to the efforts of Dorothea Dix, a fiery, single-ht of the insane - condemned to almshouses, prisons, and the streets - her life's crusade4 When she was old, ill, and penniless, Dix lived on the ground floor of Trenton's ad in an apartment set aside for her by the trustees of Trenton State until her death in 1887 When she was old, ill, and penniless, Dix lived on the ground floor of Trenton's ad in an apartment set aside for her by the trustees of Trenton State until her death in 1887

Like all such institutions, Trenton hardly evolved as its founder anticipated In particular, it was soon overwhelht - or whose fa World War II, Trenton State, long since expanded froe of four thousand patients5 The census dropped sharply after the war, but was rising rapidly in the late 1950s By 1961, there were nearly twenty-five hundred patients, ten ti was n residents The six hundred patients in the so-called West hospital, for example, were cared for by six psychiatrists; the five hundred chronic patients in the annex - predominantly senile or epileptic - were cared for by just one doctor The presence of a large number of chronic patients obscured the fact that most patients who came to Trenton stayed a relatively short time, perhaps three months The census dropped sharply after the war, but was rising rapidly in the late 1950s By 1961, there were nearly twenty-five hundred patients, ten ti was n residents The six hundred patients in the so-called West hospital, for example, were cared for by six psychiatrists; the five hundred chronic patients in the annex - predominantly senile or epileptic - were cared for by just one doctor The presence of a large number of chronic patients obscured the fact that most patients who came to Trenton stayed a relatively short time, perhaps three months

”You really were not close to patients,” said Dr Peter Baumecker, orked at both the hospital's insulin unit and the rehabilitation ward during Nash's stay The poorest and sickest patients wound up at Trenton ”I remember very few patients specifically,” Baued out the eye of another There was another patient who'd lost his eye when the police beat him up after he'd killed his father But that was very exceptional”6 ”There were good wards and bad wards Trenton was not as plush as other places As a matter of fact, Trenton was pretty crummy,” recalled Baumecker in 1995 ”But I re We helped an awful lot of people” places As a matter of fact, Trenton was pretty crummy,” recalled Baumecker in 1995 ”But I re We helped an awful lot of people”7 Later Nash would recall, with great bitterness, the fact that he was assigned a serial number at Trenton, as if he were an inmate of a prison8 To occupy a room shared by thirty or forty others, to be forced to wear clothes that are not your own, to have no place, not even a locker, for your things, even your own soap or shaving creaine Yet this is how Nash - a man who craved, because of his nature and the nature of his illness, solitude and ers If he had dreaded military duty, what must this have been like for him? To occupy a room shared by thirty or forty others, to be forced to wear clothes that are not your own, to have no place, not even a locker, for your things, even your own soap or shaving creaine Yet this is how Nash - a man who craved, because of his nature and the nature of his illness, solitude and ers If he had dreaded military duty, what must this have been like for hiht to Payton One, the round floor of Payton, off to the right of the e of admissions then and conducted the initial interview ”Nash was my patient,” said Baumecker ”He didn't like ainst the letter He had soainst the letter B B”9 The ad room that had a cot, a couple of chairs, a desk, and a smallBaumecker asked Nash the usual questions, such as ”Do you hear voices?” He tried to find out whether Nash had delusions and whether they were elaborate He watched his expressions to see whether the e The hijacking of a Portuguese ocean liner, the Santa Maria, Santa Maria, off Caracas that week - and the subsequent efforts of the hijackers, who turned out to be anti-Salazar rebels, to obtain asylum in Brazil - was, it seemed, very much on Nash's mind; he had his own private theory about it off Caracas that week - and the subsequent efforts of the hijackers, who turned out to be anti-Salazar rebels, to obtain asylum in Brazil - was, it seemed, very much on Nash's, Nash's ”case” was presented to the staff, and he was interviewed in the dorroup of residents That hen the prelinosis was reached, treatned a psychiatrist

One wound up in Trenton if one had no money or insurance, or was too sick for a private institution to handle The decision to commit Nash to an overcrowded, underfunded, and understaffed state institution see in retrospect Alicia had at least soinia, although by noorried that her son's treatment would eat into her capital, was surely able to pay for soivings: ”We went down to talk to the on the case and pay special attention to John It was the only state hospital that John ever stayed in”11 John Danskin recalled: I had heard he was in Trenton I called his fa I drove down to Trenton State I wanted to find out what the hell happened I was shocked It wasn't brutal but he was being treated rather roughly The attendant kept calling hiendary John Nash” He was all right too He gave , ure out what's wrong with a genius? I resented them12

News that Nash had been committed to a state hospital spread quickly around Princeton One person deeply disturbed by the notion that a genius like Nash was incarcerated at a state hospital, notorious for its overcrowding and aggressive s, electroshock, and insulin coma therapy - was Robert Winters13 Winters, a Harvard-trained econoer of the physics department at the time, was friendly with both Al Tucker and Don Spencer Winters contacted Joseph Tobin, the Institute for Advanced Study's psychiatric consultant and director of the Neuro-Psychiatric Institute in Hopewell, which is a fewhim in late January to say, ”It is in the national interest that everything possible be done to bring Professor Nash back to his original productive self” Winters, a Harvard-trained econoer of the physics department at the time, was friendly with both Al Tucker and Don Spencer Winters contacted Joseph Tobin, the Institute for Advanced Study's psychiatric consultant and director of the Neuro-Psychiatric Institute in Hopewell, which is a fewhim in late January to say, ”It is in the national interest that everything possible be done to bring Professor Nash back to his original productive self”14 Tobin suggested that Winters contact Harold Magee, Trenton's medical director at the tiee, as he later wrote to Tobin, that ”there would be a thorough study of Dr Nash's condition before any treatested that Winters contact Harold Magee, Trenton's medical director at the tiee, as he later wrote to Tobin, that ”there would be a thorough study of Dr Nash's condition before any treatment was started at the state hospital”15 In truth, this was too much to expect As Seymour Krim, a beat writer in New York, wrote in 1959 in his essay ”The Insanity Bit” about his own experiences in mental hospitals, that work ”in a flip factory is determined by orization and treatment in order to handle the battalions of miscellaneous huh tru in their iven, or perhaps even before, Nash was transferred from Payton to Dix One, the insulin unit17 Ehrlich, the psychiatrist at Princeton Hospital who had recommended Trenton, was convinced that Nash would benefit from the treatments available at Trenton Ehrlich, the psychiatrist at Princeton Hospital who had recommended Trenton, was convinced that Nash would benefit froinia, or Martha gave explicit consent for insulin coma therapy is not clear ”I don't reive further permissions beyond the commitment,” Baumecker recalled ”In those days you could do just about anything without asking anybody” Whether Alicia, Virginia, or Martha gave explicit consent for insulin coma therapy is not clear ”I don't reive further permissions beyond the commitment,” Baumecker recalled ”In those days you could do just about anything without asking anybody”19 Martha recalled that she was consulted: ”That was a drastic decision We were extra wary of anything that ht affect his mental abilities We discussed this with doctors” Martha recalled that she was consulted: ”That was a drastic decision We were extra wary of anything that ht affect his mental abilities We discussed this with doctors”20 The insulin unit was the most elite unit within Trenton State Hospital21 The The unit had two separate wards - one with twenty-two male beds, the other with twenty-two female beds unit had two separate wards - one with twenty-two male beds, the other with twenty-two fe like ”the inside of the Lincoln Tunnel” Danskin later described it as looking like ”the inside of the Lincoln Tunnel”23 Its chief had the eye and ear of the hospital's directors It had the s Only patients ere young and in good health were sent there Patients on the insulin unit had special diets, special treatment, special recreation ”All the best of what the hospital had to offer was showered on them,” said Robert Garber, as a staff psychiatrist at Trenton in the early 1940s and later president of the American Psychiatric association He said, ”The insulin patients got a hell of a lot of TLC In the fareat appeal Patients' relatives were overwhelmed” Its chief had the eye and ear of the hospital's directors It had the s Only patients ere young and in good health were sent there Patients on the insulin unit had special diets, special treatment, special recreation ”All the best of what the hospital had to offer was showered on them,” said Robert Garber, as a staff psychiatrist at Trenton in the early 1940s and later president of the American Psychiatric association He said, ”The insulin patients got a hell of a lot of TLC In the fareat appeal Patients' relatives were overwhelmed”24 For the next six weeks, five days a week, Nash endured the insulin treat, a nurse would wake hiot to the ward at eight-thirty, Nash's blood sugar would already have dropped precipitously He would have been drowsy, hardly aware of his surroundings, perhaps half-delirious and talking to himself One woman used to yell, ”Jump in the lake Jump in the lake,” all the ti deeper and deeper into unconsciousness until, at one stage, his body would becoers would be curled At that point, a nurse would put a rubber hose through his nose and esophagus and a glucose solution would be administered Sometimes, if necessary, this would be done intravenously Then he would wake up, slowly and agonizingly, with nurses hovering over hiain And by the late afternoon, when the whole group would walk over to occupational therapy, he would be ae juice in case anyone felt faint Very early in the ive hiot to the ward at eight-thirty, Nash's blood sugar would already have dropped precipitously He would have been drowsy, hardly aware of his surroundings, perhaps half-delirious and talking to himself One woman used to yell, ”Jump in the lake Jump in the lake,” all the ti deeper and deeper into unconsciousness until, at one stage, his body would becoers would be curled At that point, a nurse would put a rubber hose through his nose and esophagus and a glucose solution would be administered Sometimes, if necessary, this would be done intravenously Then he would wake up, slowly and agonizingly, with nurses hovering over hiain And by the late afternoon, when the whole group would walk over to occupational therapy, he would be ae juice in case anyone felt faint

Very often, during the coar levels dropped too far would have spontaneous seizures - thrashi+ng around, biting their tongues Broken bones were not uncommon So man,” recalled Baumecker ”We'd all become very alars Soet very hot and we'd pack them in ice”26 Good, firsthand accounts of the experience are difficult to find, in part because the treate blocs of recent memory Nash would later describe insulin therapy as ”torture,” and he resented it foras a return address on a letter ”Insulin Institute”27 A hint of how unpleasant it was can be gleaned from the account of another patient: A hint of how unpleasant it was can be gleaned froh the first sodden layers of consciousnessthe smell of fresh woolthey make ness The sickness, the taste of blood iny pain in my headthis was my unbroken routine for three monthsvery little of it is clear in retrospect save the agony of e from shock every day28

It's true, as Garber said, that insulin patients were coddled coot richer and ot special desserts They had ice creaes and perained weight That was considered a good sign The doctors on the ere proud that their patients were in good physical health ”People would put on a lot of weight because of the insulin,” recalled Bauive thear had a lot of calories For some of these spindly, skinny schizophrenics it wasn't such a bad thing”29 But patients often hated it Nash's subsequent obsession with his diet and weight”force-fed” But patients often hated it Nash's subsequent obsession with his diet and weight”force-fed”

Treating schizophrenic patients with insulin coma was the idea of Manfred Sackel, a Viennese physician who thought of it during the 1920s and used it on psychotic patients, especially ones with schizophrenia, in the mid-1930s30 His notion was that if the brain were deprived of sugar, which is what keeps it going, the cells that were functioning inally would die It would be like radiation treatments for cancer Some practitioners who used it in the 1950s, when the first effective antipsychotic drugs became available, took the view that insulin shock was ard to delusional thinking His notion was that if the brain were deprived of sugar, which is what keeps it going, the cells that were functioning inally would die It would be like radiation treatments for cancer Some practitioners who used it in the 1950s, when the first effective antipsychotic drugs became available, took the view that insulin shock was ard to delusional thinking31 No one understood the e-scale studies in the late 1930s found that insulin-treated patients had better andoutcomes than untreated individuals, but evidence for insulin's efficacy was hardly overwhele-scale studies in the late 1930s found that insulin-treated patients had better andoutcomes than untreated individuals, but evidence for insulin's efficacy was hardly overwhel32 It was in any case riskier and far more involved than electroshock, and by 1960, insulin shock therapy had been phased out by erous and expensive when compared with electroshock The conclusion was that insulin wasn't worth the investment of time and money or the risks

The treatments produced at least te to Garber: They'd see everybody hovering over the caht that was very therapeutic For the first ti, round privileges I think it helped Patients were brighter, more alert, more conversational33

While Nash later blaaps in his memory,34 he also told his cousin Richard Nash, whoet better until the money ran out and I went to a public hospital” he also told his cousin Richard Nash, whoet better until the money ran out and I went to a public hospital”35

As dangerous and agonizing as it was, insulin was one of the few treatments available for serious illnesses like schizophrenia which, until theincarceration And, like other state hospitals, Trenton was a laboratory for every ”cure” that ca Before the war, Garber recounted: [We] treated all patients with the tools that were available Colonic irrigation was still used So was fever therapy We had a strain of malaria that ould inoculate patients with Later on we used a typhoid strain We'd inject a typhoid vaccine and within hours patients would experience nausea, vo, diarrhea and fevers of 104 to 105 We'd do that for eight or ten weeks, two or three days a week We did it to take the starch out of disturbed patients

At Trenton the first order of the day, when I arrived at the hospital supervisor's office at 8 AM AM was to see who could be ht to fifteen patients who needed to be secluded [The roolazed tiles, with terrazzo floors There was a toilet and a sink and a drain in the middle of the floor so that if a patient, say, smeared feces around the rooive yourself a handle to bring the patient under control36

After six weeks, Nash, whose insulin treated to be effective, was transferred to Ward Six, the so-called rehab or parole ward37 There was group therapy every day, some recreation, and occupational therapy ”This was the cream of the patient crop,” Baumecker recalled ”There were only about fifteen beds Other wards had thirty patients per rooot individual attention, went on trips, and were allowed to go horoup therapy every day, some recreation, and occupational therapy ”This was the cream of the patient crop,” Baumecker recalled ”There were only about fifteen beds Other wards had thirty patients per rooot individual attention, went on trips, and were allowed to go hoan to work on a paper on fluid dynamics while he was on Ward Six Baumecker recalled, ”The patients made fun of him because he was always so up in the clouds 'Professor,' one of them said on one occasion, let me show you how one uses a broom' ”39 Alicia visited Nash every week Once he was allowed out on passes, she took hiroup and out to Swift's Colonial Diner Alicia visited Nash every week Once he was allowed out on passes, she took hiroup and out to Swift's Colonial Diner40 It was the highlight of Nash's week It was the highlight of Nash's week

He seeer a threat to hie, pointing out that, contrary to the popular belief, ”We had to discharge people as fast as we could to get the census down”41 He was discharged on July 15, a ed on July 15, a month after his thirty-third birthday42 A few ot out, Baumecker called the Institute for Advanced Study and asked to speak to Oppenheimer about whether Nash was now sane Oppenhei no one on earth can tell you, doctor” A few ot out, Baumecker called the Institute for Advanced Study and asked to speak to Oppenheimer about whether Nash was now sane Oppenhei no one on earth can tell you, doctor”43

CHAPTER 41