My mother was newly married and living in New York when she learned that her brother, Philip Dever Cummins, had suffered a mental breakdown. Sixty years later, the moment remained fixed in her memory: She was sitting on a bed in the living room of a cramped apartment, reading a letter from her mother, who had written from Ann Arbor, Mich. The report from home was warm, understated and devastating. Irrational behavior. Depression. Hospitalization. All of it took my mother by surprise. A great sadness washed over her, and she began weeping for her brother and how terrible it must have been for him.
There is a story of mental illness in almost every family. My Uncle Phil is the central character in ours, the foremost troubled mind emerging from our particular mix of history and genetics. Many relatives were burdened by depression or other disorders before and after him, but Phil carried the heaviest load. He was, in a sense, the exaggeration of us all. The same impulses that others struggled with occasionally, but that could be controlled or concealed enough to function in everyday society, overwhelmed him much of his life, starting with that long-ago spring when he was hospitalized at age 22 with what experts today might classify as schizoid affective disorder.
By the time I got to know him, when I was about 11, Phil was living with my grandparents at their redwood-and-stone farmhouse on the western edge of Ann Arbor. He had his own hideaway room in the basement down the hall from the white lift-top freezer where my grandmother kept her black walnut cookies. When we visited at Christmas or on summer vacation, the bedrooms filled quickly and I'd be sent down to Phil's room to sleep on a cot. I considered it an honor to be let into his special space. It signified that my uncle approved of me, which meant something, because he didn't approve of much.
Some of my strongest childhood memories are of nights spent in that dark subterranean room: Phil on the edge of his bed, flicking the drooping end of his cigarette onto a ridged white saucer, soft yellow light filtering from his shortwave radio, his brow furrowed, a faint smile, and then a series of questions beginning with, "Dave, who has the strongest arm from right to third: Kaline, Clemente or Colavito?" He might move from there to modern literature, about which I knew nothing. Was he mistaking me for my older sister and brother, the smart ones, or did he sense something that I didn't? I was amazed and secretly heartened by the way he took my answers seriously.
I had only a vague awareness then of the dimensions of Phil's mental history. My family has a strong humanist sensibility that honors every person and prefers poetic underdogs to self-satisfied winners, so this was not a matter of shame. There was nothing to hide in that respect, no embarrassment about having a crazy uncle. But along with the family's sensitivity and prevalent low-grade depression came a powerful respect for privacy and a tendency to avoid acknowledgment of irreversible pain. (My mother is the sort who, if you backed a car up over her foot, would apologize and say it was her fault.) It was from those impulses that Phil's story was left mostly untold.
There were some obvious ways that he differed from other adult males in the family. He never married. He lived with his parents. He did not work regularly and kept odd hours, often staying in his room during daylight and then shuffling through the house in the middle of the night in his robe and slippers. His brown hair was usually wet and slicked back. He sometimes seemed to be chuckling at a joke understood only by him. When he laughed harder, he crinkled his face so violently that it scared me. I heard him now and then criticizing, or even ridiculing, my little grandmother, which simply was not done. His gargly voice had a surprising hint of the South. But almost all that I knew about his history of hospitalization came from a few color slides among the scores of family scenes that my grandfather would show us on his projector. They were of Phil standing near a highway and a country bridge in some faraway place. I was told they were taken when my grandparents visited him during his long stay in North Carolina.
HIGHLAND HOSPITAL. Asheville, North Carolina. An Institution
Employing All Rational Methods in the Treatment of Nervous, Habit,
and Mental Cases: Especially Emphasizing the Natural Curative
Agents--Rest, Climate, Water, Diet, Work, and Play
The old brochure describes such a beautiful place. From the grounds Phil looked out on a vista of "near-by hills, with their soft green slopes, gradually blending with the more distant, rugged ranges till the skyline is broken by the pearly haze of far-off peaks." From the tap he drank water of "crystalline clearness, perfect purity, complete softness and cool mountain freshness." At the cafeteria his body was nourished with "a rational, scientific, wholesome, vitamin-rich, yet dainty, dietary." From the moment he arrived at Highland Hospital in 1942, he was in the care of "a corps of over a hundred workers" overseen by Duke University professors of neuropsychiatry who believed they could determine the "present disorder and its causative factors" and then provide treatment for "the removal of both cause and effect." The regimen included frequent examinations and discussions, regular hardball games between two teams of patients and doctors, the Blues and the Golds, light gardening and farming, work in the storehouse, hikes in the hills, horseshoes, table tennis, volleyball, board games and dances.
Such serene surroundings, such a healthy environment. But for every sign of improvement there came a corresponding spell of withdrawal and despair. When Phil's behavior worsened, doctors tried to jolt him back with insulin shock therapy and electric shock treatments. The positive results in every case proved ephemeral. He remained hospitalized for 17 years, the prime of his life, during which time the "cause and effect" of his troubles persisted and the only thing removed was part of his brain.
It was only recently, several years after Phil's death in 1992, that I began to appreciate the daily struggle of his long stay in Asheville. My awakening came when Aunt Jean Chulak, the family genealogist, sent me a box of documents from Phil's life. Inside were letters to Phil from his parents (my grandparents Andrew and Grace Cummins) and a lesser number of letters from Phil to them or other family members, as well as voluminous correspondence between my grandparents and various doctors at Highland Hospital. In some ways these papers seem anachronistic, evoking a time long gone from the mental health scene. The transforming world of psychotropic drugs was yet to be discovered. Doctors resorted more often to long-term institutionalization and such things as seizure-inducing shock treatments. The diagnostic vocabulary psychiatrists used then also had an archaic ring, the words less technical, more lyrical. (In their reports on Phil, they often noted that he was "too philosophical in his thinking.") But the story that emerges from the box is timeless nonetheless. There can be nothing outdated about a wounded mind and a family trying desperately to mend it.
Among the scores of letters, one provides the context for all the others. It was from Phil to his parents, postmarked April 2, 1945. He was 27 then, in his fourth year at the hospital. The previous fall he had sent a fairly upbeat letter home describing his daily routine. Five months of silence followed. Now came the explanation, the most thorough written account of his despair.
Dear Mother and Dad,
I am sorry to be so tardy in writing you, but it is difficult when one feels that anything one has to say is going to be a burden on the reader. I only hope that things aren't actually as bad or rather as hopeless as they seem to me at present. I know that one should be careful in saying a thing like this. I could go on writing about what is going on here, baseball, work, etc. but that would be just holding back on the things that are uppermost in my mind. For I have been feeling pretty terrible and despondent for a long time now and without any signs of improvement. Dr. Billig [Otto Billig, Highland Hospital's chief psychiatrist] says that he is convinced that I have improved greatly and am still getting better, but to tell you the truth, I feel worse than I did when I came down here and that after four years of so-called hospitalization, I just feel that I am doomed to gradual incapacitation of a more or less general nature, being regarded as something of a sub-human species halfway between a gorilla and a man. For I am pretty much all by myself in the world, have difficulty in making friends and adjusting myself with no ideas practically, nothing to say and getting no enjoyment or satisfaction out of anything I do. I am also tired most of the time, worried, apprehensive, and very unhappy. It's just downright torture, that's all it is.
One shudders to imagine being a parent and reading that letter from your son. Not much room for encouragement, but my grandfather, a construction engineer, searched his rational mind for angles of hope. In his next letter to Phil, he argued that the brutally realistic nature of Phil's self-analysis in itself represented an improvement from the bizarre and delusional behavior that had led to his hospitalization in the first place.
"To have reached that point has been a wonderful accomplishment," Grandfather wrote. With enough effort and time, he said, a "reasonable amount of happiness would come," although "nobody probably is happy all of the time."
Tests showed Phil's IQ was an exceptional 150, meaning, his father said, that he "could accomplish a lot worthwhile for society" as soon as he felt secure and confident. To counter the sense of being alone in the world, he recited a list of his son's old friends and then suggested, "After all one only has a very few real friends." He closed by inviting Phil to visit Ann Arbor. The peas, radishes and onions were up.
Phil eventually got away from Asheville for three weeks. According to a letter Grandfather later wrote to Billig, the visit to Ann Arbor was soothingly routine, at least on the surface. He saw his brothers and sisters, talked about his condition, went to shows, bowled, played table tennis and bridge, watched basketball and hockey games at the University of Michigan and "voluntarily helped around the house." He also spent "quite a bit of time" reading Thomas Mann's The Magic Mountain, in German.
As engaged as he was in Ann Arbor, Phil could not forget his worries. "On the whole his sense of well-being was not good," his father reported. "He complained of headaches and tiredness and evidently thinks a lot about his difficulties." He was indeed a chronic hypochondriac, a trait that later would become all too familiar to many of his younger relatives, including my brother, Jim, and me and several of our children. During Phil's visit home, he read his father's magazines and took particular note of insurance company ads that would give him "ideas about physical ailments." He would then "magnify the symptoms." He also read an article about mental illness in Newsweek that reinforced his feelings of hopelessness and left him further depressed.
My grandfather suffered from minor depression himself and had reached some conclusions over the years about the best way to counteract it. For the most part he had been successful, at least to the extent that he rarely showed his inner struggle to his family or society. In letters to his son, one can sense him hoping against hope that what worked for him could help someone he loved who was in a far more weakened mental state. One night in February 1946, after paying a working visit to a Morton Salt plant in Manistee, Mich., he took out the desk stationery from the Hotel Chippewa and wrote his son a letter filled with his homegrown psychology. It read in part:
I would suggest that you concentrate the mind on something other than yourself. You will feel better and time will go faster. I found that out at the hospital when I was hurting. Effort I believe will make it possible to minimize the pain due to trouble or any other reason. You know Phil if in your letters you did not say you were having trouble one would never know it. I am not saying that as a suggestion that you don't mention it, in fact I want you to feel entirely free to say just what you do feel. I mentioned it only to emphasize how rational, reasonable, sympathetic and intelligent your letters are. You know what FDR said during the depression viz. "The only thing we have to fear is fear itself" and I believe that applies in your case. The biggest obstacle confronting you is the fear you have of the future. Yet your I.Q., your general conduct and ability it seems to me does not warrant that belief. In any case DON'T GIVE UP. Also try to see as many funny things in life as you can--I'm making a collection of jokes. Tell me any new ones you have heard. Here is one for you . . .
He then recounted a corny old story involving the Hollywood producer Darryl F. Zanuck and a would-be actor who stuttered. If only a joke collection could have been enough. The next several months were better for Phil, but he took another turn for the worse in the summer of 1946, a regression documented month by month in reports from the Highland doctors to my grandparents. First came a report that Phil exhibited "a sense of unreality." Next he was showing "great concern about other people's influence upon him." By September he was displaying "bizarre behavior" that compelled the staff to confine him to the building and resume treatments of sub-shock doses of insulin. All of this was received with ever-deeper sadness and concern by my grandparents, who refused to give up hope that some treatment could return Phil to a relatively normal life.
In the spring of 1947, my grandfather's search for cures led him to explore, for the first time, the possibility of a brain operation. In a letter to Billig, he asked: "Do you think that this holds any promise in his case and does such a procedure call for a special diagnosis as well as special surgery available only at certain hospitals?"
Literature teems with tales from asylums and mental hospitals that are cold or brutal warehouses where patients are mistreated or regarded as the very "sub-human" species that Phil feared he had become. Highland Hospital seems not to fall into that category. As I pored over the letters sent to my grandparents, it struck me from both the frequency and the substance of their reports that these doctors cared about Phil and were doing the best they could, given what their profession understood about mental illness at the time and the limited number of treatments available. Without being overly harsh or fatalistic, they grasped the seriousness of Phil's condition and the uncertainty of his recovery. Billig, in responding to the question about brain surgery, confessed that after treating Phil for more than five years he was "somewhat at a loss" about the best course of action. The shock treatments seemed to have lost some effectiveness, he said, but a brain operation, while successful in some cases, usually was recommended for psychoses "of a somewhat different type." He nonetheless told my grandfather that it was worth considering further, and passed along the name of a specialist in Washington.
Two weeks later, another Highland psychiatrist, Joseph Goldstein, sent a report to Ann Arbor stating that he and others on the staff did not consider Phil a suitable candidate for a lobotomy: "The operation as a rule is hardly to be considered seriously for one who has been making a fairly good hospital adjustment, such as Phil has been doing. It certainly usually is reserved for cases showing much more behavior disturbance. Also, it should be borne in mind that the operation, even with the most favorable response, tends to have certain side-effects, such as impairment in ability to plan, difficulties in initiative, tendencies to impulsiveness, child-like behavior at times, etc., as well as, of course, certain risks and expenses associated with the operation itself."
But as Phil's condition worsened early that summer, the doctors changed course again. What had been deemed no longer effective (electric shock) or unpromising (brain surgery) were back in the mix. They told my grandfather that they had been using a "more intensive" form of shock treatment recently, and then explained, "By intensive, we mean decreasing the time interval between the treatments." There was no change in the total number of treatments or their intensity. "It may possibly only have a temporary effect," Edward A. Tyler wrote, "but would give us some idea as to what we might expect from a pre-frontal lobotomy, if that became necessary." The alternative, in Tyler's opinion, was to place Phil in the "locked section in the back hall." Not much of a choice.
The cycle of hope and despair continued. Two weeks after my grandfather gave Highland permission to perform intensive electric shock treatments, he received a positive report from Tyler. There had been a "marked change" in Phil. He was now said to be "very friendly, cooperative, outgoing--again neat and clean" and played "an excellent game of baseball on the 4th of July." The optimistic outlook in this case was even shared by Phil himself, who wrote a buoyant letter to my parents, his sister and brother-in-law. It began:
Dear Mary and Elliott, How are you people after all these months? I sure would like to see you and the old homeland again before long, at least for a little while. I hope that you are all actually in good health and spirits and are enjoying life. The folks in A.A. [Ann Arbor] have undoubtedly told you something of what has been going on lately with me. The electric shock treatments which Dr. Tyler gave me are proving very effective in a real way (that is, a way that I can feel & understand).
He was feeling better than at any time since he was a kid, Phil told my parents. In his despairing letter of two years earlier, he had refused to write about his daily activities in Asheville. Now he was eager to tell relatives what he was doing: how he hit a double over the center fielder's head and made only one error at second base and shot a bull's-eye in archery from 40 yards out and couldn't wait to start pitching horseshoes again, just as he had done in his childhood. He recalled the carefree days in Jackson, Mich., when he and his brother, Bob, would play at "the neighborhood courts down the street from Judy's toward E. Sharp Park"--and the time when he pitched 12 straight ringers.
Phil's brighter attitude led to another visit home in August 1947. For the one-week visit, the family was under instructions to "just treat him as though he had been in the hospital for a physical illness and was at home for a short period before his recuperation." He played golf, saw some college friends and spent two days in Detroit visiting my parents. In a letter back to the doctors, my grandfather reported that Phil "talked freely about the electric shock treatments and seemed to be thinking some of the future"--all good signs.
Then, in November, another unfortunate turn. Phil had relapsed into "fantastic thinking" and was said to be "entirely too philosophical in his thinking." Several months of dispiriting reports followed. In early 1948 another of his doctors, B.T. Bennett, reported that Phil was "no longer receptive to the idea" of more electric shock treatments. (A common response: As a rule, the more a patient received electric shock, the less receptive he was for the next round. Not hard to understand, since treatments then were delivered without anesthesia. Orderlies often held down patients as the jolt was delivered.)
The staff was now giving careful thought to a prefrontal lobotomy, but remained uncertain, Bennett said, because Phil exhibited two quite different disorders. His more debilitating behavior, which they called hebephrenia, characterized by delusions and inappropriate laughing, probably would not respond to brain surgery, they said, whereas the operation might be more effective in treating his obsessive-compulsive behavior.
As sad as the news was, my grandparents wrote back saying that they were grateful for the detailed explanation of their son's condition. They wondered what a lobotomy entailed and how much it would cost. The answer: between $1,000 and $1,200, including hospital fees. As the year neared an end, Phil was examined by R. Burke Suitt, a brain surgeon at Duke University, who concluded that the most effective operation would be not a lobotomy but a topectomy, which involved the removal of "a small amount of tissue on either side of the front part of the brain surface." If successful, it could "produce a relaxation of the patient's fears and tension, permitting him to express himself more spontaneously and relieving the general pressure under which he lives his life."
Suitt offered my grandparents his assessment of risk, and though it was offered in a reassuring tone, I don't know how anyone could have taken it in stride. "The over-all mortality rate is exceedingly low, in the neighborhood of three percent."
They scraped away part of Phil's brain in January 1949, the year I was born. He was flown up to New York City, where the operation was performed by J. Lawrence Pool at the Neurological Institute of Columbia-Presbyterian Medical Center. It took three hours. The next day, Phil was "reading magazines, books, and feeling much better," and within a week he made "an uneventful and happy" return to Asheville, where he was examined again and found to be "more spontaneous in expressing his feelings, and his repetitious and philosophical examination of his own thoughts were definitely lessening."
There were few of the feared side effects. He took more interest in his appearance, ditching the beret he had worn as an affectation and expressing a desire for a new suit and hat. But one doctor, William W. Magruder, did notice that Phil seemed bored with the hospital routine. "If it is just being tired of five years of the same thing, that is good. If it is losing interest in his surroundings, that is not good."
Which was it? His parents visited Asheville in late March. Phil told his doctors that he thought the visit was too short, that everything seemed rushed, but that he enjoyed the company. If he did, his parents could hardly tell.
"When Mrs. Cummins and I were there--we could not talk to him at all," my grandfather noted in a letter to the doctors a few weeks later. Yet within a few weeks, Phil was sociable enough to begin working outside the hospital at a frame shop in downtown Asheville. Reports from the owner, Gene Rezutto, indicated that he was an excellent employee. With the exception of a few seizures, treated with Dilantin, Phil remained relatively stable for the rest of 1949. He took a vacation to Kill Devil Hills, N.C., with "an attractive companion" and made another trip home, where my grandfather detected what he called a "sweet reasonableness" interrupted only by a moment of high tension "due possibly to the three harum-scarum children who were visiting." My grandfather was particularly heartened by the way Phil made decisions during the stay, including setting up an appointment with the dentist and making his own arrangements for the return to Asheville.
By this point, as I read the letters in the box, I was rooting so hard for Phil that I could not bear more disappointing news, but here it was: May 16, 1950, a letter from Magruder to my grandfather and the line, "Things have not gone as smoothly with Phil as I had hoped they would." He had visited Phil at the frame shop, and found him "not working but standing gazing at a picture." He seemed utterly unresponsive to the people around him. Rezutto said that Phil was becoming increasingly difficult to work with, exhibiting a "great deal of inappropriate laughter and behavior." He refused simple requests, treating them like orders, which he hated. Soon he was let go and returned to the hospital grounds.
And that is how it went for the next eight years--brief periods of hope and temporary freedom followed by relapses, with no permanent breakthroughs. He worked in the cafeteria until the head dietitian complained that he was inflexible. He tried selling hosiery, but could not get many orders. He went to a training program in Kansas City for a month, and finished among the top 10 in a class of 55 students, but no jobs resulted. When he filled out an employment application for United Air Lines, he added a supplemental page that began by noting that "due to the nature of father's work during twenties and thirties, we moved from city to city quite often, consequently I attended an unusual number of elementary and high schools"--and then went on to list the schools and dates in meticulous detail. No job there, either.
The letters stop in 1958. Phil had neared the end of his second decade in the hospital. Seventeen years lost--from Pearl Harbor through Korea and Ike and McCarthy to the approach of JFK. Vir-tually all of his twenties and thirties--lost. Finally, when my grandparents moved into their modern house at the farm, he left Asheville for good and came home to Ann Arbor.
There was no dramatic breakthrough in treatment that brought him home. It was, rather, a combination of time and age, a few new drugs, and the balm of the farm itself. He came back to Ann Arbor for a visit and never left. That is when I got to know him, when they started sending me down to sleep in his mysterious lair. To say that I got to know him is not quite right. I thought I knew him; he was my blood uncle, after all, and he treated me with respect and I liked him, and during the '60s I even began to romanticize him, putting him in my pantheon of rebels. If insanity was the only honest response to an insane world, then Phil was the most honest person I knew.
It sounded good, but I didn't really have a clue. Not until I read the letters in that box. I'm haunted by one letter. Not the 1945 song of despair to his father, heartbreaking as it is, but the note he sent my parents two years later recalling his childhood and the time he tossed 12 straight ringers. That's the image that made me weep, much as my mother wept in Manhattan. I can hear the heavy clang of a horseshoe hitting the rusted pole and thudding to earth, a winner, and I can see Phil chuckling softly, nothing inappropriate about this laughter, and squinting his eyes. Here he is the unbroken child, not doomed, not incapacitated, not tortured, not with nothing to say, brilliant and athletic, my uncle.
Many years after he left Asheville, I saw him toss consecutive ringers at the makeshift pit between the vineyard and the peach orchard at my grandfather's farm. How I wish that I could freeze that moment and hold on to it forever and say, This is Phil, as he grasps the horseshoe at an angle and loops his arm back and strides forward and the crescent sails toward home in a perfect arc.
David Maraniss is an associate editor at The Post. This article is excerpted from Nothing to Hide: Mental Illness in the Family, published this month by New Press.