The Patient—IV: The Air Is Too Still

This is the last part of a four-part series. Read the first part.

(Why here?) I’m finding Sylvia and I think it’s lovely to stay with beautiful people. (Problem) I graduated from a secretarial school but I didn’t go to work. (Why?) My mother is mothering me too much. I got away besides the nicotine gets into my sputum and makes me nervous. This is the reason why I play rock music and the guitar. (What do you do at home?) I listen to the radio but I kept on thinking that I need a blood test and a pap smear. (Did you have any contact?) Maybe. (Ideas of harming yourself?) I was foolish to take all my pills once but I immediately woke my parents. (Why do you get angry?) I twisted my mother’s arm before I came here.

For about a week, Miss Frumkin stopped smoking, kept herself neat, and took her medication.

She told a therapy aide that she liked Creedmoor, “because I always get well here”— something she often said ten minutes after saying that Creedmoor was hell. By early November, the therapy aides were noting that Miss Frumkin was uncoöperative and untidy, threatened them with lawsuits, wore bizarre clothes, chain-smoked, and disturbed other patients in the dormitory, by sitting on the floor all night praying. At the end of November, a nurse noted that Miss Frumkin pretended to take her medication but was caught throwing it into a garbage can.

At the beginning of December, a nurse noted that she enjoyed foraging through the garbage cans and that she often sought out secluded areas with male patients. On December 24, 1972, when her two P.C. expired, Miss Frumkin signed a voluntary form agreeing to remain at Creedmoor. On January 9, 1973, an attendant on the four-to-twelve-thirty shift noticed around suppertime that Miss Frumkin was missing. The attendant telephoned the Frumkins. Sylvia wasn’t at home. The following day, the Frumkins received a call from Daisy and Mark Hayes, the leaders of a Buddhist group that Sylvia had attended in 1972, who had heard from Sylvia, She was at LaGuardia Airport.

She had left the hospital with another patient, a young man named Jean-Paul. They had decided to stow away on a plane and go to California. An airline ticket agent had become suspicious of Sylvia and Jean-Paul when Sylvia had addressed the agent as Peter Sellers. Jean-Paul had sensed the agent’s suspicion and had fled, leaving Sylvia alone at the airport with her fantasy that she was going to Hollywood to make a movie and that all the people she met along the way were in the movie with her. She had telephoned the Hayeses, had told them where she was, and had said that she wanted to go either to California or to their house. The Hayeses had then telephoned the Frumkins.

Sylvia’s father, Irving Frum-kin, went to LaGuardia with the Hayeses while Harriet Frumkin telephoned Creedmoor to tell the attendants on duty at Clear-view where Sylvia was. Three Clearview attendants went to LaGuardia and took her back to the ward. After her return to the hospital, her medication was increased slightly. In January and early February, according to her medical records, she still spent a good deal of her time pursuing young men “in a very unladylike manner, letting them feel her and she them, kissing openly in public.” (Irving and Harriet Frumkin had much preferred the sexual segregation that existed until 1969.) Miss Frumkin had been given moderate doses of four neuroleptics during the fall of 1972; when she was given the equivalent of nine hundred milligrams of Thorazine daily, in January of 1973, her condition improved.

Her medication was then inexplicably lowered to the equivalent of four hundred milligrams of Thorazine daily, and she was discharged on March 20, 1973. She was to live at home and go to the Clearview Day Center on weekdays as an out-patient. Miss Frumkin went to the Day Center a few times, and then began going to Buddhist meetings instead. While she was attending medical-secretary school, she had planned to refurnish her room, but she had never done so. In 1973, she no longer even wanted her old furniture; she wanted to convert her room into a Buddhist shrine, with wall-to-wall pillows and prayer rugs. Mrs.

Frumkin refused to throw any furniture out, but she occasionally tried to pacify Sylvia by ringing gongs with her. (The names of almost all the people mentioned in this article, including the Frumkins, have been changed, and some details have been altered to disguise their identities.) One evening in April, Sylvia didn’t return home. At a Buddhist meeting she had attended that afternoon, the guest speaker was a man named Daniel Eiseman, who ran a halfway house for former mental patients on the fourteenth floor of the Hotel Martinique, on West Thirty-second Street near Greeley Square, in Manhattan. Eiseman was a Buddhist, a social worker, and a proponent of megavitamins.

The residents of his halfway house received megavitamins from a doctor affiliated with a nearby clinic that specialized in them. The day after the Buddhist meeting, Eiseman called the Frumkins, introduced himself, and said, “If your daughter is Sylvia Frumkin, she’s with us, she’s safe, and she’s getting megavitamins.” The Frumkins went to the Hotel Martinique to visit Sylvia and to drop off some of her belongings—clothes, cosmetics, records. She seemed content there. The Martinique had once been a thriving commercial hotel (it was in the garment district), but by 1973 it had fallen on hard times.

It was one of many hotels in midtown and on upper Broadway that had become single-room-occupancy hotels, or S.R.O.s, filled with welfare clients and former mental patients. S.R.O.s and adult homes proliferated after the Department of Mental Hygiene decided to depopulate the state hospitals; in fact, many critics said that, for the sake of accuracy, the department’s policy should be called not deinstitutionalization but trans-institutionalization. The new institutions were not limited to the S.R.O.s and adult homes, many of which housed former patients in conditions even more tawdry than those prevailing in the state hospitals.

There were also so-called skilled-nursing facilities, or S.N.F.s, and health-related facilities, or H.R.F.s. Many former patients simply wound up as derelicts. As late as 1980, eighty per cent of the New York State mental-health budget still went to the depopulated state hospitals; the public had accepted the idea of community mental-health care as long as the community mental-health-care facilities were situated in someone else’s community. One evening in June of 1973, Miss Frumkin went to a bar with another resident of the halfway house and got drunk.

She returned to the Hotel Martinique, where she faintly remembers dancing around the fourteenth floor in a nightgown she had ornamented with jujubes. She then grabbed an armful of records, went downstairs, and started dancing around in Greeley Square, giving out records to a crowd that quickly assembled. Eiseman telephoned the Frumkins. He told Mrs. Frumkin that Sylvia had gone berserk, and that she would have to come and get her daughter, because he couldn’t handle her anymore. Mr. Frumkin was out. Mrs. Frumkin took the subway into the city. When she got to Greeley Square, she saw a large crowd. “Look at that crazy girl,” a woman standing next to Mrs.

Frumkin said, pointing to a young woman who was dressed only in a bra and a half-slip as she danced and distributed records. Mrs. Frumkin recognized Sylvia. “You should be thankful it’s not your daughter,” she said to the woman. Then two policemen arrived. One of them covered Miss Frumkin with his jacket, and they took her to Bellevue. She remained there several weeks. She was given high doses of Thorazine during the first part of her stay and no medication at all during the latter part, but neither form of treatment kept her from believing that, as a result of her chanting, both Queen Elizabeth and President Nixon had come to visit her.

On July 16th, she was transferred to Creedmoor on a two P.C. When the doctor in the Clearview unit who had discharged Sylvia Frumkin on March 20th learned that she was back, he remarked to a colleague that in the pre-neuroleptic era she would have been permanently confined to Creedmoor. The drugs had made it possible for her to be a mobile chronic schizophrenic. He predicted that she would spend the next twenty years in and out of hospitals. What he didn’t predict was just how often she would be in and out of Creedmoor in the six months following her fifth admission to the hospital. On July 22nd, she escaped. On July 31st, the police picked her up on the street and took her to Elmhurst.

She has never been disposed to reveal where she was during those nine days. On August 28th, after she had spent four weeks at Elmhurst walking around naked, spitting out her medication, and hitting a number of patients and attendants, Elmhurst sent her back to Creedmoor. She next escaped from Creedmoor on September 8th, and she resurfaced at Manhattan Psychiatric Hospital, on Wards Island, on September 10th. Manhattan Psychiatric’s plan was to send Miss Frumkin back to Creedmoor, but Miss Frumkin had another plan. She walked out of the hospital, hailed a taxi, and rode home. Her parents took her back to Creedmoor that same day, with the assistance of one of their friends.

On September 26th, Miss Frumkin asked to go to Jewish services, which were held in Creedmoor’s Assembly Hall, a short walk from Building 25. She was given permission to go under the supervision of a male therapy aide. After the services, while refreshments were being served, she slipped away from the therapy aide. She arrived home that evening. Before her parents could calm her down or telephone Creedmoor, she cut the telephone line with a pair of scissors, said that she didn’t want to go back to Creedmoor, and ran out of the house. A few hours later, two patrolmen picked her up on the Throgs Neck Bridge, not far away.

She was still carrying the pair of scissors, and was aggressive and abusive. The policemen took her back to Creedmoor. On September 18th, when the two P.C. had expired, Dr. William L. Werner, who had taken over as Creedmoor’s director in 1972, had applied for a court order of retention, because the psychiatrists in the Clearview unit believed that Miss Frumkin was not well enough to be discharged. On October 23, 1973, Miss Frumkin and a court-appointed lawyer appeared at a hearing, in Creedmoor’s Building 40, before a judge of the New York State Supreme Court for Queens County. The judge ordered that Miss Frumkin be retained for a period not to exceed six months.

She decided to exercise her right to petition the court for a rehearing. The court-appointed lawyer represented Miss Frumkin at the rehearing, and, in addition, the court designated an independent psychiatrist to examine her. A psychiatrist on the Clearview staff described her at this time as “dysfunctional even within the hospital environment.” The court-appointed psychiatrist interviewed her and concluded that she should not be discharged. On December 19th, a Supreme Court judge and six jurors met and decided that Miss Frumkin should be continued on her present court commitment.

She tried to escape as she was returning to Building 25, but she was restrained. Between July and December, whenever Miss Frumkin had not been absent without leave from Creedmoor she had been receiving moderate doses of various neuroleptics, which didn’t have any effect on her. She had tried to pull off the wigs that some of the female therapy aides wore, had changed her clothes ten times before she could be persuaded to leave the dormitory in the morning, had fought with female patients, and had had sex with male patients. Her medication was changed often, and she often demanded to see the medication cards accompanying her medication cups.

On the morning of January 27, 1974, a therapy aide named Mary Dodd was giving out medication in Miss Frumkin’s ward. When Mrs. Dodd handed Miss Frumkin her pills, she accused Mrs. Dodd of giving her the wrong medication. Mrs. Dodd told her she was simply giving her what the doctor had ordered. Miss Frumkin started screaming at Mrs. Dodd. When Mrs. Dodd tried to pour water into Miss Frumkin’s medication cup, Miss Frumkin spit the pills at Mrs. Dodd and spilled water all over Mrs. Dodd and herself. Another patient assisted Mrs. Dodd by taking the medication tray. Miss Frumkin hit Mrs. Dodd.

“I finally remembered that if anyone is having hysterics, a slap calms them; so I slapped her on the face, not in anger or to harm her but to calm her, which it did,” Mrs. Dodd later reported. Mrs. Dodd was brought up on disciplinary charges, because at Creedmoor hitting a patient is forbidden, no matter what the provocation. After statements were taken from Miss Frumkin (whose account of the event varied each time she was questioned), from Mrs. Dodd, and from the patient who had assisted her, Mrs. Dodd was first given an official reprimand. She contested the reprimand, which the hospital eventually agreed to withdraw, for several reasons: Mrs.

Dodd had worked at Creedmoor for nearly four years and had never done anything that required special counselling or disciplinary action; Miss Frumkin was the source of a good deal of conflict in the ward, because she frequently provoked attacks on herself, then greatly exaggerated or completely fantasized the behavior of others in these incidents; and in the opinion of her supervisor Mrs. Dodd’s explanation of why she had hit Miss Frumkin indicated “scrupulous honesty as well as the need for training in the management of disturbed patients.” Instead of the reprimand, Mrs. Dodd was given some training in the management of disturbed, assaultive patients.

She worked at Creed-moor until her death, in 1980, and was never again brought up on disciplinary charges. On January 19, 1974, Miss Frumkin’s medication had been changed to eighty milligrams of Stelazine daily— the equivalent of sixteen hundred milligrams of Thorazine, and a higher dose than the total of the potpourri of drugs she had previously received. In late February, her condition took a turn for the better. Her personal appearance and behavior continued to improve in March.

She started going home on visits and went to a typing program on the Creedmoor grounds several times. In March of 1974, Harriet and Irving Frumkin met with the Clearview social worker to discuss Sylvia’s discharge. The Frumkins had by then become active in the Long Island Schizophrenia Association. One member of lisa had given them a pamphlet about Gould Farm, a community rehabilitation center that occupied six hundred acres in the Berkshires, in western Massachusetts. Gould Farm’s community was composed of about thirty full-time staff members, their spouses and children, and about forty guests—both men and women, most of them between the ages of nineteen and forty.

Many of the guests had been in psychiatric hospitals, but Gould Farm accepted only people who were “in a reasonably good state of remission.” The brochure made it clear that Gould Farm could not offer anyone a permanent home; most guests stayed for a period of between three months and a year. In early April, Miss Frumkin was given a week’s leave from Creedmoor. The Frumkins had made an appointment at Gould Farm, and they drove Sylvia there for a required twenty-four-hour trial visit. They liked Gould Farm immediately. Sylvia was accepted there. The Frumkins drove her back to New York.

She returned to Creed-moor for a few days, had the court order dropped, and was discharged. The first thing Miss Frumkin did at Gould Farm was to give up smoking—a habit with which she had always felt uneasy. The second thing she did was to start gaining weight on the ample breakfasts, lunches, dinners, midmorning coffee breaks, afternoon teas, and bedtime snacks provided. She was also caught skimming cream off the tops of bottles of unhomogenized milk in the milk room. After several months at Gould Farm, she weighed a hundred and ninety-six pounds. She decided to go to a Weight Watchers group in the nearby town of Great Barrington.

The executive director of Gould Farm remembers her running compulsively from table to table snatching meat from other guests’ plates, to be sure of having precisely the number of ounces of chicken or liver specified in the Weight Watchers diet; he came to regret having given his approval to her going to Weight Watchers. She lost some weight, but she did not stick with Weight Watchers long; diets lost their charm for Sylvia Frumkin as quickly as psychiatrists did. During her first months at Gould Farm, Miss Frumkin was still taking eighty milligrams of Stelazine a day, which she had been advised to do when she left Creedmoor, along with six milligrams of Cogentin and some Dalmane (she had had some trouble sleeping).

She was also taking megavitamins. Gould Farm had a consulting psychiatrist, Dr. Dale Greaney, who came to the farm once a week to see the guests. A few months after Sylvia’s arrival, Dr. Greaney began to see her every second or third week for between half an hour and forty-five minutes. Sylvia was always lucid but circuitous. In Dr. Greaney’s opinion, she was no more and no less ill than most of the other chronic-schizophrenic guests he saw at Gould Farm, but three things did set her apart from the others. The first was her physical clumsiness and lack of coördination. Like several other psychiatrists who have treated Miss Frumkin, Dr.

Greaney believed that she might have a neurological problem. He sent her to a neurologist for a consultation. The neurologist gave her a thorough examination and a test to rule out the possibility that she might have Wilson’s disease, a hereditary condition characterized by toxic deposits of copper in many organs and tissues, including the central nervous system; the test was negative. The neurologist also determined that she didn’t have any other neurological problem that would explain her behavior. (As a consequence of the neurologist’s examination, Miss Frumkin came to believe that she did have Wilson’s disease, just as insulin-coma therapy, which she had had in 1967, had convinced her that she suffered from hypoglycemia.) The second thing that made her different from guests at Gould Farm with whom she shared many of the symptoms of schizophrenia was her imperious behavior.

Dr. Greaney knew many schizophrenics who were quiet, were neat and kept their rooms clean, and had good manners. Miss Frumkin was loud, her room was messy, and she irritated most people at Gould Farm by her social clumsiness. She grated on her fellow-guests and on the staff by literally and figuratively stepping on their toes; she seemed to lack any sense of where she ended and the next person began. The third thing that he believed set Miss Frumkin apart from other schizophrenics he had seen was her unwillingness to settle for the half life of halfway houses and “sheltered workshops,” as so many chronic schizophrenics did. Some months after Miss Frumkin began to see Dr.

Greaney, her legs started to move back and forth involuntarily when she was seated. He changed her medication from eighty milligrams of Stelazine to six hundred milligrams of Mellaril, which was the equivalent of six hundred milligrams of Thorazine—a reduction of over sixty per cent in her medication. When Dr. Greaney went into private practice, in 1973, he had been antagonistic to medication. He had hoped to treat schizophrenic patients without drugs. Experience had taught him that he couldn’t, but he continued to prefer talking to people (his main interest now is couples therapy) rather than medicating them.

Eventually, he relinquished part of his job at Gould Farm to another psychiatrist, one reason being that “the work was almost all writing prescriptions.” He now goes to Gould Farm half a day a week. Dr. Greaney changed Miss Frumkin’s medication from Stelazine to Mellaril because he believed that, of all the neuroleptics, Mellaril caused the least hyperactivity. In choosing Mellaril (there were alternative ways to deal with the leg swinging), he chose one of the few drugs that could not be safely given in a dose comparable to eighty milligrams of Stelazine. Mellaril, unlike most neuroleptics, has an absolute ceiling—eight hundred milligrams.

The manufacturer warns that higher doses can cause pigmentary retinopathy—a discoloration of the retina which impairs vision. Dr. Greaney didn’t worry about decreasing Miss Frumkin’s medication, and didn’t even give her the maximum dosage of Mellaril. He regularly reduced the medication of guests at Gould Farm by anywhere from twenty-five to fifty per cent, because the guests worked six hours a day and he observed that they became too tired if they took the same medication they had been given while they were leading inactive lives in hospitals.

He didn’t notice any change in Miss Frumkin’s behavior for several months after he lowered her medication. (Some patients “decompensate” twenty-four hours after a reduction or cessation of their neuroleptic medication, and some decompensate only after eighteen months, but the average time is about three months.) Dr. Greaney did notice that Miss Frumkin was suddenly talking a great deal about religion. He decided that her preoccupation with religion was nondelusional and therefore didn’t do anything about it. After Miss Frumkin had been at Gould Farm a year, the staff met with the director to discuss her future.

Most guests either suffered relapses and went back to hospitals or improved sufficiently to go to a halfway house or return home. An occasional guest was allowed to stay on at Gould Farm if he or she was no trouble and fitted into the farm’s therapeutic community. The staff told the director that no exception should be made for Miss Frumkin. They had hoped that they could change her behavior, and had expended a great deal of energy on her, but she was as obnoxious as she had been when she arrived. On June 1, 1975, Miss Frumkin was told that she would have to leave Gould Farm in three months. The Frumkins were distressed.

“Gould Farm was such a wonderful time for us,” Harriet Frumkin recalled some years later. “Sylvia was in reasonably good shape, she wasn’t in a hospital, and she was away.” The Frumkins knew from having had Sylvia living at home several times in the early seventies that it would be better for the whole family if she did not return there. The social worker at Gould Farm tried to get her into a number of halfway houses in Massachusetts, where she had placed other Gould Farm guests. Miss Frumkin was unenthusiastic about the halfway houses, and they were unenthusiastic about her.

Between June and September, as she was threatened with the sort of change that had triggered psychotic episodes in the past, and was more vulnerable, because her medication had been lowered, she began to decompensate more visibly. She became increasingly preoccupied with religion. Unknown to some people at Gould Farm, Miss Frumkin had met a member of the American Board of Missions to the Jews one Saturday in 1972 on her way home from an internist’s office where she was then working.

Members of the A.B.M.J. are primarily Jews who believe that Jesus is the Messiah; they consider themselves spiritually reborn, and believe that their purpose in life is to bring the message of Jesus to other Jews. Miss Frumkin had not pursued the invitation to become converted to Christianity in 1972; instead, she had become a Buddhist in 1973. She had turned against the Buddhists after she was asked to leave the Hotel Martinique. At Creedmoor, after she ran away from Jewish services she had had several counselling sessions with Creedmoor’s rabbi, and had once again seemed to accept Judaism. At Gould Farm, however, a guest who was a born-again Christian had converted her to Christianity.

She considered herself born again and started to go to church. Although Gould Farm was nonsectarian, its director was an ordained Presbyterian minister, and a few of the staff members were evangelical Christians. As Miss Frumkin became obsessed with Christianity in the summer of 1975, two staff members at Gould Farm were counselled against proselytizing her. As the deadline for leaving approached, her room became “a disgrace,” she stopped taking her medication, and she started running around without any clothes on. The director telephoned the Frumkins and told them they would have to come and get their daughter. Dr.

Greaney was on vacation on August 29th, when Miss Frumkin left Gould Farm; he was not surprised to learn later that her exit had been a dramatic one. He recognized that even though her ability to function had become increasingly impaired as she had grown older, her will to succeed had survived. The reason that the staff at Gould Farm felt that her prognosis was so poor was that they could not imagine an entry point into any normal life for Miss Frumkin. At staff meetings, they asked each other, “What would she do?” She couldn’t even be hired as a clerk, because of the awkward way in which she presented herself, and, on top of that, she didn’t really want to be a clerk.

She still wanted to be a star. Dr. Greaney believed that Miss Frumkin’s combination of intelligence and grandiosity not only made her prognosis poor but also accounted for the Dionysian quality of her psychotic episodes. “If you have to be Sylvia Frumkin, maybe this is the way to be,” he said not long ago. “Many schizophrenics are grandiose, but she has such a high intelligence coupled with her grandiosity. If you see yourself going from defeat to defeat, and the next awesome chasm presents itself and you can’t cross it, maybe you stick with the grandiosity in your head instead of facing up to your homeliness and awkwardness and limitations.

I think she’s a genius at being insane.” Sylvia Frumkin didn’t want to return to Creedmoor. She got down on her hands and knees and begged her parents not to send her back there. At one of many mental-health meetings that Mr. Frumkin had attended, he had heard of a man named Kenneth Wentworth, a celebrated practitioner of megavitamin therapy. Dr. Wentworth, the director of a clinic in Nassau County, took his private patients to Brunswick Psychiatric Hospital, in Amityville, New York. Sylvia’s insurance would cover most of the cost of up to ninety days at Brunswick, but the Frumkins would still have to pay about four hundred dollars a month.

Irving Frumkin was willing to send Sylvia to Brunswick. Although there was no proof that megavitamins had ever helped his daughter in the past, he clung to the belief that at Brunswick the megavitamins would be a panacea. Harriet Frumkin was willing, too, after Sylvia put her head in her lap and cried. Joyce Frumkin, Sylvia’s older sister, was opposed to Sylvia’s going to Brunswick, and told her parents so. For years, Joyce had been sympathetic to Sylvia.

She herself had had a successful career in the fashion industry, going from one well-paid and challenging executive position to another, but she had had a series of unhappy love affairs and had been to a number of therapists in the hope of working out her problems. She and the various therapists attributed many of Joyce’s troubles to her family environment. Joyce was especially inclined to blame her father, for putting terrible pressure on her as a child to do well in school and in everything else, but at least one of her therapists believed that while Mr. Frumkin had a bad bark, Mrs. Frumkin had a much worse bite.

Joyce believed that she had got off more lightly than Sylvia because she had different genes, but she realized that she had not escaped. She wished she could be happier with herself. She wanted a good marriage and children. For years, whenever Sylvia was in a state of remission Joyce had tried to do the things she thought sisters should do for each other—she had fixed Sylvia up with blind dates, for instance— but by 1975 she had given up on the existence of a cure for Sylvia and on the possibility of having a sister she could turn to when she was in trouble.

Joyce believed that her parents were sending Sylvia to Brunswick because it was better for them to see her in a beautiful hospital than in an ugly one, that they were deluding themselves with false hopes, and that they were throwing good money after bad. Dr. Wentworth put Miss Frumkin on a special diet, and she lost weight at Brunswick, but though she was receiving neuroleptics and electroshock therapy as well as megavitamins, there was no more than a minor improvement in her condition during her stay there. She was depressed and cried a lot, and she was obsessed with being born again. While she was at Brunswick, Irving Frumkin felt terrible pains in his stomach one evening.

He was rushed to the hospital and was operated on for bleeding ulcers. As Miss Frumkin’s ninety days at Brunswick were drawing to an end, her social worker talked to her about her discharge. He thought that an adult home would be the appropriate place for her. The Frumkins drove her to see an adult home called Rockaway Manor. It struck her as a far more horrifying place than Creedmoor. “You expect a state hospital to be awful, but you expect to be treated like a human being in the outside world,” she said after seeing the lobby of Rockaway Manor. Mr.

Frumkin wanted to place his daughter in the Richmond Fellowship, a transitional-housing program with an excellent reputation, but it had a long waiting list. While Miss Frumkin was still at Brunswick, she telephoned the Manhattan office of the American Board of Missions to the Jews. She spoke of her plight to a man named Alan Goldsmith, and he called George Klopfer, who was in charge of the A.B.M.J. office in Queens. Klopfer went to Brunswick to meet Miss Frumkin, and arrived when her parents were also visiting her. He was appalled at the way she abused them: she seemed to him to be half animal and half human when she yelled at them. He ordered her to quiet down, and she did quiet down. Mr.

Frumkin was pale and gaunt after his operation. George Klopfer believed that Sylvia would cause her father’s death if she went home with him. Klopfer and his wife, Nellie, lived in a building that the A.B.M.J. owned in Hollis, Queens. Two floors of the house were used for Bible classes and offices; the Klopfers lived on the third floor with a grown son and two young daughters. The Klopfers offered to let Sylvia live with them. Like Benjamin Wilder, an uncle with whom Sylvia had once spent part of a summer, they thought that what she needed was a structured environment, which they could provide.

Unlike Benjamin Wilder, they believed that Sylvia was possessed by demons—a view of mental illness that was more prevalent in the fifteenth century than in the twentieth. The Klopfers knew that there would be tremendous battles with Sylvia, but they were convinced that they would prevail. Nellie Klopfer had been a registered nurse, and the Klopfers had had some experience with the mentally ill. The Klopfers told the Frumkins that Sylvia, who had studied art as a teen-ager, could teach their daughters to draw in exchange for her room and board. They agreed to give her mega-vitamins, although they did not believe in vitamins or any kinds of drugs.

They believed in the power of Jesus Christ to overcome the forces of Satan. For a week or two in December, right after Sylvia moved in with them, the Klopfers thought that their way of treating her was effective. Sylvia mumbled a lot. Whenever she mumbled, George Klopfer would intone, “Sylvia, I come against these forces that are making you mumble in the name of Jesus, and I demand by the blood of the lamb that you stop mumbling.” Then she would speak clearly. Sylvia was also lazy. She wouldn’t clean her room; some days, she wouldn’t get out of bed.

On her lazy days, Klopfer would recite, “There is power, there is power, there is wonder-working power in the blood of the lamb, in the precious blood of the lamb. I come against these forces in the name of Jesus, and I demand by the blood of the lamb that you dress yourself now. Lord God, we come against these symptoms.” Sylvia wouldn’t budge. Sylvia often defied the Klopfers. They told her to read the Gospels of the New Testament; she read the Book of Daniel. They told her to play gospel music on the radio; she played the Top Ten. She was unable by now to draw, much less give drawing lessons. The Klopfers fought relentlessly with Sylvia, believing that her will had to be broken.

They were soon battle-weary. She stayed up late, and they got little sleep. They developed sinus headaches. One morning right before Christmas, the Klopfers sat at the breakfast table and prayed that God would eliminate Sylvia from their midst, because they could no longer carry on the struggle. They believed that she was wearing them down as a family. George Klopfer called the Frumkins that evening to say that they had tried their best and failed, and that he was going to take Sylvia to Creedmoor. The Frumkins told him they would meet him there.

Sylvia, who had been carrying on at the Klopfers and who continued carrying on in the parking lot near Building 40, which handled all admissions from four-thirty in the afternoon until eight in the morning, quieted down as soon as she entered the building. When the resident on night duty screened her for admission, she spoke softly and sensibly. As Klopfer and Harriet and Irving Frumkin all remember it, Sylvia put on a performance worthy of Sarah Bernhardt. “The resident gave us a lecture that made us feel we were monsters to want to put a healthy young woman in a mental hospital,” Klopfer recalls. He told the Frumkins that he and Nellie would try again, and he drove Sylvia back to Hollis.

Right after New Year’s, the Klopfers went with Sylvia to a store in Flushing that was having a going-out-of-business sale. While they were shopping, Sylvia left the store and found two policemen. She told them that she was a drug addict and needed help. A few hours later, she was admitted to Elmhurst. She spent a month at Elmhurst, and then, on February 6, 1976, she was transferred to Creed-moor. The psychiatrist who treated Miss Frumkin in the Clearview unit first prescribed a combination of Mellaril and Haldol for her. He gradually raised the dose of Haldol.

On March 12th, he dropped the Mellaril and raised the daily dose of Haldol to fifty milligrams—the equivalent of twenty-five hundred milligrams of Thorazine —where he kept it for the rest of March and all of April. Miss Frumkin’s condition appeared to improve. In April, she attended a sheltered workshop, where she did such benchwork-assembly tasks as packaging cutlery, paper napkins, and condiments in cellophane for use by airlines. In mid-April, she was transferred to the Clearview Motivation Center, a “hotel” on the Creedmoor grounds which had opened in 1975 for patients who no longer needed to be confined in a locked ward.

In May, Miss Frumkin’s psychiatrist lowered her dose of Haldol to forty milligrams. When her condition suddenly deteriorated in June, he raised it to fifty milligrams again. Her condition continued to deteriorate: a few weeks later, she had to be sent back to the ward; in July, she could no longer attend the sheltered workshop. The psychiatrist kept raising the dosage of Haldol—to eighty milligrams in late June, to a hundred and ten milligrams in July, to a hundred and fifty milligrams in mid-August, to two hundred milligrams at the end of August, to two hundred and fifty milligrams on September 1st.

On this large dose of Haldol, Miss Frumkin at first showed some improvement, but by September 19th she was attacking numerous employees and was refusing to eat. On September 22, 1976, she weighed only a hundred and eight pounds—a loss of eighty-eight pounds altogether since the summer of 1974. While it was characteristic of her to hit attendants during episodes of acute psychosis, she usually gained weight during these episodes. On September 23rd, Miss Frumkin was given three hundred milligrams of Haldol—the equivalent of fifteen thousand milligrams of Thorazine. She was still experiencing delusions, hallucinations, and confusion, and had become extremely unsteady on her feet.

After she had stumbled and fallen a number of times, her psychiatrist started to lower her dose of Haldol—to two hundred milligrams on October 13th, to a hundred and fifty milligrams on October 21st, to a hundred milligrams on November 15th. Her bad behavior continued, but she started to eat, and she gained weight rapidly. In December, another psychiatrist at Clearview looked at the record of Miss Frumkin’s fifth Creedmoor hospitalization and learned that she had improved and had been discharged on eighty milligrams of Stelazine.

On December 9th, she was therefore switched from Haldol to forty milligrams of Stelazine; on December 16th, this rose to sixty milligrams of Stelazine; on January 13th, to eighty milligrams. Her behavior improved almost as soon as she was switched to Stelazine. In January, she started to attend the Clearview Day Center. On February 8, 1977—a year and two days after her sixth admission to Creedmoor—she moved back into the Clearview hotel.

In April of 1977, she returned to the sheltered workshop part time; she eventually dropped out of the Day Center and went to the sheltered workshop full time. In the fall of 1976, when Miss Frumkin’s condition was at its worst, she had been brought to the attention of Dr. Werner, the hospital’s director. Irving Frumkin had written to Dr. Werner about the intolerable conditions in her ward at Clearview; as a result of one of his letters, in which he wrote that he had banged on an outer door of the ward for twenty minutes before being let in, doorbells had been installed next to the ward’s outer doors. Dr.

Werner believed that a psychiatrist should practice his trade, and he took a few hours each week from his directorial duties to hold individual therapy session with a few patients. Miss Frumkin had become one of them. She saw him once a week. When Miss Frumkin told Dr. Werner that she wanted to get out of the hospital, that her parents had made it clear they did not want her to live at home, and that she wanted to try out a new program that had recently opened on the Creedmoor grounds, Dr. Werner asked the social worker at the Clearview hotel to try to get her into this program.

It was called Transitional Services for New York, Inc., and was conducted by a nonprofit agency whose purpose was help the mentally ill return to their communities. The social worker didn’t believe that Miss Frumkin was ready for Transitional Services but did the extensive paperwork necessary to get her discharged from Creedmoor and accepted there. Few social worker will resist a hospital director. Harriet Frumkin was also opposed to her daughter’s going to Transitional Services in the spring of 1977. She, too, didn’t believe that Sylvia was ready for it. Sylvia had made weekend visits home, but they had not gone well.

The progress notes that the therapy aides at the Clearview hotel wrote on Miss Frumkin frequently read as if they thought she should be sent back to the ward rather than on to Transitional Services. On May 10, 1977, one therapy aide wrote:

Patient’s hygiene and cleaning of her room area are still under supervision. Her clothing and makeup are examples of her impulsive, compulsive sets of decisions, a well as her supposed diet. Examples are Makeup heavily smeared on her face, in dining room she sneaks around and eats other pts. desserts, salad, etc. Clothing is either too tight, too short, too long, unmatched jewelry, etc. The wilder her at tire, the happier she seems to be.

When Sylvia is approached, she resents the fact and generally babbles off so much. It has also been brought to my attention that Sylvia relates only to doctors and those with authority.

On June 14, 1977, Sylvia Frumkin was transferred to Transitional Services. In Phase 1 of Transitional, clients were assigned to counsellors who taught them skills they would need when they progressed, after a few months, to Phase 2 (living under close supervision in small apartments, on the grounds or in the community, where they were responsible for doing their own grocery shopping and cooking) and then to Phase 3 (living under minimal supervision in apartments in Queens that had been rented by Transitional Services).

While Miss Frumkin was in Transitional, she was taught how to plan a meal, shop for its ingredients (she was unfamiliar with such concepts as unit pricing), cook the meal, and clean up afterward. Her counsellors’ notes indicated that she could cook quite well but didn’t like to clean up and usually left the kitchen in a mess. “Instructions not needed— pushing was,” one counsellor wrote. Miss Frumkin, whose weight had increased a great deal in recent months, tried Weight Watchers for a brief period but got discouraged and abandoned the diet.

Another counsellor commented on her eating habits and tried to get a stopwatch, so that she would know just how fast she was eating. A number of people—Joyce Frumkin is one of them—remembered that there were some days in the summer and fall of 1977 when Sylvia appeared “quite normal.” Dr. Werner was another person who had that impression. In the summer of 1977, Dr. Werner decided to lower Miss Frumkin’s medication. In July, he told her to skip taking her eighty milligrams of Stelazine on weekends. In August, he lowered her medication to seventy milligrams of Stelazine a day five days a week.

On October 25th, he cut her Stelazine to fifty milligrams a day five days a week, and wrote in one of the reports he periodically sent to Transitional Services that she was making considerable progress “not only in living but in her ability to seek gainful employment” and that he would be gradually diminishing her Stelazine, “as Ms. Frumkin shows no sign of any serious emotional difficulties at this time.” He concluded his report by saying that he hoped “she will eventually receive little or no medication.” Two days later, the supervisor of the sheltered workshop wrote a note saying that Miss Frumkin was still doing excellent work. She added, “I find her extremely tense and withdrawn.

Her periods of work are short and she will state that she can’t concentrate and ask to leave.” Irving Frumkin came to Transitional Services to eat lunch several days a week while Sylvia was there. He also took her to Dr. Luis Santiago, a psychiatrist at a community medical center on Long Island. Dr. Santiago was testing Anafranil, a tricyclic antidepressant that is not yet commercially available in the United States. He gave Miss Frumkin an expensive series of tests—blood tests, urine tests, and hair tests. He interviewed her, and then told her father, “Mr. Frumkin, your daughter is not schizophrenic. She’s compulsive.” At the same time that Dr.

Werner was progressively lowering Miss Frumkin’s Stelazine (by January of 1978, he had it down to forty milligrams a day five days a week), Dr. Santiago was giving her fifty milligrams of Anafranil a day and megavitamins as well. Miss Frumkin’s condition began to deteriorate. Her counsellors at Transitional noticed her deterioration shortly after her supervisor at the sheltered workshop had. Her room was filthy; she said she couldn’t wash her clothes for a week, because she didn’t have any money (she had spent it all on food); she said she could spend only ten minutes with a counsellor who had planned to spend an hour with her, because she had to watch television; she kicked another client at Transitional Services and was fined ten dollars; she appeared to be preoccupied with Christianity.

One day in December of 1977, a counsellor at Transitional Services spoke to Miss Frumkin about her increased nervousness and changed behavior. Miss Frumkin said that she was unaware of these changes in behavior and that whatever anyone may have noticed was “nothing.” The counsellor had spoken to Dr. Werner, who had agreed to let Sylvia take five extra milligrams of Stelazine in the morning. Transitional Services delayed Miss Frumkin’s referral to Phase 2 for a month, but Dr. Werner was eager to have her proceed. She was transferred to Phase 2 on January 30, 1978. Miss Frumkin moved into an apartment in another building on the Creedmoor grounds.

She and her new roommate shared a bedroom; they also had a living room, a bathroom, and a kitchen. They didn’t get along. Although Miss Frumkin had resumed smoking in 1976, when she was in the ward at Clearview, she had given it up again in 1977, when her condition improved—and, as was her custom, she then hated it when other people smoked. Her new roommate was a chain-smoker. She fought with her roommate about smoking, but the roommate wouldn’t stop, and she further angered Miss Frumkin by using the same Brillo pad to wash dishes and ashtrays.

Miss Frumkin irritated her roommate by staying up until one o’clock in the morning watching the TV set in the bedroom; the roommate liked to go to bed at nine-thirty. On the evening of February 5, 1978, Miss Frumkin called her parents to tell them she was suffering from nicotine poisoning. She soon started screaming. In the early-morning hours of February 6th, she was taken to Long Island Jewish-Hillside Medical Center, where she asked to be admitted, complaining that she was having extreme difficulty getting along with her new roommate, who smoked excessively. The admitting psychiatrist found her acutely psychotic.

Hillside Hospital had merged with Long Island Jewish Medical Center in 1972, five years after Miss Frumkin spent four months at Hillside. By 1978, Hillside had some locked wards as well as unlocked cottages, and most of its patients stayed only ninety days—until their insurance ran out. “Had I been the psychiatrist, however, I think I would have wanted to give Miss Frumkin more than eighty milligrams of Stelazine. Her history as far back as her first hospitalizations, in 1964-, indicates that she is much less responsive to drugs than most patients.

Even on an optimum dose of the optimum medication, by 1976 Miss Frumkin would probably have required several months to get over a psychotic episode. The four principal symptoms of an acute psychosis are often agitation, hallucinations, delusions, and thought disorder. Neuroleptics will usually reduce the symptoms in that order. The first thing the patient will do is calm down. With higher doses or prolonged treatment, the hallucinations will go, then the delusions. What happens too often, especially when patients are drug-resistant, is that the dose is raised only enough to get rid of the agitation, the hallucinations, and possibly the delusions.

The thought disorder and perhaps some delusional thinking remain. The patients are dischargeable from hospitals under current criteria, but the remaining symptoms keep them from functioning adequately on the outside and help to bring them back to the hospitals again. “Dr. Werner should never, of course, have lowered Miss Frumkin’s Stelazine, just as the psychiatrist at Gould Farm should never have lowered her medication when she was facing a crisis. For her, leaving Gould Farm and changing phases at Transitional were real periods of stress.

During periods of stress, it is a serious error to reduce the medication dosage, as the patient requires additional pharmacological protection against the increased stress. Dr. Werner was seeing to it that she would eventually have to be rehospitalized even before she went to another doctor, who misdiagnosed her and put her on a tricyclic antidepressant that is often effective for obsessive-compulsives but not for the symptoms of schizophrenia. I knew and liked Bill Werner. He was a warm human being, but he suffered from an illusion common to many psychiatrists.

He lowered her Stelazine for the same reason that he had the even more unrealistic idea of eventually taking her off drugs entirely. He thought that he could cure her. He was taught in medical school that schizophrenia is incurable, and he should not have forgotten that. A patient with Miss Frumkin’s case history could not fail to do anything but decompensate if she was taken off drugs, and that is why Miss Frumkin has always decompensated when she stopped taking her medication herself. It always amazes me how many psychiatrists think of major mental illnesses as conditions that are curable, when most illness in our field and others is not curable.

If you look at the average internist’s practice, you’ll see that he’s dealing with such things as heart ailments, arthritis, and diabetes —all of them chronic illnesses, like schizophrenia. What you try to do with most illness is to keep it under control. You don’t try to cure it, because you can’t, certainly not with currently available therapies, although it is likely that someday cures will be found.” Miss Frumkin stayed psychotic during her first two months at Hillside. When Joyce Frumkin came to visit her there, she found her sitting on a mattress praying. Miss Frumkin had a weird look on her face and wore on her head a pointed cap with a tassel, which she had made herself.

Other visitors remembered that she got up on tables and danced, that she broke her eyeglasses in a fit of rage, and that her speech was so pressured—so rapid and frenzied—that she would have to stop talking because she ran out of breath. In May, her hallucinations (which were primarily religious) and her bizarre behavior started to decrease. She was able to enjoy some of the many activities offered at Hillside, which has a ratio of staff to patients that is ten times as high as Creedmoor’s. At the end of ninety days, however, the Hillside resident in charge of her case decided that she was not well enough to return to Transitional Services and needed continued hospitalization.

She was transferred to Creedmoor. As soon as Hermine Plotnick, who has been Clearview’s unit chief since 1974, saw that Miss Frumkin was back in her unit, she said, “The ninety-first day is always Creedmoor.” Miss Frumkin’s seventh stay at Creedmoor lasted from May 9, 1978, to May 31, 1978. She was treated with Moban, and although it was noted that she had some religious preoccupations, she was friendly and coöperative. On May 31st, she was sent back to Transitional Services, Phase 1. After her return to Transitional, she attended a program at Hillside Day Hospital. She was in a music group, an occupational-therapy group, and a women’s group.

She dropped out of the women’s group, because, as she remembers it, she was so deeply concerned with Christianity that the things said in the group were “very offensive” to her. On June 5th, a counsellor at Transitional Services noted that she was pulling the hair out of the front of her head. On June 13th, a counsellor noted that she was unable to sleep, was up all night, and claimed she wasn’t sleepy. Shortly after midnight on June 16th, she fell on the floor of a bathroom at Transitional Services and cut her head. She suddenly thought that she was Mary Magdalene and Jesus Christ, but she remained calm. She went downstairs and showed her cut to the night supervisor.

He decided to take her to the emergency room at L.I.J.-Hillside to have her cut examined. On the way to L.I.J.-Hillside, Miss Frumkin heard a Paul McCartney song on the car radio and imagined that Paul McCartney had fallen in love with her. She became highly agitated at L.I.J.-Hillside. At five-thirty on the morning of June 16, 1978, she was transferred to Creedmoor. She signed a voluntary form and was admitted to Creedmoor for the eighth time. Several hours later, she was back in the Clearview unit. Shortly after noon, she was in a seclusion room. Two therapy aides who had known Miss Frumkin for many years walked out a back entrance to the building to go to lunch.

They could hear Miss Frumkin screaming. They knew that her seventh Creedmoor hospitalization had been her shortest; they knew that the interval between her seventh and eighth Creedmoor hospitalizations had also been her shortest. They were distressed that she was back in the ward after only sixteen days. “Is there anything to be done?” one of the women asked the other as they walked toward a nearby delicatessen. Her companion shook her head and then said sadly, “Only in the past.” Miss Frumkin was psychotic during the second half of June and most of July, 1978. Although the psychiatrist who admitted her to the Clearview unit on June 16th, Dr.

Sun Ming Wong, a native of Taiwan, diagnosed her as a manic-depressive, manic type—partly because his English was not proficient and partly because he had not read her case history—he treated her with neuroleptics. In late July, after she had failed to respond to what for her were low doses of Thorazine—eighteen hundred milligrams a day at most —she was given ninety milligrams of Haldol (the equivalent of forty-five hundred milligrams of Thorazine) for seven days. Her condition improved within the week. She was subsequently given Moban, at her request. In August, she started to attend Clearview’s Day Center. In September, she was accepted part time by Creedmoor’s typing workshop.

In November, she had two pieces of bad news: she was turned down by Transitional Services, to which she had hoped to return, and she developed tardive dyskinesia—a side effect of neuroleptics whose symptoms include involuntary movements of the tongue, lips, and mouth, and, in more severe cases, other parts of the body as well. Her Moban was drastically reduced. In mid-November, she was allowed to drop out of the Day Center, which she had found “childish,” and go full time to the typing workshop, which she enjoyed. In early December, she was transferred from the ward to the hotel. In late December, she started having religious hallucinations and delusions, which she mostly kept to herself.

She also continued to gain weight. She had come to Creedmoor in June of 1978 weighing a hundred and sixty-two pounds. By January of 1979, she weighed a hundred and eighty-five. In early January, she met with the staff at the hotel to discuss her discharge. She informed the staff that she would not consider any placement except an apartment of her own. She had been told in December that she wasn’t ready for an apartment, and had asked her social worker where she could go. The social worker had reflected that Miss Frumkin was indeed “a placement problem”: she had already been to so many places, among them the best of their kind in the community, and none of them had worked out.

The community was supposed to have a place for Sylvia Frumkin, but it didn’t seem to. In early February, Miss Frumkin suddenly had had enough of being at Creedmoor. Snow started to fall in New York City on the night of February 6th. Miss Frumkin usually went to bed around twelve o’clock, but she didn’t feel tired that night and stayed awake reading the New Testament. In the early-morning hours, she heard voices. One of the voices she heard was the voice of God. He told her to get out of the hospital.

Before daylight, the voices directed her to a place where she thought no one would think to look for her and where she thought she would be welcome to stay, at least for seventy-two hours—the length of time a voluntary patient had to remain away from Creedmoor before being automatically discharged. She got up at seven o’clock on February 7th, put on a matching skirt, blouse, vest, and jacket that her parents had bought her in December, and a pair of boots and a winter coat. She crammed the fifth piece of her outfit— a pair of slacks—into her handbag and left her room at the hotel.

She went to get her morning Moban tablet, but she didn’t swallow it; she had stopped taking her pills a few days earlier. Then she signed out for the day. Instead of going to breakfast in the dining room near the hotel, she walked out the hospital gate closest to the hotel on Hillside Avenue and walked down Hillside Avenue a few blocks to her bank. She withdrew two hundred dollars from her account. She walked from the bank to a bus stop and took a bus and a subway into Manhattan. She got off the subway at the Times Square stop and walked to the Port Authority Bus Terminal.

One Friday evening in December, when she was attending classes at the A.B.M.J. center in Hollis, she had by chance met Nellie and George Klopfer on the street. They had been visiting friends who lived next door to the center. The Klopfers had told Miss Frumkin that they had left the American Board of Missions to the Jews and were now living in Middletown, a city in Orange County, New York. They were running a halfway house there and had a small church. The Klopfers had given Miss Frumkin their address and their telephone number. In the early-morning hours of February 7th, Sylvia Frumkin’s voices had told her to go to the Klopfers’.

She went to the counter of the bus line that served Middletown, bought a one-way ticket there, and learned that the next bus left in an hour and a half. During that time, she went to a few stores in the bus terminal. She had a snack and also bought a number of items: a crochet hook and several skeins of yarn (she felt like starting an afghan); a Timex watch, which she had wanted ever since she lost her last watch, in the spring of 1978; and a large tote bag. When she got on the bus, she had a hundred dollars left. She arrived in Middletown after a pleasant two-hour ride through parts of snow-covered New Jersey and New York. The bus stopped in front of the terminal.

Miss Frumkin went inside and asked for directions to the Klopfers’. She was told that they lived a short distance away, at the top of a hill. After she walked to the bottom of their hill, she was too weary to trudge any farther through the deep snow. She saw a house, rang the doorbell, and asked the woman who opened the door if she might use her phone. She called the Klopfers. George Klopfer was surprised to hear from Miss Frumkin, and even more surprised to learn where she was.

He told her he would come and get her in his car; he drove her up to his house. Miss Frumkin immediately exacted from the Klopfers a promise not to tell anyone where she was until February 9th or 10th, so that she would be discharged from Creedmoor. She told them that if they called her parents or anyone at the hospital someone would come and get her and take her back to the hospital. She said she would rather die than return to Creedmoor. The Klopfers felt torn. They knew that the Frumkins would worry about Sylvia’s welfare, but she seemed in better shape than she had been in late 1975 and early 1976. She said she was determined to “make it” this time.

They sympathized with her wish to be out of the hospital, and agreed to take her in and not to call anyone for a couple of days. They gave her a room in their house. She gave them her remaining hundred dollars. On the night of February 9th, shortly after Miss Frumkin was discharged from Creedmoor, George Klopfer called her parents to tell them she was safe and sound. When the Frumkins learned that Sylvia had been in Middletown since February 7th, they were initially angry at the Klopfers for letting them worry about their daughter for two days, but they were relieved to learn that she was all right.

Though the Frumkins didn’t share the Klopfers’ religious ideas—they were satisfied with Judaism—they thought that the Klopfers were well-meaning people, and were grateful to them for having given Sylvia a place to live after her release from Brunswick Hospital. Even if her previous stay with the Klopfers hadn’t worked out, they had tried. Mrs. Frumkin disapproved of the various religious groups to which her daughter had turned, and associated some of Sylvia’s psychotic episodes with her religious ideas or with what Mrs. Frumkin believed was a seeking for acceptance by a group—any group —but she said that Sylvia’s mental condition was more important to her than her religion.

“I’d rather have a healthy born-again-Christian daughter than a mentally ill Jewish daughter,” she told her friends. She was glad that Sylvia was out of Creedmoor and out of the city. Miss Frumkin telephoned her parents the following morning. She sounded very happy. Her father told her that he would mail her her medication. She called her parents several times over the next ten days. She said that she was going on long walks, that she was losing weight, and that she hadn’t been taking her medication for a while and felt fine. She asked her parents to mail her some winter clothes.

For about a week, Miss Frumkin seemed content at the Klopfers, and made an effort to get along with them and with three troubled young men who were living with them. Miss Frumkin helped George Klopfer by doing some typing and filing for him. She went with the Klopfers to Bible classes they conducted in homes around Middletown. She ate reasonably. After a week, Miss Frumkin became less coöperative. She dieted at mealtimes but took food from the refrigerator between meals. She wouldn’t clean her room. She didn’t want to type or do any other work.

On Saturday, February 17th, when George Klopfer asked her to help cut wood for a wood stove that heated part of the house, she said she wouldn’t work on the Sabbath. The Klopfers were irritated with her for claiming to be Jewish when it suited her convenience. She fluctuated so much between Christianity and Judaism that they doubted whether she was a born-again Christian. On Saturday, February 24th, she again declined to work on her Sabbath. When Klopfer told her that her room was a pigpen and ordered her to clean it up immediately, she screamed at him. The Klopfers explained to her that in a small community like theirs everyone was expected to coöperate.

They suggested that since she was unwilling to be coöperative she should leave on Sunday or Monday. “My voices told me when I came here I’d be with you only a short time!” she yelled. “My voices have just told me it will be even shorter than I thought. I’m leaving today.” She stuffed her belongings into her tote bag. Klopfer offered to drive her to the bus terminal, but she insisted on walking. “I’m getting out of here, and I’m going by myself,” she, said. The Klopfers figured that Sylvia’s food and telephone calls had cost them seventy-six dollars during her two-and-a-half-week stay. They gave her back twenty-four dollars.

Shortly after she left, Klopfer called the Frumkins to tell them that he was sorry things had not worked out for Sylvia at his house and that she was on the bus. The Frumkins were disappointed. Up to then, they had thought that Sylvia was doing well. They had told their friends that the fresh country air was agreeing with her and that she would stay with the Klopfers at least until spring. They had hoped that that would turn out to be true. Mrs. Frumkin asked Klopfer if the winter clothes she had mailed Sylvia had arrived. When she learned that they hadn’t, she asked him to mail the box back when it came.

The Frumkins then telephoned the New York City Police Department, described Sylvia, and asked the police to meet the next bus from Middletown at the Port Authority Bus Terminal. The city police notified the Port Authority police, and two Port Authority policemen met the bus. Sylvia wasn’t on it. The officers questioned the bus driver, and he told them that a young woman who fitted the Frumkins’ description of Sylvia had got off the bus when it stopped in Paramus, New Jersey. The Frumkins had no idea what Sylvia might be doing in New Jersey.

Two days went by before they learned where she was. Once again, Sylvia’s voices had told her where to go, and once again she had kept her destination to herself. She had often listened to WWDJ, a New Jersey radio station that broadcast sermons and religious music twenty-four hours a day. One of her favorite radio ministers was Charles Rizzo. When Rizzo spoke on WWDJ, he gave a box number in Oradell, New Jersey, as his address. It was raining hard in Paramus on Saturday afternoon, but Sylvia’s voices had told her to go to Rizzo, and so she set out on foot for Oradell, a mile or so away. After she had walked along a road for a while, two policemen in a car saw her and stopped.

She told them that she was walking to Oradell to meet a friend; they gave her a ride to a restaurant in Oradell, where she learned that Rizzo was the pastor of the Church of the Nazarene in nearby New Milford. She called the church, and one of Rizzo’s associates came to the restaurant and drove her there. When she arrived at the church, she asked Rizzo to perform a healing on her. He told her that she would have to make an appointment for that. A member of the church drove her to Bergen Pines County Hospital, in Paramus, a general hospital with a psychiatric service. Sylvia was admitted to Bergen Pines on an emergency basis on Saturday evening.

She was very excited—she later remembered that when she was introduced to Rizzo she believed he was Billy Joel, the rock singer. She told a psychiatrist at Bergen Pines that she wanted to go to the Christian Health Care Center, a private, nonprofit psychiatric hospital in Wyckoff, New Jersey, which she had often heard mentioned on WWDJ. She was permitted to telephone the Christian Health Care Center, and was told that its charge was fifty dollars a day and that it did not accept Medicaid.

She decided that Bergen Pines was a good enough place to be for the time being: a psychiatrist had seen her right away; he and the many nurses on duty had been courteous to her; the food was good; and there were only four patients in a room. She refused to give the hospital her name on Saturday or Sunday. On Monday morning, when she was told that she couldn’t stay at Bergen Pines, because she was not sick enough to require hospitalization, she gave a psychiatrist her name, her home address, and her psychiatric history. The psychiatrist at Bergen Pines called the chief psychiatrist in the Clearview unit at Creedmoor, who suggested that Miss Frumkin return there as a voluntary patient.

She said she wouldn’t go back to Creedmoor under any circumstances. She was assigned to a social worker at Bergen Pines, who telephoned her parents. The social worker told Mrs. Frumkin that her daughter had been at Bergen Pines since Saturday but could not stay there another night. She told her that the hospital would be able to keep her only until four o’clock. If the Frumkins couldn’t arrange to fetch their daughter, she would be given a bus schedule and enough money to return home. Mrs. Frumkin told the social worker that she would call back in a few minutes. She then telephoned Hermine Plotnick. She knew that Mrs.

Plotnick had two sons, and appealed to her for help “as one mother to another.” She told her what had happened, and asked her to drive out to New Jersey, get Sylvia, and drive her back to Creedmoor. Mrs. Plotnick calmly explained to Mrs. Frumkin that because she was an employee of Creedmoor it would be illegal for her to drive Sylvia back to Creedmoor against Sylvia’s will. “For me to bring a discharged patient back to the hospital over her objections would be a violation of her rights,” Mrs. Plotnick said. “It would be like kidnapping her.” Mrs. Frumkin talked on for a while about how she had no one else to turn to except Joyce.

She said she knew that Joyce didn’t want anything to do with Sylvia and she realized that Joyce shouldn’t be involved. She then asked Mrs. Plotnick if there was any way Sylvia could be certified by two Creedmoor psychiatrists and taken back there. Mrs. Plotnick told her that no psychiatrist at Creedmoor had seen Sylvia for three weeks and that a psychiatrist at Bergen Pines, who had seen Sylvia that day, had made a judgment that she didn’t require hospitalization. Mrs. Frumkin said goodbye to Mrs. Plotnick, called Joyce at work, and asked her to drive out to New Jersey, get Sylvia, and bring her home.

Joyce Frumkin knew that nothing would be worse for her parents than having Sylvia at home, but she realized that at the moment there was no alternative. If she didn’t go after Sylvia, her parents would, so she agreed to spare them the trip to Paramus. Mrs. Frumkin called the social worker at Bergen Pines and asked her to please have the hospital keep Sylvia until seven o’clock—the earliest that Joyce could get there. The social worker said seven o’clock would be all right. Mrs. Frumkin then spoke to Sylvia and warned her that she could stay at home only if she didn’t act up.

The Frumkins had given up thinking that they could ever persuade their younger daughter to live peacefully under their roof, and didn’t want to go through the ordeal they knew they were about to face. They had hoped in late 1978 and early 1979 that Sylvia would return to Transitional Services or be placed in a Jewish foster home. Once she had run away from Creedmoor and then from the Klopfers, however, they felt that they had to take her in if no one else would. Mrs.

Frumkin often wished that there were some place on earth for her daughter besides Creedmoor or her house. Joyce Frumkin left her office at five o’clock, went to her garage for her car, and reached Bergen Pines County Hospital shortly after seven. Sylvia got into her sister’s car warily. The first thing she told Joyce was that the Klopfers had thrown her out. A few minutes later, she said they had told her that she would have to leave if she didn’t pitch in with the chores like everyone else, and she complained that they had hassled her.

She then said that Bergen Pines was the kind of hospital she should have been in, that it was much nicer than Creedmoor. “Sylvia, you’ve been in Gracie Square, St. Vincent’s, Hillside, and Brunswick,” Joyce said. “How many more nice hospitals are you going to be in?” Sylvia looked at her sister angrily. “Don’t hassle me the way the Klopfers did,” she warned her sister, and she turned on the car radio. She fiddled with the, dial until she got WWDJ, and then she listened to a different minister preach a hell-fire-and-damnation sermon every fifteen minutes.

From time to time, she said “Amen” or “Praise the Lord” or “Hallelujah.” Occasionally, she spoke out loud and laughed. “What are you doing?” Joyce asked. “I’m talking out loud,” Sylvia answered defensively. Joyce knew from experience that Sylvia was talking to her voices. Sylvia struck Joyce as surprisingly calm while they were driving across the George Washington Bridge, onto the Cross-Bronx Expressway, and over the Throgs Neck Bridge. As soon as they had crossed the Throgs Neck Bridge, however, Sylvia became edgy. “Are you sure you’re taking me home, and not back to Creedmoor?” she asked several times.

Joyce was tempted to drive Sylvia directly to Creedmoor, in the hope that if she did her sister would be admitted, but she didn’t dare. Sylvia looked at her so menacingly that Joyce was convinced she would attack her physically if they headed south on the Cross Island Parkway, toward Creedmoor, rather than west, toward Beechhurst. As Joyce reluctantly drove west, she asked Sylvia why she had run away from Creedmoor. Joyce reminded her that she hadn’t been in the ward but at the hotel, which wasn’t so bad, and that she had been working toward getting out. “I just couldn’t stand Creedmoor any longer,” Sylvia told her. “I’m going to live at home and go to Dr.

Logan Stemple, at a Christian psychotherapy center in Manhattan.” She told Joyce that she had called Dr. Stemple’s office from Bergen Pines. He was booked up all that week, but his secretary had made an appointment for her with one of his associates for the following morning. She said she had first heard about Dr. Stemple in 1975 and had wanted to go to him ever since, because he was a born-again-Christian psychiatrist and she was convinced that he could help her. Joyce asked her how she was going to pay Dr. Stemple. Sylvia said that Dr. Stemple accepted Medicaid, and she was going to apply for it soon after she got home.

She was going to pay for her first session with his associate, a born-again-Christian psychologist who didn’t take Medicaid patients, with thirty-four dollars that she had left in her savings account. Joyce and Sylvia Frumkin arrived at their parents’ home at nine-thirty. Sylvia walked into the house and greeted her parents matter-of-factly. “I’ve found Jesus, everything will be great, and don’t ask me what happened at the Klopfers’,” she said. Her mother saw her new tote bag, noticed that its zipper was broken, and asked her what the tote bag had cost. When Sylvia told her mother she had paid thirty-five dollars for it, Mrs.

Frumkin observed that salesmen could always spot suckers a mile away. Sylvia had told her mother about her new Timex watch when she telephoned home from the Klopfers’. Mrs. Frumkin didn’t see it on her wrist and asked where it was. They rummaged through the tote bag; they both became hysterical when they couldn’t find it. Sylvia remembered that she had had her watch at Bergen Pines, and said she had probably left it at the hospital. Mrs. Frumkin said she would call the social worker there the next day. She then warned Sylvia again that she could stay home only as long as she behaved herself. Sylvia said that she would be good and that she would clean her room.

She went to bed. Fighting broke out in the Frumkin house the day after Sylvia came home. She didn’t clean her room. Within a few days of Sylvia’s return, Mrs. Frumkin was complaining to Joyce that Sylvia’s room looked as if it had been in the path of a tornado. She often found herself using weather-disaster analogies to describe rooms in her house. Just before Sylvia ran away from Creedmoor in early February, she had decided that she wanted to eat fettuccine Alfredo in a certain Italian restaurant in Queens. She hadn’t got around to going there before her departure for the Klopfers’. In early March, she insisted on cooking fettuccine Alfredo at home.

Pieces of butter landed on the kitchen floor. Dirty plates, bowls, and pots and pans piled up in the kitchen sink. Sylvia didn’t like to wash dishes. Mrs. Frumkin, who regarded the kitchen as her private preserve, told Sylvia she was too fat to be eating fettuccine Alfredo and ordered her out of the kitchen. Sylvia ran out of the kitchen carrying a pot filled with noodles, butter, and cheese, which she hurled on the living-room floor. “My kitchen and my living room looked as if a cyclone had hit them,” Mrs. Frumkin told Joyce over the telephone that evening. During her first three weeks at home, Sylvia Frumkin spent most of her time in her room.

She went out only when she had an appointment with Dr. Stemple, and she was soon cancelling appointments with him at the last minute. She sat on her bed for hours at a time, her legs folded under her in the lotus position, picking at her fingernails until they bled. She often watched television until three o’clock in the morning or listened to religious radio stations, and she often telephoned the evangelists she had heard; the Frumkins’ phone bill for March was sixty-five dollars. She refused to get dressed, and came to meals wearing an unbuttoned nightgown.

Her father objected to her “indecent exposure.” Her mother objected to the large portions of food she ate at mealtimes and to her post-midnight raids on the refrigerator, especially when Sylvia ate things that Mr. Frumkin had bought for himself—bland foods for his special diet, like sour cream, cream cheese, and coffee whitener. After a few days at home, Sylvia went on a diet. She had lost several pounds at the Klopfers’, and she lost ten pounds at home while adhering more or less faithfully to a twelve-hundred-calorie-a-day diet for two weeks. During the time she was dieting, she chewed her food forty-eight times before swallowing it.

“The Lord has given me such will power,” she told her mother one evening. After three weeks of dieting, she weighed a hundred and seventy. By then, her will power had disappeared. She again began to eat great quantities of fattening foods. She stopped losing weight. By the middle of March, Irving Frumkin had had enough of having his younger daughter at home. Her idleness, her eating habits, and her foul language exasperated him. He threatened to call the police and ask them to take her back to the hospital. “What are you going to tell the police?” Sylvia responded tauntingly. “That I don’t clean my room? That I eat too much? They won’t commit me for that.” By the end of the month, Mr.

Frumkin said he was ready to leave the house if that was the only way to get away from Sylvia. April 2, 1979, was Harriet and Irving Frumkin’s fortieth anniversary. Mrs. Frumkin recalled that on April 2, 1939, after their wedding reception, in a Brooklyn catering hall, they had arranged to go by bus to Washington, D.C., for a short honeymoon, and that as they were about to board the bus she had told her husband that she would like to have some chocolate to eat on the ride. Irving Frumkin had left the bus gate and walked into the terminal. Mrs. Frumkin had thought he would return in a few minutes with a couple of Hershey bars.

Ten minutes had gone by, and the bus driver had just announced that he was about to pull out, when Mrs. Frumkin saw her new husband running toward the bus carrying a package under his arm. She had persuaded the bus driver to wait for him. Irving Frumkin had jumped on the bus and handed his wife a brown paper bag. Inside she had found a one-pound box of Whitman’s Sampler chocolates. Mrs. Frumkin had enjoyed the chocolates. She had also liked the festive cross-stitch design on the yellow box they came in. After the honeymoon was over and the chocolates were gone, she had kept the box.

On their first wedding anniversary, Irving Frumkin had handed his wife a package, saying, “This is a remembrance.” He had given her another box of Whitman’s Sampler chocolates. Each year on their anniversary, Harriet Frumkin had received a box of Whitman’s Sampler chocolates from her husband. On April 2, 1979, Irving Frumkin went to the supermarket. When he returned, he put the groceries on the kitchen table. “This is the first time in forty years I haven’t bought you a box of Whitman’s Sampler chocolates on your anniversary,” he said. “I just feel too upset with life in this house to buy one. I’m sorry.” Mrs. Frumkin told him it didn’t matter.

“My life is so bitter you would have had to bring me a whole candy factory to sweeten it up,” she said. “I know how you feel about wanting to leave the house. If I didn’t have my art students, I’d go right with you.” Joyce Frumkin had sent her parents an anniversary card and a gift. Sylvia didn’t even wish them a happy anniversary. Several days after the unhappy anniversary, Sylvia decided that she wanted to spend a few hours each day out of the house. She received a monthly Social Security Administration (S.S.A.) disability check. She was entitled to receive an additional Supplemental Security Income payment from the federal government each month when she was out of the hospital.

She told her parents she would apply for S.S.I. right away, but pointed out that it would take some time for her to receive these checks, and asked them to give her five dollars a day in the meantime, so that she would have spending money; she promised to pay them back when her S.S.I. checks came. Mrs. Frumkin gave her the money; it was worth five dollars a day to have Sylvia out of the house for a few hours. Some days, Sylvia went job hunting. Some days, she went from one McDonald’s to another. McDonald’s was having a Gold Rush game. To win the grand prize, contestants had to acquire four game stamps numbered 1, 2, 3, and 4.

Each person who got all four stamps would receive twenty-five thousand dollars. Sylvia procured many No. 1 and No. 2 game stamps. At length, she got a No. 3 stamp and was certain she would be a winner. She expected to get a No. 4 in a few more days. For a couple of weeks, she went to various McDonald’s restaurants in Queens, bought something to eat or drink, and asked for a stamp. Then she discovered that she could go into a McDonald’s without buying anything and would be given a stamp if she asked for it. As she became more obsessed with winning the game, she started to go from table to table at various McDonald’s restaurants asking customers if she might have their stamps.

The manager of one McDonald’s asked her to leave; some of the patrons had complained that she was annoying them. She left quietly. Some days, Sylvia used a good deal of her spending money for carfare to travel to McDonald’s restaurants scattered all over the borough of Queens. Other days, she spent two dollars on the round-trip subway and bus fare to Manhattan, and went to a few employment agencies. She thought that she would like to be a receptionist and that she was qualified to be one. Some days, she appeared reasonably calm, and agencies sent her out on job interviews. By the time she arrived at an interview, she was invariably keyed up, talked too much and too fast, and was turned down.

She started to go directly to firms that had placed ads for receptionists in the newspapers, but she was never hired. Harriet Frumkin said she hoped her daughter would get a job but didn’t think she would. “You get a job? Ha!” she said as Sylvia was leaving the house one morning. “As what—fat lady in a circus?” Joyce Frumkin came home on April 11, 1979, for the Passover holiday. Mrs. Frumkin had wanted her house tidied up for Passover. “God, your room looks as if a hurricane had hit it,” she had told Sylvia on April 10th. “Don’t take the name of the Lord in vain!” Sylvia had shouted at her. Mrs. Frumkin had cleaned her daughter’s room while Sylvia was out shopping that day.

On April 11th, she prepared a nice dinner. She put grape juice on the table instead of wine, because she had been told that it was inadvisable for people on antipsychotic medication to drink alcohol. When the Seder dinner was ready, Mrs. Frumkin called the family to the table. Sylvia refused to budge from the living room, where she was watching television. “I don’t want to eat your lousy food,” she told her mother. Over the years, Joyce had grown weary of Sylvia’s behavior and of her mother’s way of dealing with it. She pleaded with her mother to ignore Sylvia. Joyce was sure that Sylvia would be unable to resist the idea of everyone else’s eating and would come to the table. Mrs.

Frumkin didn’t listen to Joyce. She begged Sylvia to join them. Sylvia finally consented. “All right, I’ll eat,” she said, as if she were doing her mother a favor. She ate a large amount of food with very poor table manners. Then she suddenly noticed that there was no wine on the table, and accused her parents of blasphemy. “There has to be wine; it’s the blood of Christ,” she said. Joyce had had enough. She was distressed by the deterioration in her parents’ health since Sylvia’s homecoming: her father’s ulcers were acting up and he was losing weight, and her mother’s, arthritis was causing her pain.

“You mean every time I have a glass of Beaujolais I’m drinking the blood of your Lord?” Joyce asked her sister. Sylvia picked up a glass of grape juice and threw it at her. Joyce ducked. The grape juice landed on the dining-room floor. “If you love Jesus so much, why don’t you go off somewhere nice and far away and be a nun?” Joyce shouted. The Frumkins had purposely omitted the traditional Seder service for fear of provoking a born-again-Christian tirade from Sylvia. Now, after telling her family that their souls were damned because they hadn’t found Christ, Sylvia left the table. She stayed in her room the next morning, ate lunch alone, and left the house in the afternoon.

Late that evening, she called home. She said she was down to her last dime and was in a McDonald’s in Bayside, Queens, a few miles from Beechhurst. Mr. Frumkin had made numerous trips to fetch Sylvia when she called after losing her change purse or spending her last fifty cents on food. This time, Joyce went to fetch Sylvia, to save her father the trouble. May 1, 1979, was Harriet Frum-kin’s seventy-first birthday. The day began with Sylvia’s telling her, “You’re my mother, and I’m supposed to love you more than anyone else in the world except my husband, if I had a husband, but I hate you.” “I hope I don’t have another birthday,” Mrs. Frumkin told Sylvia. Mrs.

Frumkin said she wished she were dead almost as often as Sylvia said she wished she hadn’t been born. “So drop dead and jump into your grave,” Sylvia said. “You’re getting senile anyway. You’ve lived long enough. Go ahead and die and let me live my own life.” “I wish I could die, so I could get away from you and your big mouth,” Mrs. Frumkin said. “Thank you for a lovely birthday.” Sylvia appeared to be untroubled by their conversation and soon left to apply for a job doing crocheting. That afternoon, when she returned home, still unemployed, her mother was giving an art lesson in her studio, in the attic. Sylvia decided to prepare a snack for herself.

The directions on a package of frozen potato pancakes that she found in the freezer specified that they were to be heated without oil. Sylvia doused a few of the potato pancakes with oil and put them in a frying pan over a burner turned up high. A smoke detector in the kitchen went off. Mrs. Frumkin heard its screech and rushed downstairs. She took the potato pancakes off the stove, shouted at Sylvia, finished the lesson, and then cleaned up the messy stove, saying as she did so, “Methuselah was an adolescent compared to me.” Sylvia didn’t apologize and didn’t wish her mother a happy birthday.

When she went to her room that evening, she was whispering prayers; there was a slight smile on her face. Later that evening, Irving Frumkin went for a walk. He came home carrying a package, which he gave to his wife. When she opened it, she saw that it was her wedding-anniversary box of Whitman’s chocolates. “I wanted you to at least have a present on your birthday,” he said. “It’s been over two months since Sylvia came home. I don’t know how much more of this I can take.” Mrs. Frumkin nodded in seeming agreement.

“If Creedmoor weren’t so horrible, I wouldn’t mind sending her back there, and if she were a little crazier than she is she wouldn’t mind going, but some days she’s almost normal and I can’t bring myself to do it.” On Sylvia’s worst days, Mrs. Frumkin telephoned Dr. Stemple. He was usually with a patient, so she would leave word with the secretary that it was impossible to live with Sylvia and ask Dr. Stemple to telephone her. Dr. Stemple often didn’t return Mrs. Frumkin’s calls; the relatives of his other patients didn’t telephone him so frequently. One day, however, he made an appointment to see the Frumkins and Joyce to discuss Sylvia.

They described her behavior and asked him if he could do anything to change it. “She was psychotic when she came to me, and she’s still psychotic,” Dr. Stemple said. “I’m not sure if she’s even taking the Trilafon, and because she’s had tardive dyskinesia I don’t want to increase the dose. The way she is now, she’ll soon wind up in a hospital, but she’s so dead set against going back to one that I’m willing to keep trying to help her.” The Frumkins asked Dr. Stemple about the sessions that Sylvia had with him. “She does ninety-nine per cent of the talking,” Dr. Stemple told them.

“She hardly ever asks me a question, and about the only time I get a word in edgewise is when she’s gone on a few minutes past her session and I know my next patient is waiting. Then I finally have to interrupt her to tell her it’s time to go.” Dr. Stemple told the Frumkins that he thought he was helping Sylvia only because he understood the born-again-Christian terminology she used and because he sympathized with her suffering. The Frumkins left, favorably impressed by Dr. Stemple.

He seemed to be a soft-spoken, well-educated man with a refined manner and good intentions. In late April, Sylvia Frumkin had started to attend Fountain House, one of the oldest and most highly regarded rehabilitative programs for former mental patients in New York City. Fountain House, a nonprofit corporation, was started in the mid-forties, when a group of former patients from Rockland State Hospital, in Orange-burg, New York, got together to try to assist one another in making the difficult adjustment from life in the hospital to life in the community. In 1965, the organization had built a modern six-story clubhouse on West Forty-seventh Street.

In 1979, many former patients were being referred to Fountain House by state hospitals and clinics, and most of those referred were quickly accepted into its day program. On any given day, about three hundred and fifty members came to Fountain House between 9 a.m. and 4 p.m. and participated in meetings and performed jobs essential to the day-today running of the clubhouse. Members worked in the clubhouse dining room or snack bar; as cleaners or tour guides; or in the clerical unit, which took attendance, operated the switchboard, and put out a mimeographed daily newspaper, Fountain House Today.

Hundreds of other members came to Fountain House for social activities on evenings, weekends, and holidays. Many members who did well in the pre-vocational day program went on to the transitional-employment program after a few months. Fountain House has arrangements with about forty businesses in the New York metropolitan area—banks, advertising agencies, department stores, restaurant chains—for a hundred and forty entry-level jobs, such as merchandise ticketers, messengers, and food-counter workers. Without the vocational services provided by Fountain House, many former mental patients would remain permanently unemployed and financially dependent.

It saddens the small Fountain House staff, of about sixty people, including social workers, psychologists, and rehabilitation counsellors, that about twenty-five per cent of the people who come to Fountain House drop out in the first week and thirty-five per cent drop out within the first month. Fountain House was one of Sylvia Frumkin’s instant enthusiasms. In late April, having gone there a few times for orientation, she told her parents that it was a wonderful place. She was especially enthusiastic because twenty-five-cent sandwiches, ten-cent cups of coffee, and five-cent cups of tea were served in the dining room. She chose to work in the clerical unit.

She was not interested in the day program except as a quick means to an end. She disregarded her counsellor, who told her she would have to wait several months to be placed in a transitional job and perhaps longer to be placed in one of Fountain House’s seventy apartments. In early May, she wrote several articles for Fountain House Today. In her articles, she expressed her dissatisfaction with residential programs she had previously been in, which had required shared cooking and food (“definitely not my bag”), and her longing for a Fountain House apartment, which enabled you to do your own shopping and eat what you pleased: “I’m my own person—I like to do what I want, when I want.” For about a week in early May, Miss.

Frumkin spoke favorably of Dr. Stemple and of Fountain House. She had given Fountain House her S.S.A. check on May 3rd and had asked the membership office to give her a few dollars a day, so that her check would last her all month—a service that Fountain House provides for many members. One afternoon, Joyce Frumkin ran into Sylvia in a store between her office and Fountain House. Joyce hadn’t yet eaten lunch, and invited Sylvia to join her in a coffee shop. The two sisters talked amicably about Fountain House and about Joyce’s job as a divisional merchandise manager at a midtown department store.

For a few hours that afternoon, Joyce understood her mother’s reluctance to have Sylvia return to Creedmoor. That evening, Sylvia telephoned Joyce. She accused her of taking Cozy Carrot, an orange stuffed dog they had shared as girls, to college with her, thereby ruining her life. Sylvia then hung up. Miss Frumkin’s enthusiasms tended to wax quickly and wane even more quickly. By the second week in May, she was breaking more appointments with Dr. Stemple and had turned against Fountain House. Writing for Fountain House Today was a waste of her reportorial talents, she said; she wanted to write for Glamour instead.

She complained that most of the members of Fountain House were “crazies” and “sickies.” Within a few days, she was no longer writing for the Fountain House newspaper and rarely showed up at the clerical unit. She considered dropping out of Fountain House and returning to Creedmoor’s typing workshop as an out-patient. She continued to go to Fountain House only to eat lunch and get her daily money and because she liked coming into Manhattan to shop. May 5, 1979, was Sylvia Frumkin’s thirty-first birthday. Her parents, two family friends, and the Wilders—her mother’s brother and his wife—gave her checks for her birthday. “I love money,” she often said.

“It’s my favorite present.” One day while she was searching her room for a book she had misplaced, she came upon a long-lost twenty-five—dollar gift certificate, which Joyce had given her the previous Chanukkah Joyce had bought the gift certificate at a department store that specialized in selling clothes to women who wore large sizes. Sylvia persuaded the store manager to give her twenty-five dollars in cash instead of twenty-five dollars’ worth of clothes (Many people who saw Sylvia Frumkin recognized that there was something different about her, and did things for her that they would not ordinarily do, She often went into a restaurant, asked for a glass of water, and got it; the next person who walked in and made such a request would be brusquely informed that the restaurant didn’t give out free water or would be charged ten cents for a paper cup.) At first, Miss Frumkin said she was going to spend her total of eighty dollars of Chanukkah and birthday money on cassettes of Christian music to play on her tape recorder.

She really wanted to buy makeup. She hesitated because she thought it might be too “worldly,” and then announced to her parents one morning, “The Lord wants us to look good.” For a week, she priced makeup at half a dozen stores. The following week, she spent over sixty-five dollars on a facial and an array of lip glosses, mascara, eye pencils, and blushes at the Face Factory, a store on East Forty-second Street that sold makeup. Sylvia whiled away hours going to elegant shops on Madison Avenue and Fifth Avenue. She admired the needlepoint kits at Erica Wilson, coveted a two-hundred-dollar pocketbook she saw at La Bagagerie, and often went into the F. A. O.

Schwarz toy store. (“I wish I could live there,” she told an acquaintance.) In early May, she bought a tiny, expensive papier-mâché box containing a small piece of chocolate at a chocolatier on Fifty-seventh Street for Joyce’s birthday, which was at the end of September. On her shopping expeditions, she treated herself to numerous ice-cream cones from Baskin-Robbins. Some days, Mrs. Frumkin was glad she was making the sacrifice of keeping Sylvia out of Creedmoor, and said she was learning to weather life with her exasperating daughter; she proudly told one friend that instead of cleaning Sylvia’s storm-tossed room she simply kept its door closed and pretended there was one less room in the house.

Mrs. Frumkin was nearly as mercurial as Sylvia. At five o’clock in the afternoon, she would tell a friend that Sylvia didn’t belong in Creedmoor. At six o’clock, she would tell another friend that she didn’t think she could survive another day with Sylvia in the house. In that hour, Sylvia might have thrown a plate at her (in 1979, Mrs. Frumkin had just two dinner plates left of her original set of wedding china), or might have spent an hour talking on the telephone when Mrs. Frumkin wanted to use it herself, or might have started speaking English with a heavy Russian accent and refused to stop.

Some days, Sylvia came home unexpectedly early from Manhattan, and occasionally she found that her parents were out. Mrs. Frumkin spent a few hours once a week doing volunteer work at the office of a friend who worked for a national charitable organization. (She made use of the postage meter to send out some of her personal mail.) When the Frumkins were out, Sylvia had to go to a neighbor’s house to await their return. She might then rage at them for not allowing “a woman of over thirty” to have a key to her own house. Sylvia went out early on Saturday, May 12th, the day before Mother’s Day. She returned home that evening holding a cardboard Baskin-Robbins box in her arms.

She presented the box to her mother. Mrs. Frumkin opened the box and saw a large ice-cream cake. Written on the chocolate ice cream in yellow letters were the words “Happy Birthday, Happy Anniversary, and Happy Mother’s Day.” Because her mother loved art, Sylvia had had Baskin-Robbins surround the words with easels, paintbrushes, and palettes in many colors of icing. Mrs. Frumkin looked at the cake Sylvia had designed. “That will feed ten people,” she observed. “Why couldn’t you have bought a small cake instead and a lovely card I could have kept forever?” She asked Sylvia how much the cake had cost.

When Sylvia said it had cost ten dollars, her mother said that she had spent too much money, and that she should find out why her S.S.I. checks hadn’t yet started to come, so that she could start to pay back the money she owed her parents and pay for her room and board and telephone calls. The Frumkins had a refrigerator with only a small freezer compartment. As Mrs. Frumkin removed all the other things she had in the freezer, including Sylvia’s birthday present to Joyce, put the cake in, and rearranged the things she had removed to make room for the cake, she continued to complain about the amount of money that Sylvia was always wasting. After her mother had expressed her displeasure for thirty minutes (“Joyce needs that chocolate like she needs a sick sister”), Sylvia, who had had fun designing the cake and had looked forward to giving it to her mother, looked sad.

“You never appreciate anything I give you,” she said. “You criticize everything I do.” “You spend too much time at Baskin-Robbins,” Mrs. Frumkin answered. “Yesterday, you brought me a jar of fudge sauce from Baskin-Robbins. I’m as fond of fudge sauce as I am of arsenic.” Joyce Frumkin came home for Mother’s Day. She told Mrs. Frumkin that her Mother’s Day present would be a new haircut, hair coloring, and a manicure at her own hairdresser’s in Manhattan on May 30th, the day before Mrs. Frumkin’s students were to show their work at her annual art show. Mrs. Frumkin told Joyce that her hairdresser was outrageously expensive and that the trip into Manhattan was much too strenuous for her.

She then agreed to go. “You only have one daughter as far as I can tell!” Sylvia shouted. “I’m just a second-class citizen! I’m your stepchild! You never loved me!” She cursed her mother. Mrs. Frumkin replied that she wished she weren’t a mother, so she wouldn’t be screamed at. Sylvia went to her room and started to pack. It was raining hard. Mrs. Frumkin suggested, “Why don’t you wait until the rain stops before you run away?” Sylvia settled down in her room to watch television and stayed there until Joyce had gone. Mrs. Frumkin told Joyce that she was tired of running after Sylvia and retrieving her possessions.

She had recently sent the Klopfers a check for the money they had spent on postage to mail back the box containing Sylvia’s winter clothes. She had also sent a check for postage to the social worker at Bergen Pines County Hospital, who had been kind enough to mail back the watch and several other things that Sylvia had left there. She had just spent two dollars at a shoemaker’s to have the zipper on Sylvia’s overpriced tote bag repaired. She also told Joyce that she had been worrying for the past few weeks about how Sylvia would behave on the day of the art show.

She was afraid Sylvia would make a scene by accusing her, in front of her students and their parents, of loving her surrogate children more than she loved her, or that she would hand out born-again-Christian literature. Joyce had long since given up hope for Sylvia. Her concern was that Sylvia not continually destroy the peaceful old age that she wanted her parents, and particularly her mother, to have. Joyce asked whether her mother couldn’t arrange to have one of her friends invite Sylvia out on the day of the art show. “It falls on a Thursday,” Mrs. Frumkin said. “My friends will be working. You’re going to be in Los Angeles. There’s no one else who will take Sylvia.

Your father just tunes her out. He goes to the supermarket, he takes walks, he reads his newspaper, and he talks out loud to the guests he watches on ‘Meet the Press’ and ‘Face the Nation.’ When we’re talking and the telephone rings, he picks up the telephone and goes right on talking to me for five minutes before he says hello.” As soon as Joyce was gone, Sylvia came out of her room, threatened her mother with a bread knife, put the knife down, banged her mother’s head against one of the kitchen walls a few times, and ran back to her room screaming about Jesus. “If you’d only accept Jesus, there would be peace and harmony in this house!” she shrieked.

“This house is filled with evil spirits. When I go to sleep at night, I see demons.” On the morning of Monday, May 14th, Sylvia got up at six-thirty and left for Manhattan. After she had gone, Mrs. Frumkin got up. Her head still ached. She went into the kitchen, where she found a note and a religious pamphlet affixed to her refrigerator with a magnet. “Please read this pamphlet,” Sylvia had written. “This is the meat and drink of my Lord. It could save our relationship.” Mrs. Frumkin glanced at the cover of the born-again-Christian leaflet and tore it up without reading it.

She then sat down at her typewriter and wrote Sylvia a letter, which read, in part:

Sylvia, dear, please read this & ponder. Thank you for supplying us with your meat and drink. You can have it all but please stop stuffing it down our throats. It only antagonizes us and does nothing to improve our relationship. I don’t see where all this Jesus business has improved your rages, tantrums, foul language, and hatefulness to your own family. It made it more a travesty of love and kindness which your Jesus preached. “Love ye one another”—do you?

If this be meat and drink for the body and soul, why do you keep on constantly stuffing and gorging your former lovely lithe graceful body and ruining and blotching up your former beautiful velvety smooth complexion. Why? You not only do not “love ye one another” but you also hate yourself. Sit down calmly and think over how you appear to others and how you abuse those who love you.

Mrs. Frumkin left the note on Sylvia’s desk. When Sylvia came home, she went to her room. At dinner, she said nothing about the note.

After dinner, she went back to her room, where her mother could hear her reading the Bible aloud, praying, and listening to a religious radio station hour after hour. On Tuesday, May 15th, Sylvia got up early and fought with her father over the mess she had made in the kitchen while she prepared her breakfast—an elaborate sundae, made with some Baskin-Robbins ice cream, some whipped cream she had brought home the previous day, and the jar of fudge sauce she had given her mother. When Mrs. Frumkin got up and went into Sylvia’s room, she found the letter she had written to Sylvia on Monday on the bureau; she threw it away. On the morning of May 16th, Sylvia had another quarrel with her father.

She didn’t return home until one-fifteen in the morning on May 17th Her father had gone to bed. Her mother had stayed up waiting for her. She asked Sylvia where she had been. Sylvia told her that it was none of her business but that she had been out with a group of fellow born-again Christians distributing tracts to passersby in Times Square. She said that she hoped they had converted a few lost souls to Christianity, and that it had been an exciting and joyful evening. She went right to bed. She was up again at six-thirty. She had another fight with her father after he told her how thoughtless she had been to keep her mother up until all hours worrying about her.

Sylvia left the house angrily and went to a Christian bookshop she had heard about the previous evening. When she got there, it was closed. She was supposed to be at Fountain House at nine o’clock. She arrived at ten-forty-five. She looked at her watch and saw she would have to leave immediately for an eleven-o’clock appointment with Dr. Stemple. She set off on foot for Dr. Stemple’s office. She was eager to see him, in order to tell him that she had stopped taking her medication after her exhilarating evening of witnessing in Times Square.

After she had half walked and half run two blocks, she saw that it was already after eleven, and realized that she would be very late for her appointment. She called Dr. Stemple’s office from a phone booth and told his secretary that she would be at least half an hour late. The secretary told her that Dr. Stemple had another patient at eleven-forty-five, and gave her an appointment for the next morning. Few of Dr.

Stemple’s patients cancelled as many appointments as Sylvia Frumkin—if they did, he told her, he would not be able to pay his rent—but he had told his secretary that Sylvia was in greater distress than his other patients and that he regarded it as his Christian duty to try to help her. Miss Frumkin walked slowly back to Fountain House to get her daily money and to eat lunch—a twenty-five-cent turkey-roll sandwich, two chocolate puddings, and three containers of chocolate milk. She started to talk about Jesus to a man and a woman who were already seated at the table where she chose to sit. The woman hurriedly excused herself. The man stayed, and told her he was also a born-again Christian.

They both took out copies of the New Testament and started reading aloud. Each praised the Lord, without listening to a word the other was saying. After lunch, Miss Frumkin left Fountain House. While she was distributing leaflets the night before, she had heard about a program in the Bronx called New Life for Girls. According to her informant, a minister who was affiliated with the program also helped troubled born-again Christians find places to live. On Mother’s Day, Miss Frumkin had made up her mind that she could no longer stand living at home. At Fountain House the next morning, she had been told for the fiftieth time that there was still a long waiting list for apartments.

When she left Fountain House for the Bronx that Thursday afternoon, she was neatly dressed in a blouse, a skirt, and a jacket—three pieces of the five-piece outfit her parents had given her in December—but she was so excited that she was foaming at the mouth. That evening, she called her parents to tell them that she was spending the night in the Bronx with a young woman who was in the New Life for Girls program and that she had an appointment to see the minister who was affiliated with the program on the next morning. On the morning of Friday, May 18th, Miss Frumkin called Dr. Stemple’s office at eleven o’clock—the time she was supposed to be there to see him —to break her appointment.

He came to the telephone. She told him that she was not going to take any more medication, because she no longer needed it. He told her that it would be all right not to take the medication over the weekend, but he asked her to promise to call him on Monday morning and make an appointment to see him. “I love you as a sister in Christ,” he said. “God bless you.” She then took the subway from the Bronx to Manhattan and went to Fountain House to get her daily money. May 18th was Miss Frumkin’s last day at Fountain House; she became one of the thirty-five per cent of the participants in its programs who drop out within the first month.

On Friday afternoon, she called home to tell her mother that she had not been accepted into the New Life for Girls program. The minister and his associates had been nice, she said, but they had explained to her that their program was for former alcoholics, drug addicts, and prostitutes rather than for former mental patients. She told her mother that she had six dollars and two subway tokens in her pocketbook. She said she was going to spend the six dollars on a ticket to a performance by a born-again-Christian comedian being given at eight o’clock that evening, at the Manhattan Church of the Nazarene, formerly the Lambs Club, on West Forty-fourth Street.

She said that the comedian was a former pusher, pimp, and satanist priest, who had been rejuvenated since he had come into the bosom of the Lord. Mrs. Frumkin asked Sylvia what she was going to do about eating dinner, since she would have no money left after buying the ticket. “I don’t have to eat,” Sylvia said. “This is food and drink to me. This man is famous in born-again-Christian circles.” Her mother told her not to come home too late. Sylvia said her mother shouldn’t worry about her. “I won’t be alone,” she said. “My best friend, J.C., will be with me.” Miss Frumkin went to the Manhattan Church of the Nazarene and enjoyed the comedian’s performance.

Her parents waited up for her until after midnight. At twelve-thirty, Mr. Frumkin went to bed. His wife changed into her pajamas. A man sitting next to Sylvia in the audience had become quite ill during the performance; he seemed to be having seizures. Miss Frum-kin asked him what was wrong. He told her that he had cirrhosis of the liver. She asked him where he lived and how he was planning to get home. He said he had a room in the Bronx and would get there by subway. She told him she would take him home. They left the church together, and she hailed a cab. The man gave the cabdriver an address in the Bronx.

After he stumbled out of the cab, Miss Frumkin gave the driver her home address and rode in the cab to Queens. She rang the doorbell at one-thirty. Mrs. Frumkin came to the door in her pajamas and slippers. She was surprised to see Sylvia on the doorstep with a stranger. Sylvia introduced the man as a cabdriver and asked her mother to pay him the seventeen dollars and fifty cents she owed him. Mrs. Frumkin asked her how she had managed to run up such a bill. Sylvia explained that on her way home she had taken a man who had cirrhosis of the liver from the church to his house in the Bronx. Mrs. Frumkin shouted at her daughter for squandering money on a man who was obviously an alcoholic.

She asked her who the man was. Sylvia said she didn’t know his name. “Jesus told me to take him home,” she said. “You’re not the Salvation Army and you’re not a missionary, and you can’t be responsible for all the drunks in the world,” her mother said. “You should have let him take the subway home.” Sylvia told her mother she had been afraid he would fall on the tracks, and asked her to just pay the cabdriver and be quiet. Mrs. Frumkin told the cabdriver she had very little money in the house. The driver told her she could give him a check, payable to cash. Mrs. Frumkin wrote out a check for seventeen-fifty. The driver left. As soon as he was gone, Mrs.

Frumkin went back to shouting at her daughter. “Sylvia, if you plan to stay here you’ll have to change your ways,” she shouted. “We don’t see you for two days, then after spending your last six dollars you come home with a seventeen-dollar-and-fifty-cent bill. What kind of people are you consorting with?” “That settles it!” Sylvia shouted back. “I’m leaving this house of perdition. Only demons live here. I disown you.” Mrs. Frumkin saw an expression of pure hatred on her daughter’s face. She looked away from Sylvia’s face to her legs, and said loudly, “Sylvia, your legs are bare. What happened to the two pairs of queen-sized panty hose I gave you Thursday morning?

You can’t run off bare-legged like this. Wait until morning.” Ignoring her mother, Sylvia ran to her room, tossed into her tote bag a radio that a family friend had given her as a belated birthday present, her tape recorder, and a few other belongings, and ran back out the front door. Mrs. Frumkin threw a coat over her pajamas and chased her daughter up the street. She called to her to come home. Sylvia was running fast. When she looked back and saw her mother pursuing her, she shouted, “Get home, you! I’m not coming back!” Mrs. Frumkin ran after her daughter for two blocks, crying out once or twice, “Please don’t make me chase after you!” After she had run for three blocks, Mrs.

Frumkin fell to the pavement. She couldn’t get up. “Sylvia, please help me,” she called. “You go home and Jesus will help you!” Sylvia called back, and she kept running. Mrs. Frumkin sat on the sidewalk for a few minutes and then slowly picked herself up. She could no longer even see Sylvia. It was two o’clock in the morning, and the streets in the Frumkins’ quiet residential neighborhood were deserted. As she stumbled home, she didn’t feel like herself. It made no sense for her to be abroad at two o’clock in the morning —she rarely ventured out of her house after eight in the evening.

She had felt a peculiar sense of unreality, she told a friend the following day—as if she were taking part in a nightmare. Irving Frumkin heard his wife come back into the house. When she told him what had happened, he offered to call the police. Mrs. Frumkin said that that wouldn’t help. He went back to sleep. Mrs. Frumkin lay down on the bed and cried. Dr. Ramirez told Mrs. Frumkin that her daughter was at L.I.J.-Hillside and that in her opinion she required hospitalization in a locked unit. Mrs. Frumkin immediately asked her to admit Sylvia to Hillside. Dr. Ramirez said she couldn’t: there was a waiting list for beds in Hillside’s locked units. Mrs. Frumkin begged Dr.

Ramirez to let Sylvia sleep on a cot in a hospital corridor until a bed in a locked unit became available. Dr. Ramirez said that that would not be possible. When Mrs. Frumkin continued to plead with her, Dr. Ramirez said that Mrs. Frumkin had two choices. If she thought she could cope with her daughter at home, Dr. Ramirez could send her there and Mrs. Frumkin could seek treatment for her on an outpatient basis, but Dr. Ramirez advised Mrs. Frumkin against that choice. Or she could let Dr. Ramirez call Creedmoor to see if Sylvia could be transferred there. Mrs. Frumkin said she didn’t think it would be wise for Sylvia to return home, because she would probably just run away again. Dr.

Ramirez told Mrs. Frumkin she would telephone Creedmoor. She reached Dr. Charles Ling, the weekend on-call doctor, and he told her to send Sylvia to Building N/4, where he would screen her. Dr. Ramirez called Mrs. Frumkin to say that Sylvia would soon be taken to Creedmoor in a city ambulance. Mrs. Frumkin called the Clearview unit before Sylvia’s arrival, spoke to a therapy aide she had known for years, and asked her to lock up Sylvia’s watch, her tape recorder, her portable radio, her tote bag, and the good clothes she was wearing, so that they would not be stolen. The ambulance arrived at Hillside for Miss Frumkin at nine-forty-five.

Ten minutes later, she was back in Ward 043, Clearview’s women’s new-admissions ward, to which she had been admitted on June 16, 1978, and where she had lived until December of 1978, when her condition improved sufficiently for her to be transferred from the ward to the Clearview hotel. According to Dr. Ling’s admission note, Miss Frumkin was restless and hyperkinetic. She talked incessantly and admitted that she heard voices. The voices kept whispering to her about “God and devils.” She believed that people were after her on the street. Dr. Ling’s diagnostic impression was schizophrenia, chronic undifferentiated type.

He justified Miss Frumkin’s admission by describing her as dangerous to herself and others, and wrote that because of her acute psychotic symptoms she required skilled care and treatment in a hospital setting. Miss Frumkin did not contest the admission. She signed a voluntary-request-for-hospitalization form. Two days later, she was rescreened by Dr. Sun Ming Wong, the doctor who had admitted her on June 16, 1978, and had diagnosed her then as a manic-depressive, manic type.

He gave her the same diagnosis on May 21, 1979. In June of 1978, she had spent thirty hours in a locked seclusion room during her first five days back in the Clearview unit, and a hundred hours during her first two weeks. In 1979, she spent a hundred hours in seclusion during her first five days and two hundred hours during her first two and a half weeks. She had been extremely assaultive in 1978. During the late spring and summer of 1979, she attacked more patients and was hit, bitten, and scratched to an even greater extent than she had been the previous year.

Occasionally, she was bitten by one of the same patients who had bitten her in 1978: Barbara Herbert, who had been in and out of Creedmoor in 1978, was also in and out in 1979. In August of 1979, a male patient punched Miss Frumkin and broke her nose; it was the first fracture she had ever had after fifteen years of being struck by or leaping from automobiles and fighting in hospital wards. She was far more abusive to the hospital staff in 1979 than she had been a year earlier. She hit one therapy aide on the head with a book, bit another on the hand, and threw water at a third.

She slapped an aide on the face for refusing to give her the keys to a plastic shield that protected the television set in the dayhall, and she broke another aide’s eyeglasses. She spit in several employees’ faces, she pulled the hair of a few therapy aides and practical nurses, and she pushed a treatment-team leader across the floor of the ward. She hit or threw shoes at attendants, dining-room employees, and cleaners, and she threw chairs at visitors. She engaged in more infantile behavior in 1979 than she had in 1978, she dressed in more fanciful costumes, she disrobed more frequently, and she applied more esoteric makeup to her face; she also ate some lipstick and said it was candy.

She broke two pairs of her own eyeglasses (in 1978, she had broken only one pair), she refused more medication, and she called more black therapy aides “nigger bitches.” She remained acutely psychotic for a longer time, perhaps because she was given an even smaller amount of medication. In 1978, after five weeks she got ninety milligrams of Haldol—the equivalent of forty-five hundred milligrams of Thorazine—and that proved to be a therapeutic dose. In 1979, she was never given more than thirty milligrams of Haldol. In 1979, Dr. Sun didn’t diagnose her as a manic-depressive and medicate her as a schizophrenic, as he had in 1978.

This time, he diagnosed her as a manic-depressive and, after prescribing neuroleptics for her for several weeks, he put her on lithium in combination with a small amount of Trilafon, as Dr. Stemple had. The lithium did not help her any more than it had in the past. The small amount of Trilafon eventually stabilized her at a marginal level. In 1978, it had taken Miss Frumkin from June 16th to July 31st to be given grounds privileges for the first time. In 1979, it took her from May 19th to August 24th to get an hour of grounds privileges. On May 24th, when Mr. Frumkin came to Clearview to see Sylvia and to take her belongings home, Mrs.

Frumkin learned about Sylvia’s missing radio and clothes. She telephoned Mrs. Plotnick for the first time since February 26th, when she had called to ask for her help as one mother to another. Mrs. Frumkin was enraged. She accused Mrs. Plotnick of being personally responsible for Sylvia’s missing belongings, and implied that Clearview’s employees had stolen the radio and the clothes. After hearing Mrs. Frumkin out, Mrs.

Plotnick quietly said that it was impossible to know even when the radio was lost: three hours had passed between the time Sylvia ran out of the Frumkins’ house on the morning of May 19th and the time she turned up in the emergency room of L.I.J.-Hillside—hours that were unaccounted for. Mrs. Plotnick said she would ask Sylvia’s treatment-team leader to look for the missing skirt, blouse, and jacket. “I’m sick of this delegating, you’re always delegating,” Mrs. Frumkin said in a hostile tone. “I will not listen to any excuses.” At Joyce Frumkin’s insistence, Mrs. Frumkin telephoned Mrs. Plotnick several days later to apologize. Her apology took the form of a question and three statements.

“Why did all this have to happen to us?” she asked. “We deserved better. She deserved better. Mental illness is a fate worse than death.” A friend of Mrs. Frumkin’s who had heard her complain about life with Sylvia from the day Sylvia returned from the Klopfers’ to the day she ran away spoke to her on May 21st. The friend said she assumed that Mrs. Frumkin must be relieved to finally have Sylvia out of the house. Mrs. Frumkin denied that she had any feeling of relief. She said that it was impossible to be happy if you had a daughter in Creedmoor—and that having a child there was worse than having a dead child.

She described the early-morning hours of May 19th to her friend and told her she felt guilty for having caused such a scene after Sylvia came home with the cabdriver. “I paid the man anyway,” she said. “So I should have been kinder to Sylvia. Maybe I should have said, ‘Hello, darling,’ and let her go to bed quietly. Maybe I should even have thanked the cabdriver for bringing her home safely, and given him a tip. I always do the wrongest things.” The friend knew that before Sylvia’s departure Mrs. Frumkin had been particularly worried about how Sylvia would behave on the afternoon of Thursday, May 31st, while Mrs. Frumkin’s art show was in progress. She called Mrs.

Frumkin that evening to ask how the show had gone. Mrs. Frumkin said that her students had all produced fine portraits, seascapes, and cityscapes, and that Joyce had helped her print up a nice souvenir program, but she also said, “Who could enjoy an art show when their daughter is locked up in a seven-by-nine-foot seclusion room with nothing but a mat on the floor?” She told her friend that if Sylvia had still been living at home on May 31st she would not have been the slightest problem. “I had figured out exactly how Sylvia would spend the day,” she told her friend.

“She wanted so much to see ‘Annie’ and she loved eating out, so I had planned to give her money to see the play in the afternoon and then to eat dinner afterward.” The friend didn’t point out to Mrs. Frumkin that there were no afternoon performances of “Annie” on Thursdays, and she kept her thoughts to herself when Mrs. Frumkin went on to say, in a wistful tone, that the house was too quiet without Sylvia. “She was like a storm brewing,” Mrs. Frumkin said. “First you see the sky darkening. Then you see bolts of lightning and hear claps of thunder. Then the rain comes down in buckets.

Then the storm is over and the air is too still.” Three months after the contracts were signed, and the whole family had violated every provision of them, Sylvia Frumkin took a leave from Creed-moor’s typing workshop. In July and August, she attended a summer-school bookkeeping course at Flushing High School. After completing the course, she refused to return to the typing workshop; she had again decided to sever all her connections with Creedmoor. In late August and early September, she busied herself with a new pastime: collecting coupons.

She filled her room and the Frumkins’ garage with coupons she had clipped from newspapers and magazines she had bought, picked up on the street, or found in trash cans. Miss Frumkin tore up all the boxes she could wheedle from neighbors or compliant strangers. She saved box tops, box bottoms, and box sides for future use. She peeled off can labels and filed candy wrappers, too, acquiring a good-sized “proof of purchase” collection for money-back offers she hoped to learn of. While she was clipping, tearing, and filing, she ate to even greater excess: her weight went up to two hundred and five. In mid-September, Miss Frumkin returned to Fountain House.

On her first day back, she told her mother how much nicer the Fountain House clients were than the typing-workshop clients. Miss Frumkin’s second set of visits to Fountain House was shorter than her first. In the summer of 1980, a doctor at Creedmoor had lowered the small amount of Trilafon she was taking with the lithium, and in early September she became increasingly violent. One day, she slapped her father. Another day, she grabbed her mother’s hair, held on to it, and banged her mother’s head against a wall. On September 18th, Sylvia Frumkin was discharged from Creedmoor.

Joyce Frumkin came home on September 20th for Yom Kippur; Sylvia pounced on her and hurt Joyce’s thumb. During the first eight and a half months of 1980, Sylvia Frumkin had apparently been content with Judaism. She had gone regularly to Jewish services at Creedmoor, and had been on friendly terms with the rabbi there. A few days after Yom Kippur, Miss Frumkin met some born-again Christians who were handing out tracts in front of a Chinese restaurant in Flushing. They invited her to drive with them to an evangelical church in Pennsylvania. She went with them, enjoyed herself, and returned to her house that night around midnight in an ugly mood. Her father was asleep.

Her mother had waited up nervously for her. Sylvia called her mother a bug, threatened to swat her, and went to her room, slamming the door behind her. She stayed up all night. Harriet Frumkin lay on her bed, unable to sleep. She heard crackling sounds coming from her daughter’s room, but she was too frightened to go in and see what she was doing. Sylvia came out of her room at five o’clock on Sunday morning. Her mother saw her go into the living room and take three records from a cabinet. They were among Mrs. Frumkin’s favorite records. “Those are mine!” Mrs. Frumkin shouted.

“Put them down!” She succeeded in retrieving a Debussy record and a Beethoven record, but couldn’t stop Sylvia from smashing a twenty-five-year-old record of “The Wizard of Oz.” When Mrs. Frumkin ventured out of her room again at eight o’clock, the door to Sylvia’s room was open. She had never seen Sylvia’s room quite so chaotic. During the night, Sylvia had cut up her pillowcase with a pair of scissors—she told her mother there had been demons dancing on her pillow—and had cut up most of the coupons, box parts, and cassettes in her room. She had been particularly fond of her Barry Manilow and Elton John cassettes; now she called them blasphemous.

The unravelled cassettes looked like snakes on the floor of the bedroom. She had also cut down some posters she had bought to decorate her room, scratching the walls in the process. She kept talking about Jesus and demons and bugs, threatened to eradicate her parents, and shouted so loud that the Frumkins’ next-door neighbors, who sympathized with the family’s plight, telephoned to ask the Frumkins if they couldn’t control her. Irving Frumkin had slept through the night. The neighbors’ telephone call came shortly after he had got up, and when he hung up he left the house and called the police from a nearby candy store. Two policemen came. Sylvia insisted on telephoning Dr.

Stemple, whom she hadn’t seen in over a year. She succeeded in reaching him at his country home, in New Jersey, and asked him about demon possession. He told her she needed to go to a hospital. She then told the policemen she would go with them after she got a pocketbook from her room. She jumped through the screen of her bedroom window and landed, uninjured, in the Frumkins’ back yard. One of the policemen had been watching the bedroom door and the front door. The other had been watching the bedroom window and the door that led to the back yard. He saw Sylvia jump and land safely.

He caught her before she could make another attempt to elude him. One of the policemen, a young man, said, “My wife’s a born-again Christian, but she doesn’t rant and rave like this.” He radioed for an ambulance. The other policeman said, “You’re cursing like this and you’re talking about Jesus?” On the evening of Sunday, September 28, 1980, Sylvia Frumkin was admitted to Creedmoor for the tenth time. Dr. Werner, the hospital director, had died of a heart attack in 1978; his successor, Dr. Yoosuf A. Haveliwala, had reorganized the hospital so that it resembled the pre-1969 hospital.

Nevertheless, Miss Frumkin was admitted to the same building that had housed her in 1978 and 1979—Building N/4. In December of 1980, shortly before N/4 was closed down, she was transferred to I.P.C.U. 2, one of two newly created Intensive Psychiatric Care Units for long-term chronic patients. Her medication was still lithium and a small amount of Trilafon. She disliked the new unit even more than she had disliked Ward 043. Not long after her transfer to I.P.C.U. 2, she said she was still convinced that Jesus would help her— something that psychiatrists had failed time and time again to do. “Mental illness is worse than cancer,” she said.

“The suffering doesn’t have an end point.” One man who recently visited Creedmoor sat and listened to Miss Frumkin for an hour. He later told his wife he had forgotten for a while that he was at Creedmoor and had wondered where her brilliance might have led her if her illness had not led her there.

Burpo Fizzo is a drink.

It is colored cherry pink.

You can throw it in the sink.

Burpo Fizzo.

Burpo Fizzo tastes quite nice

When you serve it over ice.

It will help, if you take it twice.

Burpo Fizzo.

As she is singing the words to the third stanza, which begins with the line “Burpo Fizzo doesn’t smell,” she gets stuck on the first three words of the second line.

“It is said, it is said, it is said,” she repeats. She pauses, completes the line with the words “to taste quite well,” and then says irritably, “Oh, go to hell, Burpo Fizzo.” For a minute, she looks as if she is going to cry, but she quickly brightens up, tells the children again that she is Wonder Woman, tells them that she and another classmate once composed a piece of music called “A Cantata on Beech-Nut Peppermint Gum,” and starts talking quickly. “For a long time, I wanted to go on ‘What’s My Line?’ as a mental patient,” she says. “Being a mental patient really is my profession. I get room and board, fringe benefits like Medicaid and Medicare, and I get paid by S.S.A. and S.S.I.

But the show has gone off the air, and I may not be mentally ill anymore. Maybe I just have idiosyncrasies—you’d have to ask a doctor. And the Lord wants me to go on WWD J’s ‘700 Club’—that’s the Mike Douglas show of born-again-Christian programs. I want to be a doctor. I want to go from the theatre to the operating theatre. I’m going to be a doctor or a nurse, and I’m going to have the key to my front door. Lee Harvey Oswald is a patient here. God talks to me a lot. The voice is an imp in my head. I’m a good friend of Mike Nichols and Diane von Furstenberg. I first met Geraldo Rivera when I was in Elmhurst. John Travolta’s father is the Shadow.

I think the Cowardly Lion was secretly married to Judy Garland. I’m going to marry Lyle Waggoner, who plays Steve Trevor. I’m going to take Lynda Carter’s place on ‘Wonder Woman’ when I marry Steve. I want to have my own show, a show called ‘Sylvia’s.’ I’m my favorite person. I only wish I could get along with everyone else as well as I get along with me. I secretly have my own show already.” Sylvia looks at the children and tells them not to doubt her, because she really is Wonder Woman.

She reaches into a small handbag she is carrying and pulls out a piece of paper, on which she scribbles, “Muhammad Ali, apologized to me.” She tells the woman that she had a large tote bag and somehow lost it. “Please go to La Bagagerie and tell the saleslady that the girl who was so nice wants to have the two-hundred-dollar bag,” she says. “She’ll give it to you. I told her it was worth its weight in gold. Charge it to my account.” She delves into the bag again, pulls out a tube of pink lipstick that is almost used up, hands it to the younger child, and tells her, in a stage whisper, that she got it from the Queen of England. “I called Prince Charles Chuck,” she says. “I’m Peppermint Patty.

Charles Schulz is the headmaster of my high school. My sister, Joyce, went to college and got snooty. She left me and she took Cozy Carrot with her. Joyce throws twenty-dollar bills around at beauty parlors the way most people spend two dollars and fifty cents, but Joyce’s house isn’t built on rock, it’s built on sand. It’s a sand castle. Israel is the promised land, but New Jersey is Heaven. Please help me get into the Christian Health Care Center. I’d like to go to New Jersey, but maybe I’ll go to Gould Farm. The Hare Krishnas aren’t too bad, but I think they should go back to India, because they’re trying to take over our country. I’m planning to go back to school to do sixth grade.

I want to relive my childhood. I want to pay my parents rent, have a lock on my door, and have cooking privileges. Home is the place for me. Home is where the heart is. My father was my first dentist. I want to go back in the time machine for a while. When I was at Music and Art, I once had a best friend, Camilla Costello. She was Abbott and Costello’s niece. She told me, ‘Sylvia, I have many friends, but you’re my best friend.’ At the same time, I had a therapist named Francine Baden. Francine was my fairy godmother. Those were the best six months of my life, the only normal six months of my life, those six months with Camilla and Francine.

I once told Francine Baden, ‘Getting well is growing up.’ I’m not sure I want to grow up. I’m going to stay Wonder Woman forever.” She suddenly tells the children, who haven’t made a sound, to be quiet. “Sh-h-h,” she says. “Do you hear the water fountain over in the corner gurgling? Maybe I can only be Wonder Woman for two more weeks, because in two, weeks that water fountain will overflow, and by then I must get out of here.” ♦

(This is the last part of a four-part series. Read the first part.)