There are lots of myths and sometimes horror stories told about psychiatric institutions and other institutions for those with mental illness. In part, those myths may arise from the fact that we are still learning about what causes the kinds of mental illness that requires institutionalisation. Lack of knowledge often leads to the sort of fears that build up into those myths. Then, too, it’s only been in the last several decades that psychiatric institutions have become places where patients can receive helpful therapy and are treated with any kind of dignity (and there are still plenty of such places where that doesn’t happen). So it’s no wonder that being institutionalised can still carry with it a real social stigma, and that institutions themselves are often the object of both fear and morbid curiosity. If you look at crime fiction, though, you can see that there’s more to psychiatric institutions than lurid stories.
Agatha Christie makes some mention of psychiatric institutions in her novels. For instance, in Hickory Dickory Dock (AKA Hickory Dickory Death), there’ve been some odd thefts and some vandalism at a hostel for students, and the hostel’s manager Mrs. Hubbard is getting concerned. Her sister Felicity Lemon tells her boss Hercule Poirot what’s been going on, and he interests himself in the matter. When one of the residents Celia Austin owns up to several of the thefts, the matter seems to be cleared up. But two nights later, Celia dies of what seems at first to be poison. When it’s proven that she was murdered, Poirot and Inspector Sharpe investigate the crime. They look into the backgrounds and lives of the other residents of the hostel as they try to find out who would want to kill the seemingly inoffensive Celia. It turns out that just about all of the residents are hiding something. One of those residents is medical student Len Bateson. Bateson’s father has been institutionalised and among other things, he’s worried that he might fall under extra suspicion because of that fact. We don’t get to see that institution in this novel, but it’s interesting to see the public perception of such places.
There’s a very stark and harrowing portrait of an institution in Thomas Harris’ The Silence of the Lambs. Hannibal Lecter is a brilliant and noted psychiatrist. He is also a very dangerous and brutal psychopathic killer. As this novel begins, Lecter’s been confined to Baltimore’s State Hospital for the Criminally Insane. Because Lecter and the other residents are considered extremely dangerous, they’re also very tightly confined and have little freedom of movement. And many of the residents really are frightening people. FBI trainee Clarice Starling is sent into this environment because she’s been chosen to join a team that’s hunting a vicious killer known as “Buffalo Bill.” It turns out that this killer was once a patient of Lecter’s, so it’s believed that perhaps Lecter may be able to help track him down. Starling is assigned to interview Lecter and enlist his help. Lecter agrees on the condition that for each piece of information he gives, Starling has to reveal a personal secret. The novel focuses on the dangerous game of wits the two play and on the search for “Buffalo Bill,” and the institutional background for much of the story adds to the suspense and the eeriness of the story.
In Håkan Nesser’s Mind’s Eye, schoolteacher Janek Mitter is confined to a mental institution when he is convicted of murdering his wife Eva Ringard. Inspector Van Veeteren and his team did the original investigation, and on the surface, it certainly seems that Mitter is guilty. But Mitter is sure that he didn’t commit the crime, and even Van Veeteren begins to wonder if Mitter is innocent. The problem is that Mitter was extremely drunk on the night of the murder and remembers very little. That’s in fact why he’s placed in an institution instead of a prison. The institution in which Mitter lives is actually not portrayed in an overly negative way. Yes, the residents do not have a lot of freedom of movement, and they’re on a somewhat regimented schedule. But Mitter actually feels a bit safe there – certainly safer than he probably would have had he been imprisoned. A little time goes by and Mitter slowly begins to recover his memory, first in the form of frightening dreams and then more clearly. Then, Mitter remembers who actually killed his wife. Shortly after that, he himself is murdered. Now, Inspector Van Veeteren and his team re-visit this case with renewed energy to find out who the murderer is.
In Ian Vasquez’ Lonesome Point, we meet brothers Leo and Patrick Varela, who were born and raised in Belize and since then, have moved to Miami. Leo is a poet who works in a mental institution. He’s happily married and the couple is expecting their first child. Patrick is an up-and-coming politician who’s already made quite a local name for himself and is being talked about as having real national promise. Everything changes for both brothers with the arrival in Miami of Freddy Robinson, an old acquaintance from Belize. Freddy’s got a somewhat shady past, including a prison record, and is now working for some very unpleasant people. It seems that one of the patients on the ward where Leo Varela works may have some “inside information” on some unethical political tricks that Patrick Varela’s staff may have used. Freddy’s “employers” want that information. So Freddy pays Leo a visit, asking his help in releasing that patient so that he can “assist” the people who are paying Freddy. Leo refuses at first, partly because it could cost him his job, and partly because he doesn’t want to damage his brother’s career. But Freddy threatens Leo, saying that if he doesn’t do as he’s asked, Freddy will reveal a dark secret he knows about the Varela brothers’ past. So very reluctantly, Leo Varela breaks the institution’s rules and gets the patient released. He also gets himself and his brother into more danger than he could have imagined. The story of the institution where Leo Varela works is mostly told from the point of view of the employees, and although it’s not exactly a happy place, it is also not a cruel or inhumane place. And the employees are, for the most part, professional about their jobs. And for the patient involved in this case, the institution has actually provided protection.
Early in Åsa Larsson’s The Black Path the third novel to feature tax attorney Rebecka Martinsson, we find that Martinsson has been confined to a psychiatric institution. She’s been through some awful and traumatic events in both Sun Storm (AKA The Savage Altar) and The Blood Spilt, and has finally come unhinged. Through a series of psychiatrist’s reports, we see how Martinsson gradually “comes back to life.” We also see through Martinsson’s eyes what the institution is like. It’s certainly not portrayed as a delightful place. But she feels safe there and gradually feels life coming back. With help from both her therapist and the medications she’s given, Martinsson begins to feel more grounded. When she’s ready, she returns to her family’s home in Kiruna, only to be involved in the investigation of the murder of Inna Wattrang. Wattrang was Head of Information for Kallis Mining. So Inspectors Anna-Maria Mella and Sven-Erik Stålnacke look into the company’s past and its business practices. They find some questionable practices, and Mella enlists Martinsson’s help because of her expertise. In the end Martinsson helps the team find out who killed Inna Wattrang and why.
There’s a fascinating, if somewhat harrowing, look at life in an institution in Alice LaPlante’s Turn of Mind. This is the story of Dr. Jennifer White, a Chicago orthopaedic surgeon who’s been diagnosed with dementia. As the novel begins, White is still able to live in her home with the help of her caregiver Magdalena. Then one night, White’s neighbour Amanda O’Toole is murdered. Her body is also mutilated in a very professional way that only a surgeon would be able to carry off. Detective Luton is assigned to the case and it’s not long before she hits on White as a suspect. The deeper she looks, the more likely it is that White could be guilty. However, the evidence is not completely convincing and what’s more, White herself can’t help. She is gradually slipping away from what counts for most of us as reality. In fact she soon has to be placed in an institution for those who have Alzheimer’s Disease and other forms of dementia. So Luton has a very challenging task trying to find out what really happened on the night of O’Toole’s death. Is Jennifer White guilty? If so, was she aware of what she was doing? If not, what if anything does she know about the murder? Some of this novel takes place against the backdrop of the institution to which White is moved, and since this novel is told from White’s viewpoint, we see how a resident looks at life in such a place. On one hand, during her more lucid moments, White objects to being condescended to, especially when staff members refer to her as “Jenny,” or “Jen,” instead of the “Dr. White,” to which she was so accustomed. And because of staff shortages, White and her fellow residents aren’t always attended to promptly. White is also restrained at times and those parts are admittedly difficult to read. On the other, the staff members are not cruel and terribly inhumane. They are doing the best job they can under very difficult conditions. This isn’t an easy book to read, but it is very well-written and worth the read.
There are other novels, too, that take place in institutions or that feature them in some ways. They can be quite compelling settings and when done well, can add a lot to the tension in a novel.
*NOTE: The title of this post is a line from Pink Floyd’s Brain Damage.