Valerie, Kaysen writes, was about thirty years old. Valerie was tall, with tapered legs and arms, and looked a lot like Lisa. Valerie was good at curling herself into corners, and often was the one to help calm down and retrieve patients who had tucked themselves between a radiator and a wall or into another difficult-to-reach spot. Susanna describes Valerie as strict and inflexible, but nevertheless says that Valerie was the only staff person any of the girls trusted—they trusted her because she was not afraid of them. She was a woman of few words, and the girls on the ward appreciated that as well, as they had to hear “a lot of talk” every day. Each girl sees three doctors a day: the ward doctor, the resident, and her own therapist.
Susanna’s affection for Valerie is palpable in this passage, the first section of a chapter which will identify and explain the relationships between the patients and their “keepers,” or nurses, orderlies, and therapists. Valerie is the heart of the hospital staff, and is clearly the most empathetic and involved. Valerie does not tell the girls anything they don’t need to hear, knowing that their lives are hard enough without condescension or empty words, of which they surely get enough in their therapy sessions with doctors and residents.
The doctors have a special language, and use terms like “acting out,” “hostility,” “regression,” “withdrawal,” and “indulging in behavior” to make anything the girls do sound somehow “suspicious.” Nothing the girls do is ever simple, and is always seen as motivated by something else. Valerie, however, is a relief from all of this jargon, and only ever says what she means.
Valerie is the only reprieve from the complex and labyrinth set of classifications which defines life at McLean. While doctors and therapists are constantly trying to call the girls out for their bad behavior and apply a rigid vocabulary to even their most banal words and actions, Valerie talks to the girls like people rather than just patients.
The doctors are men, and the nurses and aides are women. The one exception is Dr. Wick, a female therapist who is the head of the girls’ ward, South Belknap Two. Dr. Wick “look[s] like the ghost of a horse,” and sounds like one as well. She is from Rhodesia, and is both naïve to the intricacies of American culture and easily shocked by any talk about sex—two things which Kaysen notes made her an “odd choice” to head a ward full of young women. When Susanna attempts to describe her visit to the Frick to see the Vermeer in one of her sessions with Dr. Wick, Dr. Wick is shocked by Susanna’s description of her sexual relationship with her English teacher. Their sessions, Susanna notes, are in no way therapeutic, and Susanna feels lucky that she only has to talk to Dr. Wick for five minutes each day.
Dr. Wick represents how out of touch things are on the ward, and how ineffectual is the care the girls in McLean are receiving. As someone who heads a ward full of young women brimming with confusion, desire, and pain, Dr. Wick is a very ill fit. She is easily shocked, deeply disinterested, and only further isolates her already lonely, frustrated patients. Her tenure at the hospital is symbolic of deep-rooted problems in the mental healthcare system when it comes to the prioritization of patients’ needs.
After each session with Dr. Wick, a resident arrives for another session—information from which the residents use to regulate privileges and medication. Residents change every six months, and the girls on the ward are never able to figure out how to handle one resident before another one is swapped in in their place. Sessions with the residents are similarly unhelpful, and residents are, across the board, stingy with doling out any medicines or privileges at all.
The revolving door of residents does not do any favors for the girls’ pervasive sense of instability and isolation. The patients cannot get the things they need from the residents all the time, nor can they even get a familiar face to talk to. The patients’ needs are not prioritized, and rather it is the residents’ garnering of experience which seems to be the main focus of their position on the ward.
Therapists have nothing to do with the girls’ day-to-day lives on the ward. Susanna’s therapist urges her not to talk about the hospital all, and insists that their sessions are for talking about the deeper-rooted problems in Susanna’s life. Therapists cannot affect anything at all about the girls’ lives on the ward, and their only power is to “dope [their patients] up” with sedatives that “knock the heart out” of anyone who takes them.
The therapists have little actual power over their patients’ day-to-day lives. Susanna repeatedly paints a portrait of therapists as ineffective and rather lazy, preferring to silence and sedate their patients with medication rather than try to help them to get to the bottom of their issues and make a full recovery.
Half a dozen nurses including Valerie and one or two aides are on duty during the daytime. Where the day staff are cold and removed, most of the night staff are warm and comforting—except for Mrs. McWeeney, the head night nurse, who does not get along with Valerie. The girls like Mrs. McWeeney far less than Valerie, and feel a sadness each night when Mrs. McWeeney takes over, as they know they are about to be locked up for eight hours with a “crazy woman” who hates them. The unpredictable Mrs. McWeeney makes mean faces at the girls without warning, and often withholds medications from the girls for no reason. The girls complain every morning about Mrs. McWeeney, but Valerie tells the girls there is nothing she can do about Mrs. McWeeney, and urges them to respect her.
The girls call Mrs. McWeeney a “crazy” woman, and her behavior toward the patients certainly does make her seem unstable. Mrs. McWeeney has not just disdain but outright ill will toward the girls she is tasked with caring for at one of their most vulnerable times. Unfortunately, in the “parallel universe,” this kind of unjust and cruel treatment must simply be tolerated or ignored. Valerie is the patients’ advocate in most things, but when it comes to her opposite, Mrs. McWeeney, she urges the girls to keep their heads down and behave with respect—even though Mrs. McWeeney certainly does not offer the girls the respect which Valerie offers them.
Now and then there is an influx of student nurses on the ward. The nurses are about the same age as the girls: nineteen or twenty. They are eager, innocent, and also incompetent, and the girls on the ward both pity and scorn them. More than anything, the girls on the ward are darkly fascinated by student nurses because they see “alternate versions” of their own lives reflected back at them—the lives they could be living if they weren’t locked up on a psychiatric ward.
The student nurses represent freedom and a rare glimpse of the “real” world. The patients, jealous of the student nurses’ lives, careers, and senses of normalcy and well-being, become slightly obsessed with them, looking to them as a brief reprieve from the seclusion and repetitiousness of their lives on the ward.
The students and patients love talking to one another, and patients ask nurses about current movies, school, and their personal lives. In exchange for these tidbits of life on the outside, the girls on the ward do their best to control their tics and mood swings while the students are around. “Consequently,” Susanna writes, “the [students] learn nothing about psychiatric nursing [during] their rotations.” The student nurses leave the ward having seen only shades of the girls’ real selves and real problems, and Susanna notes that for many of the patients, being remembered as almost-well is the closest they will ever come to being cured.
The patients, isolated from the “normal” routines and activities of other girls and boys their age, live vicariously through the students who pass through their lives fleetingly. Because the girls are always on such good behavior around the students, the students learn almost nothing. This is also, in a way, a gift that the students give the patients: they allow the girls to behave for a little while as they wish they could behave always, and thus be seen as they wish they could always be seen.