A fascination with the interior consciousness to the exclusion of social forms and relations and without reference to moral imperatives has enabled Vera Randal to produce a novel that is affecting and yet somehow fraudulent. Given her purpose—to expose the insane consciousness so that it will be understandable in its own terms—Miss Randal sometimes writes with sensibility. She describes the oppressive dislocation of the mentally ill but then bows out, leaving the reader holding the guts of her characters in his hands, without the faintest view of their destinies, their personalities, their conception of themselves, or the significance that their experience with insanity and mental hospitals has had and will have. There is little more to grasp in her book than a sense of a state of being, and little more to fathom than the bald fact that people go crazy and suffer. I quarrel with the way Miss Randal has fulfilled her purpose and I’m not sure that she really has written a novel after all.

The Inner Room is a series of sketches of five different levels of mental illness camouflaged as five different women. The distinctions between them are almost entirely blurred and although biographical details are included, presumably to separate them from one another and explain the source of their psychological debilitation, the book could easily be understood as a description of insanity as such, without reference to person and place. The description falls short of the mark. Both the institution and its occupants are virtually anonymous. In this respect Vera Randal reflects the common view. Insanity is a state of possession in whose grasp someone may be caught struggling and writhing in incomprehensible delirium, while the institution in which he is trapped for the duration of his cure is an impersonal edifice representing methods and techniques of strange and incalculable stupidity, or horror, or assistance and care, and somehow this union between the mentally ill and the institution gives rise, when it is successful, to another higher condition called sanity. The process is mysterious.

Through Katherine Barr, Miss Randal precisely describes the self-consciousness of a woman about to lose hold of her sanity: the blurred images, the world literally out of focus, the strange and surprising encounter with the water faucet that, wonder of wonders, still feels like a water faucet, the table still incredibly a table, the sense that the autonomic nervous system will not function, that a great assumption of intellectual will is required simply to move one foot before the other, the sense of a loss of will and direction. A scene of a group of women, terrified and impotent, stripped of all authority over themselves and treated with little courtesy or concern, waiting trembling for shock treatment, is a scene of abject capitulation. Miss Randal here penetrates the quality of the psychotic’s position in a mental hospital. But psychiatrists defend shock treatment professionally as a therapy. It is therefore beyond the moral judgment of the novelist and the reader, and so this scene fails to focus the nature of the relationship between the mentally ill and the institution. The occasional upheavals that take place in a mental hospital over the question of shock treatment are not shown. I have seen an entire population of patients flee across the grounds to which they had access shortly before the doctors arrived to administer the treatments. In maximum security wards patients engage in violent struggles with the staff. There are arguments and wretched pleading. These last-ditch efforts at self-preservation are not hinted at in Miss Randal’s book, and the use of the specter of shock treatment to cow a recalcitrant population is not assessed or even mentioned.

In Binnie Parrington, the story of a girl who has cracked after giving birth to an illegitimate child, Miss Randal comes closest to meeting the demands of her material. The confrontation between Binnie and her parents exposes the moral corruption of the parents and the quality of Binnie’s situation with just a few knifelike phrases. Binnie, utterly dislocated, barely able to center herself, clutching a piece of paper in her pocket which is a note from a friend, another patient—clutching this note as if all hope flowed from it—hears her mother say, “Binnie, you don’t care at all how we feel, do you?… It’s sick to be so self-involved.” Mother again. “I’ve started to work for the Mental Health Association, Binnie. There’s a great need. Such a great need. Do you know that one in every ten children born in this country spends some time in a mental institution?” The moral obtuseness of this chatter contains all one needs to know of the nature of Binnie’s situation, and although Binnie herself hardly emerges as a person her mother certainly does. On the whole, Miss Randal’s sane characters are better drawn than the insane with whom her book is primarily concerned. For the most part her five women are not people. They are specimens.


In the last story, Janet Haggerty hints at a point of view. Janet is well, or at least well enough to go home, and her equilibrium is threatened by the recognition that her friend Binnie has regressed. Her attachment to Binnie is intense and warm and Janet suffers for her with acute and agonizing pain. Now, if I understood Miss Randal correctly, Janet, for all that she suffers, is no longer suffering the pangs of the damned. Janet is the master of her pain. In this mastery then, would lie the distinction between sanity and insanity. This is no mean point. But I am not entirely sure that Miss Randal makes it. I found her ending ambiguous.

Although The Inner Room is a book about the insane, it does not attempt to show the relationship of the insane to his environment, how the mentally ill and the hospital staff respond to their encounter, or the kind of sanity a sojourn in one of these institutions produces. Miss Randal refers for example to the practice of confining seriously disturbed patients isolated in a locked room, but never explores its meaning or effect. It is as if a novelist were to mention in passing that his protagonist had been raped, and declined to show the significance that this experience had for him. For all Miss Randal’s sensibility she hardly penetrates the surface of the sickened consciousness and does not even consider the most pressing struggle in which the mentally ill engage in their return to sanity, the struggle for integrity, and the categorical defeat that this struggle meets in almost every instance. Miss Randal, in writing a book about the insane in a mental hospital, took on the task of dealing with a moral problem and ignored it. Occupational therapy, gym, and cold coffee emerge as major problems of institutional intransigence. This is preposterous.

A mental hospital is an institution that relies on techniques common to all organizations whose purpose it is to effect a sense of personal debasement and loss of honor among its victims. Its methods are comparable to an interrogation center in a prisoner-of-war camp. Patients lie straight-jacketed in a cell with a light burning incessantly, deprived of the ability to shield their eyes. They are locked in a room for days on end without any source of diversion and are deprived of even the most momentary and casual social encounter. A patient on admission to a disturbed ward will likely as not be deprived of all underclothing and dressed in a kimono, and a woman without a slip or a brassiere, dressed in a kimono, looks like nothing but a whore. And she knows how she looks.

The ward in a private sanitarium is a society where absolute power is vested in the hospital attendants. Incompetent, untrained, incapable of coping with the desperation and hysteria of their charges, they are reduced to employing techniques of terror to sustain the environment. If the institution is attached to a school with its blessing of student nurses and interns, and if it is large enough to allow for the presence of trained nurses and social workers on the floor, the role of the attendant is subordinate; but even there the methods persist, although they tend to be less frequently used. The goal to which the entire structure of a mental institution is geared is the imposition of controls over the emotions of the mentally ill. Personal experience, moral stricture, ethical standards, the patient as a relevant being, all are subordinated in the interest of the primary object, which is good behavior; and so the patient who emerges from a mental hospital is a person who has learned to behave himself—no more, no less.

With his defenses shattered to begin with, with whatever pride or pretensions to personal power or honor denigrated and degraded as he crosses the threshold of a disturbed ward, the patient must learn to comprehend and assess the values and standards of his jailer, because only in meeting these can he hope for even the most minimal privileges that are ordinarily accepted human expectations: the right to use a toilet in private, the right to talk to people, to use his limbs, to have the light extinguished in his room at night, freedom of the grounds, relief from shock treatment, the privilege of wearing underpants, eating in public, a kind word. And the standards and values he is required to assess and comprehend are like as not the standards and values of a moral idiot. One must learn not to be caught crying, because tears will be punished with banishment.


The slow evolution from insanity to sanity involves a profound moral assertion if morality is understood as behavior consistent with enlightened self-interest, and the author of a book about insanity must consider and resolve critical moral dilemmas if the book is to be seriously considered. Patients come to understand that self-preservation is the highest moral good and to reject all pride and sense of personal decency in the interest of ingratiating themselves with the all-powerful deity who rules the ward. They become asslicking sycophants. This entails a sanity of sorts, but it depends on a parting with one’s inner integrity, and the mustering of a carefully arranged pretense. The mental hospital is an expression of American philosophy. It is pragmatism triumphant. It works. It produces people who for all practical purposes will act sane. And that, in a society where even literature no longer concerns itself with morality, is enough.

Miss Randal’s book, well written, even sensitive to a degree, is for the most part within this tradition. She offers not a shred of evidence to show what happens to her characters, or how, as they move from their locked cells to the ward which contains the amenities, or some of the amenities, of life. She makes no attempt to explore the relationships, or examine the process that leads from shock to shattered sanity. How the patient rationalizes his situation, how and if he manages to manipulate his environment, and what new self-image he manages to reconstruct—all these she ignores. Miss Randal includes a scene where a doctor, in the privacy of his office, encourages his patient to cry over the loss of her husband. The recognition of the problems involved in giving in to such an impulse in the ward would have been more to the point.

This Issue

December 3, 1964